Books On Positive Thinking

8 Days to End Limiting Beliefs By Dr. Steve G. Jones

End Limiting Beliefs created by Dr. Steve G. Jones is a program that guides you on how to think positive. It took him years to perfect the End Limiting Beliefs guide, but once he could organize the necessary steps to separate his limiting beliefs from the good ones that sustained him, Steve built a comprehensively new system that people has never seen before. This book is divided into 8 chapters, and each chapter covers different methods and lessons. In the first chapter, people will get ways to measure their progress with limiting beliefs, ways to find out the real root cause of them, and 3 steps to identify them. 8 Days to End Limiting Beliefs is a complete book with simple practical knowledge that ran its exercise for 8 days. Meaning it is a book if wholeheartedly read and applied, within 8 days, your life will start experiencing total turn around. Continue reading...

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Use Of Cognitive Distortion Instruments In Clinical Treatment

The use of cognitive distortion instruments in clinical settings could serve a number of functions (1) provide an efficacious method for identifying patients' major forms of distorted thinking, (2) identify patients' use of particular types of distortions for particular diagnoses, (3) provide an educational tool geared toward improving patients' metacognitive skills, (4) help understand the role cognitive distortions play in maintaining dysfunctional cognitive, emotional, and behavioral patterns, and (5) provide the clinician with a clinical tool for use as pre-, post-, and interval test to track changes in patients' distorted thinking patterns.

Future Directions In Cognitive Distortion Assessment

Assessment of cognitive distortions will undoubtedly continue into the future in an effort to more accurately qualify and quantify specific cognitive distortions. Continued assessment of this cognitive construct is important for several reasons. First, cognitive distortion assessment is necessary for case conceptualization, treatment planning, and implementation of treatment techniques and patient involvement. Second, additional clinical information is needed concerning the interactions of various cognitive processes. Third, assessment and subsequent treatment of cognitive distortions will likely lead to symptom relief in immediate and longer-term time frames. Fourth, assessment may provide insight into disorder-specific cognitive constructs. Finally, research-based measures of cognitive distortions can provide the field with more effective tools to measure the cognitive construct of cognitive distortions.

How Cognitive Therapy Works

Having established that CT has beneficial and relatively long-lasting effects, researchers have sought to address how CT achieves its effects. Such efforts provide an important test of the validity of the cognitive theory of depression and may provide useful information for refining CT. Some researchers have argued that factors not specific to CT (most notably the therapeutic alliance) are responsible for effects in all forms of therapy. Beck's theory clearly states that while a good working relationship is a necessary condition, specific interventions largely drive symptom change in CT. Consistent with Beck's theory, DeRubeis and his colleagues have found that use of specific cognitive techniques predicts subsequent symptom change (Feeley, DeRubeis, & Gelfand, 1999). Similarly, sessions immediately prior to sudden gains (i.e., session-to-session intervals in which patients' symptoms improved substantially) were found to include more discussion of changes in cognitions than control...

Review Of Available Measures Of Cognitive Distortions

A review of available measures of cognitive distortions reveals five clinical instruments designed to measure the general construct of cognitive distortion within the cognitive therapy literature the Dysfunctional Attitude Scale (DAS, Weissman, 1979 Weissman & Beck, 1978), Cognitive Error Questionnaire (CEQ, Lefebvre, 1981), Automatic Thoughts Questionnaire (ATQ, Hollan & Kendall, 1980), Cognitive Distortion Scale (CDS, Briere, 2000), and Inventory of Cognitive Distortions (ICD, Yurica & DiTomasso, 2001).

Empirical Status Of Metacognitive Theory

Research on patients with GAD and worry-prone non-patients support several central aspects of this model. Individuals meeting criteria for GAD give positive reasons for worrying such that it contributes to motivation, preparation, and avoidance. Proneness to pathological worrying is positively associated with metacognitive factors including positive and negative beliefs about worrying. Patients with DSM-III-R-diagnosed GAD, compared to patients suffering from social phobia, panic disorder, or nonpatient controls, report significantly greater scores on negative beliefs about worrying and Type 2 worry. In discriminant analysis, patients with GAD were characterized by high levels of negative metacognitions while other patients were better characterized by the content of their Type 1 worries (Wells & Carter, 2001). Type 2 worry is a better predictor of pathological worry than Type 1 worry frequency and negative metacognitions predict the subsequent development of GAD 12-14 weeks later...

Types Of Cognitive Distortions

Cognitive distortions were originally identified in patients with depression. Since then, clinicians have expanded their identification and treatment of cognitive distortions to many other disorders (DiTomasso, Martin, & Kovnat, 2000 Freeman, Pretzer, Fleming, & Simon, 1990, 2004 Freeman & Fusco, 2000 Wells, 1997). Further, cognitive distortions have been found to play a role in sexual dysfunction (Leiblum & Rosen, 2000), eating disorders (Shafran, Teachman, Kerry, & Rachman, 1999), sex offender behavior (McGrath, Cann, & Konopasky, 1998), and gambling addictions (Delfabbro & Winefield, 2000 Fisher, Beech, & Browne, 1999). In addition to the identification of cognitive distortions in Axis I disorders, distortions appear to play an important role in Axis II disorders. Cognitive distortions have been identified in patients diagnosed with personality disorders. Freeman et al. (1990, 2004) have identified dichotomous thinking as a primary distortion in patients...

History And Overview Of Cognitive Distortions

Cognitive distortions were originally defined by Beck (1967) as the result of processing information in ways that predictably resulted in identifiable errors in thinking. In his work with depressed patients, Beck defined six systematic errors in thinking arbitrary inference selective abstraction overgeneralization magnification and minimization personalization and absolutistic, dichotomous thinking. Years later, Burns (1980) renamed and extended Beck's cognitive distortions to ten types all-or-nothing thinking overgener-alization mental filter discounting the positive jumping to conclusions magnification emotional reasoning should statements labeling and personalization and blame. Additional cognitive distortions, defined by Freeman and DeWolf (1992) and Freeman and Oster (1999), include externalization of self-worth comparison and perfectionism. Most recently, Gilson and Freeman (1999) identified eight other types of cognitive distortions in the form of fallacies fallacies of change...

Cognitive Model Of Low Selfesteem

The development and maintenance of low self-esteem can be understood in terms of a cognitive model (Fennell, 1997) closely based on A. T. Beck's original cognitive model of emotional disorder (Beck, 1976). The model, together with an example, is illustrated in Figure 1. It suggests that the essence of low self-esteem resides in negative core beliefs about the self (the Bottom Line), which derive from an interaction between inborn Negative core beliefs about the self Negative core beliefs about others Other people are the enemy

Exposure in Vivo Therapy versus Cognitive Therapy

One of the theoretical problems in the comparison of the effectiveness of exposure in vivo therapy and cognitive therapy is that cognitive restructuring without any form of exposure is rare in cognitive therapy. The use of exposure exercises called behavioral experiments or hypothesis testing is seen as clinically important aspects to test the validity of the beliefs. In specific phobias, cognitive therapy was generally less effective than in vivo exposure. Several studies found cognitive therapy and exposure in vivo therapy with the addition of response prevention about equally effective in obsessive-compulsives. Similarly, cognitive therapy is as effective as exposure in vivo therapy alone for social phobic complaints. In general, studies find that cognitive therapy alone is of limited value for agoraphobia as compared to exposure in vivo. More recently developed cognitive approaches focusing on catastrophic cognitions are effective with respect to reduction of panic attacks in...

Using FAP to Improve Cognitive Therapy for Depression

Cognitive-behavior therapy (CBT) for depression, developed in 1979 by Dr. Aaron Beck and his colleagues, has been shown to be an effective treatment for major depression. As with any treatment for depression, however, there is room for improvement. In particular, some clients are resistant to the methods and rationale of cognitive therapy, and outcome is endangered by what is known as a rationale-client mismatch. Examples of mismatches include clients who experience that their feelings rule no matter what thoughts they have, who are looking for a more intense and interpersonal therapy, and those that want to understand how their problems are related to their family histories. In an attempt to more effectively address the diverse needs of clients, reduce mismatches, and yet retain the value that cognitive therapy has for many clients, a combined FAP and cognitive therapy (CT) treatment was developed. The new treatment is referred to as FAP enhanced cognitive therapy (FECT). FECT...

Schema Focused Cognitive Therapy

As an extension of Beck's cognitive therapy for personality disorders, Jeffrey Young and his colleagues formulated the concept of an early maladaptive schema, defined as a long-standing and pervasive theme that originates in childhood defines the individual's behaviors, thoughts, feelings, and relationships with other people and leads to maladaptive consequences. Applied specifically to characterological issues, the goal of schema-focused therapy is to help patients to identify cognitive distortions and challenge underlying beliefs that routinely result in impaired psychosocial functioning. For example, one might hold to a maladaptive schema centered on the fear of being abandoned, which results in excessive jealousy and clinging in relationships. The therapeutic approach would be to assist the patient in uncovering his or her assumption that significant others will inevitably leave and the connection of that assumption to particular behavioral and emotional responses. Over time, the...

