The aim of this article is to review progress toward developing a cognitive theory of and therapy for chronic insomnia. The article will begin with a brief overview of cognitive behavior therapy for insomnia (CBT-I), the current treatment of choice, which devotes approximately one session to cognitive therapy. On the basis of (a) the conclusion from a recent review of psychological treatments for insomnia that cognitive therapy has received insufficient attention and evaluation and (b) the evidence that cognitive therapy for a range of other psychological disorders has improved treatment outcome, the remainder of the article describes another approach to the treatment of insomnia: cognitive therapy for insomnia (CT-I). This treatment is derived from a cognitive model that specifies five processes that function to maintain insomnia: worry (also known as cognitive arousal), selective attention and monitoring, distorted misperception of sleep and daytime deficits, unhelpful beliefs about sleep, and counterproductive safety behaviors. The aim of the treatment is to reverse all five maintaining processes during both the day and the night.
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- Go to article: Similarities and Differences Between Rational Emotive Behavior Therapy and Cognitive Therapy
The main theoretical and practical applications of Rational Emotive Behavior Therapy (REBT) and Cognitive Therapy (CT) are examined and found to be similar to each other in most respects, but REBT bases its concepts of improved treatment of neurotic disorders and of severe personality dysfunctioning largely on philosophical, existential, and humanistic bases, while CT tends to align them with empirical results of outcome studies. Both REBT and CT, however, use philosophic and empirical outcome studies to construct and validate their theories.
- 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: Cognitive-Behavior Therapy With Eating Disorders: The Role of Medications in Treatment
Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia nervosa, but there is less empirical data on its usefulness with anorexia nervosa or binge-eating disorder. The use of cognitive-behavioral therapy (CBT) is recommended as the first line of treatment for bulimia nervosa and strongly recommended in combination when medications alone have not been effective. Combined treatment also improves symptoms such as anxiety, depression, and dietary restriction. Empirical studies support the usefulness of CBT with binge-eating disorder and suggest higher remission rates with combined treatment. No single psychotherapy or medicine alone is effective in treating anorexia nervosa. CBT is typically used as part of a comprehensive treatment program with nutritional rehabilitation and prudent use of medication. Both CBT and medication may have benefits in maintaining gains for anorexia nervosa patients after inpatient treatment. More research on CBT alone and in combination with medication is needed to adequately understand the respective roles of these therapies in a comprehensive treatment of eating disorders.
- 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.
- Go to article: When Head and Heart Do Not Agree: A Theoretical and Clinical Analysis of Rational-Emotional Dissociation (RED) in Cognitive Therapy
When Head and Heart Do Not Agree: A Theoretical and Clinical Analysis of Rational-Emotional Dissociation (RED) in Cognitive Therapy
In cognitive therapy, a dissociation sometimes occurs between a person’s rational belief and the way it “feels” to that person. This phenomenon, though widely recognized, has received little theoretical analysis or research. Clinical and nonclinical examples are presented, revealing a phenomenon that is a matter of more than mere curiosity. A variety of theoretical perspectives are investigated, including implicit/explicit cognitive processing, the generation of emotion, neuroscience, metacognition, the role of emotional memories, and compassion. The implications for cognitive therapy are considered briefly and some research avenues suggested. It is argued that an examination of this neglected phenomenon could aid cognitive case conceptualization and warrants further theoretical and clinical attention.
While attention deficit/hyperactivity disorder (ADHD) is the most prevalent behavioral disorder of childhood, the past decade has seen a rise in the number of adults presenting for treatment with difficulties related to ADHD. Few treatments (particularly psychosocial treatments) offered to adult patients with ADHD, however, have been empirically tested, much less been grounded in an overarching treatment model that captures the complexity of the various neurobiological, developmental, and psychological issues germane to this clinical population. The purpose of this article is to introduce a cognitive therapy approach for treating adults with ADHD. To do so we will describe the nature of ADHD, discuss some of the clinical issues unique to this diagnosis, and outline a cognitive therapy approach for conceptualizing and treating adult ADHD, integrating a number of case examples.
With the emergence of manualized treatments in the 1980s, research protocols have focused increasing attention on documenting the integrity of treatment delivery. Two constructs have guided the conceptualization of assessing treatment integrity. The first, adherence, concerns the extent to which therapists adhere to the interventions of a therapy being tested, and measuring which particular interventions are performed. The second, competence, concerns the quality or skill in therapists’ execution of the therapy being tested. This article reviews the development of treatment integrity research for cognitive therapy in depression, and discusses salient issues that have arisen in its assessment. Recommendations for further refining the considerations of adherence and competence in the delivery of cognitive therapy are provided.
Cognitive therapy has established its efficacy in the United Kingdom as a companion therapy, along with medication, in the treatment of schizophrenia. Randomized controlled trials have been conducted in the UK, showing improvement in both positive and negative symptoms of schizophrenia. Yet, less work has been done testing and implementing cognitive therapy for schizophrenia in North America. This article describes the applications of cognitive therapy as a treatment for auditory hallucinations, primarily voices. Cognitive therapy for voices is predicated on the assumption that much of the distress and disability associated with hearing voices is due to the patient’s delusional interpretations of voices. The development of a cognitive therapy case conceptualization will be described, as will specific techniques for managing voices and secondary delusions. The objective of treatment is that of increasing the cognitive and behavioral repertoire available to voice hearers, not only to reduce distress, but also to increase options for living a meaningful life.
- Go to article: Psychotherapy According to the Socratic Method: Integrating Ancient Philosophy With Contemporary Cognitive Therapy
Psychotherapy According to the Socratic Method: Integrating Ancient Philosophy With Contemporary Cognitive Therapy
The Socratic method provides a useful framework for psychotherapy by integrating ideas from ancient philosophy with strategies from contemporary cognitive therapy. According to the Socratic method, four main components underlie the process of therapy: systematic questioning, inductive reasoning, universal definitions, and a sincere disavowal of knowledge in the therapist and the client. These components work together to guide the dialogue that occurs in most therapy sessions. In addition, the Socratic method often focuses on two major topical areas: self-improvement and cultivating virtue in everyday life. Through the use of the Socratic method, clients can explore important issues, clarify major life goals, and strive to improve their moral character.