Wednesday, April 20, 2005

Cognitive Therapy by Aaron Beck

International Universities Press, New York

Cognitive therapy works with the learning process of the client (or patient) to help replace distortions in the perception of the world that are harmful. Such distortions could be delusions of grandeur, fear of common social situations, anger for the perceived offenses of others, a sense of danger that lingers after a real danger has passed. These are just a few examples. Like humanistic client centered therapy, the client and his learning experiences are key to the healing, the cognitive therapist is a greater player though in the process and the process is goal oriented where specific problems are targeted and a procedure is developed along a schedule to provide, even guarantee results. Cognitive therapy strongly relies on the genuineness of the therapist along the lines of client centered therapy, but the therapist does not seek to become the client's life-long friend.

While relying on warmth and genuineness, the cognitive approach is almost as surgical as behavioral therapy. The warmth however, is an emotional tool to restore a patient's trust in authority and it is not an emotionally sacred component of the soul as humanists view it. Learning (or cognitive) techniques are used to give the patient a closer relationship with reality or personal self confidence in a step by step procedure, replacing faulty thought processes, with new ones. The cognitive therapist is not necessarily genuine with the patient, especially in the beginning, where there is a pretense at acceptance of, say, delusions, for instance, just to keep the patient from running away. As the patient becomes more focused on reality, the pair agrees more on basic perceptions until the therapist and the patient are congruent-- reading from the same page of reality. Cognitive therapy is not open-ended, it does not borrow from the humanist concept that life is the journey; they are simply solving problems as any healer would do. Cognitive therapy helps with symptomatic problems, but probably cannot help in the greater soul wrenching pain that can be cause by the grief of death or some other great suffering. Very likely pharmacopoeia, to relieve mental pain, combined with an emotional support system would be the only effective therapy, where family or social support, if it exists, would pick up after the therapeutic period ends.

While cognitive therapy does not augment the reason to live, the beauty of life, self actualization, it does seem very useful in combating the worst problems of life such as strong hatred. Hatred on a cultural, racial or religious basis flies in the face of all moral philosophies, there is no reasonable support for it and it can easily be discredited as ignorance. Since cognitive therapy is specifically designed to change perceptions based on false learnings, it seems very useful as tool to replace the extreme form of ignorance which hatred is with the clearings associated with peace and prosperity. In the short run cognitive therapy can be used to forestall some grievous event, which may bring about permanent schism. In the long haul, however, the natural self-actualizing process can bring us together into a joined learning where we can share our experiences, probably best through the technologies of the Information Society.

Note: Aaron Beck does have a book on hatred, which I believe extends on his observations of anger produced by the intolerance of inflexible and completely absolute moral values.

As does Skinner, Beck provides insight into the roots of problems. Skinner sees animalistic reactions to events based almost on digital programming where as Beck sees humans responding to life, either successful or self defeating, extending learning experiences of the past, either good or bad. Rogers sees it all as good, that it is a very good force that pushes us every day to succeed no matter how hopeless the circumstances. That force only needs to be empowered to align valued experiences and learnings into an internal renaissance, which of course can be shared with society to enrich us all at the deepest levels. Neither cognitive nor behavioral therapies even consider this benefit (and probably should) yet the humanist therapist no doubt occasionally wants to quicken the process of the realignment of the client's experiences with the behavioral "quick fixes" provided for by cognitive (or possibly behavioral) therapy. It may even be unethical not to try these techniques, or even resort to pharmacopoeia, if the patient is in a dangerous mental place.

P 2
The emotionally disturbed person is victimized by concealed forces over which he has no control.

The three leading schools (neuropsychiatry, psychoanalysis, behavior) maintain that source of a patient's disturbance lies beyond his awareness, conscious conceptions, specific thoughts and fantasies.

P 3
Man has consciousness contains elements that are responsible for the emotional upsets and blurred thinking that lead him to seek help.

Man has the key to understanding and solving his psychological disturbance with in the scope of his own awareness.