Brief Overview Of Cognitive Therapy

Common Themes Arising in Cognitive Therapy of Bipolar Disorders CT may be used to facilitate adjustment to the disorder and its treatment C. Dealing with cognitive and behavioral barriers to treatment adherence and modifying maladaptive beliefs. Problems with adherence to medication and other aspects of treatment are tackled, e.g., through exploration of barriers (challenging negative automatic thoughts about drugs make me worse excessive self-reliance or exploring attitudes to authority and control) and using behavioral and cognitive techniques to enhance treatment adherence (Scott & Tacchi, 2002). This and data from previous sessions are used to help the client identify maladaptive assumptions and underlying core beliefs and to commence work on modifying these beliefs. D. Antirelapse techniques and belief modification. Further work is undertaken on recognition of early signs of relapse and coping techniques. For example, developing self-monitoring of symptoms,...

Cognitive Therapy

Underlying and supporting insomnia sufferers' performance anxiety and sleep-disruptive habits are a host of dysfunctional beliefs and attitudes about sleep. Beliefs that sleep is unpredictable and uncontrollable or that one must obtain 8 hours of sleep at night to function each day can add to anxiety about sleep and, in turn, interfere with the sleep process. Furthermore, insufficient knowledge about how one should respond to a night of poor sleep may lead to practices such as daytime napping or sleeping in, which disrupt the ensuing night's sleep. Given increasing recognition of these types of sleep-related misconceptions, therapeutic strategies that specifically target these cognitions may be useful in insomnia treatment. Hence, cognitive therapy designed to correct these dysfunctional beliefs, either through formalized patient education modules or via the cognitive restructuring method similar to that commonly used in cognitive therapy with clinically depressed individuals, is...

Cognitive Theories

Cognitive theories of depression emphasize the role of accessible cognitive processes in the development and maintenance of depression. Maladaptive cognitions contribute to the etiology of depression by making individuals susceptible to depression in the face of significant negative life events. Moreover, these mala-daptive cognitions and behaviors play a critical role in the maintenance of the depressive state by preventing depressed individuals from considering any alternatives to the pervasive hopelessness that dominates their thinking. Two influential cognitive theories of depression are Aaron T. Beck's negative cognitive triad and Martin E. P. Seligman's learned helplessness theory. In his 1967 book, Depression Causes and Treatments, Beck first proposed that depression was the result of the activation of overly negative views (or schemas) of oneself, one's world, and one's future. A negative view of oneself would produce low self-esteem, a negative view of the world could produce...

Cognitive Biases

A core feature of SAD is negative interpretation of ambiguous events. A number of studies have documented various cognitive biases in SAD, including negatively interpreting others' emotions or judgments, anticipating that others will negatively interpret one's anxiety symptoms, and overly attending to perceived errors in social behavior or performance. Contemporary cognitive theories of SAD highlight these biases as critical to the development and maintenance of the disorder. Although research demonstrates a strong association between the presence of these cognitive biases and SAD, their causal status remains uncertain.

Cbt Treatment Strategies For Addictive Behaviors

For example, Toneatto (2002) noted that if gamblers continue to believe in their abilities to predict outcomes or to control the situation, then they are more likely to relapse and reengage in excessive gambling once the difficulties leading them to treatment subside. Similarly, when working with sex offenders addicts, it is necessary to become aware of cognitive distortions leading to them placing themselves in high-risk situations (Neidigh, 1991).

Theoretical Foundations And Concepts

Provided complementary adjunctive theory to the later cognitive therapy (Carroll, 1999). For a comprehensive review of this topic, see Rotgers (1996). Early behaviorism in SUD treatment used classical conditioning to explain some of the reinforcing experiences of drug users such as cue exposure, but required the addition of the work of B. F. Skinner and operant conditioning to further the understanding. Later, social learning theory added to the awareness that substance users could be affected by the modeling of others both in maladaptive ways prior to treatment, and in treatment itself. It became clear that behavioral approaches and cognitive approaches to the treatment of these disorders were complementary.

Future Directions

It thus appears that child-based CBT interventions can be an effective part of a multimodal treatment for children, particularly older children, who exhibit high levels of aggressive behavior. Future research will be concerned with the following four issues. First, although many studies have shown that conduct-disordered youths experience various cognitive distortions and deficiencies, the specificity of these cognitive deficits among diagnostic groups and youths of different ages (do cognitive distortions characterize youths with conduct problems rather than adjustment problems more generally ) needs to be established, as well as whether some of the cognitive processes are more central than others, and how these processes unfold developmen-tally (Kazdin, 1997). Second, intervention studies will have to be conducted with samples that are more similar to clinically referred subjects, that is, with high levels of comorbid-ity and living in disturbed families. Treatment trials will have...

Complementarity With Other Treatment Approaches

Cognitive therapy synergizes with other treatment approaches such as pharmacotherapy and family therapy. Above and beyond the ubiquitous phenomenon of medication side effects, some patients have more individualized In cognitive therapy, patients are helped to find the flaws in the above arguments, and to look for evidence in support of alternative views that support ongoing pharma-cotherapy. In the end, the goal is to facilitate the patients' making peace with the need to take medications for their bipolar illness, and to find the appropriate medications that will do the best job with the fewest side effects. Similarly, cognitive therapy has a great deal to offer in working with individuals with bipolar disorder and their families. As in the case of schizophrenics and their families, bipolar patients and their families often experience harmful interactional cycles of mutual criticism, control issues, and general conflict a concept broadly known in the literature as high expressed...

Evidence For Cognitive Behavior Therapy

Preliminary evidence for the efficacy of cognitive behavior therapy (CBT) in BDD comes from two randomized controlled trials (RCT) (Rosen, Reiter, & Orosan, 1995 Veale, Gournay et al., 1996). There are also several case series of behavioral and cognitive therapy (Geremia & Neziroglu, 2001 Gomez Perez, Marks, & Gutierrez Fisac, 1994 Marks & Mishan, 1988 Neziroglu & Yaryura Tobias, 1993 Wilhelm, Otto, Lohr, & Deckersbach, 1999). In the first RCT, Rosen et al. (1995) randomly allocated 54 patients diagnosed as having BDD to either group CBT or a waiting list. After treatment, 82 (22 out of 27 subjects) of the CBT group were clinically improved and no longer met the criteria for BDD compared to 7 (2 out of 27 subjects) in the waiting list group. The subjects were, however, different from those described at other centers for example, they were all female, 38 were preoccupied by their weight and shape alone, and they tended to be much less socially avoidant and handicapped...

Beliefs About Appearance

The next step is to assess what the patient's assumptions are about the defects or the image they experience. What personal meaning does it have for him What effect does his failure to achieve the aesthetic standard he demands have on his life Patients may have difficulty in articulating the meaning but a downward arrow technique can usually identify such assumptions. After eliciting the most dominant emotion associated with thinking about the defect, the therapist inquires about what is the most shameful (or other emotion) aspect of the defect. For example, the patient might believe that having a defective nose will mean that he will end up alone and unloved. For another person, the meaning of flaws in his facial skin is the feeling of disgust at being dirty and the consequent fear of humiliation. It is important to identify such assumptions as they, rather than the immediate beliefs about the defect, are a focus of cognitive therapy and behavioral experiments. Some patients may have...

Interacting Elements Of

The cognitive therapy literature recommends including the following elements in CCFs (Needleman, 1999 Persons, 1989) Core beliefs or schemas longstanding, deeply held, emotionally laden beliefs about self, others, and the world that have a profound influence on behavior (e.g., I'm a loser People are only out for themselves) Cognitive processes rumination, avoidance, cognitive distortions, and explanatory style Because cognitive therapy theorists consider identifying and targeting maintaining mechanisms crucial to successful therapy, they are important components of the CCF (e.g., Needleman, 2003). Some of the most common examples include (a) schema-consistent appraisal of situations, (b) skills deficits, (c) high levels of distress, which interfere with effective problem solving, (d) reinforcing and punishing consequences of behavior, (e) valuing short-term over long-term consequences, (f) avoidance, which prevents both disproving maladaptive beliefs and desensitizing to triggering...

Methodological Considerations In Cognitive Vulnerability Theory And Research

In retrospective studies, participants who currently suffer from an episode or symptoms of a disorder are asked to recall information about their cognitive vulnerabilities (or past stresses) before their first episodes. The major scientific shortcoming of such designs is that a participant's recall can be influenced by forgetting, cognitive biases, or even the disorder itself. For example, depressed individuals who are asked to recall past life experiences might exhibit biased recall of stressful events or past dysfunctional attitudes as a consequence of their current depressive moods.

