Topic 2: Cognitive Theories {by 2/1}

There are three readings due this week (Beck, A. T.; Beck, J. S.; Wright et al.).  For this discussion, share at least two thoughts: (1) What is your understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT?  (2) What are your initial impressions in your ability to understand and consistently apply the basic principles of CBT as a therapist?   (I realize many of you do not yet have any therapy experience. However, now is a good time to start thinking about being a CBT therapist. Many of you will be starting your practicum this summer!) Your original post should be posted by the beginning of class 2/1.  Have your two replies posted no later than 2/3.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

32 Comments (+add yours?)

  1. Cassie McGrath
    Jan 27, 2018 @ 16:16:13

    1) What is your understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT?

    Lazarus and Folkman worked to develop the concept of Cognitive Appraisal. In some ways, cognitive appraisal is the immediate cognitive thought that comes prior to the reaction. One important aspect that is discussed is how cognitive appraisals vary from person to person and even how that impacts reactions. An example of this is when someone gets in trouble in class for texting. One individual may become embarrassed or upset that he or she was spoken to. Another individual may get angry that he or she was spoken too. The reactions to this initial event vary. Another important factor to consider is that the cognitive appraisal is somewhat influence by past experiences. Lazarus and Folkman discuss that there is more to cognitive appraisal then just a simple immediate reaction to an event. They describe cognitive appraisal as more of a chain reaction of cognitive processing. They talk about cognitive appraisal as having the initial event occur and then there is an immediate thought that the individual has but this thought is followed by a cognitive process which then elicits the reaction. Another aspect of the theory that Lazarus and Folkman discuss is the way in which emotion comes in to play with cognitive appraisals. They talk about the impact of emotion being two-fold in that the emotion can affect the cognitive appraisals but in turn how the cognitive appraisal can have an impact on the emotion. Lazarus and Folkman also identify that there are two pieces of cognitive appraisal being the primary appraisal and then the secondary appraisal. I understand primary appraisal as the individual initially assessing the event and secondary appraisal processing what he or she can do.

    From this Lazarus and Folkman look into coping skills as the way in which an individual deals with overwhelming thoughts and emotions. An important distinguishing factor with coping skills is that coping skills are not everyday adaptations that the individual has made to get through the day. Coping skills and strategies are utilized when the individual does not have the resources needed in order to handle whatever the situation is presenting to them. When looking at cognitive appraisals and coping skills there is a definite connection to CBT. In CBT there is a focus on working through cognitive appraisals or automatic thoughts, when the automatic thought leads to a reaction that is maladaptive or unwanted. For example, if the individual has a consistent anxious reaction to public speaking but would like to work through this in CBT the therapist would work through the thought process and help the client to utilize coping skills to address the immediate and in the moment psychological stress that the client may be experiencing. Working through the automatic thoughts and working to adapt them and to utilize coping skills to address the way in which the individual reacts to the event are both aspects of CBT.

    2) What are your initial impressions in your ability to understand and consistently apply the basic principles of CBT as a therapist?

    I feel that I have some understanding of the general concepts that apply with CBT. I think that I have begun to understand the bottom structure of CBT but I have yet to learn any of the application. I think that when it comes to the theory and the way in which CBT is supposed to work and how in some ways it is applied I have some basic understanding and I am aware of some of the tools that are used in therapy. However, I think that I have not been able to see some of these tools in action or work through some of these basic structural concepts with a client. I think that once I learn to utilize some of the tools that CBT offers I will be able to more consistently apply these skills into practice. I think that at this point I have had exposure to more therapeutic approaches then only CBT and not a strict focus on CBT. I do feel somewhat confident in some of the basic principle of CBT. There are also aspects of CBT that I really like and can feel myself leaning towards when I consider therapy. I like the idea of utilizing homework in some way with a client and I like the idea that this homework is not a rigid concept and that there is room for some options. I also like the idea of adapting and changing automatic thoughts, although I still struggle to see how that will be done based on what I have learned up to this point in time.

