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The term maladaptive behavior refers to patterns of thinking and behaving that cause and maintain emotional problems. Pervasive, persistent maladaptive patterns of behavior that are deeply ingrained and that are not attributable to axis I disorder, Learned behavior, Cognitive Behavioral Therapy. Maladaptive behavior is any type of behavior that does not allow a person to adjust to a situation in the Maladaptive Patterns of Behavior. This content was accessible as of December 29, 2012, and it was downloaded then by Andy Schmitz in an effort to preserve the availability of this book. PDF copies of this book were generated using Prince, a great tool for making PDFs out of HTML and CSS. For more information on the source of this book, or why it is available for free, please see the project's home page.
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Outline and differentiate the psychodynamic, humanistic, behavioral, and cognitive approaches to psychotherapy.
Explain the behavioral and cognitive aspects of cognitive-behavioral therapy and how CBT is used to reduce psychological disorders. Treatment for psychological disorder begins when the individual who is experiencing distress visits a counselor or therapist, perhaps in a church, a community center, a hospital, or a private practice.
In addition to the psychological assessment, the patient is usually seen by a physician to gain information about potential Axis III (physical) problems. After the medical and psychological assessments are completed, the therapist will make a formal diagnosis using the detailed descriptions of the disorder provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM; see below). To be diagnosed with ADHD the individual must display either A or B below (American Psychiatric Association, 2000):American Psychiatric Association. If a diagnosis is made, the therapist will select a course of therapy that he or she feels will be most effective. To many people therapy involves a patient lying on a couch with a therapist sitting behind and nodding sagely as the patient speaks. These data show the proportion of psychotherapists who reported practicing each type of therapy. Many people who would benefit from psychotherapy do not get it, either because they do not know how to find it or because they feel that they will be stigmatized and embarrassed if they seek help. Remember also that confronting issues requires time to reflect, energy to get to the appointments and deal with consequential feelings, and discipline to explore your issues on your own. If it becomes apparent that a psychologist may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), the psychologist takes reasonable steps to clarify and modify, or withdraw from, roles appropriately. When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality. Psychodynamic therapy (psychoanalysis)A psychological treatment based on Freudian and neo-Freudian personality theories in which the therapist helps the patient explore the unconscious dynamics of personality. The patient may be asked to verbalize his or her thoughts through free associationA technique of psychotherapy in which the therapist listens while the client talks about whatever comes to mind, without any censorship or filtering., in which the therapist listens while the client talks about whatever comes to mind, without any censorship or filtering.
One problem with traditional psychoanalysis is that the sessions may take place several times a week, go on for many years, and cost thousands of dollars. Just as psychoanalysis is based on the personality theories of Freud and the neo-Freudians, humanistic therapyA psychological treatment based on the personality theories of Carl Rogers and other humanistic psychologists.
Carl Rogers developed person-centered therapy (or client-centered therapy)An approach to treatment in which the client is helped to grow and develop as the therapist provides a comfortable, nonjudgmental environment., an approach to treatment in which the client is helped to grow and develop as the therapist provides a comfortable, nonjudgmental environment. Carl Rogers was among the founders of the humanistic approach to therapy and developed the fundamentals of person-centered therapy. The development of a positive therapeutic alliance has been found to be exceedingly important to successful therapy. Psychodynamic and humanistic therapies are recommended primarily for people suffering from generalized anxiety or mood disorders, and who desire to feel better about themselves overall.
Cognitive-behavior therapy (CBT)A structured approach to treatment that attempts to reduce psychological disorders through systematic procedures based on cognitive and behavioral principles.
Cognitive-behavior therapy (CBT) is based on the idea that our thoughts, feelings, and behavior reinforce each other and that changing our thoughts or behavior can make us feel better. CBT is a very broad approach that is used for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, attention-deficit, and psychotic disorders. Depending on the particular disorder, some CBT treatments may be primarily behavioral in orientation, focusing on the principles of classical, operant, and observational learning, whereas other treatments are more cognitive, focused on changing negative thoughts related to the disorder. As the patient practices the different techniques, the appropriate behaviors are shaped through reinforcement to allow the client to manage more complex social situations. When the disorder is anxiety or phobia, then the goal of the CBT is to reduce the negative affective responses to the feared stimulus. Some of the advantages of the virtual reality treatment approach are that it is economical, the treatment session can be held in the therapista€™s office with no loss of time or confidentiality, the session can easily be terminated as soon as a patient feels uncomfortable, and many patients who have resisted live exposure to the object of their fears are willing to try the new virtual reality option first. Trained clinicians use computer-generated, three-dimensional, lifelike images of spiders instead of the real thing in systematic desensitization programs to help combat client fears. Aversion therapyA behavioral therapy in which positive punishment is used to reduce the frequency of an undesirable behavior. While behavioral approaches focus on the actions of the patient, cognitive therapyA psychological treatment that helps clients identify incorrect or distorted beliefs that are contributing to disorder. The goal of cognitive therapy is not necessarily to get people to think more positively but rather to think more accurately.
To this point we have considered the different approaches to psychotherapy under the assumption that a therapist will use only one approach with a given patient. As we have seen in Chapter 12 "Defining Psychological Disorders", one of the most commonly diagnosed disorders is borderline personality disorder (BPD). If the therapist is trained in a psychodynamic approach, he or she will probably begin intensive face-to-face psychotherapy sessions at least three times a week. The eclectic therapist will continue to monitor Bethanya€™s behavior as the therapy continues, bringing into play whatever therapeutic tools seem most beneficial. Psychoanalysis is based on the principles of Freudian and neo-Freudian personality theories. Humanist therapy, derived from the personality theory of Carl Rogers, is based on the idea that people experience psychological problems when they are burdened by limits and expectations placed on them by themselves and others. Behavior therapy applies the principles of classical and operant conditioning, as well as observational learning, to the elimination of maladaptive behaviors and their replacement with more adaptive responses. Albert Ellis and Aaron Beck developed cognitive-based therapies to help clients stop negative thoughts and replace them with more objective thoughts. Imagine that your friend has been feeling depressed for several months but refuses to consider therapy as an option. Imagine that you have developed a debilitating fear of bees after recently being attacked by a swarm of them.
