Cognitive Behavioral Therapy
04:20 Sep 29 2013
Times Read: 509
Cognitive therapy is a type of psychotherapeutic treatment that attempts to change feelings and behaviors by changing the way a client thinks about or perceives significant life experiences.
This is the area of psychology that I would love to pursue.
Basic principles of CBT
The theoretical structure and basic method for CBT were outlined by Aaron Beck in a classic series of papers published in the 1960s (1, 2) and then elaborated in a treatment manual for depression (8). Beck’s early writings focused primarily on pathology in information processing styles in patients with depression or anxiety, but he also incorporated behavioral methods to activate patients, reverse helplessness, and counter avoidance. As CBT matured, contributions from behavior therapy research and studies of cognitive processes in mental disorders enriched the clinical practice of this form of psychotherapy (6, 9, 10).
The CBT model
Cognitive behavior therapists typically use an integrative multisystem model to conceptualize patients and plan treatment (10). The assessment centers primarily on cognitive and behavioral observations, but biological, interpersonal, social, spiritual, and other factors are also considered. However, at the most basic level, the simplified model in Figure 1F1 helps drive specific treatment interventions and is also frequently diagrammed or explained to patients as they are educated on how CBT works.
A two-way relationship between cognition and behavior is posited in which cognitive processes can influence behavior, and behavioral change can influence cognitions.
A brief clinical example of a patient with an anxiety disorder will illustrate how the basic CBT model can be used to understand symptoms and plan treatment.
Mr. A, a 35-year-old computer programmer who lives and works in a suburb of a large city, requested treatment for panic disorder with agoraphobia. He had been symptomatic for at least 5 years. His condition had deteriorated to the point where he was largely housebound, although he was able to drive about half a mile to his workplace, where he worked in a cubicle and had little social contact. When Mr. A considered driving to the city to see an old friend or to a mall near his home, he would have thoughts such as "I can’t do it . . . I’ll faint or I’ll have a heart attack . . . I’ll panic and lose control . . . I’ll have a wreck and kill everyone in my path." As might be expected, he had intense anxiety and autonomic arousal associated with these thoughts. His behavioral response was to avoid driving anywhere other than work and to avoid going anywhere there might be crowds. Each time he avoided these activities, his basic fears were reinforced, and eventually his symptoms became deeply ingrained.
Because cognition and behavior are so closely linked, the clinician can opt to intervene at either the cognitive or the behavioral level, using practical methods of interrupting the cycle and encouraging more adaptive responses. In the clinical practice of CBT, therapists typically design strategies to influence both cognitive and behavioral pathology. For example, Mr. A’s therapist used cognitive techniques such as examining the evidence and thought records to identify and change maladaptive cognitions. The therapist also selected behavioral methods to reverse the long-standing avoidant behavior, including systematic exposure techniques.
Levels of cognition
Beck and his colleagues have identified three major levels of cognition that are relevant to the practice of CBT: full consciousness, automatic thoughts, and schemas (9). Consciousness is defined as a state in which rational decisions are made with full awareness. In contrast, automatic thoughts are the more autonomous, often private cognitions that flow rapidly in the stream of everyday thinking and may not be carefully assessed for accuracy or relevance. Many of the examples of Mr. A’s cognitions noted above in the vignette were automatic thoughts. Everyone has automatic thoughts, but in clinical states such as depression and anxiety disorders, these cognitions are often riddled with errors in logic (6, 8). In depression, automatic thoughts typically center on themes of negativity, low self-esteem, and ineffectiveness. In anxiety disorders, automatic thoughts often include overestimates of risk in situations and underestimates of ability to cope (6).
Schemas, or core beliefs, are the third and deepest level of cognition defined in CBT. Schemas are fundamental rules or templates for information processing that are shaped by developmental influences and other life experiences (see Table 1T1) (6). Because they play a major role in regulating self-worth and behavioral coping strategies, schemas are a frequent target of CBT interventions. It has been suggested that schema change may account for part of the relapse prevention effect of CBT.