    Reply

    • Matthew L
      Feb 03, 2018 @ 18:19:50

      Hi Cassie,

      To start I really liked your point on how cognitive appraisal can influenced by a variety of factors. In particular how emotional states can effect cognitive appraisal and at the same time be affected by cognitive appraisal. That sort of two way street relationship is does not really seem present in the CBT conception of automatic thoughts. Your distinction on coping skills was also very effective because it further clarified how exactly coping skills were being discussed within this context. Given that coping skills can be viewed from several different perspectives I found this small point to be very helpful. Lastly I share your struggles in trying to conceptualize exactly how we will go about changing automatic thoughts through therapy. Out of everything we have learned how to formulate effective homework tasks and the implementation of those tasks has not really been present just yet. Thought I anticipate we will learn more about it later in this course.

      Reply

    • Abbey Lake
      Feb 03, 2018 @ 18:20:25

      Hi Cassie,

      I enjoyed reading your post because you made some interesting points regarding Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT. My understanding of the reading was also that importantly coping skills are not simply everyday adaptations as you had discussed. It is important to understand that coping skills are used when an individual does not have particular resources to handle a certain situation or event. Some examples of these resources could be social support or problem solving skills. I liked your example regarding coping and public speaking because public speaking is something that makes many people anxious and CBT could be a great way to work through this challenge for some. I also feel as though once I gain more clinical experience I will be able to more consistently apply CBT skills into practice.

      Reply

    • Tori Bryant
      Feb 03, 2018 @ 20:44:37

      Hi Cassie,

      I found your response to question #1 very clarifying and insightful! You sum up Lazarus’ and Folkman’s points really well and relate it back to CBT in an understandable way. I like how you used the specific example of public speaking in regards to coping skills because I feel that is a relatable topic we will run into with some clients. CBT can help those clients with a fear of public speaking perceive/appraise that event in a more positive or less anxiety provoking way which will then in turn increase adaptive behavior. This is a super relevant example and I’m glad you referred to it in your post so we can use it when thinking of the concept of appraisal and coping.

      Reply

  2. Stephanie Mourad
    Jan 31, 2018 @ 20:36:26

    (1) What is your understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT?

    Cognitive appraisal refers to evaluating cognitive processes that intervene between the encounter and the reaction. Through this process, the person evaluates the significance of what is happening for his or her well-being. There are three types of cognitive appraisals: primary, secondary, and reappraisal. Primary appraisal consists of the judgment that an encounter is irrelevant, benign-positive, or stressful. Secondary appraisal is a judgment concerning what might and can be done. Reappraisal refers to a changed appraisal based on new information from the environment and/or the person. It’s relation to CBT is that its more of an evaluation and during CBT, therapist and client work together to digest the situation, analyze it, and find the core reasons why a particular situation is bothersome to the client. The focus isn’t only on what has happened before or after the event and reaction but rather all the factors that play in the middle.
    Coping is the person constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the person’s resources. Coping is a major factor in the relationship between stressful and adaptive/maladaptive outcomes. Coping is related to CBT in that clients, who are going though situations such as stress or anxiety, find ways to effectively deal with the situation they are currently going through. There are different types of coping that can be done through emotions and problem-focused. Both forms can facilitate and impede in the coping process. Problem focused coping is often more effective in reducing stress long term.

    (2) What are your initial impressions in your ability to understand and consistently apply the basic principles of CBT as a therapist?

    I have learned different techniques and tools used in CBT during my first semester of graduate school and my understanding of the basic principles are very limited but I am certain that by the end of the program, I will be more confident in taking on these principles and approaches. Unfortunately I do not have any experience in this field but I am planning on starting my practicum/internship in the summer and I believe that this will help me understand the process more. I am visual learner and I learn better when I am applying these principles, rather than just analyzing and understanding them. I have also been in therapy and I have seen a CBT counselor, so I think that is also a benefit in understanding the principles of CBT. I think it’s a different experience when you are the client yourself and having those principles applied to you. It gives you an understanding of how to apply those principles to your own potential clients. Overall, I need to put my learning into action in order to really know if I understand the principles of CBT and I am certain that with the help of professors and supervisors, I will be able to apply them appropriately.

    Reply

    • Lexie Ford-Clottey
      Feb 03, 2018 @ 10:57:16

      Hey Stephanie,
      In your discussion of your initial impression to both understanding and applying the principles of CBT, you mention the importance of being a visual learner. Just like you, I learn best when I can be more hands on with a task and by actually having the ability to see things in action. In my opinion, reading or learning about CBT is only one part of the process, but being able to actually use these skills in real life makes all the difference. With this said, I definitely agree that both practicum and internship will help many of us in this program gain a better understanding to the role and responsibilities of a CBT therapist. I also appreciate your honesty in this post, in which you’re able to view your own experience in therapy as a benefit to your relationship with clients, rather than something to be ashamed of. Having the knowledge of what it is like to be a client may strengthen your ability to empathize with others as a therapist. Empathy is a critical and necessary component to CBT, and a very important aspect to the therapeutic relationship.