Benefits Of Knowledge Of Cognitive Vulnerability

General knowledge of cognitive vulnerability research has practical benefits for the clinical practitioner. The legitimacy of cognitive therapy is supported by empirical evidence, not just on treatment outcome, but on the background principles and assumptions of a cognitive perspective to psychological problems. Cognitive vulnerability research comprises an important component of this basic scientific evidence. A second benefit is that cognitive vulnerability research offers the future hope for more efficacious

Help the Patient Assess and Mobilize His or Her Strengths and Resources

To assist in identifying the patient's automatic thoughts and underlying schema related to the crises he or she is experiencing, and the available resources to cope with the crisis, it is helpful to conceptualize the crisis as a ratio. A crisis results when one's perception of the risk is more powerful or threatening than the perception of his or her resources. By challenging cognitive distortions that may overestimate the risk and underestimate their resources, the patient's perception of the crisis may then become less overwhelming and manageable.

Daniel R Strunk and Robert J DeRubeis

Keywords cognitive therapy, depression, Aaron T. Beck, pharma-cotherapy, dissemination A basic supposition in cognitive models of depression is that depression is characterized by systematic negative biases in thinking. Depressed people harbor negative beliefs about themselves, the world, and their futures (Beck, 1967). For example, a depressed person may believe I am a terrible person, people think I have nothing to offer, or there's no point in trying. Negative biases are also manifested through errors in logic. Overgeneralization, drawing a global conclusion from a single fact, is one such error. A depressed woman might exhibit overgeneralization by concluding that she will never get a job after not being offered a job following one interview. Aaron Beck has argued that the wide variety of specific errors and biases that characterize depressed people's thinking accounts for their other symptoms of depression (Beck, 1967). Cognitive therapy (CT) involves an effort to correct...

Contemporary Treatment Practices

Cognitive therapy components aim to change the child's maladaptive beliefs, images, thoughts, and self-talk which influence their behavior and perceptions. The therapist often does so through eliciting what the child is thinking when experiencing negative mood states or during upsetting events. The child engages in affect education exercises (practice recognizing and differentiating feelings) and learns about the cognitive model in which thoughts impact feelings and behavior. The therapist helps the child identify maladaptive or distorted thinking and engage in cognitive restructuring activities. These activities include identifying the type of distortion being exhibited (e.g., overgeneralization, mind reading), weighing the evidence for and against the thought or belief, testing the belief through behavioral experiments, and substituting more realistic interpretations. To help children interact more effectively with their environment, they are taught problemsolving skills...

Research On Dbt For Ed

Another randomized controlled trial compared individual DBT for BN clients with a wait-list control. DBT was well accepted and there was a median purge reduction of 98 and an abstinence rate of 28.6 , which was similar to findings in a large multisite CBT for BN trial at post-treatment. DBT appeared to improve urges to eat in response to negative emotions.

Consciousness And Awareness Of Dream Themes

The patient's dreams were seen to be idiosyncratic and dramatic expressions of the patient's view of self, the world, and the future. Given that the dream material reflected the cognitive triad, it would follow that the dream would also embody the patient's cognitive distortions in those three broad areas. Beck (1967) pointed out that concentrating on the manifest content (the aware and easily described aspect of dreams) is far more satisfactory than attempting to infer underlying processes which may be vague or unreachable. Since the manifest content is readily available to the dreamer and can be reported to the therapist, it is available for immediate use in the therapy session. Utilizing material that is readily available, the patient can obtain a sense of mastery and self-knowledge without depending on the therapist to interpret the symbolism of the dream. Beck states, If the patient has a dream in which he perceives other people as frustrating him, it would be...

Cbt Applications Specific Applications Depression

Nezu, Nezu, Rothenburg, DelliCarpini, and Groag (1995) found that cognitive models can account for depression in individuals with MR. Their results revealed higher rates of automatic negative thoughts and feelings of hopelessness, and lower rates of self-reinforcement and social support in the dually diagnosed patients they studied. Studies have also shown similarities in the social interaction patterns in depressed adults both with and without DD. Hurley and Sovner (1991) suggest that patients with social skills deficits as part of their depression are good candidates for CBT. The treatment package that Hurley and Sovner recommend includes the reinforcement of behaviors incompatible with depression (e.g., making eye contact), improvement of social skills, and the challenging of negative interpretations.

Nature And Effectiveness Of

Training with later combinations of cognitive and behavioral strategies. The cognitive therapy component has been based around self-instructional training or the cognitive methods of Beck and Emery (1985). Controlled trials with DSM-III-R-or DSM-IV-diagnosed GAD patients demonstrate that cognitive-behavioral treatments are associated with significant clinical improvement. Moreover, these studies show that treatment gains are maintained at 6 and 12 months following the end of therapy. In one study there was evidence of maintenance of gains at 2 years (Borkovec, Newman, Pincus, & Lytle, 2002). Cognitive-behavioral therapy (CBT) appears to be associated with the largest treatment effect when compared with anxiety management, nondirective psychotherapy, or psychoanalytic psychotherapy (Durham et al., 1994). Fisher and Durham (1999) examined recovery rates in GAD in six randomized controlled trials published since 1990. Each of these studies used the trait version of the Speilberger...

Theoretical Approaches

Advances in treating pathological worry in GAD should emerge from a specification of cognitive factors involved in the escalation and persistence of worrying. Initial theoretical attempts and hypotheses concerning the function and origin of worry emphasized concepts of blocked emotional processing (Borkovec & Inz, 1990). Borkovec and colleagues suggest that worry is an attempt to avoid future aversive events. It may also divert attention away from negative thought intrusions in the form of imagery. Worrying itself can be negatively reinforced by its suppressing effects on aspects of somatic anxiety experience. The long-term consequences of this process include inhibition of emotional processing and the maintenance of anxious meanings. A detailed cognitive model of pathological worry and GAD was subsequently advanced by Wells (1995, 1997). The model emphasizes the role of metacognitive beliefs and metacognitive appraisals in the development and persistence of excessive and...

Therapeutic Aspects Of Group Therapy

Group therapy is an economical way to deliver treatment. The rationale for including group cognitive therapy (GCT) in current treatment programs rests in part on nonspecific operational principles such as universality, support, and peer feedback that are shared with other group therapies (Yalom, 1985). However, GCT has the advantage of being a short-term, problem-oriented approach, consistent with individually administered CBT. Several of the more important reasons for utilizing GCT are described below.

Changing Cognitive Contents

These (sometimes called cognitive events) are the automatic self-statements clients (as well as everyone else) say to themselves constantly, such as I'll never complete this task or What a dumb thing to do They might be considered the what of thinking. Self-statements such as these are considered by Araoz (1985) to be a form of ongoing negative self-hypnosis. These cognitive events are relatively easy to access with judicious therapist questioning (e.g., What was going through your mind just now ). Using standard cognitive therapy techniques, alternative, more adaptive self-statements can be developed jointly by the therapist and client.

The Present Status Of

LTE has theoretical, epistemological, ontological, and practical differences from the two main approaches to cognitive therapy as defined by the author classical, closer to a modernist epistemological, and constructionist, closer to a postmodern point of view (Caro, 1990, 2002).

Cbt For Offenders With Intellectual Disabilities

Although empirical investigations are limited, cognitive-behavioral interventions for the treatment of offenders with intellectual disabilities are posited as potentially effective approaches in reducing recidivism rates. Barron, Hassiotis, and Banes (2002) in their review of the literature found evidence for the effectiveness of group cognitive therapy with social skills training in reducing anger and aggression, as well as reducing recidivism rates, in low-risk sex offenders with mild intellectual disabilities. Covert sensiti-zation, a cognitive technique involving imagery based on operant and classical conditioning as well as observational learning, was successfully used as part of a multicomponent intervention strategy in the treatment of a fire setter (Clare, Murphy, Cox, & Chaplin as cited in Barron et al., 2002). Similar to other subgroups of persons with mental retardation, there is a dearth of empirical investigations that examine psychotherapeutic treatments for offenders...

Arthur Freeman and Ray W Christner

In recent years, a number of leading cognitive-behavioral therapists have contributed cognitive-behavioral approaches in the treatment of personality disorders (Beck, Freeman, & Associates, 1990 Beck, Freeman, Davis, & Associates, 2004 Freeman, 1987, 1988 Freeman & Leaf, 1989 Freeman, Pretzer, Fleming, & Simon, 1990, 2004 Linehan, 1993 Linehan, Cochran, & Kehr, 2001 Pretzer & Fleming, 1989 Young, 1988, 1990). Cognitive-behavioral therapists not only focus on symptom structures or manifest problems, but also address underlying schemas or core beliefs and issues that perpetuate or exacerbate the patient's problems. This formulation is consistent with the principal contemporary theories of cognitive structure and cognitive development, all of which stress the function of schemas as determinants of rule-guided behavior (Galambos, Abelson, & Black, 1986 Neisser, 1976 Piaget, 1970, 1974,1976, 1978 Schank & Abelson, 1977).