He can correct the misconceptions producing his emotional disturbance wit the same problem solving apparatus the he has been accustomed to using at various stages in his development.

P 8
Behavior therapists have downgraded the importance of thinking in their zeal to emulate the precision of the physical sciences (control??). They have rejected data and concepts derived from man's reflections on his conscious experiences. Only behavior that could be directly observed has any relevance. Since thoughts feelings and ideas which are only accessible to the person experiencing them are not valid data.

P 9
The behavior therapist with his faith in the determative form of environmental (observable) uses external stimuli to help the patient; administering rewards and punishments, exposing the patient to situations or objects that frighten him.

The troubled person is led to believe that he can’t help himself.

P 51
The specific content of the interpretation of an event leads to a specific emotional response. We can generalize that, depending on the kind of interpretation a person makes, he will feel glad sad scared or angry or he may have no particular emotional reaction alt all.

P 55
Cognitive model:
Stimulus -> conscious meaning -> emotional response

P 67
Anger can be caused if the individual interprets commands or restrictions as encroaching on his rights. Restrictive authority may anger an individual even though he had no desire to break a rule. His rights include expectations of respect courtesy, consideration and loyalty from others as well as autonomy, freedom of action and expression.
Social or professional status may prompt the expectation of special privileges and may cause offense of they are not accorded or anger is a person of lower status tries to claim privileges to which he is not "entitled."

P 70
A breach of code produces the same reaction as an attack.

"They have no right to act that way", or "he should not have done that", or "those hippies should be locked up, they have no business with their hair that long or being so dirty."

Acceptable forms of behavior constitute a moral code that is embedded in the domain. Codes vary widely between groups and may be idiosyncratic. Anger produced by a violation may seem appropriate to the angry individual but may be unhealthy to others. A violation of his personal standards is an attack on his domain.

P 71
Situations that lead to anger:
  • Direct and intentional attack
  • Direct, unintentional attack
  • Violation of laws or social mores, hypothetical threats, substandard behavior, breach of idiosyncratic moral code

The arousal of anger is the individual's appraisal of an assault on his domain, including his values, moral code and protective values. The individual must take the infringement seriously and label it negatively. If a person is concerned with his own safety, he will be anxious not angry; it cannot be a present danger. The individual focuses on the wrongness of the offense and the offender rather than on any injury he may have sustained.

P 78
The devastating aspect of acute emotions disturbance is the slippage of controls previously taken for granted. The patient has to grapple to retrain voluntary control over concentration, attention, and focusing. He has trouble framing thoughts or following along a consistent line of thinking. His awareness of himself and his surroundings is not only lathered, but diminished, so that he has difficult in perceiving many details in his environment.

P 79
Feelings such as "I am losing my grip", or "I am falling apart", or "I am going crazy", are signs of acute neurotic reactions rather than psychosis.

P 84
Ideational Content of Neurotic Disorders

Depression Devaluation of domain
Hypomania Inflated evaluation of domain
Anxiety Neurosis Danger to domain
Phobia Dangers connect with specific, avoidable situations
Paranoid State Unjustified intrusion on domain
Hysteria Concept of sensory abnormality
Obsession Warning or doubting
Compulsion Self command to perform specific act to ward off danger

P 89
Thinking disorder: sometimes a feature of schizophrenia but when less gross and more circumscribed it is an important component of common psychiatric syndromes.

Patients systematically misconstructed specific kinds of experiences ranging from subtle inaccuracies in mild neurotics to grotesque misinterpretations and delusions in psychotics.

Departures from reality and logic occurred in ideation that was relevant to the patient's specific problems. Depressive concerned about self worth, anxious patient was concerned with danger.

Distortions have characteristics of automatic thoughts, appear to rise as if by reflex without antecedent reflection or reasoning. They seem plausible to the patient even though the implausible to other people. They are less amenable to change by reason or contradictory evidence.

P 214-215
Cognitive therapy seeks to alleviate psychological stresses by correcting faulty conceptions and self-signals. By correcting erroneous beliefs we can lower excessive reactions.