      Reply

    • Abbey Lake
      Feb 03, 2018 @ 18:07:00

      Hey Stephanie,

      You explained cognitive appraisal in a very detailed and sophisticated way. It is important that you considered the three different types of cognitive appraisal. You also made a strong point that the factors that come into play in the middle rather than just before or after an event are significant. It is also important to understand that coping can either be emotion focused or problem-focused as you had mentioned. I think that problem-focused coping is more effective in reducing stress in the long term mostly because it is more direct and targeted towards a specific situation that may be challenging for an individual and causing the individual distress. I agree that practicum and internship will help each of us to gain a significant amount of confidence in practicing CBT.

      Reply

  3. Tori Bryant
    Jan 31, 2018 @ 22:36:23

    1) Lazarus’ and Folkman’s concept of cognitive appraisal and coping appears to express the idea that how one appraises an event cognitively, will influence how that individual then copes cognitively and behaviorally with that event. Appraisal and coping are both process based because people can reexamine an event and shift their response to it. These notions are related to CBT because appraisals are similar to how one perceives a stimulus/event, which determines what the person thinks about the stimulus/event. If someone perceives/appraises a stimulus he or she is experiencing presently as extraordinarily stressful, he or she is not going to cope or behave in an adaptive way. For example, those with a specific phobia expect whatever object or event they fear to be incredibly stress inducing; however, those who practice CBT can help shift how those with specific phobias appraise, or cognitively shift, how they perceive the stimulus. Once the stimulus is appraised or thought of in a more reasonable way, coping and behavior will be much more functional for the individual who was greatly stressed by it.

    2) My initial impression in my ability to understand and consistently apply the basic principles of CBT as a therapist is largely positive. I do think it is important to keep in mind that simply because the principles of CBT are laid out so clearly and appeal to logic, that does not mean applying the principles is a simple thing to do. When I consider my ability to apply these principles I attempt to envision myself at my ideal practicum placement, which would be at a women’s crisis center. The first principle Judy Beck mentions states, “Cognitive behavior therapy is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms.” When reading this principle, it seems fairly obvious that those who practice CBT should approach therapy individualized, ever-evolving way; however, those who are survivors/victims of trauma typically have so many maladaptive, but understandable, cognitions that can change moment-to-moment, day-to-day, and so on. To meet a client’s needs, therapists need to keep up with these various cognitions and address them appropriately which can be a great challenge. The theory behind the principle seems to make a lot of sense, but the practice is much more complex and demands rigorous participation on the therapist’s end.
    I also believe that the because most, if not all, of the principles require collaboration between client and therapist it is imperative that the therapeutic alliance is extremely strong. If the therapeutic relationship is not sound especially in regard to CBT, most of the work required to make significant changes cannot be done. As a trainee, it will be crucial to evaluate how one is doing in building that relationship with clients. Utilizing and understanding these CBT principles appropriately is going to require intentional time, practice, and experience.

    Reply

    • Stephanie Mourad
      Feb 03, 2018 @ 11:44:56

      Hi Tori,
      I agree with you in the sense that therapists need to keep up with various cognitions and address them appropriately. Clients come into therapy for various reasons and not all the CBT principles will apply to each client so I agree that it is important to realize that all clients should be treated separately when conducting therapy. Everyone is different and there will be certain things that therapists will use with one client that they may not necessarily use with another client. I also agree that with practice, we will become better therapists and that we need to be put into work to really understand these principles.

      Reply

    • Teresa DiTommaso
      Feb 03, 2018 @ 13:21:25

      Hi Tori,

      I really appreciate your example of working with trauma patients in reference to CBT. Although J.Beck presents the principles in a clear, structured way, it is clear that the application of CBT is much more complicated than it seems on paper. The example of trauma clients is such a salient example of how these cognitions, or automatic thoughts and core beliefs, can vary so much really puts this into perspective. One of the most important segments I think I have read from these posts is that becoming an effective CBT therapist requires “intention.”

