1. CT - cognitive therapy - Aaron T Beck
2. REBT - Rational Emotive Behavioral Therapy - Albert Ellis
3. CBM - Cognitive Behavioral Modification - Donald Meichenbaum
4. ACT - Acceptance Commitment Therapy - Steven Hayes
5. DBT - Dilectical Behavioral Therapy - Marsha Linnehan

1. Psychoanalysis
2. Behaviorism

1. Alfred Alder - "Socratic Method and Goals" (1927)
2. Karen Horney - "Shoulds and self acceptance" (1937)
3. Piaget - "Schema and accomodation" (1948)
4. Freud - "Biological Determinist"
5. Beck - "Classical psychoanalyst" studied depression and anger (1960)
6. Ellis - Psychoanalyst (1950) "Exposure Therapy"

1. Skinner - Overt Behavior "Operant Conditioning and Private Events, Black box" (1953)
2. Wolpe - Covert Behavior "Systematic Densensization and Operationalized Definitions" (1958)
3. Palvov - Stimulus-Response

1. New CBT approaches were initated during prime days of behavior therapy
2. Dissatisfaction with one school
3. Lack of empirical studies
4. 3rd party-payers

- need for evidence

- need for effective treatment

-need for short-term treatment

1. Kelly's Construct Theory

- Personal Construct - we construct our own reality

2. Rotter's Expectancy Learning Theory

- Do we expect to be reinforced for this behavior

1. George Kelly - Personal Constructs
2. Julian Rotter - Expectancy
3. Bandura - Self-Efficacy (mastery)

1. He started in psychiatry, was trained as a psychoanalyst.
2. He believed that cognition influences emotion.
3. He set up a system of psychotherapy
4. He believed that cognitive therapy provides simple solutions to mysterious problems.

1. System of personality
2. System of psychopathology
3. Set of principles and strategies

1. Karen Horney
2. He believed that Alder was the first cognitive therapist.

1. Developed REBT therapy
2. He went to City College received a Bachelors in Business Administration.
3. Went back later to get degree in clinical psychology from Teachers College
4. In 1953 felt psychoanalysis was ineffective and over generalized, started calling himself a psychotherapist.

1. Karen Horney and Fromm
2. Was trained by Horney.

1. REBT - Rational Emotive Behavioral Therapy

As a research project he did what he feared the most---talked to a girls on campus.

Technique - Exposure Therapy

1. Ellis - 1961
2. Beck - 1963
3. Mahoney - 1974
4. Meichenbaum - 1977
5. Bandura - 1977

1. Cognitive Restructuring
2. Problem-Solving
3. Coping

1. Machine Model (Freud)
2. Linear-Causal Model (Behaviorism)
3. Information-Processing Model (Stimulus-Response)
4. Cognitive-Structurally Differentiated Model (CBT)

1. ever-evolving formulation
2. therapeutic alliance
3. collaboration
4. goal oriented and problem focused
5. emphasizes present
6. educative
7. time limited
8. structured
9. identify, evaluate and respond
10. uses a variety of techniques

EF-TA-C-GOPF-EP-E-TL-S-IER-VT

1. The angle should be 45 degree angle.
2. able to reach out and touch patient
3. no osbstruction between you and patient

1. Efficacy - proven in research
2. Effective  - proven in the field

1. An evolving framework for understanding the patient.
2. It begins at the first contact with the patient (even on the phone)

What brings you into treatment at this time?

1. When--did these problems begin?
2. What---was happening around that time?
3. Why do you believe---the problems started at that time?
4. Rule out anything biological (substance abuse)
5. What behavioral, emotional and physioloical symptoms are associated with these cognitions?

Behavior, emotions, and physiological responses are powerfully influenced by our perception and interpretation of events.

1. It is the most fundamental level of belief.
2. They are global, rigid, and overgeneralized.

1. They are the actual words or images that go through a person's mind.
2. They are situation specific and may be considered the most superficial level of cognition.

Culture fits in everywhere:

1. core beliefs
2. intermediate beliefs
3. automatic thoughts

1. It is self-fulling prophecy.
2. The behavior that is maintaining the schema.

It is the opposite of schema maintenance.

Ex: you fear relationships - so you become the life of the party.

You assume you know what people think without having sufficient evidence of their thoughts.

Ex: "He thinks I'm a loser"

Technique: Vertical Descent --> "If he thinks you are a loser, what would that mean to you and why would it bother you"

You predict the future - that things will get worse or that there is danger ahead.

