Cognitive Behavior Modification

Chapter 27

Cognitive Behavior Modification

• Cognition– Belief, thought, expectancy, attitude, or

perception

• Cognitive Behavior Modification – Cognitive Behavior Therapy– Helping clients through behavioral

modification methods and through focusing on debilitating thoughts and beliefs

Cognitive Restructuring Methods

• Assumptions:– Individuals interpret and react to events

in terms of their perceived significance– Cognitive deficiencies can cause

emotional disorders• Focus of therapy: Cognitive

restructuring– Changing faulty thinking patterns

• Approaches include behavior modification components

Cognitive Restructuring Methods

• Rational-Emotive Behavior Therapy (REBT)– Developed to help individuals change

irrational thought– Utilizes in vivo behavioral homework

assignments– Procedure:

• Identify irrational thoughts• Challenge thoughts• Teaching client (through modeling and homework)

to replace the irrational self-statements with statements based on “rational” beliefs

Effectiveness of REBT

• More effective than no treatment• More effective than various other

treatments in decreasing client’s irrational self-talk (46%)

• More effective than other treatments in reducing emotional distress (27%)

• No effect on behavioral measures (approaching feared object)

Cognitive Restructuring Methods

• Beck’s Cognitive Therapy– Faulty and negativistic though patterns lead

to behavioral and emotional problems• Procedure:

– Identification of dysfunctional thoughts– Use various methods to counteract the

dysfuctional thoughts• Ex: Hypothesis testing

– Use of homework assignments that utilize behavior modification procedures to develop desirable daily activities

• Gentler, less confrontational approach than REBT

Beck’s Distorted Thought Patterns

• Dichotomous thinking – all or none evaluations

• Overgeneralization – rule or belief applied too broadly

• Arbitrary Inference – drawing inaccurate conclusions based on insufficient, ambiguous, or contrary evidence

• Magnification – exaggeration of the meaning or impact of an event

Effectiveness of Cognitive Therapy

• Effective in treating depression• Most research has focused on

treatment of depression• More research needed to evaluate

this treatment for other disorders

Self-Directed Coping Methods

• Self-Instructional Training– Five steps:

• Adult demonstration of self-instructing• Child performs while adult verbalizes• Child performs the task and verbalizes out

loud• Fading of overt self-instructions• Task performance with covert self-

instructions

Self-Directed Coping Methods

• Meichenbaum’s Stress Inoculation Training– Teaches cognitive skills that allow clients to

deal with stressful events• Three Phases:

– Reinterpretation phase• It is not the stressor that is the cause of stress

reaction but it is the way the client views the event

– Coping training phase• Clients learn coping strategies

– Relaxation, self-instruction, and self-reinforcement

– Application phase• Clients practice skills in stressful situations

Effectiveness of Stress Inoculation

• Many of the components (relaxation, modeling, desensitization) have been validated when applied independently

• Evidence suggests that this method is as effective as its component procedures

Self-Directed Coping Methods

• Problem Solving Training– Teaches people how to proceed through logical

reasoning to satisfactory solutions to personal problems

– Steps in personal problem solving:• General orientation• Problem definition• Generation of alternatives• Decision making• Implementation• Verification

• Evaluation of problem solving methods– Adults and children can rapidly learn skills, but

do not often apply them appropriately

Mindfulness and Acceptance

• Mindfulness– Awareness, observation, and description

of one’s overt and covers behaviors, as they occur, in a nonjudgmental way

• Acceptance– Set of behaviors in reaction to

mindfulness• Refraining from judging one’s sensations,

feelings, and behaviors• Thoughts are viewed as just responses, just

passing events

Mindfulness and Acceptance

• Acceptance and Commitment Therapy (ACT)– Three phases:

• Learning that past attempts to control troublesome thoughts and emotions have not only been unsuccessful, but increased the frequency of these thoughts

• Learning to experience thoughts and emotions in a nonjudgmental way

– Done through use of mindfulness training and acceptance exercises

• Identifying values in various life domains and then translating these values into goals and actions

– Evaluation• Early studies find positive results

– Equivalent to systematic desensitization for treatment of math anxiety

– Effective in reducing stress in the workplace• Relatively new approach and more research needed