      Reply

    • Aleksa Golloshi
      Feb 03, 2018 @ 15:45:10

      Hi Tori,

      I enjoyed reading about your thoughts involving the therapeutic relationship between a client and therapist. I agree when you say the relationship needs to be strong in order to apply CBT principles effectively and to ensure that the client’s needs are being met. I too believe the therapist should have extensive training and skills so that the client is benefitting from the therapy. It would not be fair to the client to partake in therapy that was not addressing their main concerns or helping them with maladaptive behaviors as effectively as possible, therefore the therapist should spend time truly understanding their client and the reasons that have led them to seek help.

      Reply

    • Cassie McGrath
      Feb 03, 2018 @ 16:13:05

      Hi Tori,

      I really like that you mentioned the collaboration between the client and the therapist. You are identifying something that could easily be overlooked when you begin working with clients. I think that it is easy to get wrapped up in the techniques and the things that we are learning in our classes that sometimes you can lose site of the client. Being able to maintain a balance between your personal growth in the techniques and to dually pay attention to the client is very important. Even in the future, once there has been a mastery of the concepts and practices of CBT that collaboration is important. I think that there are times where collaboration can get lost when the clinician is focused on the techniques or comparing clients. I think it is really important that you are already thinking about this and that it is something that you continue to pay attention to.

      Reply

    • Allexys Burbo
      Feb 03, 2018 @ 16:46:47

      Hey Tori,

      I think you make a great point in explaining how important it is to keep in mind that while the underlying principles of CBT are clearly outlined this does not necessarily make their application simple in nature. In any case, it is essential that the learning clinician work hard to ensure that these principles stay at the forefront of consciousness so that he/she is able to practice effectively within the realm of CBT. Additionally, as you alluded to, client factors will significantly impact the course of the therapeutic alliance and in turn the course of therapy. In this instance especially, the learning clinician will need to be confident in his/her knowledge of basic CBT principles as challenges to the therapeutic orientation may emerge and threaten the clinicians ability to apply therapy both effectively and consistently.

      Reply

  4. Sarah Mombourquette
    Jan 31, 2018 @ 22:59:25

    1) Cognitive appraisal can be described as the way that a person processes an encounter in relation to its impact on well-being. The process is explained by Lazarus and Folkman as “evaluative” because it involves an evaluation of significance in the person’s life. Primary cognitive appraisals include irrelevant, benign-positive, and stress appraisals. Benign-positive appraisals are important to consider in relation to CBT because it is when a person expects the outcome of an encounter to enhance his or her well-being. Therefore, this could be an internal protective factor for a person who is constantly exposed to risk factors connected to depression or anxiety. Stress appraisals could also be connected to CBT because they relate to the anticipation for harms or losses, threats and challenges. The concept of threats is important to consider because it reflects a negative expectation that has not taken place yet. The anticipation, or worry, can directly relate to various anxiety disorders presented in clinical settings. On the other hand, because a challenge involves focusing on the potentiality for growth, a clinician could work with a client to transform the encounter from a threat to a challenge. Secondary appraisals also take coping into consideration when evaluating an encounter. In other words, secondary appraisals determine the likelihood that skills and strategies will be able to accomplish their goals. Therefore, the practice of CBT can not only help to practice new skills and coping strategies, but can also enhance a client’s confidence in these strategies.

    2) I was originally drawn to CBT because of its basis in evidence-based treatment. Therefore, I have found that my initial impressions of my ability to understand the basic principles of CBT are positive. Because CBT is so grounded in science, I am able to trust that the principles and skills presented to us are effective because there is concrete evidence to back them up. This trust in the effectiveness of CBT has therefore made it easier to grasp the overarching concepts. As a therapist, I hope that my confidence in CBT can indirectly give my clients confidence in the process as well. I do not have any direct experience with CBT yet. However, I think that having an understanding of the basic principles is the minimum foundation from which I can continue to learn and grow as a therapist. It is important to learn and study the concepts before applying them. However, I do not think it would be possible to be fully confident in my application of the principles of CBT without practice. While I recognize that our starting point is in a classroom setting, I look forward to the application of these principles in my practicum and internship because I will be able to directly apply everything I have learned to a clinical setting.

