Cognitive Therapies

Rational-Emotive Therapy (RET)

• A directive therapy based on the idea that psychological distress is caused by irrational and self-defeating beliefs

• Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes

• Therapist’s job is to challenge client’s irrational beliefs• Best known pioneers of cognitive therapy are Albert Ellis

and Aaron Beck. A Activating Event ( ex. Insult)

B Belief ( ex. “ I must be liked by everyone to be happy”

C Consequent Action- Unhappiness

Beck’s Cognitive Therapy• Beck approaches the manner through a Socratic manner, and

gets the patient to correct their irrational thought.• Aimed at identifying and changing inappropriately negative

and self-critical patterns of thought• Good treatment for depression• Beck’s system of therapy is similar to Ellis’s, but has been most

widely used in cases of depression.

Beck’s Cognitive Therapy• Depressed person might have automatic thoughts like these:• "I always fail at everything."• "I'm the world's worst mother."• "I am doomed to be unhappy.“

• With cognitive therapy, a person learns to recognize and correct negative automatic thoughts. Over time, the depressed person will be able to discover and correct deeply held but false beliefs that contribute to the depression.

Group Therapies

Family Therapy• Form of group therapy that sees the family as at least partly

responsible for the individual’s problems• Seeks to change all family members’ behavior to the benefit of

the family and the individual

Couple Therapy• A form of group therapy intended to help troubled partners

improve their communication and interaction• Empathy training• Partners taught to share feelings and listen to and understand

partner’s feelings

Self-Help Groups• Small, local gatherings of people who share common

problems and provide mutual assistance at very low cost• Alcoholics Anonymous is an example

Anxiety Disorders• Any disorder in which anxiety is a characteristic feature or

avoidance of anxiety motivates abnormal behavior

Specific Phobias• Intense fear of specific situations or objects• Common phobias include animals, heights, closed places,

needles• Social phobias• Excessive fear of social situations

• Agoraphobia• Intense fear of crowds and public places or other situations that require

separation from source of security, such as the home• Panic Disorder • Recurrent panic attacks in which the person experiences intense

terror without cause• Person is often left with fear of having another panic attack• Can lead to agoraphobia• Abnormalities in serotonin levels

Other Anxiety Disorders• Generalized anxiety disorder• Prolonged vague but intense fears not attached to any particular

object or circumstance• Obsessive-compulsive disorder• Driven to disturbing thoughts (obsessions) and/or performing

senseless rituals (compulsions)• Abnormalities in serotonin levels

• Posttraumatic Stress Disorder• Reexperiencing of an extremely traumatic event• Symptoms

• Increased arousal • Avoidance of stimuli associated with the trauma

Causes of Anxiety Disorders

• Conditioning• For example, phobias can be learned through classical

conditioning

• Feelings of not being in control can lead to anxiety• Predisposition to anxiety disorders may be inherited• Displacement or repression of unacceptable thoughts or

impulses can lead to anxiety• Abnormal GABA levels

Behavior Therapies• Based on the belief that all behavior is learned• Objective of therapy is to teach people new ways of behaving

Using Classical Conditioning Techniques• Systematic desensitization• Gradually associating relaxation with what was feared

• Extinction• Ending of old fears or reactions

• Flooding• Full-intensity exposure to feared object

• Aversive conditioning• Eliminate undesirable behavior by associating it with pain and

discomfort

Operant Conditioning• Behavior contracting• Client and therapist set behavioral goals and agree on

reinforcements the person will receive• Token economy• Clients earn tokens for desired behaviors and exchange them for

desired items or privileges• Often used in schools and hospitals

Modeling• Person learns new behaviors by watching others perform

those behaviors• Sometimes used in conjunction with operant conditioning

Psychosomatic Disorders• Real physical illness with psychological causes such as stress or

anxiety• Tension headaches, for example• Research indicates that most, if not all, illnesses may have a

psychosomatic component

Somatoform Disorders• Physical symptoms without any physical cause• Person experiences symptoms as real• Somatization disorder

• Vague, recurrent physical complaints without physical cause• Conversion disorder

• Dramatic, specific disability without physical cause• Hypochondriasis

• Minor symptoms are interpreted as sign of serious illness• Body dysmorphic disorder

• Person becomes preoccupied with imagined ugliness and cannot function normally

Causes of Somatoform Disorders

• Freud• Symptoms related to traumatic experience in the past

• Cognitive behavioral• Examines ways in which the behavior is being rewarded

• Biological perspective• May be real physical illnesses that are misdiagnosed or

overlooked

Insight Therapies

Psychoanalysis

• Designed to bring repressed feelings and thoughts to conscious awareness

• Free association• Patient talks about whatever comes to mind

• Transference• Client’s feelings about authority figures, both positive and

negative, transferred to therapist• Insight• Awareness of previously unconscious feelings and memories

and how they influence present behavior

Client-Centered Therapy• Developed by Carl Rogers• Goal is to help clients become fully functioning• Therapist expresses unconditional positive regard• Therapy is nondirective• Therapist reflects clients’ statements

Gestalt Therapy• Outgrowth of the work of Fritz Perls• Emphasizes the wholeness of personality• Attempts to reawaken people to their emotions and

sensations in the here-and-now• Encourages confrontation with issues• Therapist is active and directive

Personality Disorders• Disorders in which inflexible thinking and maladaptive ways of

thinking and behaving learned early in life cause distress in the person and/or conflicts with others

