1. Discuss personality as seen by A. T. Beck. What we think about situations affects how we feel. We respond to situations with cognitions that lead to behaviors and feelings. Beck is more of behavioral-cognitive than cognitive. Personality has links to situation-behavior, situation-cognition, cognition-behavior, behavior-cognition, and cognition-emotions.

2. Discuss the general causes of problems from Beck's point of view. Problems are caused mostly by five cognitive causes, ineffective or self-defeating behavior, social support deficit (an environmental cause), and difficult circumstances. Beck focused mostly on the cognitive causes.

3. Discuss the five cognitive causes of problems from Beck's point of view. First is automatic thinking, which is verbal words or labels, reminiscences, or images. A characteristic of automatic thoughts is that people have difficulty changing their automatic bad thoughts about themselves. Automatic thoughts tend to be used consistently despite the invalidating circumstances. They are idiosyncratic and usually precede an expression of emotion.

Second is self-instruction problems, which are over-monitoring (paying too much attention or being too self-conscious) and under-monitoring (paying too little to the effect, as in some kind of addiction). These problems are characterized by too many shoulds and oughts, over-mobilized do's and don't's, and deficient self-rewards or excessive self-punishments. They change their rewards and are excessively critical of themselves. Depressed people are tougher on themselves, and they tend to raise their performance standards.

Third is unrealistic anticipation or expectation, which can be expressed verbally (left side of brain), visually (right side of brain), or emotionally (middle brain) all at the same time. A person can verbally say good things about themselves but emotionally be down on themselves. These three elements of the brain for a depression triad with the three corners being negative view of self, experiences, and the future.

Fourth is idiosyncratic rules and internal signals, which asks the true meaning of each event for the individual.

Fifth is faulty cognitive processes, which are faulty ways that people think. Some examples are: (a) distorted perception (habituation is how we adjust to physical stimuli), (b) arbitrary inference (using contradictory information to confirm a preexisting belief (dead men do not bleed)), (c) overgeneralization (making a general rule out of a single incident (impotent)), (d) magnification (Beck)/catastrophizing (Ellis)(making a mountain out of a mole hill), (e) dichotomous reasoning (all or none thinking with no gray areas), (f) selective abstraction (focusing on one small portion of an experience), and (g) oversocialization (obeying the behavioral norms of a subgroup even when it is not good for the person (juvenile delinquency)).

4. Discuss the theory of therapy from Beck's point of view. People come to therapy because they are distressed. The therapist's primary goal is to alleviate distress by adjusting the client's thinking to agree with reality. The secondary goal is to teach a method of dealing with dysphoria (negative feelings). The general approach of therapy is to: (a) help people become aware of the content of their thinking, (b) help people recognize when their thoughts go awry, (c) substitute accurate thoughts for inaccurate thoughts, and (d) collect and use feedback about how the changes are working. The advantages of cognitive therapy are that the person has already developed cognitive processes, that they validity, and that this process restores a feeling of control.

5. Discuss the process of therapy from Beck's point of view. The therapeutic relationship, in Beck's opinion, is very important and needs to be warm, empathetic, and genuine (in the Rogerian tradition). Rapport and trust are essential, and the client should never feel judged or labeled. The therapist can use a team approach and solve problems through collaborative empiricism. The therapist should match his or her style to the client's style and always convey hope. Beck has a very good sense of humor, and he will even joke with the client if possible.

Therapy should prepare the client for cognitive therapy, and in the first two sessions, the therapist should establish a clear connection between thoughts and feelings. With Beck, this is usually done directly, whereas with someone like Meichenbaum, the process would be more interactive and evolved. The therapist should explore the client's feelings and symptoms, provide capsule summaries of what the client says, and check to see whether the client agrees with the summaries. This is also active listening. The therapist should deal with behavioral and motivational difficulties early in therapy. Sometimes, depressed people do not want to do anything. The therapist should then move next to the content and pattern of the client's thinking (recognizing, recording, and testing specific cognitions). Finally, the therapist should address general assumptions predisposing the person for depression. This is to find out why the client even gets depressed.

The course of treatment should be fifteen to twenty-five sessions with a mean of fifteen sessions over eleven weeks. They should be two per week for the first four to five weeks, weekly for the next ten to fifteen weeks, and two-week intervals for the last two sessions.

6. Discuss the constant's across therapy. An assessment should be done with the Beck Depression Inventory each session on a continual basis or at least every two or three sessions (the higher the score on the test, the higher the level of depression). There should be homework weekly so that the client will always have something to do. There should be a treatment plan before every session and setting an agenda with the client at the beginning of each session. Some general strategies consist of intellectual questioning in order to analyze the rationality of the client's thinking, experiential (analyze the client's experiences and involve the client), and behavioral (to change behavior and to elicit cognitions during the performance of behavior). Problem reduction is also important, where the therapist identifies problems with common cognitive causes and groups them into some important themes. He or she should concentrate on the key components of the disorder.

7. Discuss the techniques from Beck's point of view. Some common techniques with this style of therapy are given below.

				Tom of Bethany

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Lesson 19. Cognitive Theories: Larry Crabb

 

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