    Reply

    • Lexie Ford-Clottey
      Feb 03, 2018 @ 13:35:16

      Hi Sarah,
      I think it is important that you emphasized CBT being grounded on evidence-based treatment, since this factor is critical in the understanding of this therapeutic orientation. This distinction sets CBT aside from other forms of therapy, and allows for clients to receive the best treatment as indicated by research. Knowing that CBT is based on science and supported by research allows me to trust these principles and feel confident in my ability as a therapist. Therefore, my understanding of CBT as being centered on evidence-based treatment is the main reason I applied to this program. I also like how you mention that in order to apply the principles of CBT one has to first understand what CBT is. I agree with this reasoning, and believe it would be quite difficult for a therapist to build a relationship with clients if they are uncertain about the principles of CBT. This shows that an efficient CBT therapist is one that is both knowledgeable and collaborative in their approach to therapy.

      Reply

  5. Lexie Ford-Clottey
    Feb 01, 2018 @ 10:32:57

    1. The concept of cognitive appraisal, as discussed by Lazarus and Folkman, is centered on well-being, in which a person evaluates whether a particular event/encounter with the environment is relevant and in what ways. In order to better understand an individual’s personal interpretation of a situation and possible reactions, the role of primary and secondary appraisal is important within this process. Through primary appraisal an individual is able to assess the event and may ask themselves “How does this affect my well-being” in trying to determine if the situation is not important (irrelevant), good (benign-positive), or stressful. Primary appraisal is an individual’s way of deciding how significant an event may or may not be, indicating that some situations can be perceived as threatening while others may provide an opportunity/benefit. Secondary appraisal involves managing the situation, in which what can be done is based on the types of strategies utilized and if coping options are available. This shows that it is important to keep in mind the variability associated with cognitive appraisals, indicating that people and groups differ in their sensitivity and vulnerability to certain events, as well as in their interpretations and reactions. For example, the finalizing of a divorce for one person may represent a sense of relief or freedom while another person may respond with anger. With this said, reactions to comparable conditions vary, indicating that the appraisal of a situation involves a chain of cognitive activity that is based mostly on past experiences. Therefore, in order to understand variations among individuals under similar conditions, it is important to take into account the cognitive processes that intervene between the encounter and the reaction, and the factors that affect this mediation. The concept of cognitive appraisal relates to CBT in the sense that appraisals can be accurate or inaccurate. How individuals may interpret or react to situations is important, indicating that maladaptive cognitive appraisals are thought to cause or maintain distress/impairment. With this said, the goal of the CBT therapist is to help clients modify these appraisals (automatic thoughts) in order to reduce stress and increase well-being.
    Coping, often related to cognitive appraisal, focuses on a person’s efforts to manage demands, especially when these demands exceed personal resources. How individuals deal with stressful feelings and thoughts can be defined by the relationship between the person and the environment, which is constantly changing. With this said, the two forms of coping that people tend to use in most stressful encounters include emotion-focused coping and problem-focused coping. Emotion-focused coping is most often used when an individual feels as if they cannot manage the source of the problem, in which the stressor is seen as unchangeable. This form of coping can result in avoidance or distancing. Problem-focused coping is when individuals feel they have control over the situation and that the problem can be managed. This form of coping is most effective in facilitating change and allows for the individual to develop more adaptive behavior patterns. Coping is related to CBT because effective coping skills serve a major role in the process of therapy and specifically in treatment strategies. With CBT being a direct and focused form of therapy, a CBT therapist would most likely find problem-focused coping as a great way to facilitate new skills and behaviors. CBT is heavily based on helping clients develop appropriate and adaptive behaviors, in which effective coping strategies allows for individuals after therapy to deal with stressors more efficiently.

    2. With this being my second semester in this program, I find my initial impression in my ability to understand and consistently apply the basic principles of CBT as positive but still a work in progress. The therapeutic orientation of CBT is one that makes sense to me, but in no means do I feel confident in my ability to utilize specific techniques and tools on actual clients without supervision. Although I have no prior clinical experience, I consider the role-plays and group work I have participated in last semester (specifically PSY 600) as helpful in understanding the responsibility of a CBT therapist. I am also confident that starting internship will provide me the opportunity to further my understanding of the structure of CBT from a more hands-on approach. In my opinion, reading or learning about CBT is only one part of the process, but being able to actually use these skills in real life makes all the difference. I view my ability to consistently apply the basic principles of CBT as one that is going to take practice, in which making mistakes is okay because nobody is perfect. There are also many features of CBT that I like and find useful within the therapeutic process. One think I like about CBT is its focus on collaboration and active participation. As a therapist, I see myself working together with clients to set goals and treatment options. It is important that my role as a therapist is viewed as one that is from a teacher or coach stance rather than me dictating what someone should and should not do. I also find the use of homework between sessions as a central and necessary feature to treatment. I like the idea of giving clients homework because it allows them to practice new skills outside of therapy while providing an opportunity for more adaptive thinking. With this said, I view this process as one big learning opportunity that involves both an understanding of CBT as well as the ability to apply these skills effectively in therapy.