High rates of anxiety disorders in childhood populations imply that the development of evidenced-based treatments with proven efficacy is warranted. Anxiety disorders, as they appear in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR),6 identify many conditions observed in children and adolescents. CBT for anxiety disorders contains treatment methods adapted from behavioral therapy and advances in behavioral therapy that have been added by addressing the cognitive components of psychopathology and adjustment. Treatment steps in CBT often use directed efforts to improve functioning in all three realms.
The different diagnostic entities within the anxiety disorders manifest themselves with varying symptom presentations. Advances in empirically-based treatments have focused on anxiety disorders in general and specific methods for individual diagnostic disorders. A series of studies have found treatments that contain a combination of approaches useful in diminishing the incidence of anxiety symptoms and avoidance behavior in children and adolescents. Kendall’s findings are consistent with those of Barrett,13 which examined the additive effects of CBT and family management. The effectiveness of GCBT was also later corroborated by Silverman and colleagues.14 They investigated the efficacy of GCBT for treating various anxiety disorders (overanxious disorder, GAD, separation-anxiety disorder) in children and adolescents.
In a study specifically designed for adolescents with GAD, separation anxiety, and SAD, Siqueland and colleagues15 found equal effectiveness of CBT alone and CBT combined with attachment-based family therapy at post-intervention and 6–9-month follow-up. Outside of the multi-component studies that have addressed a variety of conditions, no specific form of CBT has been tested for GAD in children. The hallmark of this condition is the development of excessive or exaggerated distress associated with the separation from home or an individual the patient is separating from. Beidel and colleagues23 studied the effects of a structured behavioral therapy in a group of 67 patients with SAD between 8–12 years of age. Social skills training (SST) for enhancing social competence with children and adolescents24 has also been tested in a randomized controlled trial. In the study by Barrett13 mentioned earlier in this article, the effects of GCBT, CBT, and family involvement versus a waitlist control demonstrated the intervention’s efficacy in terms of illness remission in a group of patients with mixed anxiety disorders, which included 19 with SAD. Selective mutism is a condition of low incidence, but significant social and academic impact that occurs in approximately 1% of children.28 Although the illness is not formally categorized under the anxiety disorders in the DSM-IV-TR, elements of anxiety are clearly important components of this illness.
Simple phobias are manifested when a child avoids contact with specific objects or situations. Panic disorder involves discrete periods of intense fear or discomfort called panic attacks. In one small contemporary study by Ollendick36 which employed a multiple baseline design, many CBT elements were employed.
PTSD requires the development of discernable distress and symptoms after exposure to a serious stressor.
The results of the study conducted by Deblinger and colleagues41 permitted the field to assess the role of parent involvement. Being able to deliver this type of modality to larger numbers of traumatized youth is sometimes feasible via the use of group interventions. Originally believed to be a rare condition in adulthood, and especially rare in childhood, OCD is one of the more prevalent childhood and adolescent psychiatric conditions. March and Mulle46 compiled information about OCD in children for a treatment manual that has been tested in a number of studies. Larger studies providing individual treatment, individual treatment combined with parental involvement, and group treatments have found improvement rates ranging from 25% to 67% of subjects showing significantly diminished functional impairment after treatment.47 Studies with more robust research designs showed more robust levels of improvement.
CBT either in individual application or in group, and sometimes enhanced by parental involvement, has yielded meaningful improvement in a variety of anxiety disorders. Frequently, the notion of having a child referred for therapy conjures up images of blame and criticism in a parent’s mind. E-newsletter Opt-inSent no more than 2–3 times each month, our E-Newsletter brings you recent findings and commentary from the psychiatric literature. CBT has been shown to help people with various conditions - both mental health conditions and physical conditions. Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change. Learn More The spirit of MI is that the therapy is a collaboration between two experts the client and the therapist. Evoking– Is where I help you increase your understanding of your own motivation for change; getting your feelings and ideas about the change you want your desire, ability, reason and need for change and how to work towards it (commitment and action plan). Planning- Involves both the commitment to change and the plan andacting on it when there is agreement on specific steps towards the desired change. CBT, one of the most popular evidence based therapies is about the interactions between how a person thinks, feels and behaves.
Learn More CBT is one of the most popular evidence based therapies.
An important advantage of CBT is that it tends to be short, taking three to six months for most emotional problems. The central premise of CBT is that your thoughts – not external events – create your feelings. The negative thoughts that contribute to depression & anxiety are distorted and often illogical, even though they seem absolutely true and valid. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards e.g.
Often the therapy will look at how thinking patterns may have begun in early childhood and the impact patterns of thinking may have on how we interpret the world as adults. Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting or suicide thoughts or attempts.
SFBT is an evidence based therapy that is future-focused, goal-directed, and focuses on solutions, rather than on the problems. The SFBT conversations focus on the present or on the future, on what is already working, and how a client would like their life to be, rather than focusing on the past and the origin of problems. Scaling questions (SQ) is used to help clients to assess their own situations, track their own progress, or evaluate how others might rate them on a scale of 0 to 10. Coping Questions such as “How have you managed to carry on?” or “How have you managed to prevent things from becoming worse?” open up a different way of looking at client’s resiliency and determination.
Mindfulness has to do with the quality of awareness that a person brings to everyday living; learning to control your mind, rather than letting your mind control you. Learn More Mindfulness as a practice directs your attention to only one thing, and that one thing is the moment you are living in. IPT examines connections between life events and wellness and strives to enhance our ability to respond more effectively. Learn More A basic IPT premise is that illness or disorder is not the client’s fault but instead works to help the client understand the connection between the illness and life events.
Therapy can be done individually or in groups and can be supportive in nature with a problem solving focus if advice given is asked for.
Stress Management – teaching relaxation (imagery, progressive muscle relaxation), problem solving.
Relapse Prevention – identifying early warning signs of illness, creating a plan, outlining steps (e.g.
Learn More Most people have suffered some form of traumatic experiences (physical, emotional, mental, sexual) in our past or present.