The Anger Episode Model

Models Anger

Anger becomes a clinical problem when the outcomes are more negative than positive. Outcomes can be interpersonal, emotional, cognitive, and medical. At the interpersonal level, relationships are likely to be weakened following an anger episode as less time is spent with the person viewed as the instigator Also, angry people are avoided by others. This leads to additional problems such as job dissatisfaction, greater likelihood of disagreements at work, and more conflict with friends and romantic partners. Anger is also likely to be followed by other negative emotions such as continued irritation, sadness-depression, disgust, concern, and guilt. These are especially likely to emerge for persons high in trait anger. It is also important to note that some positive feelings may also emerge including a feeling of relief and satisfaction. Some people do report that their anger serves them well. Nevertheless, for high-trait-anger adults, short- and long-term outcomes of anger are...

Howard Kassinove and Raymond Chip Tafrate

Anger is defined as a negative psychobiological state, of varying intensity and duration, which is reported by verbal labels such as annoyed, pissed-off, angry, and furious. Angry states are associated with cognitive distortions and unrealistic evaluations of the triggering stimulus, moderate to high autonomic reactivity, private experiences that often include fantasies of revenge, and public expressive behaviors that may include yelling, gesturing, and profanity. Whether or not public behavioral expressions of anger actually emerge will vary, based on the individual patients' social learning history and the contingencies of the present environment.

Anger Management Interventions

In order to prevent an aggressive reaction to a triggering stimulus, it is necessary for youths to manage their anger arousal and process the interpersonal exchange such that a more prosocial response is exhibited. The anger management treatment protocols focus on the three hypothesized components of the anger experience physiological responses, cognitive processes, and behavioral responses (Novaco, 1979). If anger reactions are comprised of heightened physiological arousal, cognitive distortions, impulsive thoughts, and aggressive responding, then the intervention must focus on helping young people develop self-control skills in each of these areas. The cognitive component of anger management targets both cognitive deficiencies and distortions that are characteristic of those with an aggressive and impulsive response to perceived provocation. Specific cognitive problemsolving skills seem to be missing for aggressive youth. They generate few possible solutions to interpersonal...

Social Problem Solving

Problem solving (often referred to as social problem solving to emphasize that such activities occur in social or interpersonal contexts) is the cognitive-behavioral process by which a person attempts to identify or discover effective or adaptive solutions for stressful problems encountered during the course of everyday living (D'Zurilla & Nezu, 1999 Nezu, in press). Problem-solving therapy (PST) provides for systematic training to help individuals cope more effectively with such stressful events by teaching them to apply a variety of skills geared to help them either (a) alter the nature of the problem (e.g., overcoming obstacles to a goal), (b) change their distressing reactions to the problem (e.g., acceptance that a problem cannot be changed), or (c) both.

Problemsolving Formulation Of Depression

The concept of emotional stress refers to the immediate emotional responses of a person to a stressful life event, as modified or transformed by appraisal and coping processes. Although emotional stress responses are often negative (e.g., depression), they can also be positive in nature (e.g., hope, relief, exhilaration). Negative emotions are likely to predominate when the person (a) appraises a problem as harmful or threatening to well-being, (b) doubts his or her ability to cope with the situation effectively, and or (c) makes ineffective or maladaptive coping responses. On the other hand, positive emotions may emerge and compete with negative emotionality when the person (a) appraises the problem as a challenge or opportunity for benefit, (b) believes that he or she is capable of coping with the situation effectively, and (c) makes coping responses that are effective in reducing harmful or threatening conditions and or the negative emotions that are generated by them. This model...

The Social Problemsolving Process

Social problem solving is the cognitive-behavioral process by which a person attempts to identify adaptive solutions for stressful problems. Problem-solving therapy (PST) helps individuals cope more effectively with such problems by teaching them to apply a variety of skills geared to help them either (a) alter the nature of the problem (e.g., overcoming obstacles to a goal), (b) change their distressing reactions to the problem (e.g., acceptance that a goal cannot be reached), or (c) both.

Effective Versus Ineffective Problem Solvers

Important differences have been identified between individuals characterized as effective versus ineffective problem-solvers. In general, when compared to effective problem solvers, ineffective problem solvers report a greater number of life problems, more health and physical symptoms, more anxiety, more depression, and more psychological maladjustment. In addition, a negative problem orientation has been found to be associated with negative moods under routine and stressful conditions in general, as well as pessimism, negative emotional experiences, and clinical depression. Further, persons with a negative orientation tend to worry and complain more about their health (see Nezu, Wilkins, & Nezu, in press, for a review of this literature).

Cognitive Processing Therapy

Emphasizing CT techniques, CPT (Resick et al., 2002) includes both exposure and cognitive therapy. For exposure, the client writes a detailed account of the trauma that is read to the therapist. Stuck points, or points in the narrative that hold significant meaning and anxiety for the client, are identified and cognitive techniques are used to closely examine these points. In addition, trauma-related beliefs about safety, trust, power control, esteem, and intimacy are examined in sessions that focus on each specific type of cognition.

Summary And Future Directions

Cognitive-behavioral treatments show great promise for the treatment of PTSD secondary to war experiences. Clinical interventions that involve combinations of CBT techniques such as exposure therapy, AMT, and cognitive therapy need to be examined in randomized clinical trials both alone and in conjunction with pharmacological approaches. No such trials currently exist for PTSD secondary to any type of traumatic event. There is a clear need and a demand for these clinical trials.

Timothy R Elliott and Warren T Jackson

Thus, the great variety of patient and family needs in rehabilitation and community settings provides a wonderful opportunity for application of virtually all CBT approaches behavior management, learning theory as it applies to didactics and patient education, cognitive techniques that inform psychoeducational interventions, and empirically supported CBT protocols for specific disorders and adjustment difficulties. In rehabilitation settings, CBT may be conceptualized in its broadest form.

Components of Relapse

High-risk situations are conceived of as either Intrapersonal (i.e., negative emotions, distorted thinking) or Interpersonal (i.e., conflicts with others, inability to cope with offers to engage in the addictive behavior, and so on). Early on in their work, Marlatt and Gordon and their colleagues identified a range of Intra- and Interpersonal factors that were most highly associated with relapse to substance use among treated addicts (Marlatt & Gordon, 1985).

Empirical Work Begins

Rebecca Propst and colleagues (Propst, Ostrom, Watkins, Dean, & Mashburn, 1992) succeeded in reducing depression by combining the principles of Cognitive Therapy with Christian beliefs and practices. Alone and with colleagues, Brad Johnson (1993 Johnson, Devries, Ridley, Pettorini, & Peterson, 1994) showed that the principles of Rational Emotive Behavior Therapy also could be combined with Christian beliefs and practices to reduce psychological disturbances such as depression. Quite importantly, Propst found that nonbelieving therapists were in no way less effective in using the combined approaches to reduce depression in Christian clients when compared to believing therapists,

Using Cbt With Children And Adolescents

When applying the CBT framework in the conceptualization and treatment of school-age children with problems, professionals must possess an understanding of the fundamentals of child and adolescent development. Those clinicians grounded in the nuts and bolts of development will avoid implementing interventions that are incompatible with a child's functional level. To benefit from a number of cognitive-based strategies, a child must have the capacity to attend to information, comprehend language, use working memory, and verbally express him- or herself. School-based practitioners should use and focus on these individual factors when designing a specific program for a student. In case conceptualization and treatment design, school-based clinicians should determine the precise mix of cognitive and behavioral techniques based on the student's developmental level. For instance, the more immature a student's cognitive or language development, the greater is the proportion of behavioral to...

The Status Of Cbt Treatment Research

Treatment design flows directly from an individual's unique case formulation. Because the literature concerning treatment outcome for sex offenders is nonconclusive, any interventions that have received empirical support in the literature that address specific identified targets of vulnerability relevant for an individual patient should be considered. Examples of such interventions include techniques that have been shown to be effective with regard to changing cognitive distortions, increasing anger management, decreasing deviant sexual arousal, or increasing social problem-solving ability. Because the clinician is unable to rely on any one of the empirically supported cognitive-behavioral treatment programs specifically designed for sex offending behavior, there are many studies supporting the use of various CBT techniques that address the various vulnerability factors.

Treatment Procedures And Formats

Child-based CBT interventions have been increasingly used to try to decrease children's aggressive, antisocial behavior and assume that children engage in aggressive behavior as a result of (a) learned cognitive distortions, such as biased attention to aggressive cues and the attribution of hostile intent to the action of others (b) cognitive deficiencies, such as poor problem-solving and verbal mediation skills and (c) a related tendency to respond impulsively to both external and internal stimuli, which has also been described as an inability to regulate emotion and behavior (Lochman et al., 2000). Accordingly, the child-focused CBT approach to treating child conduct problems targets the disturbed cognitive processes and behavioral deficits thought to produce aggressive and disruptive behaviors. They help the child identify stimuli that typically precede aggressive and antisocial behaviors and perceive ambiguous social situations in a nonhostile manner, challenge cognitive...