    Reply

    • Stephanie Mourad
      Feb 03, 2018 @ 11:54:42

      Hi Lexi,
      I agree with you that our PSY 600 course gave us a little bit of a head start with conducting therapy. I enjoyed “practicing therapy” with our classmates and it gave us an idea of what the process may look like. It gave us opportunities to ask questions, analyze the situation together, and be able to apply our CBT principles and skills.
      I agree that the collaboration and active participation is important as well in CBT. I like that its not just the therapist telling the client what to do and how to act but rather, the therapist and client working together as a unit to come up with therapeutic goals and techniques. Homework is also important in CBT and I think its important with active participation. Therapists should emphasize the importance of homework from the initial session so that clients are prepared to be active in the process.

      Reply

    • Tori Bryant
      Feb 03, 2018 @ 20:50:32

      Hi Lexie,

      I really appreciate the realness of your answer to question #2. I think if we, as trainees, started seeing clients believing we are completely prepared and competent in applying the concepts of CBT, we would be very surprised and unprepared for the curveballs that would be thrown our way. As helpful as 600 was with getting us started in practicing these rapport building techniques, we still have a lot to cover and it will be really important to take honest looks at ourselves throughout this growing experience. I do think we have more knowledge and understanding than we realize and hopefully we can all take comfort in that and be patient with ourselves as we go with the flow of doing really good therapy and making mistakes along the way. Utilizing each other and supervision will be really good resource for us going forward!!

      Reply

  6. Allexys Burbo
    Feb 01, 2018 @ 11:51:02

    (1) According to Lazarus and Folkman, the cognitive appraisal functions as a mediator between events and responses. This evaluative process refers to the mental judgment, discernment, and choice of the individual that occurs just below the level of awareness. Cognitive appraisals function in a way similar to automatic thoughts. In CBT, automatic thoughts are the reflexive thoughts that occur at the preconscious level. Both cognitive appraisals and automatic thoughts are usually based on past experiences in that their presence influences the events to follow. Cognitive appraisals consider the well-being of the individual and, in this instance, primarily determine whether an event will present harm or loss, a threat, or a challenge. Similar to this notion, automatic thoughts mediate outcomes and are dependent on the interpretation of such cognitions – that is, if an event triggers a negative association, the response will reflect this automatic thought. Coping proves another significant component within the cognitive-behavioral approach specifically in its relationship to stressful and adaptive/maladaptive outcomes. The coping process refers to the changing cognitive and behavioral efforts, exemplified by the individual, to mediate specific external/internal assessments that exceed or strain the individual’s resources. In its relation to CBT, coping functions as a self-preservation mechanism. Since the focus of CBT is on positively altering the cognitive-behavioral relationship, coping is utilized as an avenue for the individual to adjust to perceived threats by implementing effective counter strategies. Coping, in this instance, is not only a process that occurs internally but one that can be acquired through external means and regulated on a conscious level (through CBT practices).

    (2) In general, I feel confident in my ability to understand and apply the basic principles of CBT as a therapist although I am also cognizant that application goes beyond outlined principles. Because the experience of the client carries a significant amount of weight in the therapeutic process, clients will ultimately alter and determine the course of sessions. Since CBT principles are grounded in evidence-based research, however, their application in theory would be much easier to adhere to – that is to say that while client dynamics may fluctuate, CBT principles will remain consistent across each experience. Through my current and past work experiences I have been able to implement and demonstrate successfully some key CBT concepts – skills that have been reinforced and strengthened through this program. While my ability to demonstrate consistency is still to be determined, it is with practice that these skills will become second-nature and CBT principles readily accessible within the therapeutic setting.