Being culturally sensitive, staying focused in the present by identifying the impact of trauma rather than re-enacting the story(which can be re-traumatizing), going at the clients pace, normalizing the clients experience and setting clear boundaries for the work is essential to build a safe and therapeutic relationship. Once the relationship is established we look at how the traumatic experiences impact the client’s life in the form of substance abuse, mental health problems, decreased functionality, difficulty trusting or establishing healthy relationship to name a few. Self-Compassion – is a learned practice through repeated statements of love, acceptance and forgiveness towards ourselves which helps counter the negative thoughts of failure, inadequacy and suffering associated with trauma. Breath – Practicing focusing on our breath is very helpful to staying in the present and greatly aids in preventing the trauma response.
See the license for more details, but that basically means you can share this book as long as you credit the author (but see below), don't make money from it, and do make it available to everyone else under the same terms.
However, the publisher has asked for the customary Creative Commons attribution to the original publisher, authors, title, and book URI to be removed. The therapist will begin by systematically learning about the patienta€™s needs through a formal psychological assessmentAn evaluation of the patienta€™s psychological and mental health., which is an evaluation of the patienta€™s psychological and mental health.
In some cases of psychological disordera€”and particularly for sexual problemsa€”medical treatment is the preferred course of action. The therapist will summarize the information about the patient on each of the five DSM axes, and the diagnosis will likely be sent to an insurance company to justify payment for the treatment.
One approach to treatment is psychotherapyProfessional treatment for psychological disorder through techniques designed to encourage communication of conflicts and insight., the professional treatment for psychological disorder through techniques designed to encourage communication of conflicts and insight.
Though this approach to therapy (known as psychoanalysis) is still practiced, it is in the minority. The decision to not seek help is a very poor choice because the effectiveness of mental health treatments is well documented and, no matter where a person lives, there are treatments available (U.S.
It is possible that some of your colleagues, friends, and family members will know that you are seeking help and some may at first think more negatively of you for it. This question is not always easy to answer because there is no clear demarcation between a€?normala€? and a€?abnormala€? behavior. Begin in your school, community, or church, asking about community health or counseling centers and pastoral counseling. Be sure to ask about the degrees that the therapist has earned, and about the reputation of the center in which the therapy occurs.
All people have the right to appropriate mental health care just as they have a right to general health care.
The client may also be asked to report on his or her dreams, and the therapist will use dream analysisA technique of psychotherapy in which the therapist listens while the client describes his or her dreams and then analyzes the symbolism of the dreams. The therapist listens while the client talks about whatever comes to mind, without any censorship or filtering. The therapist listens while the client describes his or her dreams and then analyzes the symbolism of the dreams in an effort to probe the unconscious thoughts of the client and interpret their significance. The therapist uses the patienta€™s expressed thoughts to try to understand the underlying unconscious problems.
The patienta€™s use of defense mechanisms to avoid the painful feelings in his or her unconscious.
The unconscious redirection of the feelings experienced in an important personal relationship toward the therapist. To help more people benefit, modern psychodynamic approaches frequently use shorter-term, focused, and goal-oriented approaches.
But the goals of people with other psychological disorders, such as phobias, sexual problems, and obsessive-compulsive disorder (OCD), are more specific. CBT treats the symptoms of the disorder (the behaviors or the cognitions) and does not attempt to address the underlying issues that cause the problem. In some cases observational learning may also be used; the client may be asked to observe the behavior of others who are more socially skilled to acquire appropriate behaviors. Exposure therapyA behavioral therapy based on the classical conditioning principle of extinction in which people are confronted with a feared stimulus with the goal of decreasing their negative emotional responses to it. An agoraphobic might be taken to a crowded shopping mall or someone with an extreme fear of heights to the top of a tall building. Systematic desensitizationA behavioral treatment that combines imagining or experiencing the feared object or situation with relaxation exercises.
The continued pairing of the relaxation responses with the feared stimulus as the patient works up the hierarchy gradually leads the fear response to be extinguished and the relaxation response to take its place. Fears of spiders are more directly habituated when the patient interacts with a real spider, and fears of flying are best extinguished when the patient gets on a real plane. Specially designed computer equipment with a head-mount display is used to create a simulated environment.
For instance, a person who thinks a€?no one cares about mea€? is likely to feel rejected, isolated, and lonely.
Beck and the psychologist Albert Ellis (1913a€“2007) together provided the basic principles of cognitive therapy. She was fighting with her parents almost daily, and the fights often included violent behavior on Bethanya€™s part.
Her suicide attempt was not successful, but the authorities required that she seek psychological help.
First, because her negative mood states are so severe, they will likely recommend that she start taking antidepressant medications.


Person-centered approaches will be used in which the therapist attempts to create a therapeutic alliance conducive to a frank and open exchange of information.
The therapist may focus on childhood experiences related to Bethanya€™s attachment difficulties but will also focus in large part on the causes of the present behavior.
For one, cognitive therapy will likely be used in an attempt to change Bethanya€™s distortions of reality. Hopefully, Bethany will stay in treatment long enough to make some real progress in repairing her broken life. In eclectic therapy, the therapist uses whatever treatment approaches seem most likely to be effective for the client. Based on what youa€™ve learned in this section, what treatment options would you explore in your attempt to provide him with the best help available?
Studies employing cognitive-behavioral therapy (CBT) in adults suffering from this group of illnesses have laid the ground work for their application in youths.
Pharmacologic treatment studies of youths with various anxiety disorders have primarily centered on the use of antidepressants, with some promising results in terms of efficacy.1 However, recent warnings and studies2,3 regarding the negative outcomes associated with the use of many psychopharmacologic agents in childhood seem to warrant the development, scientific study, and dissemination of therapeutic interventions that are void of serious adverse events.
These include generalized anxiety disorder (GAD), panic disorder with or without agoraphobia, acute and posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), separation-anxiety disorder, social anxiety disorder (SAD), and specific phobias.
The basic model used to guide treatment suggests that youths with anxiety disorders demonstrate problems in three realms of functioning. Methods of identifying and understanding physiologic arousal are used to help the young patient gain better control over the arousal.
Table 2 provides a list of different cognitions and associated behaviors that children experience, which may be responsive to CBT interventions.
This article addresses methods found effective in studies of a variety of disorders, and reviews additional data for the specific conditions. These approaches have used a sequential combination of relaxation training, instruction in altering the youth’s thoughts and images about feared situations, and, then, guided exposure of the patient to feared situations starting with the least feared situation to the most feared. The diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria10 and included overanxious disorder (n=30), avoidant disorder (n=9), and separation-anxiety disorder (n=8). The study examined the effectiveness of group CBT (GCBT) in a cohort of children 7–14 years of age.