Ex: "I won't get the job"

Technique: Vertical Descent - "If you don't get the job, what would that mean to you and why would that bother you"

You believe that what has happened or will happen will be so awful and unbearable that you won't be able to stand it.

Ex: "It would be terrible if I failed"

Technique: Feared Fantasy - "If it would be terrible if you failed, what is the worst that could happened"

You assign global negative traits to yourself and others.

Ex: "He's a rotten person"

Technique: Define terms: "How do you define rotten person?"

You claim that the positive accomplishments you or others attain are trivial.

Ex: "Those successes were easy, so they don't matter"

Technique: Evaluating Assumptions, Rules, Standards: "What is the % that you believe that those successes are trivial?"

You focus almost exclusively on the negatives and seldom notice the positives.

Ex: "Look at all the people who don't like me"

Technique: Examining the Evidence - "What is the % of people that don't like you...what about the left over % that do?"

You preceived a global pattern of negatives on the basis of a single incident.

Ex: "This generally happens to me. I seem to fail at a lot of things"

Technique: Externalizing Voices: "Patient, I seem to fail at a lot of things...Therapist -  but I am successful at many things as well"

You view events, or people, in all-or-nothing terms.

Ex: "I get rejected by everyone"

Technique: Scaling/Shades of Grey: "On a scale of 1 to 10 what number would you say you get rejected...10...What number would you say 911 was...10...what about 911 compared to getting rejected...7?"

You interpret events in terms of how things should be rather than simply focusing on what is.

Ex: "I should do well.  If I don't then I am a failure"

Technique: Examing and Challenging Shoulds

You attribute a disporporatiate amount of blame for negative events to yourself and fail to see that certain events are also caused by others.

Ex: "My marriage ended because I failed"

Technique: Pie Chart - "What % is your husbands"

You focus on the other person as the source of your negative feelings and you refuse to take responsibility for changing yourself.

Ex: "My parents caused all my problems"

Technique: Pie Chart

You interpret events in terms of standards that are unrealistic by focusing primarily on others who do better than you and then judging yourself inferior in the comparison.

Ex: "She's more successful than I am"

Technique: Identifying Conditional Beliefs

You focus on the idea that you could have done better in the past, rather than on what you could do better now.

Ex: "I shouldn't have said that"

Technique: Examining Shoulds

You ask a series of questions about "what if" something happens, and you are never satisfied with any of the answers.

ex: "Yeah, but what if I get anxious"

Technique: Feared Fantasy - "If you get anxious what is the worst that can happen?"

You let your feelings guide your interpretation of reality.

Ex: "I feel depressed; therefore my marriage is not working out"

Technique: Evaluating Assumptions, Rules, and Standards

You reject any evidence or arguments that might contradict your negative thoughts.

Ex: "I'm unlovable" you reject as any evidence that people like you."

Technique: Evaluating the Evidence

You view yourself, others and events in terms of black/white evaluations (good-bad or superior-inferior)

Ex: "If I take up tennis, I won't do well"

Technique: Scaling/Shades of Grey

1. Setting the Agenda
2. Mood check
3. Reviewing the Present Problem
4. Identifying and setting goals
5. Educating the patient to the cognitive model
6. Pt's Expectations for therapy
7. Educating Pt about to Disorder
8. Collaborative Homework
9. Providing Summary
10. Eliciting Feedback

• Provide the patient with a brief rationale
• It is focused---quick and to the point
• It elicits active participation in a productive way
• Collaborative

• Keeps objective track of how the patient is doing
• subjective (0-100 or low, med, high)
• objective (BDI, BAI)

• Therapist ask the patient to bring him up to date
• What changes occured since intake?
• Ask questions---what else could you tell me to help me understand you better?

• Turn presenting problems into goals to work on in therapy
• Desirable, measurable and behavioral goals
• Operationalized goals

Teach the patient to become their own cognitive therapist

• Elevator technique (generate an automatic thought) DTR
• 3 Column Technique (situation-->automatic thoughts-->emotions)

• Have to socialize the patient to the cognitive therapy model
• What is your understanding of how therapy works?
• "how can I help you?" - Beck
• Patient's get better because they apply themselves

• Provide information -- Psychoeducation about disorder
• Normalize ("I have worked with patient's experiencing symptoms as you and they did well in treatment)

Therapist and patient discuss things that patient thinks he can do by the next session.

