Cognitive therapy Camille Huggins, PhD - PowerPoint Presentation

1. Cognitive therapyCamille Huggins, PhD

2. In the last class We reviewed: The elements of the counseling relationship. The types of questions that is important for counseling. The therapist-client relationship.

3. Lesson Objectives Overview of Cognitive Behavioral Therapy. Understand the illogical errors of thinking. Review Socratic Questioning Review the use of questions during counseling

4. A show of hands How many have done any sort of counseling before? How did you engage with the client? What kind of questions did you use to ask the client about their problem? How do you how to ask the right question? How many have heard about Cognitive Behavioral Therapy?

5. Cognitive Behavioural TherapyCBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior.

6. Cognitive Behavioral TherapyTwo of the earliest forms of Cognitive Behavioral Therapy were Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.

7. Aaron T. BeckCognitive Therapy (CT), or Cognitive Behavior Therapy (CBT) was pioneered by Dr. Aaron T. Beck in the 1960s, while he was a psychiatrist at the University of Pennsylvania. Having studied and practiced psychoanalysis, Dr. Beck designed and carried out several experiments to test psychoanalytic concepts of depression.

8. Aaron T. BeckBeck was born in Providence, Rhode Island, USA, the youngest child of four siblings to Russian Jewish immigrants. Beck was married in 1950 to the Honorable Phyllis W. Beck, who was the first woman judge on the appellate court of the Commonwealth of Pennsylvania.They have four adult children, Roy, Judy, Dan, and Alice. Beck's daughter, Judith S. Beck, Ph.D., is a prominent cognitive behavioral therapy (CBT) educator and clinician, who wrote the basic text in the field.

9. Depression Dr. Beck began to look for other ways of conceptualizing depression. He found that depressed patients experienced streams of negative thoughts that seemed to arise spontaneously. He called these cognitions “automatic thoughts.” He found that the patients’ automatic thoughts fell into three categories. The patients had negative ideas about themselves, the world and/or the future.

10. Negative view about the worldNegative view negative view About oneself about the future

11. Negative view about the worldEverybody hates meI can’t do anything right My life is a mess

12. Negative view of oneself I am a horrible personNo one will ever love meI will never get this rightI am too fat

13. Negative view of the FutureI will never graduate I will always be poorNo one will ever love me again

14. Illogical errors in thinking These thoughts are logical errors or cognitive distortions which are Systematic errors in reasoning, often stemming form early childhood errors in reasoning; an indication of inaccurate or ineffective information processing. The logical errors can also be understood in the following categories.

15. Illogical errors in thinking All-or-none reasoning (splitting) or dichotomous thinking – This creates a ‘false dilemma’ that there are only two alternatives in any situation. Issues are understood in absolute terms. (always, every, never). This is a tendency to think in extremes e.g “If I can’t get it 100% right, there’s no point in doing it at all”

16. Illogical errors in thinking Overgeneralization and hasty generalisations – Wide generalizations taken from isolated cases. Selective abstraction, Filtering and misleading vividness– Focusing on negative, aspects of an event while ignoring other positive aspects. Misleading Vividness- “a fallacy in which a very small number of particularly dramatic events are taken to outweigh a significant amount of statistical evidence.

17. Illogical errors in thinking Disqualifying the positive – Continually deemphasizing or "shooting down" positive experiences for arbitrary, ad hoc reasons.Arbitrary inference (Jumping to conclusions) – Drawing conclusions (usually negative) from minimal or no evidence. This involves ‘mind reading, fortune telling’) Magnification and minimization –Catastrophizing is typical here. Persons who endure depression often minimise the positives and exaggerate the negatives.

18. Illogical errors in thinking Assessment- The therapist assesses the client by attending closely to his/her dialogue to detect the logical errors.This takes place in a collaborative relationship via use of the Socratic dialogue.

19. TREATMENT- Socratic dialogue helps to challenge maladaptive beliefs and assumptions. Basically, it is a series of questions that help the client arrive at logical answers to and conclusions about a certain hypothesis. The three-question technique is a form of guided discovery.