• Approximately 3% of men and 1% of women have a personality disorder

• Rate among prisoners is close to 50%

Personality Disorders

• Schizoid• Withdrawn and lacks feelings

for others• Paranoid• Very suspicious of others

• Dependent• Inability to make decisions or

act independently and cannot tolerate being alone

• Avoidant• Social anxiety leading to

isolation

• Narcissistic• Grandiose sense of self-

importance• Borderline• Instability in self-image, mood,

and interpersonal relationships• Antisocial• Pattern of violent, criminal, or

unethical behavior with no sense of remorse

Causes of Antisocial Personality Disorder

• Combination of biological predisposition, adverse psychological experiences, and an unhealthy social environment

• Also possible link to damaged frontal lobe during infancy• Emotional deprivation during childhood may lead to antisocial

tendencies

Childhood Disorders• Attention-deficit/hyperactivity disorder (AD/HD)• Characterized by inattention, impulsiveness, and hyperactivity• Causes not fully understood• Psychostimulants

• Drugs that increase the ability of children with AD/HD to focus

• Autistic Disorder• Characterized by lack of social instincts and strange motor

behavior• Fail to form normal attachments to parents• May withdraw into their own world• Causes are not known

Schizophrenic Disorders• Severe disorders characterized by disturbances of thought,

communication, and emotions• Hallucinations• Sensory experiences without external stimulation

• Delusions• False beliefs about reality

• Disorganized speech• Disorganized thinking

Types of Schizophrenic Disorders

• Disorganized schizophrenia• Bizarre and childlike behavior• May engage in incoherent

conversations• Catatonic schizophrenia• Can alternate between a

catatonic state (mute and immobile) and an overly active state (overly excited and shouting)

• Paranoid schizophrenia• Marked by extreme

suspiciousness and complex delusions

• Undifferentiated schizophrenia• Clear symptoms of

schizophrenia that do not meet criteria for other subtypes

Causes of Schizophrenia

• Biological predisposition to schizophrenia may be inherited• Twin studies show genetic link – higher concordance rate

amongst identical vs. fraternal• Adoption studies – individuals are more at risk if a

biological parent exhibits schizophrenia than if the adoptive parent exhibits schizophrenia• Diathesis-Stress model support a genetic influence

• Excessive levels (overactivity) of dopamine lead to psychotic symptoms

• Abnormalities of brain structures• Abnormal patterns of connections between brain cells• May involve family relationships and social class

Positive Symptoms• Hallucinations and delusions are the most vivid and

conspicuous symptoms of schizophrenia. • “Positive” symptoms — exaggerations and distortions of

normal perception and thinking • Positive symptoms make treatment seem more urgent, and

they can often be effectively treated with antipsychotic drugs

Negative Symptoms• “Negative” symptoms are so called because they are an

absence as much as a presence: • inexpressive faces, blank looks, monotone and monosyllabic

speech, few gestures, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously

• Negative symptoms are the main reason patients with schizophrenia cannot live independently, hold jobs, establish personal relationships, and manage everyday social situations.

• These symptoms are also the ones that trouble them most.

Dissociative Disorders• Disorders in which some part of the personality seems

separated from the rest• Often involves memory loss and change in identity

Dissociative Disorders• Dissociative amnesia • Loss of memory without a physical cause

• Dissociative fugue• Involves flight from home and adoption of a new identity and

amnesia for past events• Depersonalization disorder• Person suddenly feels strangely changed or different

• Dissociative identity disorder• Person has several distinct personalities that emerge at different

times• Previously called multiple personality disorder• More than one identity or personality• Nonpsychotic disorder• Associated with childhood trauma/abuse• Does not respond to antipsychotic medication• More commonly diagnosed in females• Memory loss

Causes of Dissociative Disorders

• Seems to involve unconscious processes• Memory impairments may also include biological factors such

as normal aging and Alzheimer’s disease• Dissociation is common with use of some drugs such as LSD• Trauma may also be involved

Biological Treatments

Antipsychotic Drugs• Used for schizophrenia or psychosis• All antipsychotics block dopamine receptors in the brain• Phenothiazines (Thorazine)

Antidepressant Drugs• Tricyclics and MAO inhibitors• Most common antidepressants prior to late 1980s• Work by increasing amount of the neurotransmitters serotonin

and norepinephrine• Effective, but have serious side effects• Nardil

• Selective Serotonin Reuptake Inhibitors (SSRIs)• Work by blocking the reuptake of serotonin• Prozac, Paxil, Zoloft, Effexor

Lithium• A naturally occurring salt that is used to treat bipolar disorder

(manic depression)• Nobody knows how lithium works to alleviate symptoms• Problem with people stopping medication when symptoms

ease

Other Medications• Psychostimulants• Use to treat disorders such as AD/HD• Concern that psychostimulants are being overused

• Antianxiety medications• Use to treat anxiety disorders• Produce a feeling of calm and mild euphoria• Valium is a common antianxiety medication

• Benzodiazepines, Valium

Electroconvulsive Therapy• Commonly known as “shock therapy”• Used as a treatment for severe depression• Causes brief convulsions and temporary loss of consciousness• Memory loss is a side-effect• Newer techniques minimize effects on memory

Psychosurgery• Brain surgery performed to change a person’s behavior or

emotional state• A prefrontal lobotomy is an example• Psychosurgery is rarely used today