At post-treatment, 67% of patients who received CBT and 40% of patients who received CBT and family therapy did not meet criteria for their primary diagnosis. In childhood, these worries often concern issues related to ability to perform, punctuality, and competence in various settings and circumstances. The illness may characterize itself by the affected individual refusing to go to school, or refusal to leave home or even go to sleep. The effects of both individual and group forms of the intervention yielded symptom remission for periods as long as 2 years. Though the reaction is commonly acknowledged by adults and adolescents to be excessive, such is not always the case with children.
This approach uses SST in combination with relaxation techniques, social problem-solving, positive self-instruction, cognitive challenging, and graded exposure to social situations in 12 weekly sessions, followed by two booster sessions 3 and 6 months later. Cognitive-Behavioral Group Therapy for Adolescents (CBGT-A)25 is a 16-session intervention that includes cognitive restructuring, behavioral exposure, social skills training, and problem-solving.
CBT that rewards children for gradually allowing more people to hear and see them speak at increasing volume and at increasing length has been found to be most effective in meta-analytic comparisons in relation to no treatment or alternative treatments that do not involve exposure and reinforcement.28 However, studies with a substantial number of subjects are limited.
The avoidance functionally impairs the child and may include avoidance of the name of the object, pictures of the object, and physical contact with the object.
Very often patients will seek medical treatment for fear they may be at imminent risk of dying. Panic disorder is seen in approximately 3% of adult samples31 and is twice as common among females than males. These elements included breathing training, relaxation, coping strategies, and gradual exposure. The consequent symptomatology that evolves must include elements of re-experiencing the traumatic event, a consistent pattern of avoidance of themes associated with the traumatic event, and a hyperarousal which may manifest itself as difficulties with sleep, concentration, and even anger outbursts. They examined the impact of TF-CBT in three randomized cohorts of children only, parents only, and both parents and children. March and colleagues43 conducted an 18-week study of 17 subjects who had developed PTSD after a single stressor. Incidence has been found in the range of 1% to 3% of all youths.44 Youths with OCD experience repetitive ideas (obsessions) that are distressing by themselves or that provide strong suggestions to the youths that a certain set of actions is required to prevent future harm to the self or others. Over the years, relaxation approaches and cognitive treatment to build alternative ideas have been found of limited impact in adult patients. Children and adolescents have been trained to delineate in detail the obsessive cognitions that fuel their compulsive actions and state the strength of urges to follow the dictates of those cognitions. In one study, Barrett and colleagues48 found 88% of children who received individual therapy to be free of a diagnosis of OCD as compared to 76% who received group CBT and 0% in the waitlist control group. Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM, Southam-Gerow M, Henin A, Warman M. It is designed to strengthen personal motivation for commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. The belief is that the client already has in them what is needed for change and it is the therapist job is to help call this inner wisdom forward. During sessions, the client and therapist are working together to understand what the problems are and to develop a new strategy for tackling them. Thoughts about life situations and events create your feelings and behaviors so the premise of CBT is that changing your thoughts will change your feelings and behavior. People tend to prefer CBT if they want a more practical treatment, where gaining insight isn’t the main aim. DBT is a modification of standard cognitive behavioral treatment emphasizing skills training, homework assignments, symptom rating scales, and behavioral analysis in addressing life problems. The SFBT approach assumes that all clients have some knowledge of what would make their life better and that everyone who seeks help already possesses at least the minimal skills necessary to create solutions. Mindfulness is the process of observing, describing, and participating in reality in a nonjudgmental manner, in the moment and with effectiveness. When you recognize the moment, what it looks like, feels like, tastes like, sounds like – you are being mindful.The purpose is not to induce relaxation but to change our relationship to pleasant, unpleasant and neutral experiences.
The intent is not to fix how we are thinking or feeling but to bring greater awareness to the experience just as it is and to allow the space necessary to make a more mindful, intentional choice.
IPT typically addresses four interpersonal areas: grief, role transition, role dispute and interpersonal conflicts.
The psychodynamic relationship between therapist and client is an important aspect of the therapy as the client works out their issues through transference and countertransference and resistance. Many have residual negative effects of these experiences in the form of negative thoughts or feelings (may be flashbacks or reliving of the event).  Some will clear naturally and with support over time while others persist. You may also download a PDF copy of this book (46 MB) or just this chapter (3 MB), suitable for printing or most e-readers, or a .zip file containing this book's HTML files (for use in a web browser offline). During the assessment the psychologist may give personality tests such as the Minnesota Multiphasic Personal Inventory (MMPI-2) or projective tests, and will conduct a thorough interview with the patient.
For instance, men who are experiencing erectile dysfunction disorder may need surgery to increase blood flow or local injections of muscle relaxants. The fundamental aspect of psychotherapy is that the patient directly confronts the disorder and works with the therapist to help reduce it.
It is estimated that there are over 400 different kinds of therapy practiced by people in many fields, and the most important of these are shown in Figure 13.2 "The Many Types of Therapy Practiced in the United States". Most generally, you will know that you or others need help when the persona€™s psychological state is negatively influencing his or her everyday behavior, when the behavior is adversely affecting those around the person, and when the problems continue over a period of time. Just as you go to a dentist for a toothache, you may go to therapy for psychological difficulties. The analyst engages with the patient, usually in one-on-one sessions, often with the patient lying on a couch and facing away. The therapist then tries to interpret these free associations, looking for unconscious causes of symptoms. The analyst may try out some interpretations on the patient and observe how he or she responds to them.
The patient might forget or miss appointments, or act out with hostile feelings toward the therapist.
For instance, the patient may transfer feelings of guilt that come from the father or mother to the therapist. In these a€?brief psychodynamic therapies,a€? the therapist helps the client determine the important issues to be discussed at the beginning of treatment and usually takes a more active role than in classic psychoanalysis (Levenson, 2010).Levenson, H. Humanistic therapy is based on the idea that people develop psychological problems when they are burdened by limits and expectations placed on them by themselves and others, and the treatment emphasizes the persona€™s capacity for self-realization and fulfillment. A person with a social phobia may want to be able to leave his or her house, a person with a sexual dysfunction may want to improve his or her sex life, and a person with OCD may want to learn to stop letting his obsessions or compulsions interfere with everyday activities.
