1. An Overview 2. The Role of Emotions in Cognitive Therapy 3. The Therapeutic Relationship: Application to Cognitive Therapy 4. Structure of the Therapeutic Interview 5. The Initial Interview 6. Session by Session Treatment: A Typical Course of Therapy 7. Application of Behavioral Techniques 8. Cognitive Techniques 9. Focus on Target Symptoms 10. Specific Techniques for the Suicidal Patient 11. Interview with a Depressed Suicidal Patient 12. Depressogenic Assumptions 13. Integration of Homework into Therapy 14. Technical Problems 15. Problems Related to Termination and Relapse 16. Group Cognitive Therapy for Depressed Patients Steven D. Hollon and Brian F. Shaw 17. Cognitive Therapy and Antidepressant Medications 18. Outcome Studies of Cognitive Therapy Appendix: Materials *The Beck Inventory *Scale for Suicide Ideation *Daily Record of Dysfunctional Thoughts *Competency Checklist for Cognitive Therapists *Possible Reasons for Not Doing Self-Help Assignments *Research Protocol for Outcome Study at Center for Cognitive Therapy *Further Materials and Technical Aids

Cognitive Therapy of Depression

This article presents a theory of how different types of discrepancies between self-state representations are related to different kinds of emotional vulnerabilities. One domain of the self (actual; ideal; ought) and one standpoint on the self (own; significant other) constitute each type of self-state representation. It is proposed that different types of self-discrepancies represent different types of negative psychological situations that are associated with different kinds of discomfort. Discrepancies between the actual/own self-state (i.e., the self-concept) and ideal self-states (i.e., representations of an individual's beliefs about his or her own or a sitmifieant other's hopes, wishes, or aspirations for the individual) signify the absence of positive outcomes, which is associated with dejection-related emotions (e.g., disappointment, dissatisfaction, sadness). In contrast, discrepancies between the actual/own self-state and ought self-states (i.e., representations of an individual's beliefs about his or her own or a significant other's beliefs about the individual's duties, responsibilities, or obligations) signify the presence of negative outcomes, which is associated with agitation-related emotions (e.g., fear, threat, restlessness). Differences in both the relative magnitude and the accessibility of individuals' available types of self-discrepancies are predicted to be related to differences in the kinds of discomfort people are likely to experience. Correlational and experimental evidence supports the predictions of the model. Differences between self-discrepancy theory and (a) other theories of incompatible self-beliefs and (b) actual self negativity (e.g., low self-esteem) are discussed.

http://persweb.wabash.edu/facstaff/hortonr/articles%20for%20class/Higgins.pdf

Self-discrepancy: a theory relating self and affect.

People approach pleasure and avoid pain. To discover the true nature of approach-avoidance motivation, psychologists need to move beyond this hedonic principle to the principles that underlie the different ways that it operates. One such principle is regulatory focus, which distinguishes self-regulation with a promotion focus (accomplishments and aspirations) from self-regulation with a prevention focus (safety and responsibilities). This principle is used to reconsider the fundamental nature of approach-avoidance, expectancy-value relations, and emotional and evaluative sensitivities. Both types of regulatory focus are applied to phenomena that have been treated in terms of either promotion (e.g., well-being) or prevention (e.g., cognitive dissonance). Then, regulatory focus is distinguished from regulatory anticipation and regulatory reference, 2 other principles underlying the different ways that people approach pleasure and avoid pain.

/pdf/beyond-pleasure-and-pain-15he2ycgoe.pdf

Beyond pleasure and pain.

