In Cognitive Therapy Over Time, Dr. Keith S. Dobson shows how this empirically validated approach works in practice over the course of six sessions. Cognitive therapy is a popularly taught and practiced manualized treatment useful with a wide variety of client issues and disorders. In this approach, the therapist develops a strong relationship with the client and within that context uses a number of methods to teach the client how to attend to thoughts and evaluate them consistently.
The ultimate goal of this aspect of the approach is to enable the client to assess the usefulness and realism of their thinking, and therefore learn to avoid types of thinking that lead to personal distress or disorder. During therapy, the therapist develops a case formulation based on cognitive models of various disorders, but that also incorporates the individual personality of the client. The case formulation helps the therapist choose the interventions that will be used throughout the therapy and provides a consistent framework for the eclectic mix of techniques often required to help a client.
In the sessions on this DVD, Dobson works with a woman in her late 30s who presented with a number of health and anxiety-related concerns and whose primary concern, related to her panic attacks, became the focus of therapy. Dobson first assesses the nature of the panic disorder, as well as her anxiety in general, and then works with the client to reduce the frequency of panic attacks.
The primary interventions demonstrated include in-session panic induction, between-session homework, and cognitive restructuring. In addition, the therapist assesses the client's history to obtain a more complete set of information on which to base a case conceptualization.
Cognitive therapy is one of the most widely researched treatment models for a number of reasons. It is a model that has broad applicability to many disorders. Thus, while the approach was first developed for the treatment of depression, it has now been expanded to other problems such as anxiety disorders, eating disorders, personality disorders, problems of anger and affect regulation, substance use disorders, psychotic conditions, and relationship distress, among others.
The second reason for the growth of the cognitive model is that a number of its testable hypotheses have been supported in various research studies. These include studies related to correlations among cognitive constructs and other variables that have been hypothesized to be related, as well as in studies where cognitive variables have been used to predict symptoms, disorders, or dysfunctional patterns of behavior. Notably, studies of the meditation of therapy have also been conducted, and research again generally supports the cognitive model which underlies cognitive therapy.
The third and perhaps the most significant reason for the development of cognitive therapy is that the results of a large number of treatment studies support the clinical efficacy of the approach. Further, while the majority of these studies have been conducted using the methods of randomized clinical trials, studies done in more naturalistic settings also generally endorse the clinical value of the approach. Given these strong outcomes, cognitive therapy has become a well-established therapy in the current era of evidence-based health care.
A final set of reasons for the development of cognitive therapy is that its methods are fairly intuitive and have also been written into treatment manuals. The intuitive aspect of the model makes it attractive to potential patients, as they can understand their disorders or problems from the framework provided by the cognitive model.
The manualized nature of the treatments also makes it easier to disseminate the treatment to a new generation of psychologists, psychiatrists, and mental health professionals. The public demand for these treatments, coupled with the comparably easy training relative to some other psychotherapy models, has increased the access to these treatments and has allowed for their incorporation into health care programs.
Cognitive therapy is a present-oriented, practical and purposeful treatment. It aims to have the therapist and patient work together as a treatment team, in a respectful and collaborative relationship. Within this context, the therapist educates, coaches, and encourages the patient to try new ways to look at his or her problems and new adaptive ways to behave.
A series of methods are used to teach the patient to learn how to attend to his or her thoughts and to evaluate these thoughts in a fairly consistent way, both with respect to how realistic and functional these thoughts are. Over time, the therapist will develop a case formulation that draws on cognitive models of various disorders, but also reflects the unique characteristics of the patient with which he or she is working. This formulation guides the interventions that the therapist encourages.
As the patient recovers functioning in the areas that prompted the need for treatment, he or she will become more aware of the cognitive appraisals that are made. Across a series of sessions, patterns in these appraisals often become apparent, which reflect beliefs, assumptions, or schemas that the patient has often held since childhood and that may be the bases for the problems experienced by the patient.
As it becomes appropriate, the patient and therapist will explore the nature of these schemas and may work together using schema therapy to test out their value and functionality in the patient's life. If indicated, the therapist and patient may then work together to modify core beliefs or schemas through a series of possible interventions.
Although cognitive therapy provides a systematic way to conceptualize patient's problems, the actual interventions that are used will be individualized for each individual patient and his or her unique life situation. Cognitive therapy has been described as a technically eclectic form of therapy: While there are a large number of potential techniques that can be used, other interventions are created as the treatment unfolds and others yet may be adapted from additional treatment models.
Despite this apparent eclecticism, however, a cognitive case conceptualization underlies all cognitive therapy cases, and the ability to develop a sound case conceptualization is viewed equally as a measure of competent cognitive therapy as is the deployment of the interventions themselves. Models have been developed to measure cognitive therapy competence and a system has been established to credential competent cognitive therapists.
About the Therapist:
Keith S. Dobson, PhD, is a professor of clinical psychology at the University of Calgary. He has served in various roles there, including past director of clinical psychology and coleader of the Hotchkiss Brain Institute Depression Research program, and current head of psychology. His research has focused on both cognitive models and mechanisms in depression and the treatment of depression, particularly using cognitive–behavioral therapies.
Dr. Dobson's research has resulted in more than 150 published articles and chapters, nine books, and numerous conference and workshop presentations in many countries. Recent books include The Prevention of Anxiety and Depression (Dozois & Dobson, 2004), Risk Factors for Depression (Dobson & Dozois, 2008), Evidence-Based Practice of Cognitive–Behavioral Therapy (Dobson & Dobson, 2009) and the Handbook of Cognitive–Behavioral Therapy, 3rd Edition (Dobson, 2010).
In addition to his research in depression, he has written about developments in professional psychology and ethics, and has been actively involved in organized psychology in Canada, including a term as president of the Canadian Psychological Association. He was a member of the University of Calgary Research Ethics Board for many years, and is president of the Academy of Cognitive Therapy, as well as the president of the International Association for Cognitive Psychotherapy.
Among other awards, he has been given the Canadian Psychological Association's Award for Distinguished Contributions to the Profession of Psychology.
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