Key behavioral concepts
In the development of modern methods of CBT, findings from basic research on behavioral concepts and techniques have been blended with cognitive theories. The most important of these findings are the following:
CBT for depression frequently uses behavioral interventions such as activity scheduling and graded task assignments to reactivate the patient. All CBT protocols for anxiety disorders contain elements of exposure and response prevention to interrupt the avoidant behaviors that play a central role in maintaining the disorder and to desensitize the patient to the physiological symptoms of anxiety. CBT for many axis I and axis II conditions may include efforts to improve coping behavior and other skills.
CBT applications
Reviews and meta-analyses of the voluminous literature on CBT outcome studies have concluded that this treatment approach is highly effective for depression and anxiety disorders (6, 14, 15). Studies typically show CBT to be as effective as antidepressant medication for the treatment of depression. Studies investigating combined treatment with CBT and medication for depression have had mixed results. Although individual studies of CBT for mild to moderate depression have shown only a trend for an advantage for combined treatment with medication, it has been argued that the sample sizes in these studies were not adequate to demonstrate superiority of using both treatments together (16). Studies with patients who had chronic or severe depression and studies with larger numbers of subjects have found that CBT is an efficacious treatment for more extreme cases of depression and that combined treatment gives better results than either treatment alone (16—18). In the treatment of anxiety disorders, studies show no consistent trend for an advantage for combined treatment (19), but one investigation suggested that adding alprazolam to CBT may decrease effectiveness (13). The overall results of studies of patients with depression or anxiety disorders indicate that CBT may be used alone as an effective treatment for these conditions and that for severe or chronic depression, combined therapy with medication is recommended.
Other conditions for which there is substantial empirical evidence that CBT is efficacious include bulimia nervosa and binge-eating disorder as well as schizophrenia, where it can be used as an adjunct to pharmacotherapy (6—7, 20). CBT has also been shown to reduce the risk of relapse in bipolar disorder (21). Cognitive behavioral formulation and treatment methods have been described for many of the personality disorders (22), and dialectical behavior therapy, which is a modified form of CBT, has been shown to be efficacious in reducing suicidal behavior in patients with borderline personality disorder (4). As with other forms of psychotherapy for personality disorders, little empirical research has been conducted. Additional possible indications for CBT include substance abuse disorders (23), fibromyalgia (24), and chronic fatigue (25). CBT has also been found to be useful in helping patients with medical disorders cope with pain and disability (26). One notable recent study (27) found that CBT significantly reduced the frequency of subsequent suicide attempts among patients who had previously attempted suicide.
CBT methods
General procedures
The term collaborative empiricism is often used to describe the therapeutic relationship in CBT (6). A highly collaborative relationship is established in which clinician and patient work together as a team to identify maladaptive cognitions and behavior, test their validity, and make revisions where needed. A principal goal of this collaborative process is to help patients effectively define problems and gain skills in managing these problems. As in other effective psychotherapies, CBT also relies on the nonspecific elements of the therapeutic relationship, such as rapport, genuineness, understanding, and empathy. Table 2T2 lists the general elements of CBT.
CBT for uncomplicated depression or anxiety disorders can typically be completed in a range of 5—20 sessions. If axis II disorders are present or if the patient has severe or chronic illness, treatment may need to extend beyond 20 sessions. Booster sessions or continuation CBT can be used to decrease the risk of relapse (28).
CBT sessions are structured to increase the efficiency of treatment to improve learning and combat inertia in the patient and to focus therapeutic efforts on specific problems and potential solutions. Sessions begin with an agenda-setting process in which the therapist assists the patient in selecting items that can lead to productive therapeutic work in a single session. Homework assignments are used to extend the patient’s efforts to change beyond the confines of the treatment session and to reinforce learning of CBT concepts. Homework also helps structure therapy by serving as a recurrent agenda item that links one session with the next.
Psychoeducation is another key feature of CBT. When possible, the therapist uses illustrations from the patient’s own experiences to demonstrate CBT principles and procedures. For example, if a patient exhibited a "mood shift" (a sudden appearance of a strong emotion suggesting that he or she had just had an outpouring of intense automatic thoughts) early in therapy, the therapist might pause to help the patient identify the automatic thoughts. Material gleaned from this process can then be used to explain the basic cognitive model (the relationship between cognitions and emotions) and to introduce the patient to the concept of automatic thoughts. Readings and other educational aids are also used extensively in CBT. Typically, patients are asked to read self-help books (29—34), pamphlets, or handouts during the beginning phases of therapy. Workbooks can be used for specific problems such as depression, obsessive-compulsive disorder, other anxiety disorders, and perfectionism. Another useful option for psychoeducation is to recommend that patients use an interactive CBT computer program (see below).