The intellectual approach consists of identifying the misconceptions, testing their validity and subsisting more appropriate concepts. Often the need for broad attitudinal changes emerges when the patient realizes that the old rules served to deceive and defeat him (or others.)

The experiential approach exposes the patient to experiences that can change misconceptions. Encounter groups may help a person to perceive other more realistically and consequently to modify his inappropriate maladaptive responses. A patient in response to a psychotherapist’s warmth and acceptance modifies his stereotypes of others, a "corrective emotional experience."

The behavioral approach encourages the development of specific forms of behavior that lead to more general changes in the way the patient views himself with the real world. Practicing techniques for dealing with people who frighten him, as in assertive training enables his regard of others as well as increasing self-confidence.

P 216
Folk wisdom is at the core of much psychotherapy, yet it is often blended with myths, superstitions, and misconceptions that aggravate an unrealistic orientation.

Many people are not motivated to engage in self-improvement without professional guidance.
** What if the patient just needs support and advice in self-improvement... self-improvement alone is not going to ease the pain, he hardly mentions pain.

Psychotherapy can have its greatest impact because of the authority attributed to the therapist, his ability to provide an appropriate systematic set of procedures.

P 222

Paranoid and depressed patients often automatically react to the therapist with suspicion. The therapist must establish common ground; find a point of agreement and the attempt to extend the area of consensus. If the therapist attempts to assume an over optimistic attitude, the patient may think the therapist is being unrealistic. In trying to reason with a paranoid patient the therapist may just play into a role within the patient's paranoia.

By taking a neutral stance the therapist may encourage the expression of distorted ideas and listen to them attentively. When the patient is ready, the two can examine the evidence surrounding the ideas. Paranoids and depressives have been regarded as impermeable to therapy because there has been an attempt to correct their thinking to early. Even fixed delusions may become amenable if the therapist is sensitive and patient.

P 233
Aldous Huxley: The problem of freedom in the psychological rather than political sense is a technical problem. It is not enough to wish to be free, it is not enough to work at achieving freedom, correct knowledge in knowing how to get there is also essential.

  • The perception of reality is not the same as reality itself; at best it is a rough approximation
  • Interpretations of sensory input are dependant on inherently fallible cognitive processes such as integrating and differentiating the stimuli; physiological and psychological processes can alter perception and comprehension

Fatigue or a high state of arousal may distort reality. Reliable knowledge depends ultimately on having sufficient information so that a choice can be made among alternative hypotheses.

P 239
(Automatic thoughts)
A basic procedure for helping a patient identify his automatic thoughts is to train him to observe the sequence of external events and his reactions to them.

P 246
(Too many rules)
We have seen that people apply rules in regulating their own lives and in trying to modify the behavior of other people. When these rules are framed in absolute terms, are unrealistic or are used inappropriately or excessively, they frequently produce maladjustment. The results can be anxiety, depression phobia, mania, paranoid state, obsession.

The ideas are generally not irrational but are too absolute, broad and extreme, too personalized and are used too arbitrarily to help handing the exigencies of life. When rules are discovered to be false, self-defeating, or unworkable, they have to be dropped.

P 309-309
Standards for evaluating therapy
  • The system should be well defined and clearly described
  • The general principles of treatment should be sufficiently articulated so that everyone is reading from the same page
  • There should be empirical evidence to support the validity of the principles underlying the therapy
  • The efficacy of the treatment should have empirical support such as analog studies, single cases which are investigated, well designed trials with control groups, etc

P 310-311
Cognitive therapy, central model
The content of a person's thinking affects his mood. Self-enhancing or self-deflating content produces feeling so elation or sadness respectively.

Frustration is responsible for the arousal of anger. If the same situation is either perceived as threatening or innocuous will lead respectively to anxiety or a neutral response. Self-signals or automatic thoughts contribute to arousal of anxiety. Negative thinking produces anxiety and there is compulsive intrusion of automatic thoughts following stress.


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