As you can see in Figure 13.4 "Cognitive-Behavior Therapy", CBT is based on the idea that there is a recursive link among our thoughts, our feelings, and our behavior. The goal is simply to stop the negative cycle by intervening to change cognition or behavior. People who learn to improve their interpersonal skills through skills training may be more accepted by others and this social support may have substantial positive effects on their emotions.
The assumption is that the fear will subside as the client habituates to the situation while receiving emotional support from the therapist during the stressful experience. An unpleasant stimulus is intentionally paired with a harmful or socially unacceptable behavior until the behavior becomes associated with unpleasant sensations and is hopefully reduced. In cognitive therapy the therapist helps the patient develop new, healthier ways of thinking about themselves and about the others around them. If the therapist can remind the person that she has a mother or daughter who does care about her, more positive feelings will likely follow. She had very severe separation anxietya€”if her mother left the room, Bethany would scream until she returned. At times she seemed terrified to be without her mother, but at other times she would leave the house in a fit of rage and not return for a few days.
These drugs are likely to help her feel better and will reduce the possibility of another suicide attempt, but they will not change the underlying psychological problems.
The therapist will understand that because Bethany does not have good relationships with other people, she will likely seek a close bond with the therapist, but the therapist will probably not allow the transference relationship to develop fully.
She feels that people are rejecting her, but she is probably bringing these rejections on herself.
This article will delineate the principle components of CBT along with recent advances in its uses.
Cognitive-behavioral therapy (CBT) has a history of working with anxiety disorders in adults prior to the availability of modern pharmacologic agents4 and seems likely to serve as a promising viable option in children. There are also nonspecific anxiety disorders as well as those that are attributable to a medical etiology.
First, they experience high levels of physiologic arousal involving the autonomic nervous system in selected situations or in anticipation of encountering those situations. Following this step, many approaches instruct the youths in methods to gain control over their bodies and find and practice a means to diminish arousal.
Focus on anxiety conditions in general may be most useful as many children and adolescents with anxiety disorders present with several disorders at the same time.
While in the feared situations, the child utilizes relaxation and cognitive methods to cope with arousal and distress so he or she can remain in the situation until anxiety subsides. Treatment conditions included either 16 weeks of CBT (n=27) or an 8-week wait-list control condition (n=20).
Once again, the group was diagnostically heterogeneous and included subjects with overanxious disorder (N=30), separation-anxiety disorder (N=30), and SAD (N=19). In this study, 56 youths (6–16 years of age) were randomized to either GCBT or a wait-list condition.
At follow-up, 100% in the CBT alone group were diagnosis-free while 80% of the combined CBT and family therapy group were free of a disorder. Additionally, it is often noted that over the course of the illness, the theme or focus of the worries changes. For separation anxiety, the treatment focuses on building relaxation skills, challenging cognitions that state that separation may lead to harm to either the child or important attachment figures, and exposure to increasingly long separation experiences.
Furthermore, the consequent behaviors must interfere significantly with ongoing functioning.
Subjects were randomly assigned to the behavioral treatment or a nonspecific intervention which consisted of study skills and test-taking strategies. This method by itself and in combination with parental involvement were compared to a wait-list control group in a study with children 7–14 years of age.
In a small randomized, controlled trial26 there were significant reductions in clinician-rated interference scores in the CBGT-A group (n=11) compared with the untreated group (n=22). Phobias are fairly common, appearing in up to 10% of youths.29 Empirically supported treatments for phobias involve more behavioral therapy approaches than CBT approaches.
In addition, these fears are accompanied by the presence of a number of bodily symptoms which may include chest pain, dizziness, nausea, chills, trembling, and palpitations. Patients were randomly assigned to either trauma-focused CBT (TF-CBT) or child-centered therapy. These three treatment arms were contrasted to regular care in the community in a group of 100 sexually abused children who developed PTSD.
Children and adolescents most often experience obsessions that they must avoid contamination, that actions or items need to be checked for completion, or that they must engage in responses that even-out actions such as touching items with one side of their body the same number of times as the other side of the body. As interventions were developed for youths, these components were generally left out of the methods. They then rank the level of anxiety associated with exposure to situations and agree to expose themselves to situations at an ever-increasing level of anxiety without engaging in compulsive responses. In one of the most comprehensive studies conducted by the Pediatric OCD Treatment Study (POTS) team with 112 patients in two research centers, CBT alone was compared to sertraline alone, CBT and sertraline in combination, and medication placebo.49 CBT in combination with sertraline was more effective than CBT or sertraline alone.
In 1991, the National Institutes of Health consensus statement identified barriers of accessibility that often interfere with taking advantage of the benefits of CBT.50 The most seminal issue is the number of individuals trained to deliver the modality to the large number of children that are affected by anxiety disorders. It is important for these healthcare providers to understand that CBT moves away from dynamic interpretation.
An overview of controlled studies of anxiety disorders treatment in children and adolescents.
Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. Cognitive behavioral and attachment based family therapy for anxious adolescents: Phase I and II studies.
Separation anxiety disorder in children and adolescents: epidemiology, diagnosis and management. Treating anxiety disorders in children with group cognitive-behavioral therapy: a randomized clinical trial. The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement.
Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study.
School-based intervention for adolescents with social anxiety disorder: results of a controlled study. Empirically supported treatments for specific phobia in children: Do efficacious treatments address the components of a phobic response?
Cognitive behavioral treatment of panic disorder with agoraphobia in adolescents: a multiple baseline design. A treatment study for sexually abused preschool children: outcome during a one-year follow-up.
Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor.
Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity.
Acceptance, empathy and affirmation are key MI ingredients in recognizing a person’s absolute worth and autonomy to make choices that are right for them. The therapies focus on the thoughts, images, beliefs and attitudes that we hold (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems. Our thoughts can block us seeing things that don’t fit with what we believe to be true. Clients learn four sets of important skills – Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance.