Cognitive methods
Table 3T3 lists cognitive methods used in CBT. The most important and frequently used cognitive technique is the use of questions that encourage the patient to break through rigid patterns of dysfunctional thinking and to see new perspectives. The two terms most often used to describe this form of inquiry are Socratic questioning (asking questions that guide the patient to become actively involved in finding answers) and guided discovery (a series of questions that help the patient explore and change maladaptive cognitive processes). Examples of some of the specific techniques that might be included in guided discovery are examining the evidence exercises and two-column analyses of the advantages and disadvantages of holding a core belief.
One of the most useful cognitive interventions is the thought change record. In the beginning phase of therapy, patients may be introduced to thought recording by asking them to make a note of automatic thoughts that occur in stressful situations and to identify emotions associated with these thoughts. As the patient gains knowledge and experience with CBT, a full five-column thought change record can be used in which the patient identifies cognitive errors in automatic thoughts, generates rational alternatives, and charts the outcome of making these changes (8). Other frequently used cognitive techniques include imagery, role play, rehearsal exercises, and homework assignments to put modified cognitions into action.
Behavioral methods
Table 4T4 lists behavioral methods used in CBT. Activity and pleasant event scheduling are commonly used to help depressed patients reverse problems with low energy and anhedonia. These techniques involve obtaining a baseline of activities during a day or week, rating activities on the degree of mastery and/or pleasure, and then collaboratively designing changes that will reactivate the patient, stimulate a greater sense of enjoyment in life, or change patterns of social isolation or procrastination. Graded task assignments, in which problems are broken down into pieces and a stepwise management plan is developed, are used to assist patients in coping with situations that seem especially challenging or overwhelming.
Some of the most useful behavioral methods for treating anxiety disorders are hierarchical exposure to feared stimuli, relaxation training, and breathing training. Exposure protocols can be either rapid or gradual. Typically, a hierarchy of exposure experiences is developed, with sequential increases in the degree of anxiety provoked. Patients are encouraged to expose themselves gradually to these stimuli until the anxiety response dissipates and they gain a greater sense of control and mastery. Progressive relaxation and breathing exercises may be used to reduce levels of autonomic arousal and support the exposure protocol. These techniques also may be used alone to help manage panic attacks or other symptoms of anxiety disorders.
One particularly useful way to encourage the patient to use behavioral skills learned in therapy sessions is to develop a coping card. Key elements of a coping strategy or management plan—typically including both behavioral and cognitive strategies—are recorded on a small card that the patient carries at all times. Coping cards might contain, for example, antisuicide plans detailing what to do if suicidal thoughts return, strategies for coping with critical remarks from a spouse, or specific ideas for combating procrastination at work. Coping methods that are generated and rehearsed in therapy sessions are then carried out with the help of coping cards in real-life situations.
Computer-assisted CBT
One of the newest and most interesting methods of conducting CBT is through computer-assisted psychotherapy (35). Multimedia software has been shown to be effective in the treatment of depression (36, 37), and innovative multimedia programs using virtual reality have been developed for exposure therapy for anxiety disorders (38, 39). In one study, a computer-assisted therapy software program (37) was shown to be superior to standard CBT in helping patients acquire knowledge about CBT and in reducing maladaptive cognitions. Computer programs are typically combined with the human elements of therapy in an integrated treatment package. Computer-assisted CBT can be used to decrease the amount of clinician time required for effective therapy, provide stimulating psychoeducational experiences, and offer engaging alternatives to standard treatment.
Summary
CBT is based on the concept that mental disorders are associated with characteristic alterations in cognitive and behavioral functioning and that this pathology can be modified with pragmatic problem-focused techniques. CBT is well established as a treatment for depression, anxiety disorders, and eating disorders. There is growing evidence that it can play an effective role in the clinical management of a large range of other disorders, including schizophrenia, bipolar disorder, and axis II conditions.