ions as internal properties of clients rather than as hypothetical constructs of therapists has resulted in considerable confusion about the types of changes effected by different approaches to the modification of behavior. It is widely assumed that behavioral and psychodynamic approaches are concerned with fundamentally different subject matters. The latter methods supposedly treat complexes, repressed impulses, ego strengths and mental apparatuses, the underlying causes of behavior, whereas behavioral approaches are believed to modify only superficial behavior. This apparent difference in subject matter, however, exists primarily in the therapists’ conceptualizations, not in actual practice. Ego strength, to take an example, is a www.freepsychotherapybooks.org 235 hypothetical construct and not an entity within the client. One can neither observe nor modify hypothetical constructs. The person’s behavior— broadly defined to include cognitive, emotional, and motor expressions—is the only class of events that can be altered through psychological procedures, and therefore it is the only meaningful subject matter of psychotherapy. Similarly, stimulus variables are the only events that the therapist can modify to effect behavioral change. Psychotherapy, like any other social influence enterprise, is thus a process in which the therapist arranges stimulus conditions that produce desired behavioral changes in the client. If, for instance, a psychotherapist creates conditions that increase the frequency of the behaviors from which ego strength is inferred, the client will be said to have acquired increased ego strength as a function of treatment. On the other hand, if the frequency of www.freepsychotherapybooks.org 236 ego-strength behaviors has been reduced in the course of psychotherapy, the client has suffered a loss in ego strength. Clearly, ego strength is simply a hypothetical abstraction whose presumed behavioral referents are the only reality the psychotherapist can modify. In the final analysis, social-learning approaches and all other existing forms of treatment modify the same subject matter, namely, behavioral phenomena. Most discussions of change-inducing processes, however, focus on treating the inferences made from behavioral events as though these abstractions existed independently and caused their behavioral referents. Philosophers of science have cautioned against the attribution of causal potency to described properties of behavior. Their warnings have had little impact on personality theorizing. Neither traits nor types, as concepts, have www.freepsychotherapybooks.org 237 any real existence. They are merely words, and words do not exist in the eye of the observer nor in the people observed. A man can not be said to have either a type or a trait, but he can be said to fit either a type or a trait. At present the fit will be inexact, for dimensions of personality have not yet been quantified well enough to permit of accurate measurement. In the case of height, the measurement can be precise, and little confusion results from saying that a man has a certain height. Observation and concept are so closely related that the phrase is not ordinarily understood to mean more than it says, namely, that the extent of a given datum of observation in one direction fits a certain section of an ideal dimension of distance. But if an attempt is made to fit some mode of human conduct to the trait of courage, the looseness of correspondence between behavior and concepts leads to mischievous reification. The concept parts company with behavior, picks up undefined notions in its flight from reality, and finally acquires an independent real existence in its own right, so that when it is said that a man has courage, he will be thought of as the fortunate owner of something considerably www.freepsychotherapybooks.org 238 more significant than a certain pattern of behavior [Pratt, 1939, p. 115]. Similarly, a person who is plagued with “weak ego strength” will be viewed as suffering from something vastly more significant than the behavioral referents from which the construct is inferred. For purposes of further illustration, let us designate behaviors in which persons violate social and legal codes of behavior and frequently engage in assaultive activities as the external expressions of an inferred zoognick. Based on prevailing clinical practices, the zoognick would come to represent an intrapsychically functioning agent. An honorific causative power would be conferred upon this hypothetical zoognick, whereas the observed behavior from which its existence is inferred would be depreciated as superficial behavioral manifestations. Before long, www.freepsychotherapybooks.org 239 psychological tests would be constructed to measure zoognick strength on the basis of which diagnosticians would tautologically attribute clients’ behavior to the action of the underlying zoognick. Proceeding on the assumption that “patient variables are not conceived to be behaviors, but constructs concerning internal constellations” (Wallerstein, 1963), psychotherapeutic goals would be stated in terms of removing the pernicious zoognick. On the other hand, direct modification of the deviant behavior would be considered not only superficial but potentially dangerous, since elimination of the symptomatic expressions might force the zoognick to emerge in equally pernicious substitute forms. A sufficiently charismatic exponent of zoognick theory could undoubtedly develop a sizable following with the same extraordinary conviction in the vital importance and causative potency of www.freepsychotherapybooks.org 240 zoognicks as that shown by adherents of libidinal forces. Oedipal complexes, collective unconsciouses, and self-dynamisms. Finally, humanists would embrace zoognick theory as more befitting the complexities of human beings than those simplistic mechanistic doctrines that stubbornly insist that the zoognick is the deviant behavior rechristened. Most treatment approaches devote remarkably little attention to the selection of objectives; when they are specified (Mahrer, 1967), the intended outcomes generally include a variety of abstract virtues described in socially desirable terms, such as reorganization of the self, restoration of functional effectiveness, development of individuation and self-actualization, establishment of homeostatic equilibrium, where there is id there shall ego be and where superego was there shall conscious ego be, achievement of identity, www.freepsychotherapybooks.org 241 acceptance of self-consciousness, enhancement of ego strength, or the attainment of self-awareness, emotional maturity, and positive mental health. While some of these objectives allude to vaguely defined behavioral characteristics, most refer to nebulous hypothetical states. These abstractions convey little information unless they are further defined in terms of specifically observable behavior. Behavioral Specification of Objectives A meaningfully stated objective has at least two basic characteristics (Mager, 1961). First, it should identify and describe the behaviors considered appropriate to the desired outcomes. The term “behavior” is used in the broad sense to include a complex of observable and potentially measurable activities including motor, cognitive, and physiological classes of responses. www.freepsychotherapybooks.org 242 After the intended goals have been specified in performance, and preferably in measurable terms, decisions can be made about the experiences that are most likely to produce the desired outcomes. For example, the statement, “Increase the person’s self-confidence and self-esteem,” designates a therapeutic intent; but it furnishes little guidance, since it does not reveal the kinds of behaviors the person will exhibit after he has achieved increased self-esteem. Once self-esteem and the behaviors that will be esteem producing for a particular client have been delineated, one can arrange conditions that will create the requisite behaviors and thereby produce the condition of positive selfevaluation. In some instances learning vocational skills may be most relevant to acquiring selfesteem; in some cases developing interpersonal competencies that will secure positive responses from others may be most appropriate; in other www.freepsychotherapybooks.org 243 cases eliminating alienating social behaviors may be required if self-evaluation is to be altered; and finally, in cases where a person is relatively competent socially and vocationally, an increase in self-esteem behavior may require the modification of stringent, self-imposed standards of behavior upon which self-approving and self-deprecatory responses are contingent. Similarly, unless the goals specify the behavior that persons will exhibit when successfully self-actualized, internally integrated, self-accepted, personally reconstructed, homeostatically equilibrated, or emotionally matured, such goals provide little