At the end of the session the client is complimented for having managed to date and is invited to observe and experiment with behaviors that result in positive movement in the direction of the client’s identified goal. The practice is to observe, be curious, pay attention to experience not be controlled by it. It is important to know that it is not necessary to retell the incident in order to heal and that strategies can be learned to provide relief.  It is also important to honor our experience and to find meaning in our lives and relationships despite these experiences for they are something that happened to us -  they are not what defines us. Maladaptive behavior is learned by either respondent or operant means to either client’s situation and to offer intervention into maladaptive behavior patterns. Or they may be prescribed medications (Viagra, Cialis, or Levitra) that provide an increased blood supply to the penis, which are successful in increasing performance in about 70% of men who take them.
Therapy includes assessing the patienta€™s issues and problems, planning a course of treatment, setting goals for change, the treatment itself, and an evaluation of the patienta€™s progress. The therapists who provide these treatments include psychiatrists (who have a medical degree and can prescribe drugs) and clinical psychologists, as well as social workers, psychiatric nurses, and couples, marriage, and family therapists. Feeling good about yourself is the most important thing you can do, and seeking help may be the first step in doing so. Often people seek therapy as a result of a life-changing event such as diagnosis of a fatal illness, an upcoming marriage or divorce, or the death of a loved one.
Youa€™ll probably be surprised at how many people have been to counseling, and how many recommend it.
Furthermore, you can be confident that you will be treated with respect and that your privacy will be protected, because therapists follow ethical principles in their practices. The goal of the psychotherapy is for the patient to talk about his or her personal concerns and anxieties, allowing the therapist to try to understand the underlying unconscious problems that are causing the symptoms (the process of interpretationA technique of psychotherapy in which the therapist uses the patienta€™s expressed thoughts to understand the underlying unconscious problems.).
On the basis of the thoughts expressed by the patient, the analyst discovers the unconscious conflicts causing the patienta€™s symptoms and interprets them for the patient. The therapist attempts to help the patient develop insight into the causes of the resistance.
Humanistic therapies attempt to promote growth and responsibility by helping clients consider their own situations and the world around them and how they can work to achieve their life goals.
In these cases it is not necessary to revisit childhood experiences or consider our capacities for self-realizationa€”we simply want to deal with what is happening in the present. For instance, if we are feeling depressed, our negative thoughts (a€?I am doing poorly in my chemistry classa€?) lead to negative feelings (a€?I feel hopeless and sada€?), which then contribute to negative behaviors (lethargy, disinterest, lack of studying).


The client and the therapist work together to develop the goals of the therapy, the particular ways that the goals will be reached, and the timeline for reaching them. An advantage of the flooding technique is that it is quick and often effective, but a disadvantage is that the patient may relapse after a short period of time. Recent advances in virtual reality have allowed clinicians to provide CBT in what seem like real situations to the patient. A child who wets his bed may be required to sleep on a pad that sounds an alarm when it senses moisture.
The idea of cognitive therapy is that changing thoughts will change emotions, and that the new emotions will then influence behavior (see Figure 13.4 "Cognitive-Behavior Therapy"). The therapist will also realize that Bethany will probably try to resist the work of the therapist. If she can learn to better understand the meaning of other peoplea€™s actions, she may feel better. Minami is research assistant in the Department of Psychiatry at New York University (NYU) School of Medicine in New York City.
Gallagher receives grant support from the National Heart, Lung, and Blood Institute, the National Institute of Mental Health, and the Youth Smoking Prevention Program of Philip Morris USA. A review of well-controlled studies of different anxiety disorders in youths will be provided. Arnold and colleagues5 opined that CBT may be the optimal treatment modality for anxiety disorders in youths.
Second, accompanying the physiological arousal, the youths experience cognitive events that indicate that the arousal is a signal of danger or likely harm that is connected to the situation. Patients are then directed to understand the nature and content of thoughts, images, and interpretations of events or situations that are anxiety arousing.
However, specific conditions such as OCD and PTSD contain characteristics that are not responsive to elements of treatment programs designed for anxiety disorders in general. By study endpoint, the majority of patients (>60%) in the CBT arm failed to meet threshold criteria for an anxiety disorder. These children were randomly assigned to GCBT, GCBT plus family management, and a wait-list control group.
In the GCBT, more than five times the number of patients were illness-free when compared to the control group. Unfortunately, the study did not include a group that received no form of treatment and thus the study has limited utility. Beyond the presence of worries, this illness is accompanied by problematic symptoms such as concentration and sleep difficulties. Specific studies on this condition have reported positive impact when one element of the condition has included school refusal. The behaviorally treated group significantly improved in the realm of functioning and symptom reduction. Similar to other programs with a caregiver component, the combined approach taught parents to enhance their children’s skills by encouraging more social contact and rewarding children for meeting target experiences. At posttreatment, 45% of the treatment group no longer met criteria for SAD compared with 5% of the untreated group. To classify as a bona fide disorder, the individual must experience a number of additional worries which include having future attacks or concerns about the repercussions of the symptoms which sometimes produce an alteration in the individual’s consequent behaviors. In a larger scale controlled trial, Landon and Barlow32 enrolled 21 subjects between 14–17 years of age. Of those that completed the protocol (81%), 57% no longer met formal criteria for PTSD; 6 months after treatment this percentage increased to 86%.
Repetitive, intrusive thoughts or images about violence or sexual actions, or urges to engage in violence or sexual actions are also common.45 The disorder hinders mental, social, and academic performance.
As a result, the core components of CBT for OCD include exposure to situations that stimulate obsessive ideas, and the prevention of the compulsive responses in reaction to the obsessive thoughts. Remission rates for CBT and sertraline were 54% at the end of 12 weeks of treatment, while CBT alone had a remission rate of 39%, and sertraline alone resulted in 21% remission rate. Although CBT has been determined efficacious or promising in the treatment of several of the disorders, it is primarily learned by psychologists and some psychiatrists.
This article cites multiple examples that highlight the type and focus of parental and family involvement. Research has suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed e.g. Therapy is practiced by thousands of psychologists and other trained practitioners in the United States and around the world, and is responsible for billions of dollars of the health budget.
But therapy is also effective for general depression and anxiety, as well as for specific everyday problems.
Your sessions with the help provider will require discussing your family history, personality, and relationships, and you should feel comfortable sharing this information.