Rationale For Cbt For Somatization

These cognitive distortions elicit negative emotions and maladaptive behaviors. Thoughts of possible illness give rise to feelings of anxiety, dysphoria, and frustration, which are likely to maintain physiological arousal and physical symptoms. Intending to prevent injury or exacerbation of symptoms, somatization patients typically cope by withdrawing from activities. Such time away from activities provides opportunities for additional attention to be focused on one's physical health. Further, patients suffering from these physical symptoms, distorted cognitions, and negative affect may seek repeated physician visits and diagnostic assessments. Physicians, in turn, attempting to conduct thorough evaluations and avoid malpractice suits, may encourage somatizing behavior by ordering unnecessary diagnostic

Etiologies Of Child And Adolescent Suicide

Cognitive-behavioral models of child and adolescent suicide build on the aforementioned research and are aimed at understanding the mechanisms through which suicidal thoughts and behaviors develop, and ultimately at modifying such thoughts and behaviors through effective psychosocial treatments. This work has focused primarily on the confluence of affective, cognitive, and behavioral factors associated with suicidal thoughts and behaviors. Affectively, depressed mood and anhedonia, a diminished capacity to experience pleasure, are correlates of suicidal thoughts and behaviors (Nock & Kazdin, 2002). Cognitively, it has been proposed that suicidal thoughts and behaviors are the result of cognitive distortions, through which an individual systematically misconstrues the environment in a negative way. Research has supported this theory by demonstrating that suicidal ideation is associated with a higher frequency of negative automatic thoughts, and more impressively by showing that...

Treatment Of Child And Adolescent Suicide

CBT for self-injurious thoughts and behaviors also typically emphasizes developing emotion regulation and distress tolerance skills. Self-injury often functions as a method of increasing or decreasing an individual's affective experience, and sometimes occurs in the context of an inability to inhibit impulsive responding to provocative events. Therefore, more adaptive skills for generating or relieving one's affective experience or for tolerating distress and inhibiting impulsive responding are taught and practiced. These skills include identifying and labeling positive and negative emotions, expressing emotions verbally and nonverbally, engaging in pleasurable activities, and engaging in distraction and relaxation exercises. Consistent with the CBT approach, there is also a consistent emphasis on self-monitoring of thoughts, behaviors, and emotions. Similarly, attention is devoted to evaluating the antecedents and consequences of self-injurious thoughts and behaviors.

Lesia M Ruglass and Jeremy D Safran

Early theories from the cognitive tradition examined the therapeutic relationship only insofar as it facilitated the implementation of cognitive therapy techniques (e.g., Beck, Rush, Shaw, & Emery, 1979). The therapeutic relationship was not viewed as a change mechanism in and of itself but rather as a prerequisite for the successful employment of certain cognitive-behavioral strategies. Therapists were encouraged to display positive characteristics such as warmth, accurate empathy, and genuineness. These qualities were viewed as essential to the development and maintenance of the therapeutic relationship, which would presumably be one of trust, rapport, and collaboration. Beck et al. (1979) emphasized the process of collaborative empiricism that developed between patient and therapist in the service of the treatment goals. The idea here is that the therapist and patient form an alliance around the task of examining the validity of the patient's thoughts and beliefs in a scientific...

Origin And Evolution Of The Concept Of Therapeutic Alliance

Despite these obstacles, cognitive therapists have become increasingly interested in the concept of the alliance in the past decade or so. One reason for this has been the vast amount of empirical evidence supporting the importance of the alliance across a range of different treatment modalities including cognitive therapy (see Horvath, 2001). Bordin's (1979) reformulation of the alliance as a transtheoretical construct played a central role in stimulating interest by psychotherapy researchers and in making the construct more meaningful to cognitive therapists. Bordin posited that change in all forms of psychotherapy has to be predicated on a good alliance. His conception of the alliance included three interdependent components tasks, goals, and the

Review Of Relevant Literature

Early efforts to delineate those aspects of treatment that were manualized and could be measured focused on the concept of competence. Quickly, though, it also became clear that as a prerequisite for the competent administration of a given therapy, it first had to be specifically delivered (Waltz, Addis, Koerner, & Jacobson, 1993). That is, being adherent to a given therapy is a precondition for competence it does not, however, ensure that simply because a treatment is being used, it is being used in a skillful or competent manner (McGlinchey & Dobson, 2003). Early efforts in the field included the development of the Cognitive Therapy Scale (CTS Young & Beck, 1980), as a measure of competence, and the Minnesota Therapy Rating Scale (DeRubeis, Hollon, Evans, & Bemis, 1982 later revised to be the Collaborative Study Psychotherapy Scale Hollon et al., 1988), as a measure of the relative adherence to cognitive therapy, interpersonal therapy, and pharmacotherapy.

Considering Cognition

Not surprisingly, CBT emphasizes children's cognitive functioning. CBT seeks to educate children about their cognitive processes and help reduce maladaptive and dysfunctional beliefs. Cognitive functioning is complex, and children vary in the nature of their cognitive dysfunction. For example, it is important to recognize the distinction between cognitive deficiency (lacking of information processing) and cognitive distortion (biased, flawed thinking). Distorted thinking has been implicated in internalizing disorders such as depression and anxiety, where the child misperceives, misinterprets, or misconstrues some aspect of his or her environment. In contrast, impulsive or hyperactive children suffer more from cognitive deficiencies in a variety of situations they may act without thinking about consequences. CBT is tailored for the child so that cognitive distortions can be identified, tested-out challenged, and replaced. Additional problem solving (putting thinking between stimulus...

The Measurement Of Treatment Fidelity

Treatment adherence and competence scales have been devised in recent years, typically for use in the evaluation of a clinical trial. The Collaborative Study Psychotherapy Rating Scale (CSPRS Hollon et al., 1988) is a 48-item measure that rates therapists on whether or not they provided a number of treatment methods in a given session, including CBT techniques, general therapeutic skills, therapist directiveness, IPT techniques, and clinical management. The CSPRS has demonstrated adequate discriminability of these various therapy behaviors. It has also been adapted for other research notably the component analysis of cognitive therapy for depression conducted by Jacobson et al. (1996 Gortner, Gollan, Dobson, & Jacobson, 1998). In the latter study, the adapted CSPRS was able to discriminate between behavioral, automatic thought, and core belief interventions in cognitive therapy. The principal alternative measure of adherence in CBT is the Cognitive Therapy Adherence and Competence...

Application Of Cognitivebehavioral Therapy

Most notably, psychophysiologic insomnia is recognized for its complex multifaceted etiology and manifestation, and is effectively conceptualized and treated through a CBT model. Treatment for primary insomnia with cognitive-behavioral strategies is well-documented and continues to be a rapidly growing area of research (Morin et al., 1999). Therapies such as stimulus control, progressive muscle relaxation, paradoxical intention, and cognitive therapy for insomnia (i.e., challenging dysfunctional beliefs and attitudes specifically about sleep) employ a variety of cognitive-behavioral principles aimed at improving sleep quality. For example, rumination about needing to get a full 8 hours of sleep every night or fear that insomnia will be fatal are common irrational beliefs that are likely to lead to cognitive or physiological arousal states incompatible with sleep. In turn, the inability to sleep is likely to lead to further rumination, creating a vicious cycle. Employment of...

Jesse H Wright and David A Casey

Cognitive therapy and pharmacotherapy have common attributes of being structured, problem-oriented interventions with well-defined theories and strong empirical support for efficacy. Although these major treatment methods are derived from different theoretical perspectives, they are often used together to offer patients a full range of biological, cognitive, and behavioral therapies for psychiatric disorders. Research studies have typically implemented the two forms of therapy as separate entities, administered by different clinicians who may not share a unified model for treatment (Wright, 2004). The principal findings of research on combined treatment are discussed here, and methods are suggested for promoting integration of therapies in clinical practice. Recent brain imaging studies suggest intriguing potential mechanisms for treatment interaction at the neurobiological level. PET scan research on CBT and pharmacotherapy for depression have found activation of different pathways....

Assessment In Clinical Practice

Record, Persons, Davidson, & Tompkins, 2001 Daily Record of Dysfunctional Thoughts, Beck et al., 1979) to identify automatic thoughts, underlying schema, and cognitive distortions. Successful use of the thought record depends on a number of factors the clinician's willingness to use this tool the clinician's knowledge about how to use this tool to help the patient identify cognitive distortions the ability of the patient to consciously access and write down his her automatic thoughts the ability of the patient to see this as a valuable tool and the willingness of the patient to use the thought record outside of session. Persons and colleagues (2001) identified other drawbacks to this tool such as difficulty in eliciting automatic thoughts from patients reluctance by patients to use the thought record in session beliefs by patients that it is not helpful and noncompliance with homework assignments to complete thought records. Despite these limitations in clinical practice, results...