Principles of behavior modification

Reciprocal inhibition is a process of relearning whereby in the presence of a stimulus a non-anxiety-producing response is continually repeated until it extinguishes the old, undesirable response. A variety of the techniques based on reciprocal inhibition, such as systematic desensitization, avoidance conditioning, and the use of assertion, are described in detail. Behavior therapy techniques evaluated on the basis of their clinical efficacy are found to have striking success over traditional psychoanalytic methods. Currently, more comparative studies are required which will validate the merit of behavior therapy in the psychotherapeutic field while experimental research should continue to refine the techniques.

Psychotherapy by reciprocal inhibition

necessarily simple. It is fair assumption that prospective readers understand the gas laws, equivalent pressures and other basic facts. The chapter on Signs and Symptoms dwells a little lengthily on psychomotor aspects and in this chapter Dr Bennett mentions that the noble gases possess narcotic properties, an interesting fact for anaesthetists. The causes of narcosis are grouped as one chapter and include pressure alone, psychological origins, raised partial pressures of oxygen or inert gases. In the following chapter, Dr Bennett indicates that tissue carbon dioxide retention is not the prime cause of compressed air intoxication though increased oxygen partial pressure and carbon dioxide retention are synergistic. The chapter on Electrical Activity of the Brain and Inert Gas Narcosis is well done, this being Dr Bennett's forte. Other chapters in the book include Possible Mechanisms of Narcosis, Action of Gases on Synaptic Mechanisms, Prevention of Narcosis, and Recent Developments in the Field. Apart from small points, the book is well compiled, with a minimum of first edition errors. The illustrations and graphs are clear, while the references are comprehensive and detailed. This is clearly a book to be recommended to every scientist interested in underwater research, hyperbaric medicine and anaesthesia, and Dr Bennett should be encouraged with any further publication.

Behavior therapy techniques : a guide to the treatment of neuroses

The practice of multimodal therapy

Multimodal Behavior Therapy

A Reciprocal Inhibition (3) technique for the treatment of children's phobias is presented which consists essentially of an adaptation of Wolpe's method of “systematic desensitization” (4). Instead of inducing muscular relaxation as the anxiety-inhibiting response, certain emotion-arousing situations are presented to the child's imagination. The emotions induced are assumed, like relaxation, to have autonomic effects which are incompatible with anxiety. This technique, which the authors have provisionally labelled “emotive imagery” was applied to nine phobic children whose ages ranged from 7 to 14 years. Seven children recovered in a mean of 3.3 sessions and follow-up enquiries up to 12 months later revealed no relapses or symptom substitution. An outstanding feature of this paediatric technique is the extraordinary rapidity with which remission occurs.

Arnold A. Lazarus

Papers

Behavior therapy techniques : a guide to the treatment of neuroses

The practice of multimodal therapy

Multimodal Behavior Therapy

The use of “Emotive Imagery” In the Treatment of Children's Phobias

Learning theory and the treatment of depression.