cognitive therapy question???

[The2abraxis]

I was reading some Beck and had a question regarding depressogenic assumptions. there seems to be a great importance to them, but what is the most effective way of indentifying them?? he states that one should look at patterns at a person's automatic thoughts, but are there other ways?

also, if the therapist sees a pattern, is it good/bad to infer (assuming there is a good amount of "data") certain beliefs then check them with the patient???

thanks!

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[erg923]

see below

 

[erg923]

The depressogenic schematas are tricky because according to his theory, they may be not be present when the person is not in a depressive state. A trigger, (i.e., stress) is assumed to activate the propensity to these cognitions. In other words, they are "latent but reactive". However, experimental psychopathology researchers, particularly cognitive psychologists, have been successful in attempting to illicit these schematas in depressive prone individuals through the use of a mood priming paradigms. Usually transient mood induction or Velton procedure

 

[The2abraxis]

The depressogenic schematas are tricky because according to his theory, they may be not be present when the person is not in a depressive state. A trigger, (i.e., stress) is assumed to activate the propensity to these cognitions. In other words, they are "latent but reactive". However, experimental psychopathology researchers, particularly cognitive psychologists, have been successful in attempting to illicit these schematas in depressive prone individuals through the use of a mood priming paradigms. Usually transient mood induction or Velton procedure

thanks for the reply!

it seems like mood priming would elicit the "automatic thoughts" (maybe in some cases the underlying assumptions as well), and if they do, is there a method that can be used (or maybe even a form of questioning?) to pin point out the assumptions directly??

im kind of seeing if there is a "philosophical" approach to it, aka, using logic to pin point them. the method of finding a pattern in thoughts fits this criteria, but i was wondering if there was a more effective way.

sorry if this is confusing

 

[jpaquette]

Great topic! When I do CBT with patients, I like using a downward-arrow or "what-if" technique in order to get to the underlying self-defeating beliefs/depressogenic assumptions. Start off with a daily mood log or 5 column sheet, and have the patient identify their negative automatic thoughts that led to them experiencing their negative emotions. At this point, I'd invite them to identify the negative thought that was most painful/significant for them, and use that as the springboard to delving deeper. In using a downward arrow technique, have the patient start off at their negative thought, and ask questions like "if that were true, what would that mean?" etc. If you run this type of questioning to its conclusion, you'll often help the client reach the point of identifying their depressogenic assumptions.

As far as level of transparency when working with patients, I personally like to be pretty open about my hypotheses regarding things like this. I'd even consider having a print-out of the depressogenic beliefs, including things like
"in order to be happy, I must be successful in everything I do," or "If I make a mistake it means I am inept," etc. I believe Beck traditionally had 6 of these, but there are certainly more that can be considered in this vein. As far as openness goes though, I'd say that's a personal decision dependent on your style as a therapist and the type of work you're doing. There's no right or wrong answer; though, here in grad school, the right answer tends to be whatever your supervisor tells you to do.

 

[erg923]

...yea I am lil confused now. Bottom line is that, yes, there is experimental research that has found evidence for distorted thinking (depressive schematas) in formerly depressed patients. In clinical work, yes, you will see evidence of these cognitions if you work with depressed patients. I have anyway. Whether these cognition cause negative affectivity, or whether negative affectivity causes the cognitions is less clear.

 

[The2abraxis]

Great topic! When I do CBT with patients, I like using a downward-arrow or "what-if" technique in order to get to the underlying self-defeating beliefs/depressogenic assumptions. Start off with a daily mood log or 5 column sheet, and have the patient identify their negative automatic thoughts that led to them experiencing their negative emotions. At this point, I'd invite them to identify the negative thought that was most painful/significant for them, and use that as the springboard to delving deeper. In using a downward arrow technique, have the patient start off at their negative thought, and ask questions like "if that were true, what would that mean?" etc. If you run this type of questioning to its conclusion, you'll often help the client reach the point of identifying their depressogenic assumptions.

As far as level of transparency when working with patients, I personally like to be pretty open about my hypotheses regarding things like this. I'd even consider having a print-out of the depressogenic beliefs, including things like
"in order to be happy, I must be successful in everything I do," or "If I make a mistake it means I am inept," etc. I believe Beck traditionally had 6 of these, but there are certainly more that can be considered in this vein. As far as openness goes though, I'd say that's a personal decision dependent on your style as a therapist and the type of work you're doing. There's no right or wrong answer; though, here in grad school, the right answer tends to be whatever your supervisor tells you to do.

just what I was looking for, thanks! so it seems like continually questioning to find out what the thought(s) mean to a patient would be effective.

one more question (kind of stated in the first post): Is it "anti-therapeutic" to suggest what the assumption/belief may be? In my readings, Beck stated that it is bad to infer, but I feel like infering would allow the patient to understand what is being looked for/clarify what an assumption is. I could see where infering can be bad (such as basing it off one session), but it would seem to be helpful to write out some assumptions the person may have (like you said before), show them to the person, and pin point out which ones define a person's belief system. do the costs outweigh the benefits when doing this?

 

[RayneeDeigh]

Oh that's so bizarre, this thread is exactly what I was thinking I would need to read more about yesterday afternoon at work. This forum has ESP.

