______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
Technique: Live the New Belief (J. S. Beck, 2020)
Leahy (2017) presents emotion-focused techniques for access- ing and recognizing emotional experiences. These techniques aim to assist the client in identifying the cognitive elements triggering or maintaining an emotional state. Clients must first learn to identify their emotions and differentiate emo- tions from thoughts. Emotions can be accessed in sessions by having clients recount a particular event or situation or by asking clients to attend to the physical sensations they are having during the discussion or the event. Once the emotion is accessed, the therapist can ask clients to explore the thoughts they are having (or have had). When a client experiences a particularly strong emotion in response to a particular thought, it can provide the therapist with a hint that the thought may be quite problematic. This cues the therapist to consider this thought for evaluation and modification. Empathy, validation, and understanding are all critical in helping clients access and process emotion within the cognitive model. Empirical Support, Efficacy, and Applications There is a strong movement within psychology toward increas- ing the use of empirically supported treatments, also termed evidence-based practices. Cognitive therapy is represented strongly in such literature and is generally accepted to have had favorable results in research studies. The movement toward empirically supported treatments includes heated debates involving complaints regarding research designs, observations that the provision of therapy in a research setting lacks ecologi- cal validity, and concerns that the nature of therapy prevents it from being appropriately tested through traditional clinical trials. As this course is intentionally focused on application rather than research, a thorough review of the evidence base for cognitive therapy will not be presented. However, cognitive therapy is effective for a variety of disorders, including (but not limited to) depression, anxiety and panic disorders, substance abuse, obsessive-compulsive disorder, and posttraumatic stress disorder. Additionally, it has been shown to be effective in combination with other interventions. For example, with regard to depression, it has been shown that adding cognitive therapy to antidepressant medication therapy improves rates of recovery when compared to medication alone for patients with severe, nonchronic depression (Hollon et al., 2014). Given the extensive literature base, studies are no longer focused on how well this therapy works but on expanding the multiple ways cognitive therapy is understood to be effective (Messer & Kaslow, 2019). In their 2012 review of 269 meta- analyses, Hofman and colleagues (2012) note findings that CBT is effective in treating a wide range of conditions but that variation in efficacy does exist. For example, CBT is gener- ally effective at treating substance use but appears to be most highly effective in treating cannabis and nicotine dependence.
Once the client has developed a new belief to substitute for the old belief, the client can approach tasks “as if” the new belief is true. Example: T: So, the theme we’ve established through iden- tifying your automatic thoughts and beliefs is that you think you are inadequate. What has it cost you by behaving as though this thought is true? C: I don’t socialize. I haven’t applied for the job that I really want. I haven’t taken very good care of myself. T: How would you behave differently if you thought, “I am adequate?” C: I would probably put in my application for that job! T: I think this would be a good time for us to discuss adding a tool to your repertoire. For some people with situations similar to yours, it has been very helpful to act as if they are adequate and to start making choices based on that perception. It’s kind of like “fake it until you make it.” Would you be will- ing to try something like that? C: I could give it a try, but I think it will be hard. T: It very well might be hard, but we can take it one step at a time and see if we can’t make it more reasonable. What’s the first step in submitting a job application? C: Well, I’d have to request the actual application. T: Good, let’s start with that. Break it down into small steps. Emotion-Focused Techniques Often, clients present for treatment due to a complaint about their mood. Most sessions involve a discussion of emotions associated with the client’s distress and maladaptive thought patterns. As part of cognitive therapy, the clinician can assist the client in differentiating emotions from cognitions, learn to label and describe their emotions, distinguish the intensity of emotions, become mindful of how cognition affects feelings, observe how cognitive restructuring can lead to changes in emotional experience, and normalize emotions and mood. Clients may come to therapy to “be happy”; psychoeduca- tion regarding the normal fluctuation of mood in response to psychosocial stressors is essential in assisting the client in developing realistic expectations.
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