This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
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- Go to article: Another Step Forward for Cognitive Therapy: Cognitive Therapy of Personality Disorders
- Go to article: Stability and Change of Sociotropy and Autonomy Subscales in Cognitive Therapy of Depression
Sociotropy and autonomy have been demonstrated to be a diathesis for depression as well as predictors of treatment outcome. There are few studies, however, that have investigated whether these vulnerability factors change with cognitive therapy (CT) and are associated with outcome in CT. Also, it appears that the autonomy construct may have both positive and negative content and it is important to examine these two aspects of autonomy in treatment. In this study, depressed outpatients (N = 149) were followed from intake to the 12th session of CT. The treatment outcome variables included depression (Beck Depression Inventory), hopelessness (Beck Hopelessness Scale), and sociotropy and autonomy (Sociotropy-Autonomy Scale [SAS]). Using a repeated measures analysis, depression symptoms and hopelessness decreased significantly over time. Both subscales of sociotropy, preference for affiliation and fear of criticism and rejection, were positively associated with depression at intake, and decreased significantly over time in those who responded to treatment. However, independent goal attainment, one subscale of autonomy, increased significantly over sessions and was associated with treatment response. The second subscale of autonomy, sensitivity to others’ control, demonstrated no change. The results suggest that independent goal attainment may be an indicator of psychological health. Implications for future research using the SAS and its subscales in treatment and vulnerability research are described.
- Go to article: Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
These authors appreciate Ellis’ clarification that he encourages REBT therapists to use many of the same principles and methods used by CT therapists. His assertions that many of these elements are done more frequently or thoroughly in REBT than in CT are best evaluated by objective observers via empirical analysis of therapy transcripts, session videotapes, and treatment manuals. Such research would have particular value if it linked therapy methods with treatment outcome and relapse prevention for particular problems. In this regard, Ellis’ recommendation that REBT become more empirical is welcome. Also, these authors clarify the distinction they make between the terms philosophical and philosophically-based; empirically responsive and empirically-based. Finally, the authors applaud Ellis’ major contributions to the field.
This article elaborates on the construct of dysfunctional vulnerability schemas in Obsessive-Compulsive Disorder (OCD)(Sookman & Pinard, 1995,1999; Sookman, Pinard, & Beauchemin, 1994). These schemas are conceptualized as a central mechanism of excessive threat appraisals proposed to be the predominant cognitive problem in anxiety (Beck, 1996; Beck & Clark, 1997). Four domains of beliefs are hypothesized to comprise vulnerability in OCD: Perceived Vulnerability; View of/Response to Unpredictability, Newness, and Change; View of Strong Affect; and Need for Control. A study carried out with 111 subjects indicated that OCD patients more strongly endorsed these beliefs compared with patients with other anxiety disorders, mood disorders, and normal controls. The discriminant function derived from these four belief domains was effective in classifying OCD patients and other subjects into their respective groups. The results support the inclusion of dysfunctional vulnerability beliefs in cognitive assessment and treatment of OCD.
- Go to article: Cognitive Therapy for Generalized Anxiety Disorder: Significance of Comorbid Personality Disorders
Thirty-two patients diagnosed with generalized anxiety disorder were treated with cognitive therapy. Patients attended weekly one-hour sessions and there was no predetermined duration of treatment. Prior to treatment, each patient was evaluated for a comorbid personality disorder (PD) using the Structured Clinical Interview for the DSM-ffi-R Personality Disorders (SCID-II). Patients completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at the intake evaluation and at their final session. Sixteen of the 32 patients were diagnosed with a comorbid PD at the intake evaluation. A total of 22 patients completed a minimum course of cognitive therapy, which was defined as six sessions. Overall, there was a significant reduction of BAI and BDI scores for patients with and without a PD. There was no significant difference between the two groups. However, patients with a comorbid PD were more likely to drop out of treatment Seven of the 10 dropouts had a comorbid PD as compared to only 9 out of the 22 completers.