To see the tables and to read more on this please follow this link http://focus.psychiatryonline.org/article.aspx?articleID=50521
top 10 Influential Psychologists/theories15:15 Sep 23 2013
Times Read: 515
A study that appeared in the July 2002 issue of the Review of General Psychology created a ranking of the 99 most influential psychologists. The rankings were mostly based on three factors: the frequency of journal citations, introductory textbook citations, and the survey responses of 1,725 members of the American Psychological Association.
10 Influential Thinkers in Psychology
The following list provides an overview of 10 psychologists from this ranking survey. These individuals are not only some of the best-known thinkers in psychology, they also played an important role in psychology's history and made important contributions to our understanding of human behavior. This list is not an attempt to identify who was the most influential or which school of thought was best. Instead, this list offers a glimpse of some of the theoretical outlooks that have influenced not only psychology, but also the larger culture in which we live.
1. B. F. Skinner
In the 2002 study ranking the 99 most eminent psychologists of the 20th century, B.F. Skinner topped the list. Skinner's staunch behaviorism made him a dominating force in psychology and therapy techniques based on his theories are still used extensively today, including behavior modification and token economies.
2. Sigmund Freud
When people think of psychology, many tend to think of Freud. His work supported the belief that not all mental illnesses have physiological causes and he also offered evidence that cultural differences have an impact on psychology and behavior. His work and writings contributed to our understanding of personality, clinical psychology, human development, and abnormal psychology.
3. Albert Bandura
Bandura's work is considered part of the cognitive revolution in psychology that began in the late 1960s. His social learning theory stressed the importance of observational learning, imitation, and modeling. "Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do," Bandura explained in his 1977 book Social Learning Theory.
4. Jean Piaget
Jean Piaget's work had a profound influence on psychology, especially our understanding children's intellectual development. His research contributed to the growth of developmental psychology, cognitive psychology, genetic epistemology, and education reform. Albert Einstein once described Piaget's observations on children's intellectual growth and thought processes as a discovery "so simple that only a genius could have thought of it."
5. Carl Rogers
Carl Rogers placed emphasis on human potential, which had an enormous influence on both psychology and education. He became one of the major humanist thinkers and an eponymous influence in therapy with his "Rogerian therapy." As described by his daughter Natalie Rogers, he was "a model for compassion and democratic ideals in his own life, and in his work as an educator, writer, and therapist."
6. William James
Psychologist and philosopher William James is often referred to as the father of American psychology. His 1200-page text, The Principles of Psychology, became a classic on the subject and his teachings and writings helped establish psychology as a science. In addition, James contributed to functionalism, pragmatism, and influenced many students of psychology during his 35-year teaching career.
7. Erik Erikson
Erik Erikson's stage theory of psychosocial development helped create interest and research on human development through the lifespan. An ego psychologist who studied with Anna Freud, Erikson expanded psychoanalytic theory by exploring development throughout the life, including events of childhood, adulthood, and old age.
8. Ivan Pavlov
Ivan Pavlov was a Russian physiologist whose research on conditioned reflexes influenced the rise of behaviorism in psychology. Pavlov's experimental methods helped move psychology away from introspection and subjective assessments to objective measurement of behavior.
9. Kurt Lewin
Lewin is known as the father of modern social psychology because of his pioneering work that utilized scientific methods and experimentation to look as social behavior. Lewin was a seminal theorist whose enduring impact on psychology makes him one of the preeminent psychologists of the 20th-century.
10. Reader's Choice
Following the examples of Eugene Garfield's 1977 ranking list and Haggbloom's 2002 ranking, the final position on this list has been left blank in order to allow "the reader's best case for a psychologist who should have made the list" (Haggbloom, 2002).
Source : http://psychology.about.com/od/historyofpsychology/tp/ten-influential-psychologists.htm
On a personal note... I agree with Skinner being #1. I think he is the leader in behavioral psychology. While behaviorism may not be the dominant school of thought today, his work in operant conditioning remains vital. Mental health professionals often utilize operant techniques when working with clients, teachers frequently use reinforcement and punishment to shape behavior in the classroom, and animal trainers rely heavily on these techniques to train dogs and other animals.
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