20. Soractic QuestioningIs disciplined questioning that can be used to pursue thought in many directions and for many purposes, including: to explore complex ideas, to get to the truth of things, to open up issues and problems, to uncover assumptions, to analyze concepts,

21. Socratic dialogueHow do you do the Socratic dialogue?Socratic dialogue helps to challenge maladaptive beliefs and assumptions. Basically, it is a series of questions that help the client arrive at logical answers and conclusions about a certain hypothesis. The three-question technique is a form of guided discovery.

22. Socratic dialogueEmotional reasoning – Assuming reality to reflect emotions, e.g. "I feel it, therefore it must be true." . There is little appeal to rationale and logic. Labeling and mislabeling – Related to overgeneralisation.Personalization – Bias toward internal attribution. Musturbation- Assuming that there are ‘musts’ and ‘shoulds’. This is when we assume that things ‘must’ be a particular way or ‘should’ be a particular way.

23. Socratic dialogueThe three-question technique is a form of guided discovery. Bring material to therapy so that the client and therapist can challenge maladaptive assumptions or ineffective beliefs. Several different techniques are used for challenging different distorted beliefs. Re-AttributionsChallenge AbsolutesDe-Catastrophizing- The ‘What if’ techniqueScaling- Turning Dichotomies into continuums

24. Questions for clarification:Why do you say that? How does this relate to our discussion? "Are you going to include diffusion in your mole balance equations?"

25. Questions that probe assumptions:What could we assume instead? How can you verify or disapprove that assumption? "Why are neglecting radial diffusion and including only axial diffusion?"

26. Questions that probe reasons and evidence:What would be an example? What is....analogous to? What do you think causes to happen...? Why:? "Do you think that diffusion is responsible for the lower conversion?"

27. Questions about Viewpoints and Perspectives:What would be an alternative? What is another way to look at it? Would you explain why it is necessary or beneficial, and who benefits? Why is the best? What are the strengths and weaknesses of...? How are...and ...similar? What is a counterargument for...? "With all the bends in the pipe, from an industrial/practical standpoint, do you think diffusion will affect the conversion?"

28. Questions that probe implications and consequences:What generalizations can you make? What are the consequences of that assumption? What are you implying? How does...affect...? How does...tie in with what we learned before? "How would our results be affected if neglected diffusion?"

29. Questions about the question:What was the point of this question? Why do you think I asked this question? What does...mean? How does...apply to everyday life? Why do you think diffusion is important?

30. Exercise Thinking about all we have reviewed and discussed. Please break into groups of three and review the following case. Identify the illogical errors of thinking. What kind of question would you ask for further information? Please take 10 minutes to complete the exercise.

31. Case Study Dana Akingbala is a twenty-five year old student of UWI. She is from Nigeria and has been residing in Trinidad for two years in order to attend the university. Since she began her education in Trinidad, she has been experiencing sever depression. She feels lonely and misses her family in Nigeria. She does not believe that she can survive without them and that she is could never be happy if she does not live in Nigeria. Despite her complaints she has had the support of her boyfriend Martin who she met in Trinidad a year ago. He is often very caring toward and provides financial support. Nonetheless she opines that his financial support to her is not evidence of his love and care towards her.

32. She is of the opinion that Martin would help anyone in need. Martin contacted Dana’s lecturers about her depression. He also shared that she is often angry and anxious. Dana’s lecturers were quite surprised by this news, given that she performs very well at school . When Dana’s learned that Martin spoke to her lecturer she bellowed at him, saying “you did this because you do not love me. You have done this because you want to put me in a mad house. You are a wicked man, All of you Trinidadians are wicked.

33. Summary Today we learned about cognitive behavioral therapy which includes illogical errors of thinking, Socratic dialogue and the use of questions during counseling. You reviewed a case study and identified the illogical error of thinking and what questions you would use to get more information. Next week we will continue to with formulating questions to illicit information and more case studies to analyze.