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Cognitive Therapy With Youth The Schools
Jody Lieske, PhDLicensed Pediatric Psychologist
Children and Adolescent Clinic, P.C.Hastings, Nebraska
o An event triggers the beginning of the cycle (Beck 1964).
o The event triggers a thought in the students mind that generally comes unintentionally and automatically.
o Next there is an emotional response to the thought.
o Based on the thought and emotion, a behavior occurs.
The Cognitive Model
The Cognitive Model
Situations themselves do not cause us to have certain feelings.
It is our thoughts about the situation that lead to the feelings.
THOUGHTS
BEHAVIORS
EMOTIONS
Cognitive Triad
Reactions (behavior, emotions, compensatory strategies)
Automatic Thoughts Intermediate Beliefs Core Beliefs
Levels of Thought/Behavior
Reactions (behaviors/em
otions)
Automatic thoughts
Intermediate/Core Beliefs
Levels of Thoughts and Behavior
ATs and images are the quick, evaluative thoughts and images that occur in response to outside events (Beck et al., 1979).
Can be positive or negative, helpful or unhelpful, accurate or inaccurate
Youth are not always aware of their automatic thoughts.
Automatic Thoughts
1. Negative automatic thoughts and images often represent situations in which a person is assuming the worst, often with little or no evidence to support the assumption.
2. Permissive automatic thoughts and images are ideas a student has that allow or excuse behavior that would otherwise cause feelings of guilt or discomfort.
3. Coping thoughts and images help a person to handle difficult situations in a healthy way.
Three Common Categories of ATs
Examples of ATs
Negative “I blew it.”
“He doesn’t want me anymore.”
“There’s no use trying.”
“She thinks I’m stupid.”
“I can’t do it.”
Permissive “I’ve earned it!”
“Just this once…”
“I held up my end of the bargain—it’s not my fault if they didn’t.”
“Everyone else does it, so I may as well.”
They blame me for it, so I may as well do it.”
COPINGo “I will just do my best, and that will be enough.”
o “I am proud of myself for trying.”
o “No matter what, I can learn from this, and try again if I need to.”
o “Everyone makes mistakes.”
o “I may do even better than I expect!”
Examples of ATs
Errors in logical thinking Occur more frequently in persons who are in
emotional distress or have a psychiatric disorder than in people without emotional concerns (Beck, 1976)
Cognitive Errors
Underlying beliefs are the way we understand ourselves, others, and the world around us. Automatic thoughts
are quick, evaluative thoughts that are informed by those underlying beliefs.
The lens through which we see the world.
Often formed as a result of interaction between our genetic makeup and our early life experiences.
Intermediate and core
Underlying Beliefs
A student’s internalized “rules” for how they think the world should work.
Rules are often framed as if-then statements. If one things happens, then it will lead to a
specific result (positive or negative).
Intermediate Beliefs
The foundation of how we see ourselves, others, and the world (Beck et al., 1979)
Usually developed in childhood and based on experience
Usually related to beliefs about helplessness or unlovability
Core Beliefs
Behaviors that students use to deal with their underlying beliefs and to live according to the “rules” of their world.
3 Categories: Maintaining strategies Opposing strategies Avoiding strategies
Compensatory Strategies
Student 1: “Counseling may be helpful, but it may be a waste of time. I’ll give it a couple of sessions before I make a decision.”
Student 2: “Meeting with a counselor is a waste of time. She won’t get what I am going through and I’m missing art class.”
Student 3: “I really need some help. The counselor really helped Amy, so maybe she can help me.”
What would you guess that each is feeling?
When a student’s distress is a reasonable reaction to a situation, rather than related to unhelpful or inaccurate thoughts and beliefs, we move to collaborative problem solving.
A decision point: Problem solving or intervention?
A process in which the clinician asks questions in a manner that helps the student identify the problem, determine how to best respond to it, and in some cases, how to change the situation.
Collaborative Problem Solving
Appropriate when: The student’s emotions are appropriate to the
situation. The student is in a situation that places them at
significant risk for harm. You and the student have checked the student’s
thought and it appears both accurate and useful. The student is functioning at a lower level and initially
finds it difficult to understand how the beliefs, thoughts, and behaviors relate to the problem.
Collaborative Problem Solving
Identify the problem Think about possible solutions Choose a solution to try How well does it work?
ITCH (Munoz, Ippen, Rao, Le, & Dwyler, 2000)
Situation
• What happened around you just before you felt the way you did?
AT
• What thoughts went through your head?
Emotion
• What emotion(s) did you feel-in one word description?
Thought Record
Involves asking strategic questions to lead a student to a new perspective
Use Columbo approach (Selekman, 1993)
Guided Discovery
Catch Check Change
The Three C’S
“What evidence do you have that the thought is true or untrue?”
“Is there another explanation?” “What is the impact or your believing this
thought?” “What should you do about it?” “If this happened to a friend, what would you
tell him or her?” “Is this thought helpful?”
Checking Thoughts
“What is the worst thing that will happen?” “What is the best thing that could happen?” What is the most likely thing to happen?” “If the worst thing happened, could you deal
with it?”
Checking Anxious Thoughts
Kids laughing in the hall
They told a joke They think I am fatThey are trying to make me mad
How Likely Is Each Explanation
Replacement thoughts are not just thinking a happy thought!
Help students develop thoughts that are believable and in their own words.
Changing Thoughts
Is a skill or ability deficit is getting in the way?
Is the student not invested in therapy? Has the student developed some resistance? Are the concepts being explained in a way
that is too complex for the student?
Difficulties with Checking or Changing Thoughts
Helps students to delve into the meaning of automatic thoughts, looking for underlying beliefs
Thoughts are a reflection of our beliefs about ourselves and the world
The Downward Arrow
Behavioral Experiments Behavioral Activation Replacement Behaviors Exposure Relaxation Techniques
Behavioral Techniques
Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953-959.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
Three of the best sources for reviewing the empirical evidence that supports CBT
Jody [email protected]
Children and Adolescent Clinic, P.C.2115 North Kansas Ave
Hastings, Ne 68901
Questions?