• To continue to improve on in-between sessions
• What could get in the way?--cognitive rehearsal (imagine a time when you will not do it)
• it will get commitment
• To increase the likelihood they will perform it ---they should write it down ---self-monitoring

Review with patient what was covered during the entire session, reinforces important points including:

• presenting problems
• goals
• patient agreed to do for homework

Patient's report of therapy session

• Ex: "Did I say something to make you feel uncomfortable?
• strengthens rapport
• demonstrates empathy toward patient

• Hot cognition is a motivated reasoning phenomenon in which a person's responses (often emotional) to stimuli are heightened.

• Is is open ended questions to get patients to reach a conclusion.
• by creating cognitive dissonance

•  is an uncomfortable feeling caused by holding conflicting ideas simultaneously
• it is not equal
• Ex: Patient - "I'm a failure"...asks questions to arrive at the conclusion it is not true

• It is a technique to examine the consequences - both positive and negative of holding a particular belief.
• will either maintain the belief or change.

Belief or Behavior

(selling drugs)

1. Advantages - reinforcers (anxiety reduction)

* money

* power

* women

2. Disadvantages - going to jail

* loosing family

* loosing childen

* fear of being killed

Belief or Behavior

CBA & Paradoxical CBA

Status Quo                  Change (Specify)

Advantages                   Disadvantages

Disadvantages                  Advantages

• In order to examine and challenge the thoughts, have to know what you are talking about.  Need to know what a word means to you.
• Reduce impact of labeling
• can do by using dysfunctional thought record

Ex: "I'm a loser"

"I'm dumb"

"I'm worthless"

• Logs that are used to see patterns in a patient's behavior
• How many times does this happen?
• Use the following logs to help patient identify:

* Activity Schedule

* Food Log

* Panic Log

* Thought Log

• Examines the implications for the assumption (Using Vertical Descent)

"If that were true what would that mean to you and why would that bother you?"

• the vertical descent will lead to the underlying assumption

• They are moral imperatives
• They often imply a judgment about the worth or value of self or other
• Self-criticism, guilt and shame are side effects of these moralistic "should" statements

Ex: "I should always be perfect"

CD: "Shoulds"

• In order to prevent rejection or negative appraisal by others, the patient may develop "conditional rules" ---guidelines or strategies---that will serve to protect her from rejection.

Ex: "In order to be attractive, I need to be perfect in my appearance"

A technique to get to the patient's underlying fears which they are unaware of (leads to core belief)

• The Vertical Desent Technique---"What if" technique

Ex: "If loosing your job were true, what is the worst that could happen?"

• Once they accept that it is true --> it reduces the anxiety about it
• somethings you learn to accept and make the best of

Making a situation more absurd than it is

The purpose is to test the hypothesis ---"core beliefs"

Survey the family around the patient in order to normalize what is going on

* catastrophizing

* mind reading

* worried what others are thinking

• Motivational Interviewing---on a scale of 1 to 10 how important is it for you to change

* give examples that are much worst in order to get patient to see their situation is not as extreme

Imaginary Experiences

• exposure
• memory rescripting (history of trauma)

A technique used to modify the negative thought

• the therapist goes first (postive or rational position) to model while the patient takes the negative position ** after a while they switch

• It creates modeling

• helps resolve conflict resolution
• communication

• The therapist plays the role of the ---Rational thought (RT)
• The patient plays the role of --- Automatic Negative Thought (ANT)

* Helps the patient see their own dysfunctional thinking

It is putting things into perspective.

Ex: It may be true that the person made mistakes

helps patient to see how much of the blame is theirs

Technique: Pie Chart

• They are mental shortcuts to make judgments
• We see the same things in several different ways

It is a technique to examine the evidence for or against the validity of negative beliefs.

Ex: For - Tom doesn't like me - 20%

Against - Lots of friends like me - 80%

20% - 80% = 60% 

1. Cost-Benefit Analysis
2. Examining the Evidence
3. Rating/Scaling
4. Putting Things in Perspective
5. Feared Fantasy
6. Acceptance Paradox

1. Revevant Childhood Data
2. Core Beliefs
3. Intermediate Beliefs (conditional assumptions/beliefs/rules) postive and negative
4. Compensatory Strategies
5. Situation
6. Automatic Thought
7. Meaning of Automatic Thought
8. Emotion
9. Behavior