Cognitive techniques are aimed at delineating and testing the validity and reasonableness of the patient’s specific misconceptions and maladaptive assumptions.Therapy involves highly specific learning experiences aimed to teach the patient how to do the following:
A) Monitor his negative, automatic thoughts (cognition).
B) Recognise the connections between cognition, affect, and behaviour
C) Examine the evidence for and against his distorted negative cognition.
D) Substitute more reality-oriented interpretations for his distorted negative cognition.
E) Learn to identify and alter the dysfunctional beliefs that predispose him to distort and negatively evaluate his experiences.
Behavioural assignments are used with more severely depressed patients not only to change behaviour but also to elicit cognition associated with specific behaviours. A sampling of these behavioural strategies include a Daily Activity Log,in which the patient logs his hourly activities; a Mastery and Pleasure Schedule, in which the patient rates the activities listed in his log; a Graded Task Assignment, in which the patient sequentially attempts various steps to accomplish a task that the patient believes is impossible. Furthermore, behavioural assignments are created to help the patient test out certain maladaptive cognition.
Various verbal techniques are used to explore the logic behind, and basis for, specific cognition and assumptions. The patient is given an initial didactic explanation of the rationale for Cognitive Therapy. Next, he learns to recognise, monitor, and record the negative thoughts associated with incidents in which he felt particularly upset (sad, anxious, etc.). The cognition and underlying assumptions are discussed and examined for logic, validity, adaptiveness, and enhancement of positive behaviour versus maintenance of pathology. For example, the depressed person’s tendency to feel responsible for negative outcomes while consistently failing to take credit for his own success is identified and discussed as a specific verbal technique. Therapy focuses at times on specific target symptoms (such as, suicidal impulses). The cognition supporting these symptoms are identified (for example, “Life is worthless and I can’t change it.”) and then examined with logic and empirical methods.
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