The poor reality testing and the thinking disorder in schizophrenia may be attributed to a deficiency in cognitive resources related to the neurobiological deficiencies. Recent therapy and research have demonstrated that, far from being a bizarre psychologically incomprehensible phenomenon, schizophrenia can be understood within our conventional conception of human nature. This humanizing trend is especially evident in the cognitive approaches to this disorder. Research has established that there is a continuum from normal experiences of paranormal beliefs, hallucinations, thinking problems, and withdrawal to their counterpart in schizophrenia. The kinds of biases in schizophrenia are also evident in common social problems such as prejudices and ethnocentrism as well as in interpersonal strife. Dysfunctional attitudes about attachment and performance in schizophrenia form the infrastructure for persecutory delusions and negative symptoms, respectively. Grandiose delusions, on the other hand, are shown to be an overcompensation for a sense of loneliness, inferiority, and vulnerability.
- Go to article: Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy
Aaron T. Beck’s Cognitive Therapy (CT) and Albert Ellis’ Rational Emotive Behavior Therapy (REBT) are compared. A major difference between these therapies is that CT is an empirically based therapy and REBT is philosophically based. The origins and subsequent development of the therapies are reviewed with this difference highlighted. Comparisons between CT and REBT practice are made regarding attitudes toward client beliefs, use of guided discovery, types of cognition addressed, and the nature of the client-therapist relationship. The scientific foundations of CT are summarized in terms of the specificity of its conceptual models, the construction of targeted treatment protocols, and empirical findings that support both CT conceptualizations and treatments.
The understanding of delusions, while historically focused on neuropsychological deficits, can be approached from the same cognitive perspective as that applied to other forms of psychopathology. The cross-sectional analysis of delusional thinking shows several cognitive characteristics: egocentric bias (irrelevant events are construed as self-relevant); externalizing bias (strong internal sensations or symptoms are attributed to external agents); and intentionalizing bias (other people’s behaviors are believed to be based on intentions—usually malevolent—towards the patient). In addition, defective reality testing precludes reevaluation and rejection of erroneous conclusions. Consequently, cognitive distortions such as selective abstraction, overgeneralization, and arbitrary inferences are prevalent. From a developmental perspective, grandiose delusions appear to arise from earlier daydreams of glory, serving as a compensation for feelings of loneliness, inadequacy, and inferiority. The daydreams become increasingly real to the patient until they become overt delusions. Persecutory delusions typically begin as a fear of retaliation or discrimination. Because of attentional bias, these fears receive pseudoconfirmation until they become fully formed beliefs that preempt normal information processing and displace more realistic beliefs.
- Go to article: Treatment Attitude and Therapy Outcome in Patients With Borderline Personality Disorder
This study investigated the degree to which two ways of defining attitude toward treatment (i.e., attitude toward talking with a therapist about problems, expectation for improvement) predicted therapy outcome. The sample consisted of 28 patients who participated in an open clinical trial evaluating the efficacy of cognitive therapy for borderline personality disorder and who completed assessments at baseline and 12-month follow-up (Brown, Newman, Charlesworth, Crits-Cristoph, & Beck, 2004). When attitude toward treatment was defined as attitude toward talking with a therapist, this variable predicted suicide ideation and scores on two measures of depression at the 12-month assessment. When attitude toward treatment was defined as expectation for improvement, this variable predicted scores on one measure of depression and number of borderline personality disorder criteria met at the 12-month assessment. These results provide preliminary evidence that positive attitudes toward treatment are associated with more clinical improvement, although future research should replicate this finding with a better developed measure of treatment attitudes.
Extreme variability has been observed in individual responses to stressors. It appears that a more detailed analysis of individual variation in cognitions related to stress may result in a greater understanding of their differential responses. An idiographic cognitive model of the psychological processes that mediate stress and that underlie stress management techniques is presented in the form of an illustrative series of hypotheses based on Beck’s cognitive model (Beck, Rush, Shaw, & Emery, 1979). The model is presented in detail and is applied to a clinical case example in which traditional nomothetic stress management techniques were ineffective. The advantages and disadvantages of a more idiographic approach to stress are examined as are the implications of the cognitive view of stress for research and practice.