Criticisms Of Cbt With Chronic Pain Clients

In summary, CBT has strong empirical support as an effective treatment for chronic pain clients. More research is needed to explore whether cognitive therapy or behavior therapy is superior with chronic pain clients in general and for what types of problems or outcomes. In addition, the benefits of adding CBT to active treatments for chronic pain clients, especially low back pain clients, demand further exploration.

Arthur A Freeman and Bradley Rosenfield

By presenting a cogent rationale for how each homework activity is relevant to the patient's treatment goals, the therapist can increase both the salience of the goals and the probability of homework adherence (Beck, Rush, Shaw, & Emery, 1979). It is vital to reframe each collaboratively generated homework assignment as a positive incremental step on the road to increasing social skills, mood elevation, anxiety reduction, and other desirable goals. Simultaneously, the therapist and patient collaboratively test problematic thoughts, beliefs, assumptions, and schemas. The therapist must socialize the patient to the cognitive model (Addis & Carpenter, 2000). In this way, new skills replace lifelong deficits increasing self-efficacy, reinforcing treatment attendance, and gradually challenge mal-adaptive core beliefs. It is imperative for the patient to recognize the relationship between the homework task, the patient's core beliefs and automatic thoughts, and his or her emotional...

Elements Of Cbt For Adult Adhd

Receiving the diagnosis of ADHD is often a liberating experience and offers the first cognitive reframe of a patient's chronic difficulties. To this point, most patients have viewed their difficulties as confirming their maladap-tive core beliefs (e.g., I'm lazy). Many patients have communicated a sense of relief at finally having a coherent (and nonjudgmental) explanation of their difficulties, hearing that they are not alone in their struggles, and that there is indeed hope for change. The neurobiological and cognitive-emotional elements of the experiences of adults with ADHD are unavoidably intertwined. An ongoing case conceptualization allows the clinician and patient to understand how these various factors coalesce to influence that patient's automatic reactions. It also provides a therapeutic touchstone for assessing efforts to modify these reactions and to develop alternative options, particularly for maladaptive core beliefs and self-defeating compensatory strategies. The most...

Kelly L Gilrain and Jacqueline D Kloss

Independent of the nature of the dysfunction, sleep disorders are increasingly recognized as a growing public health concern that affects not only individuals' sleep, but also their psychological, social, and physical health. Because of underlying neuroendocrine, respiratory, and neurological etiologies, most sleep disorders are generally considered in the medical arena, and warrant appropriate medical or pharmacologic therapies. Nonetheless, behavioral, cognitive, and affective factors often serve as either contributors or consequences of sleep disorders and warrant attention to mitigate or prevent the impact of these conditions. The emerging area of behavioral sleep medicine incorporates the complex interactions between these psychological factors and physiological symptoms. Specifically, cognitive-behavioral strategies are ideally suited to help individuals manage sleep disorders and enhance quality of life for those who suffer from them.

Jesse H Wright and D Kristen Small

The author may receive a portion of profits from sales of Good Days Ahead, a computer program described in this article. A portion of profits from sales of Good Days Ahead is donated to the Foundation for Cognitive Therapy and Research and the Norton Foundation. Gruber et al. (2001) have reported similar findings in a study of a hand-held computer program for social phobia. Their computer program was designed to assist in group cognitive therapy by reinforcing the material taught in group sessions, giving prompts to confront fears, involving users in exercises to modify automatic thoughts, and providing progress reports. In a study comparing standard group CBT and computer-assisted CBT (with reduced therapist contact), there were advantages on some measures for standard therapy at the end of treatment but at the follow-up assessment, no differences were found between the treatments (Gruber et al., 2001).

Cognitive Formulation

Health anxiety is part of the anxiety spectrum of disorders. As such, cognitive behavioral formulations of this condition emphasize elements that are central to other experiences of anxiety. Specifically, perceptual and memory biases give rise to the cognitive distortion or magnification of problems, engagement in affective reasoning (e.g., If I feel it, it must be true), and underestimation of coping ability. Feelings of apprehension and worry are experienced as a result, which exacerbate existing cognitive distortions and the cycle repeats itself. and thus unworthy of attention. However, for patients who are convinced of their grave health status, threat reappraisal causes further distress and forces the patient to remain hyper-vigilant. This, in turn, increases the frequency of negative thoughts and the extent of cognitive preoccupation. As implied in the above discussion of comorbidity, anger, depression and malaise, and other emotional states are common correlates of health...

Symbolism Imagery In

Beck et al. (1985) acknowledged the emotional and cognitive power of imagery in creating corrective experiences with anxious patients who have upsetting, catastrophic visual images of danger before and during bouts of anxiety. As with verbal cognitions, these visual cognitions often represent a distortion of reality whereby patients who visualize such upsetting scenes tend to react as though they were actually occurring. Beck and colleagues found it useful to have patients visually relive and reexperience their inaccurately constructed beliefs as a means of enhancing cognitive restructuring. They further observed that a patient's distressing visual images can be activated, challenged, and modified by an array of imagery modification interventions, e.g., induced imagery, modification of induced images, identifying cognitive distortions within the imagery, decatastro-phizing imagery, substituting positive imagery, substituting contrasting imagery, imagery rehearsal, and a variety of...

Thomas E Joiner Jr and Foluso M Williams

Interrelated and are affected by cognitive change. The suicidal belief system (suicidal thoughts and ideations) and the cognitive triad (thoughts about the self, others, and the future) are two areas within the suicidal mode that are primary areas targeted in a cognitive-behavioral intervention. The core beliefs that permeate the cognitive triad fall within three domains. The first two, helplessness and unlovability, were specified by Beck (1996). The third is the domain of distress tolerance (e.g., I can't stand feeling this way), proposed by Linehan (1993). Dialectical behavioral therapy (DBT) also focuses on emotion regulation. According to the theory that forms the basis of this therapy, behavior patterns that comprise suici-dality, such as self-injurious behavior, parasuicidal behavior, and actual suicide attempts, have developed, in part, to regulate emotions that the person has not learned to regulate in a more adaptive way (Linehan, 1993). Part of the processes in DBT...

The Cognitive Hypnotherapeutic Treatment Of Psychological Disorders

Why should anyone use hypnosis at all in cognitive therapy Although the literature is somewhat equivocal, there is evidence that hypnosis may result in clients suspending their usual critical, evaluating cognitive processes, enabling them to hold two somewhat contradictory ideas in their minds simultaneously (what has been called trance logic). It has also been argued that a hypnotic trance may lower resistance to considering new ideas by taking advantage of and fostering increased openness to experience. Finally, hypnosis often has the ability, perhaps because of its reputation and the social context in which it is used, of engaging clients' interest and thereby enhancing their motivation. Irving Kirsch and his colleagues (Kirsch, Montgomery, & Sapirstein, 1995), in a meta-analysis, found that hypnosis added significantly to the therapeutic effect size of cognitive-behavior therapy alone.

Mark J Williams and Robin B Jarrett

Adult Cognitive Therapy (CT) Cognitive Therapy for Depression (Beck, Rush, Shaw, & Emery, 1979) is an active, structured, time-limited, problem-oriented therapy to reduce depressive symptoms by altering negative views of self, world, and future (the cognitive triad). Early sessions focus on educating patients about depression and the cognitive model as well as identifying and testing negative automatic thoughts (i.e., thoughts correlated with negative mood). Thoughts are then evaluated through cognitive (logical analysis) and behavioral (hypothesis testing) tasks. Collaboratively, the patient and therapist determine whether the evidence supports the negative thoughts. Patients learn to identify logical errors in their thinking and consider alternative views. Effective treatment of major depressive disorder may include acute, and when necessary, continuation, and maintenance phase therapies as discussed below.

James D Herbert and Kristy Dalrymple

Social Anxiety Disorder (SAD also known as Social Phobia) is defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a marked and persistent fear of social or performance situations in which embarrassment may occur. These situations may include public speaking, eating in public, writing in public, speaking with authority figures, conversations, dating, as well as many others. The fear must be excessive or unreasonable, lead to avoidance and or significant distress, and must interfere with occupational, academic, or social functioning. A cardinal feature of the disorder is fear of negative evaluation by others. Persons with SAD tend to hold negative beliefs about themselves (e.g., thoughts of inadequacy), and engage in excessive self-focus during social interactions.

Treating Low Selfesteem

The model forms a basis for an individually tailored cognitive conceptualization of the difficulties for which the patient has sought therapy. It is the foundation for an integrated program of cognitive-behavioral interventions, which draws on established protocols for treating depression and anxiety, as well as the clinical literature on changing schemas and core beliefs (e.g., Beck, Freeman, & Interventions are designed to target elements of the cognitive model in a systematic sequence. However, the exact order of events, and the relative emphasis given to different elements, will vary from patient to patient. The rule of thumb is to start with maintaining processes, relating specific day-to-day changes to background assumptions and beliefs, but waiting to work on these broader issues until the therapeutic relationship is firmly established and the patient has a sound grasp of the principles and practice of CBT and is able to work effectively with painful emotions. Specific,...