The following provides a summary of these principles as developed by the American Psychological Association (2010).American Psychological Association. When we or other people look at the negative behavior, the negative thoughts are reinforced and the cycle repeats itself (Beck, 1976).Beck, A.
The procedures are problem-solving and action-oriented, and the client is forced to take responsibility for his or her own treatment.
In virtual reality CBT, the therapist uses computer-generated, three-dimensional, lifelike images of the feared stimulus in a systematic desensitization program. Why rational emotive behavior therapy is the most comprehensive and effective form of behavior therapy.
She started acting out more and morea€”yelling at her parents and teachers and engaging in impulsive behavior such as promiscuity and running away from home. When confronted about them, Bethany said that one night she just got more and more lonely and nervous about a recent breakup until she finally stuck a lit cigarette into her arm.
And the therapist will likely begin using some techniques of behavior therapy, for instance, by rewarding Bethany for successful social interactions and progress toward meeting her important goals. This article elaborates on what constitutes CBT and reviews controlled trials of CBT in samples of children with anxiety disorders. Finally, because of the arousal and associated ideas, the youths engage in behaviors that lead to avoidance or escape from the situation in ways that hinder their functioning, or the youths tolerate the situation with high levels of distress and discomfort that hinder concentration or effective performance in the situation.
Means of challenging the truth or accuracy of their thoughts are provided and youths are usually directed to find a set of internal coping statements that more accurately reflect the true nature of the situation. The treatment program with the most empirical support for anxiety disorders in general is tailored to meet the needs of each child. This is a striking contrast to the outcome of the control group, where only 5% of patients no longer met diagnostic criteria. At the end of the study, remission rates for the active treatments were almost 65% as compared to 25% for the wait-list control group. Notably, youths in the control group did not improve from the pre- to the post assessments. However, it does provide a test for a family therapy approach that helped parents relax overly-attached interactions and alter overprotective behaviors.
Of note, the occurrence of school refusal has been reported in approximately 75% of children with SAD.16 King and colleagues21 reported higher levels of school attendance and reduced anxiety at separation after participating in combined CBT and parent-teacher training in anxiety management for a treatment group in comparison to a waiting-list control group.
Overall, there was a difference of 62% in cases that were diagnosis-free at the end of treatment between the behavioral treatment and the control group (67% versus 5%). Significantly more children who participated in SST alone or SST with parent involvement no longer met diagnostic criteria for SAD compared with the wait-list control group (58%, 87.5%, and 7%, respectively, at post-treatment assessment). Masia-Warner and colleagues27 found a similar pattern in a program conducted at schools that socially anxious teens attended.
The illness may or may not be accompanied by agoraphobia, which is an exaggerated worry of being in a situation or location from which escape is difficult.
In fact, similar to depression, it had been believed that panic disorder was not present in pre-pubertal children.
They were randomly assigned to either CBT treatment or a wait-list, which served as a control condition. To reduce anxiety, youths often engage in repetitive behaviors that diminish anxiety temporarily only to have it return within a relatively short period of time.
In a graduated fashion, youths are directed to resist engaging in the compulsive actions while anxiety is allowed to run its natural course of increase followed by gradual diminution of intensity as the body runs out of energy. Rates for combined treatment and CBT alone were significantly higher than rates for placebo, which was only 4%. The majority of non-doctoral therapists continue to receive supervision in other forms of therapy during training. Barrett13 helped identify the utility of a parent psychoeducational component in one study.
Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice.
Rogers argued that therapy was most productive when the therapist created a positive relationship with the clienta€”a therapeutic alliance. The client is assigned tasks to complete that will help improve the disorder and takes an active part in the therapy. Specially designed computer equipment, often with a head-mount display, is used to create a simulated environment. At times Bethany would have a close friend at school, but some conflict always developed and the friendship would end. DBT is essentially a cognitive therapy, but it includes a particular emphasis on attempting to enlist the help of the patient in his or her own treatment. Gallagher is also director of cognitive-behavioral therapy training in the Division of Child and Adolescent Psychiatry at NYU School of Medicine. Minami reports no affiliation with or financial interest in any organization that may pose a conflict of interest.
It also examines elements such as duration of effect or gains which in some cases have been maintained for periods up to 5 years. The origins of the arousal in connection with the situations of concern for a particular child are not always specified in the basic model.
This step helps patients keep a realistic framework so that images or thoughts of danger do not fuel avoidance. Each patient practices skills to match anxiety conditions such as separation from important adults, speaking in front of an audience, or approaching dogs or another feared animal. The 12-month follow-up revealed >20% greater illness remission rates for the combined treatment than GCBT alone.
As the name represents, this illness was characterized by the presence of numerous problems revolving around worries.
However, Last and colleagues22 found no difference in the return rate to school between an educational support therapy and CBT in a randomized trial with 56 school-refusing children. Youths in the CBT condition were taught to challenge ideas that making errors in front of a group or experiencing signs of negative evaluation or disinterest were intolerable events. Both treatment groups maintained relative gains at 12-month follow-up with no significant difference between the CBT with and without parents groups. Adolescents in the treated group were free of diagnosis in 67% of the cases, compared to only 6% in the attention-control group.
Changes were evident in the realms of PTSD symptomatology, behavior problems, and depression. In a 2-year follow-up,42 the group assessed progress at four different time points (3, 6, 12, and 24 months). As a consequence of the condition, patients often continue the compulsive behaviors, gobbling up large chunks of their time, or they avoid situations with which the obsessions are associated, thus constricting their activities and range of behaviors. Exposure sessions are often designed to last longer than 60 minutes so that children and adolescents are allowed to experience significant decreases in anxiety even in the face of obsessive worries. The group concluded that youths with OCD should be provided with CBT and medication in combination or CBT alone as the preferred means of treatment, with the final decision made based on the level of functional impairment with combined treatment used for moderate to severe disorders. In addition, issues that need closer examination seem to affect the magnitude of change produced by these interventions. The focus of this intervention was not related to disparagement, but guided parents to teach their children to approach previously feared situations, to coach their children to use their newly learned cognitive-behavioral skills, and reward their offspring for employing courageous actions. At the end of the session, they will plan another assignment ‘Homework’ to do outside the sessions.  At the start of the therapy, the therapist might ask the client to keep a diary of any incidents that provoke feelings of anxiety or depression, so that they can examine thoughts surrounding the incident. The therapeutic allianceA relationship between patient and client that occurs when the therapist is genuine, treats the client with unconditional positive regard, and develops empathy with the client.
