Dreams represent a powerful, condensed metaphor for irrational beliefs which patients may not otherwise be able to articulate. While contemporary psychodynamic therapists have discarded Freud’s emphasis on dreams as intentional disguise of instinctual wishes, they continue to use dreams as diagnostic and treatment tools. Such work can be integrated with other types of treatments, including cognitivebehavioral, to examine the latent, primitive and non-verbal aspects of cognitions. This article illustrates how dream work can be utilized in symptom-focused psychotherapy with examples drawn from several specific treatment areas: bereavement, depression, trauma, cross-cultural counseling, and behavioral medicine.
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- Go to article: Impact of Social Developmental Experiences on Cognitive-Behavioral Therapy for Generalized Social Phobia
Impact of Social Developmental Experiences on Cognitive-Behavioral Therapy for Generalized Social Phobia
The current study examined how the social developmental experiences of people with generalized social phobia (GSP) affect their therapeutic relationships and treatment response. GSP patients (N = 27) completed measures of social learning experiences, and then participated in a 12-session group cognitive-behavioral treatment program. Both patients and therapists completed the Working Alliance Inventory (WAI) and rated their perceptions of each other at sessions 3 and 8. Self-reported childhood parental abuse was associated with a weaker working alliance and a more negative patient-therapist relationship. Childhood abuse also increased the risk of a poor treatment outcome, as reflected in less change in symptoms of social phobia and depression.
The Suitability for Short-Term Cognitive Therapy Rating Scale (SRS) defines 10 criteria to assess suitability for short-term cognitive-behavioral therapy (CBT). This study examines the relationships between pretreatment SRS scores and outcome of 113 patients treated with short-term CBT for a wide range of disorders. Using the reliable change index (RCI) as a measure of outcome, 65 individuals (57.5%) of the sample experienced statistically reliable improvement. Married status, employed status, female gender, and anxiety disorder as a primary diagnosis were positively correlated with posttreatment RCI. Awareness of emotion and security operations were the SRS items most strongly correlated with outcome. Also correlated were the two alliance potential items (in-session and out-of-session evidence) and the acceptance of personal responsibility for change. Hierarchical multiple linear regression analysis resulted in a three-variable model where married status, primary anxiety disorder, and mean SRS score accounted for 20% of the variance in RCI scores. We conclude that the SRS adds predictive value to the assessment of potential to succeed in CBT.
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.
This opening article outlines some key themes of an evolutionary approach to psychopathology, and explores possible implications for cognitive therapy. Evolutionary psychology suggests that many of our mental mechanisms are designed to promote survival and reproduction, not happiness, or even mental health, as such. This article focuses on the concept of evolved strategies and their phenotypic expressions, to fit specific niches. It suggests that evolved strategies and their phenotypic expressions partly operate through two psychobiological systems, called the defense and safeness systems, which detect and respond to threats and punishments, and safeness and potential rewards, respectively. Various cognitive schemas, rules and automatic thoughts, especially those linked to psychopathology, are often products of the linkages in strategies as coded in defense and safeness systems. The latter part of the article gives a brief exploration of the view that self-to-self relationships (self-evaluations and “self-talk”) evolved from social cognitions and behavior. Negative self-evaluations, self-criticism, and self-attacking are viewed as internalized interactions between a hostile, dominant part of self, and an appeasing, subordinate part of self. One way of undermining this interaction is to introduce the notion of compassion for the self. A brief consideration is given to the development of “compassionate mind” in work with shame-prone people as expressed in high self-criticalness and/or self-hating. Throughout the text the main problems addressed are those of the more chronic, emotional difficulties often associated with some degree of what is called personality disorder.
This article describes the rationale for and the content of a 24-session group cognitive-behavioral therapy (CBT) tailored to the needs of individuals following a first episode of psychosis. The CBT group approach aims to increase coping with psychotic symptoms as well as help clients deal with other clinical realities such as low self-esteem, stress, anxiety, depression, suicide and substance abuse. Qualitative results, regarding process and satisfaction with treatment, are promising and suggest further investigation of this group intervention.
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.
We describe the three stages (exploration, insight, action) of the Hill cognitive-experiential model of dream interpretation, discuss clinical issues related to using dream interpretation in therapy, and provide a brief overview of the research and suggestions for further research.
The universal and nonrandom distribution of anxiety, fears, and depression suggests that there may have been underlying evolutionary pressures leading to adaptations for pessimistic thinking. Symptoms and processes that today we may label as psychopathology may have solved problems in an evolutionarily relevant environment, providing variations in individual behavior as a response to variations in availability of resources and vulnerability to threats and danger from predation. For example, investment strategies, the focus of this article, change with seasonal variation. Hibernation is marked by reduction of demand by limiting metabolic rates, activity, and arousal during winter months when resources are reduced, and conservation is salient, whereas manic enthusiasm focuses on short windows of opportunity, emphasizing overvaluation of pleasure, exploration, breeding, and diversification. A general theoretical model of investment strategies is proposed that accounts for sex differences in parental investments. Cognitive schemata focused on pessimistic strategies are viewed as operating through evolved algorithms that attempt to assure that behavioral and genetic investments are protected. These cognitive biases may account for male strategies of diversification and female strategies of consolidation and protection, and suggest possible determinants of a greater likelihood of females to be characterized by inhibition and depression.