Coping And Adjustment

In the cognitive domain, patients may experience significant difficulty adjusting core beliefs about themselves (self-schemas), others, and the world as a disease progressively alters their functioning. Cognitive restructuring, developing coping statements, thought-stopping, and evaluating and adjusting expectations can be useful for helping individuals who are struggling in this area. Increasing a sense of self-efficacy in the face of changing demands or increasing the individual's perceived control over demands may be the focus of treatment. Assessing and changing problematic automatic thoughts that interfere with a patient's adjustment and coping behaviors may also be important for therapy. Other cognitive targets for treatment include enhancing capabilities related to perception and judgment, using distraction techniques, improving decision-making skills, and utilizing and sharing aspects of wisdom.

Literature Review Of Cbt For Ptsd

These theoretical models led to the development of the three most widely used treatments for war-related PTSD today cognitive therapy, anxiety management therapy, and Cognitive Therapy PTSD develops into a chronic disorder when individuals cognitively process the trauma in a manner that leads them to feel constant threat. This feeling of threat exists due to consistent negative appraisal of the traumatic event and to the manner in which the event is encoded and established in the memory. These cognitive distortions prevent individuals from leading productive, normal lives because they are plagued by their past. As well, these aversive cognitions produce maladaptive behaviors such as substance abuse in an attempt to control their emotions. Cognitive restructuring is one type of cognitive therapy used in the treatment of PTSD. It involves recalling the experience and verbalizing what happened and what emotions they felt at the time and subsequently. This sampling of cognitions permits...

Methodology Of Behavioral Assessment

The specific types of target problems being assessed. Methods of behavioral assessment include direct observation by another or self-observation in vivo, in vitro, or during performance on an analogue measure. Regardless of the specific tool selected or designed, a commonality across all tools is the monitoring of important and relevant aspects of the target response. For example, a behavioral assessment tool for monitoring panic attacks might include the day, situation, symptoms, thoughts, anxiety levels, the time the panic attack began, time ended, and behaviors. A mood diary might include the situation, feeling, rating of feelings, automatic thought, belief rating, specific type of cognitive distortion, rational thought, rerating of negative automatic thought, and rerating of feelings. A tool for monitoring tantrums might include the day, frequency of tantrums, duration of each tantrum, situations precipitating tantrums, and the behaviors of significant others in response to the...

Description Of Cbt Model For Adhd In Adults

From a CBT standpoint, then, these executive function deficits associated with ADHD exquisitely influence core beliefs by affecting the ongoing experiences from which individuals compose personal meaning. Considering the cumulative effects of the many problems associated with ADHD on one's adaptive functioning and ongoing sense of self, the adult with ADHD likely presents for assessment and treatment with a history of problems that may have been encoded in the form of maladaptive beliefs (e.g., I'm a failure I'm incompetent). Consequently, the symptoms of ADHD and the reactivation of maladaptive beliefs (and concomitant emotions) routinely disrupt the individual's life, further eroding what is often an already fragile sense of self-efficacy and further impairing the effective execution of cognitive problem solving.

John H Riskind and David Black

Keywords cognitive vulnerability, cognitive bias, beliefs, cognitive structures Cognitive vulnerabilities are faulty beliefs, cognitive biases, or structures that are hypothesized to set the stage for later psychological problems when they arise. They are in place long before the earliest signs or symptoms of disorder first appear. These vulnerabilities are typically purported to create specific liabilities to particular psychological disorder after individuals encounter stressful events, and to maintain the problems after their onset. Only by addressing these vulnerabilities can long-term therapeutic improvements be maintained, and the risk of recurrences or relapse be reduced. Before further reviewing the roles of cognitive vulnerability concepts in cognitive-behavior therapy (CBT), it is necessary first to briefly describe several components of the CBT model as a whole. According to CBT, each disorder is associated with particular cognitive content (e.g., Beck, 1976). To illustrate...

Victoria M Follette and Alethea A A Smith

Exposure therapy has increasingly been found efficacious with a variety of anxiety-related disorders including phobias, generalized anxiety disorder, and posttraumatic stress disorder. Originally developed using concepts from basic learning theory, concerns about enhancing the efficacy of exposure therapy have led to the enhancement of this technique with additional components. The primary augmentation has been the integration of cognitive techniques. As cognitive conceptualizations of various forms of psy-chopathology, particularly anxiety and depressive disorders, became dominant, the integration of cognitive and exposure strategies grew to be routine practice. Cognitive-behavioral therapy has incorporated basic learning theory along with cognitive strategies to address some of the above concerns. One early integrative example is stress inoculation training (SIT) which uses modified forms of exposure and cognitive techniques (Meichenbaum, 1974). In addition to exposure, SIT provides...

Cbt And The Trauma Memory

There does not appear to be any superiority between cognitive therapy and exposure or between exposure and stress inoculation. There also does not appear to be any advantage of combining treatments so that exposure plus cognitive therapy or exposure plus stress inoculation are not superior to each intervention alone. There may be a slight advantage of individual therapy over group. That said, the exact components of care applied to older victims should be broadly considered and multiple in scope at least at the treatment planning stage. In effect, it is likely that all methods discussed have efficacy but the exact proportion for which older client is unknown. Cognitive therapy is also effective. It addresses the internal representations of the trauma and its residual effects. Foa, Rothbaum, and Furr (2003) also noted empirically supported personal efficacy skills are built within the broad category of CBT. Again, they include exposure therapy, anxiety management programs, and...

Cbt For Obesity The Past

Since the early 1980s, additional treatment strategies have become routine components of treatment, including cognitive therapy procedures, nutritional training, and exercise. Two key considerations motivated the inclusion of cognitive therapy (Foreyt & Poston, 1998). First, there was the recognition that many obese people engage in negative or self-defeating monologues related to their eating, their physical appearance, and their self-worth. These maladaptive cognitions often result in emotional distress and poor treatment adherence. Second, the problem of weight regain following behavioral treatment heightened the role that cognitive factors play in relapse and suggested the possibility that the inclusion of cognitive strategies could prevent relapse and improve long-term outcome. As a consequence, behavioral treatment of obesity evolved into a comprehensive lifestyle intervention with CBT as its core.

Empirical Support for CBT for Childhood PTSD

Several important treatment outcome studies have examined the efficacy of CBT for PTSD in children. In the late 1980s, following the introduction of PTSD into DSM-III (APA, 1980), Saigh (1987a,b 1989) carried out a series of single-case trials of imaginal flooding therapy for traumatized children and adolescents in Lebanon. This treatment involved children identifying and describing their traumatic experiences over a multiple baseline with outcome, measured through self-reported ratings of anxiety and depression. This and other similar treatments have been associated with a reduction in trauma-related symptoms, including exaggerated startle response, nightmares, intrusive thoughts, avoidance, impaired concentration and memory, self-reported anxiety, depression, and guilt (Saigh et al., 1996). In a third intervention, King et al. (2000) randomly assigned sexually abused children with posttraumatic stress symptoms to either a child CBT condition, a family CBT condition, or a wait-list...

Summary And Conclusions

Phobias can be distressing and debilitating disorders. Individuals with agoraphobia, specific phobia, and social phobia experience fear in particular situations or around particular objects that often manifests itself in a panic attack or paniclike symptoms. The experience of panic leads to anticipatory anxiety about having future symptoms of panic, resulting in avoidance of the phobic situation. CBT has been found to be effective in treating these phobias through a combination of exposure, cognitive therapy, and psychopharma-cology. Continued research on treatments for phobias will help to find the most cost-effective treatments that can be generalizable across various patients and settings.

Cognitivebehavioral Therapy Interventions For Anger Problems

Cognitive restructuring is a method of identifying mal-adaptive thoughts, beliefs, or attributions that lead to anger outbursts and learning appropriate responses. It is important to help angry clients accept the rationale for changing their thoughts (i.e., that thoughts influence feelings and the problematic behaviors associated with them) and to convince angry clients that they have a choice in how they decide to interpret anger-provoking situations. Once the client accepts this rationale, techniques of rational emotive behavior therapy or cognitive therapy can be used to restructure problematic thinking. The inductive nature of cognitive therapy techniques may be more acceptable to some types of angry clients and may be a better technique if an angry individual is struggling with the rationale for cognitive restructuring. Some angry clients may benefit from imaginal methods for cognitive restructuring more so than the verbal methods that comprise cognitive therapy and rational...

