Unit on Cognitive Therapies

Slide 1: Cognitive therapies

Slide 2: Today: Stabilize client first

Slide 3: When is stabilizing important?

• Suicidal ideation
• Homicidal ideation
• Insomnia
• Significant weight loss

Slide 4: How do you challenge SI?

1. Assess suicidal ideation
2. Assess lethality
3. Listen, understand and support before trying to change.
4. Increase size and strength of support network.
5. Challenge beliefs about their life and death.
6. Decrease depression.
7. Get help for yourself.

Slide 5: Step 1: Assess suicidal ideation

• Be willing to listen.
• Is thinking about suicide:
1. A commitment to suicide?
2. An attention-getting tactic?
3. A desire for something different?
Keep their ambivalence about suicide in mind.
• Be aware that:
ideation > plan > attempts > completion

Slide 7: Step 2: Assess lethality

• Risk factors:
• Recent shaming event or loss
• Gender, racial, and marital status differences
• Depression or other mental illness
• Lack of perceived social support
• Recent suicides in community
• Plan
• Lethality of plan
• Availability of method
• History of attempts
• Family history of suicide
• Impulsivity
• Few perceived obstacles to acting on plan
• Substance use or abuse

Slide 8: Step 3: Listen, understand and support

1. Listen
2. Assess and influence
3. Check out and observe consequences

Slide 9: Step 4: Increase strength of support network

Slide 10: Step 5. Challenge beliefs about their life and death

• Challenge dichotomous thinking
• Identify successes and people who have been supportive
• Recognize unidentified consequences of suicide

Slide 11: Step 6. Decrease depression

• Monitor depression (BDI-2)
• Challenge maladaptive thinking patterns
• Increase number of pleasurable activities
• Notice successes
• Gain evidence to challenge maladaptive thinking.

Slide 12: Step 7. Get help!

• People often feel alone and overwhelmed when working with someone who is suicidal.
• Engage their support system.
• Get a consult.
• Get help for yourself.
• Take care of yourself.

Slide 13: Rational Emotive Behavior Therapy

Slide 14:

• We are both "inherently rational and irrational, sensible and crazy" (Weinrach, 1980, p. 154).
• If we have the choice, wouldn't it make sense to be rational and sensible rather than irrational and crazy?

Slide 15: We make ourselves happy or unhappy...

• No one else makes us happy or unhappy…
• We're the only ones who can do this and we do this with our style of thinking…
• Life is often unfair and unfortunate things do happen.

Slide 16: Why do we develop irrational beliefs?

• Nature
• Nurture
• How do our families socialize us to think irrationally?

Slide 17: Everyone occasionally uses irrational beliefs, but...

• We differ in:
• the frequency with which we use them
• our willingness to challenge them

Slide 18: Common themes of irrational beliefs

• If I am not liked by all others, that is terrible and I am no good.
• If I don't consistently do a perfect job, I'm no good.

Slide 19: Cognitive triad (Aaron Beck)

• Beck describes the consequences of this style as:
• Events are perceived negatively
• Negative attitudes towards self
• Future is seen as continuation of present

Slide 20: Ellis' view of the therapist's role

• Goal: To change thought patterns
• Directive: Openly acknowledge their expertise.  Provide a fair amount of direction.
• Empathy: Must understand, but not accept beliefs
• Style: Often very verbal and challenging even in the first sessions
• Focus: Thoughts, not events in present or past

Slide 21: How are these goals met in therapy?

1. Educate about this philosophy

Slide 22: ABCs of cognitive therapy

• Activating Event
• Beliefs
• Consequences

Slide 23: How are these goals met in therapy?

1. Educate about this philosophy
2. Heighten awareness of the consequence of their beliefs.
                     On a scale from 1 to 100...

Slide 24: ABC analysis

Slide 25: How are these goals met in therapy?

1. Educate about this philosophy
2. Heighten awareness of the consequence of their beliefs.
3. Identify underlying themes and thought errors

Slide 26: Thought errors

• All or nothing or dichotomous thinking
• Overgeneralizing or stabilizing
• Discounting or minimizing
• Magnification or catastrophizing
• Emotional reasoning
• Self-blame or internalizing
• Mind reading

Slide 27: How are these goals met in therapy?

1. Educate about this philosophy
2. Heighten awareness of the consequence of their beliefs.
3. Identify underlying beliefs
4. Dispute irrational beliefs

Slide 28: How can thought errors be changed?

• Persuasion, questioning and challenge
• You're worthnothingif you don't succeed here?
• Counter belief with an opposite and believable statement
• I may not be the best student in the class, but that doesn't mean that I'm worthless… (good)
• School isn't important and I don't have to bother. (bad)
• Homework to encourage behavioral change
• Group therapy
• Bibliotherapy
• Humor

Slide 29: “Love Me, Love Me, Only Me!” (To the tune of “Yankee Doodle”)

Slide 30: Imagery is also useful...

Slide 31: How are Ellis and Beck different?

• Direct questioning and persuasion
• Hierarchical stance
• More theoretical

• Emphasizes Socratic method
• More collaborative in nature
• More research based

Slide 32: Nonetheless...

Page by jms
URL= http://psy1.clarion.edu/jms/cptcognitivepp.html

Last modified November 1, 2001.