Exposure treatment can be carried out in real situations or through imagination, and it is used in the treatment of panic disorder, agoraphobia, social phobia, OCD, and posttraumatic stress disorder (PTSD). The client and the therapist work together to prepare a hierarchy of fears, starting with the least frightening, and moving to the most frightening scenario surrounding the object (Table 13.1 "Hierarchy of Fears Used in Systematic Desensitization").
A common use is in helping soldiers who are experiencing PTSD return to the scene of the trauma and learn how to cope with the stress it invokes. In a standard approach, patients are treated at a hospital where they are administered a drug, antabuse, that makes them nauseous if they consume any alcohol. A dialectical behavioral therapist begins by attempting to develop a positive therapeutic alliance with the client, and then tries to encourage the patient to become part of the treament process. Variations in CBT approaches, such as the efficiency of group CBT models in the treatment of childhood anxiety disorders when compared to other forms of treatment or no-treatment controls, are reviewed. Rather, CBT concerns itself with building skills so that the child or adolescent can function effectively in the situation without experiencing undue distress.
The decision was made in the DSM-IV17 to modify the criteria of GAD for children and eliminate the diagnosis of overanxious disorder.
CBT in this study was accompanied by a high drop-out rate (16%), perhaps because the method did not involve intense instruction in anxiety management.
They also were exposed to experiences in which they encountered negative reactions during public speaking exercises. Results revealed that only two patients dropped out of the study and 84% of the sample that completed the CBT intervention were deemed diagnosis-free at the post-treatment assessment. In another study, Cohen and Mannarino40 compared the efficacy of TF-CBT to nondirective supportive therapy (NST).
The initial impact after the intervention on the parameters of PTSD, depression and behavioral problem were deemed comparably diminished at each of the four follow-up time points.
Schmidt and Woolaway-Bickel51 identified how factors such as compliance with assigned CBT homework and patient motivation may moderate individual responses to CBT. Other investigators15 have identified the positive aspects of parental involvement by helping alter overprotective behaviors.
Later on in the therapy, another assignment might consist of exercises to cope with problem situations of a particular kind.
The patient then confronts her fears in a systematic manner, sometimes using her imagination but usually, when possible, in real life.
Ellis noticed that people experiencing strong negative emotions tend to personalize and overgeneralize their beliefs, leading to an inability to see situations accurately (Leahy, 2003).Leahy, R. In DBT the therapist aims to accept and validate the clienta€™s feelings at any given time while nonetheless informing the client that some feelings and behaviors are maladaptive, and showing the client better alternatives. This article focuses primarily on those anxiety conditions where the literature substantiates the use of CBT in children and adolescents.
Table 1 provides common warning signs of the types of anxieties youths may demonstrate that can help cue a referral for treatment. A large study by Kendall and Warman18 identified the diagnostic overlap between the criteria for these two conditions, but nevertheless the term does periodically resurface in the childhood anxiety literature and thus merits clarification with respect to the condition’s potential interchangeability.
None of the individuals in the wait-list condition were diagnosis-free at the end of the study. This cohort of 65 preschool children who had experienced sexual abuse was randomized to one of the two treatment arms. Cohen52 correctly pointed out that it is not clearly understood which particular aspects of CBT are most responsible for the positive changes found.
Other forms of CBT intervention24 capitalize on teaching parents to enhance their children’s skills by encouraging more social contact and rewarding children for meeting target experiences. Clinical management of depression, hopelessness, and suicidality in patients with bipolar disorder. The therapist will use both individual and group therapy, helping the patient work toward improving interpersonal effectiveness, emotion regulation, and distress tolerance skills. The TF-CBT group once again demonstrated significantly more improvement in PTSD symptoms than the control group. Thus, issues such as duration of treatment and amount of exposure need to be more critically assessed.
Similarly, in panic disorder a patient may misinterpret his or her feelings of anxiety as a sign of an impending physical or mental catastrophe (such as a heart attack), leading to an avoidance of a particular place or social situation. Neuropsychological predictors of functional outcome in cognitive behavioral social skills training for older people with schizophrenia. Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: Impact of alcohol deterrents on outcome.
Finally, with very debilitating forms of these disorders, combined treatments using medication and CBT may prove the most effective approach, as was demonstrated in the POTS randomized controlled trial.
Aversion therapy is also used to stop other specific behaviors such as nail biting (Allen, 1996).Allen K. The intent is that clients may begin to implement some of the behavioral changes they just envisioned. The next step is to identify the most recent times when the client has had small pieces of miracles (called exceptions) and get them to repeat these forgotten experiences.
His goal was to develop a short-term therapy for depression that would modify these unproductive thoughts.
The sessions may also lead to transferenceAn occurrence in psychotherapy in which the patient redirects feelings experienced in an important personal relationship toward the therapist., in which the patient unconsciously redirects feelings experienced in an important personal relationship toward the therapist. In REBT, the therapista€™s goal is to challenge these irrational thought patterns, helping the patient replace the irrational thoughts with more rational ones, leading to the development of more appropriate emotional reactions and behaviors. Yet, despite these caveats, it behooves the practitioner to become familiar with these potentially powerful methods for assisting youths in a relatively short period of time.
Chronic nailbiting: A controlled comparison of competing response and mild aversion treatments. If a client claims that a€?everybody at work is out to get me,a€? the therapist might ask him to provide instances to corroborate the claim.
Some therapists believe that transference should be encouraged, as it allows the client to resolve hidden conflicts and work through feelings that are present in the relationships.
Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder.
If the patient has trouble dressing or grooming, then reinforcement techniques, such as providing tokens that can be exchanged for snacks, are used to reinforce appropriate behaviors such as putting on onea€™s clothes in the morning or taking a shower at night. If the patient has trouble interacting with others, reinforcement will be used to teach the client how to more appropriately respond in public, for instance, by maintaining eye contact, smiling when appropriate, and modulating tone of voice.




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