Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
Their review also reveals that CBT is effective for positive and secondary symptoms of psychotic disorders but less so for relapse prevention and chronic symptoms. Evidence that CBT is effective for anxiety disorders is consistent and broad. Its efficacy for insomnia exceeds other interventions for treating insomnia (specifically regarding sleep quality, total sleep time, waking time, and sleep efficiency). Hofman and colleagues also note CBT has demonstrated effectiveness with conditions such as bulimia, anger and aggression, and stress management (Hofman et al., 2012). There are specific evidence-based treatments available for various disorders. Given the copious resources and treatment protocols available, the aspiring clinician is encouraged to seek supervision from a qualified provider in their efforts to learn, select, and implement the appropriate therapy for specific disorders. This introductory course has focused on general principles associated with cognitive therapy; however, the reader should be aware that there are additional considerations for providing cognitive therapy to specific populations (e.g., children and adolescents) and in various modalities such as group treatment. The general summaries described subsequently of how the cog- nitive model is applied to frequently encountered psychological disorders are drawn partly from Beck and Haigh (2014) and Beck and Weishaar (2005), along with examples of associated emotional, behavioral, and physiological responses. Note that these are only examples; they are not intended to provide an exhaustive list of cognitions or responses for each disorder. These summaries demonstrate the versatility of the cognitive model and how it can readily provide key information about a client’s experience. Consistent with Figure 1, these summaries demonstrate how a person views an event or how experience mediates their behavioral and physiological responses. The goal in treating such disorders is to assist the client in moving from distorted, maladaptive cognitions to healthier, adaptive cognitions. The case conceptualization then guides the choice of treatment technique. DEPRESSION The cognitive model posits that depression is maintained through a person’s negative views of the self, the world, and the future. Persons may view themselves as inadequate, incompetent, worthless, unlovable, or flawed in some way. The individual may view the world as lacking pleasure or meaning and see their future as hopeless and void of positive possibili- ties. Such hopelessness and inability to see other perspectives or options can result in suicidal ideation. An example belief may include “Nothing I do is right.”
Emotional responses may include: • Depression • Feeling “down” • Pessimism • Sadness • Irritability Behavioral responses may include: • Avoidance (e.g., substance use to “numb the pain”) • Isolation
• Withdrawal • Anhedonia Physiological responses may include: • Psychomotor retardation or agitation • Fatigue • Lack of energy • Decreased libido • Change in appetite • Hypersomnia or insomnia
PHOBIA The cognitive model of phobia describes the anticipation of threat or harm in response to specific situations or objects. As a result, the individual may go to great lengths to avoid such situations. An example belief might be “I am in danger.” A person’s emotional response might be anxiety and fear. Their behavioral response might be avoidance of situations, objects, or other reminders. The physiological response might be feeling “on edge,” a racing heart, or sweating. PANIC DISORDER In the cognitive model, panic disorder is characterized by unre- alistic beliefs that unexplainable, novel, or out-of-the-ordinary experiences signal imminent catastrophe. For example, short- ness of breath may be regarded as a sign of an impending heart attack. Such fear can result in constant vigilance and excessive attention to internal sensations or experiences others may not even notice. Emotional responses may include anxiety, fear, or terror; behavioral responses may consist of hypervigilance and avoidance. Physiological responses may include: • Racing heart • Shortness of breath • Stomach upset
• Palpitations • Trembling • Paresthesia (numbness or tingling) • Hot flashes or chills • Hyperventilation
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