Question, jpaquette mentioned that traditionally there are 6 depressogenic assumptions but a quick googling couldn't tell me what they are. Does anybody know offhand? (what a Jeopardy question)

 

[jpaquette]

Nice psychotherapy Jeopardy question, Raynee! The 6 traditional assumptions are as follows:
1. To be happy I must succeed.
2. To be happy I must be accepted by all people at all times
3. If I make a mistake it means I am inept
4. I cannot live without love
5. Someone disagreeing with me means they don’t like me
6. My value as a person depends upon what others think of me

These are the original 6, there are more recent adaptations of similar self-defeating beliefs as well (such as "People who love each other should never fight or argue," "If I'm rejected, it proves there's something wrong with me," etc.).

As for the prior question about inferring in front of patients, different therapists have different thoughts about that. Beck, as you mentioned, prefers not to. My supervisor (who is something of a CBT specialist) however, is very open and transparent about this kind of thing, as long as it's done in a collaborative and curious manner (i.e. "Based on our work and our conversations, I'm wondering if this might be something you feel is true about you," etc.). Also, providing some psychoeducation for your patient, and explaining that this is a normal way of thinking that people who are depressed can often fall into, can help normalize this issue for patients. I think the most important thing is to not come at this issue from an overly authoritative place, and rather to approach it delicately and in the form of questioning. But, long story short, I don't think it's anti-therapeutic to be open with your patients about this.

Oh that's so bizarre, this thread is exactly what I was thinking I would need to read more about yesterday afternoon at work. This forum has ESP.

Question, jpaquette mentioned that traditionally there are 6 depressogenic assumptions but a quick googling couldn't tell me what they are. Does anybody know offhand? (what a Jeopardy question)

 

[The2abraxis]

Thanks! It seemed like it would be harder than it should be to allow a patient to express their assumptions without showing them what they could be; as opposed to them telling you unknowingly (through interview and such). I guess verbalizing what an assumption is/could be can help them identify their belief quicker.

On a further note, this thread could be an "all cognitive therapy questions" kind of thread, if this is where it would be :-D

 

[PsyDr]

there is a great book called somethign like

"cognitive therapy techniques"

i believe the author's name starts with an L

it has some good ways of soliciting these cognitive distortions

 

[jpaquette]

I'd recommend Judy Beck's "Cognitive Therapy: Basics and Beyond." It gives a nice background regarding the theory of CBT, and is boiled down to a pretty easy level in terms of learning. It's a bit dry, but as far as getting a handle on the approach I think it's pretty good.

Another good resource is Leahy's "Cognitive Therapy Techniques," which the previous poster mentioned. It's a little less theory-focused, and has lots of really good worksheets and techniques to use in therapy. It's really good in terms of learning the "how-to" of CBT, though may be better if you already have a good background in the approach.

 

[The2abraxis]

ya ive been reading a few of becks book, particularly "Cognitive Therapy and the Emotional Disorders", "Cognitive Therapy for Depression", and "Anxiety Disorders and Phobias: A Cognitive Perspective."

there was a good book this local teacher wrote (he worked with Albert Ellis) called "The New Rational Therapy." It goes into a philosophical approach into some issues, but in a way gives techniques as well :-D

 

[The2abraxis]

So I was reading up on anxiety disorders and techniques used for visual imagery, and a few techniques suggested were: replacing the bad image with a good one, changing the bad image/focusing on the good aspect, etc...

I am not 100% sure, but these techniques do not seem like they would work all too well, or they would only be very temporary. Are they used just for an "instant relief"?? I would think one would want to get to the meaning of the image or the facts behind the image, etc... Maybe I am wrong??

 

[Ollie123]

So I was reading up on anxiety disorders and techniques used for visual imagery, and a few techniques suggested were: replacing the bad image with a good one, changing the bad image/focusing on the good aspect, etc...

I am not 100% sure, but these techniques do not seem like they would work all too well, or they would only be very temporary. Are they used just for an "instant relief"?? I would think one would want to get to the meaning of the image or the facts behind the image, etc... Maybe I am wrong??

I've mostly read about it being used in the context of exposure therapy. There the idea is they learn to control their fears (even temporarily) in a controlled setting, while they are gradually placed in greater and greater fear-inducing situations.

From everything I've heard, visual imagery is more just a tool to be used in that context, not a therapy by itself. Exposure therapy for phobias is probably one of the most effective therapies out there right now - one of the few with a very high success rate across a wide variety of populations.

 

[The2abraxis]

ooh I wasn't talking about the visual imagery as a whole, I was talking about the techniques used to counter visual images one may have in regard to their anxiety. I was wondering, are these techniques were truly effective? (the techniques of substiuting a bad image for a positive one, imagining the negative in a positive context: viewing onlookers in their underwear, etc...)

 

[jpaquette]

One of the neat things about CBT is the plethora of tools and techniques that you have at your disposal as a clinician. I think you're right in saying that the odds that any particular tool/technique working for an individual is oftentimes low; however, the key is finding the technique that fits and works for that person (it can often take running through several techniques before finding the right one for a given person/problem). Taking a bit of a "shotgun" approach within the larger CBT framework is often the way to go.

 

[The2abraxis]

ya I was thinking that, just because it might not work for the majority, having it in the toolbag may be useful for someone else. thanks :-D

 

[Markro311]

I fully agree with being multimodal/eclectic when it comes to clinical techniques and tools, but I am often interested...when do you consider something "fits" a particular client? When the client reacts well to it? When you see change in behaviors? When the therapeutic alliance seems to be stronger? When you see change through objective measures? Sometimes I feel that many therapists think they are using techniques which are in the best interest of the client, but really they may not be and it may just be their own biases convincing them that they are.