Deborah Slalom and E Thomas Dowd

By using cognitive restructuring techniques, erroneous beliefs and cognitions are challenged in order to produce a corrected understanding of the effects of pathological gambling. Core beliefs are challenged producing doubt. This doubt allows gamblers to examine their cognitions and make other choices that could lead to nongambling behaviors. Indeed, the success of treatment is dependent on dispelling these cognitive errors (Sharpe & Tarrier, 1992 Toneatto, 2002).

Individual Based Approaches

In general, group interventions for caregivers have many functions, including the provision of respite for care-givers, an opportunity for caregivers to receive and give peer support, and an increase in caregivers' self-efficacy. Unlike support groups, psychoeducational interventions teach care-givers practical skills for caregiving and specific coping strategies in addition to providing support through a group format. Psychoeducational interventions also tend to be more intensive and time-limited than traditional support groups. Although not all psychoeducational group interventions use a behavioral or cognitive-behavioral orientation, most are grounded in cognitive and behavioral principles. Caregivers participating in cognitive-behavioral psychoedu-cational groups may learn how to (a) challenge negative thoughts, (b) be more assertive, and (c) control their frustration level, as well as learn specific caregiving skills derived from behavioral principles (e.g., managing difficult...

Empirical Support Of Cbt For Addictive Behaviors

Replacement behaviors, and changing the relationships between cognitive distortions and physiological arousal and gambling. The investigators used relaxation training, imaginal and in vivo exposure, and cognitive restructuring as primary modalities. Following treatment the client showed a significant decrease in frequency and intensity of gambling impulses. With the exception of placing a single bet, the client did not gamble for 10 months. Additionally, the client reported a decrease in anxiety based on the Beck Anxiety Inventory.

Review Of The Research Literature On Cbt And Chronic Pain

There is firm evidence in the research literature that both cognitive-behavioral and behavioral treatments are superior to no-treatment control conditions on a variety of outcomes (e.g., reducing pain levels, use of pain medications, negative thoughts, extent of physical disability as well as enhancing pain control, psychological adjustment, physical functioning and health status and psychosocial functioning) and these effects are maintained at follow-up for a variety of chronic pain clients (see meta-analysis studies by Morley, Eccleston, & Williams, 1999, and van Tulder et al., 2000). In addition, multidisciplinary pain treatment programs that incorporated CBT and behavioral therapy approaches were significantly more successful than unimodal treatment or no-treatment controls (see meta-analysis studies by Cutler et al., 1994, and Flor, Fydrich, & Turk, 1992).

The Practice Of Cbt For Older Adults With Depression And Personality Disorders

CBT highlights the importance of the relationship between the therapist and patient and the value of specific, measurable goals. Sessions typically begin with the collaborative development of an agenda, and treatment typically combines (1) psychoeducation about psychiatric problems (2) methods of managing cognitive distortions, behavioral deficits and excesses, and problematic physical environments

Carrie Winterowd Aaron Beck and Dan Gruener

Everyone has been in pain at some point in his or her life. However, unrelieved chronic pain is perhaps one of the most challenging problems faced by health care consumers as well as practitioners and providers. It is estimated that 75-80 million people in the United States suffer from some sort of chronic pain, at an annual cost of 65-70 billion (Tollison, 1993). There are a number of personal, social, and environmental consequences of having unrelieved, chronic pain (see Gatchel & Turk, 1999) that may be very difficult for clients to deal with including physical suffering, emotional distress, negative thoughts, behavioral problems (e.g., inactivity, seeking attention), and psychosocial stress (e.g., life role changes, relationship issues, legal problems). Given these experiences, psychological interventions are important for clients who have chronic pain. Note. Significant portions of this manuscript have been excerpted from Winterowd, C., Beck, A., & Gruener, D. (in press)....


As the disease progresses, the goal of treatment is relieving stress on family caregivers. Cognitive-behavioral strategies play an important part in helping caregivers manage stressors more effectively, and in examining their role and involvement in providing care.


As depressive symptoms play a significant role in the course of bipolar illness, much attention is paid to patients' negative views of themselves, their lives, and their futures. Although it is important for patients to acknowledge that they have bipolar disorder and to engage in the proper treatment, it is not helpful if they make dire assumptions about their condition that make them feel helpless and hopeless. Thus, it is important to teach patients the basic cognitive therapy skills of recognizing their automatic thoughts and related beliefs, and rationally responding so as to reduce subjective stress, maintain a constructive outlook, and stay focused on goals in a productive manner. It is critical that individuals with bipolar disorder learn to utilize such skills in the face of their suicidal ideation and feelings, as well as when they maintain a sense of shame and stigma. For example, a patient who views himself as synonymous with his bipolar illness, and thus declares himself...

Empirical Findings

Linked to an increased onset of affective episodes in bipolar disorder. Additionally, the bipolar patients' cognitive styles play an important interactional role, thus supporting the contention that a cognitive case conceptualization is important even in the treatment of a disorder that seems to be so frequently driven by biological factors. In general, bipolar patients who demonstrate maladaptive thinking styles are more apt to develop affective symptoms, including both depressive and manic episodes. Specifically, there is some evidence that perfectionistic beliefs, poor autobiographical recall, excessive goal-directedness, and high degrees of both sociotropic and autonomy-related beliefs represent vulnerability factors that need to be addressed in cognitive therapy for bipolar disorder (see Newman et al., 2001, for an overview). Recently, a number of randomized, controlled trials have shown the promise that cognitive therapy holds for improving the overall treatment package for...

The Ccf Process

The cognitive therapy literature provides several guidelines for the CCF process (Needleman, 1999 Persons, 1989). These guidelines suggest that therapists should base CCFs on empirically validated and theoretically derived assessment methods. In addition, the CCFs should result from collaboration between therapist and client the therapist should elicit the client's feedback about each element of the individualized formulation. CCFs should be parsimonious, including the fewest underlying beliefs and mechanisms that can comprehensively explain clients' behavior and problems. The guidelines also suggest that the formulation is According to the cognitive therapy literature, therapists should neither hold on to their CCFs too rigidly nor should they modify the CCFs too easily (i.e., without sufficient justification). To decrease the likelihood of confirmatory bias, therapists should search for evidence that refutes their model and honestly consider alternate hypotheses to explain clients'...

Anorexia Treatment

The focus of Stage 3 is the identification, evaluation, and modification of beliefs about weight, food, and self. Many of these beliefs emerge during the weight change interventions in Stage 2. The therapist's position is one of curiosity about the client's assumptions and predictions about weight gain and idiosyncratic rule violations. New behaviors are presented as experiments, the purpose of which is to test the client's negative predictions. Other methods for modifying beliefs are cost-benefit analysis, decatastrophizing, decentering, and Socratic questioning of the client's assumptions. Through the use of a downward arrow, the client's core beliefs about the self can be more fully explicated. Particular attention is paid to the client's personal values. Clients often view their AN symptoms as the embodiment of these values. However, inconsistencies usually exist between personal values and the consequences and outcomes of AN. These inconsistencies between client values, life...

Outcome Validation

Because so much of the technology still remains new, and to many, an unproven area, researchers worldwide have embarked on a peer-review method for researching effectiveness. Even the most useful, established applications seemed at first to be little more than novel high-tech variations on more traditional approaches. Now as some technologies have matured, researchers are more closely examining their cost-effectiveness, level of public acceptance, and ways they can provide treatment that would simply not be possible otherwise. In looking at the durability of technology-based behavioral interventions, initial findings have supported the long-term efficacy of self-help, computer-based treatment (Gilroy, Kirkby, Daniels, Menzies, & Montgomery, 2003). A 6-month follow-up on binge eating disorders comparing a multifactorial treatment, which included VR, to traditional cognitive therapy found that a significantly higher number of patients (77 versus 56 ) had quit bingeing after 6 months,...


Due to the structured, didactic, and directive nature of CBT, some therapists may argue that CBT is not appropriate for use with children. They point out that CBT techniques may exceed children's developmental capabilities, direct challenges of a child's beliefs may be off-putting to the child, the CBT approach neglects children's affect, and children may find the work dull (Friedberg et al., 2000). Friedberg's group recommend presenting CBT concepts in simple terms and in the context of negative feelings experienced by the child to avoid these roadblocks. Furthermore, games and play can be used as nonthreatening means to present the CBT approach and assist the child in viewing beliefs that may be confirmed or discounted through behavioral experimentation (Friedberg et al., 2000).

Change Strategies

Exposure and response prevention in the context of opposite action (where urges to engage in dysfunctional behavior are overcome by doing the action opposite to the urge) are important in targeting urges to avoid (difficult foods, eating situations or body image situations, negative moods, interpersonal situations, maturational situations) and urges to engage in repetitive acts (e.g., body checking). In these situations, clients are asked to construct a hierarchy of avoided situations and exposed to these with plans to prevent the old dysfunctional response and to engage in new adaptive behaviors. The aim would also be to generalize new adaptive responses to other situations and contexts.

Liberation Lifestyles

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