    Reply

    • Teresa DiTommaso
      Feb 03, 2018 @ 13:31:20

      Hi Allexys,

      Although you recognize that there are important core principles to CBT that need to be followed, what I really appreciated about your post was a reminder to me, and to all of us, about the amount of fluctuation that results from the client. The client’s fluctuations, in cognition, emotion, behavior, or all of the above, determine treatment. An ability that is vaguely mentioned, although not a “core principle” is being about to adapt to our clients needs in multiple ways. This may be through our approach, treatment plan, or altering goals. It is so important to remember that changes in our patients happen throughout treatment, whether good or bad, and although it may seem like an obvious fact that this happens, I feel as if you have pointed out one of the most important keys to success a therapist must possess: adaptability and flexibility. However, I feel as if those skills cannot be learned through the classroom, but only through practice.

      Reply

  7. Teresa DiTommaso
    Feb 01, 2018 @ 14:08:00

    1.
    According to Lazarus and Folkman, appraisal is defined as the process of an individual perceiving a particular event in relation to the well being of that person. This process is ongoing and always changing, and mediates the reactions to the environment by the individual in relation to the characteristics of the person who is doing the appraising. It is not the situation or event that is simply being viewed or experienced, but the appraisal is how the individual reacts to such event. Those reactions can take many forms and are influenced by multiple factors of the individual, such as the individual’s beliefs about the situation, values, commitments, and style of thinking. Appraisal, at its core, is a cognitive act. In addition to being an immediate response, appraisals “go far beyond immediate and indeliberate cognitive-affective responses” (26). Cognitive appraisals are very applicable to CBT because of the relation to core beliefs, and therefore automatic thoughts. Individuals appraise an event based on previous experiences and prior appraisals. That is why appraisals are essentially reappraisals, those that change resulting from new information gained by the individual. The accumulation of all of this information through appraisals can be seen as part of developing core beliefs. For example, if an individual was constantly berated for not doing well in school by his or her parents, a core belief that could develop is that they are not intelligent. Therefore, this individual could appraise a new educational opportunity as threatening to them, with an assumption that “there is no use in trying because I will fail.” So instead of seeing the educational opportunity in a positive light or appraising it as a possibility, the individual may have the automatic thought: “I am not smart enough to succeed.” Through evaluating how an individual appraises certain situations, it is possible to uncover core beliefs and automatic thoughts and how those influence the cognitive appraisal process.
    In regards to coping, it is the constant change in the way one responds cognitively or behaviorally in response to trying to deal with internal or external demands that are appraised by the individual as stressful. Just like appraisals, coping is a process that involves three major features: assessment of what the person actually does or thinks, what this person does contextually, and regarding changes in coping strategies as a stressful event occurs (142). Coping strategies are really just how an individual deals with a particularly stressful situation, and over a period of patterns, those strategies can become either adaptive or maladaptive. Lazarus and Folkman mention two main categories of coping strategies and the discussion of these strategies I think are most important when talking about CBT. The first, emotion-focused forms of coping are centered on decreasing emotional stress, avoidance, minimization, and trying to attain positive value from negative events (150). This coping strategy attempts to change the meaning of the experienced stressful event. The second form of coping is the problem-focused form of coping, which attempts to directly define a problem, generate solutions, compare potential solutions, choose a solution, and act on said choice (152). Although emotion-focused coping does not always have a negative output, in relation to CBT, it seems that the problem-focused form of coping is the most applicable and appropriate means of teaching new coping skills to clients. Most importantly, it is in line with one of CBT’s main principles, that it is goal oriented and problem focused. Although there are many important facets of coping that can be applied to CBT, what I found to be most applicable was the problem-focused forms of coping Lazarus and Folkman put forward.

    2. Judy Beck has finally offered a straightforward conceptualization of the core principles of CBT and the main conceptualizations that one needs in order to become a therapist of this orientation. Although practice is never as simple or linear as presented in a book, it has really given me some ideas of where I can begin my application. With Beck’s breakdown of the conceptualization of patients, I believe I can start to see myself applying those steps. Beck speaks of first identifying present thinking, problematic behaviors, precipitating factors that are influencing the patient’s current state, developmental events, and during patterns of interpreting (7). Through this breakdown of conceptualization, I can imagine myself taking each of these steps to begin to conceptualize a case. By focusing on the present problem, the therapist can work backwards. If a client has been diagnosed with depression, then it is easier to work from that diagnosis back to their problematic thoughts and behaviors and the influences that have lead them to this point. I believe I can implement this idea of working backwards now that I know more of the standardized steps. Additionally, the cognitive model of events-automatic thoughts-reactions, in relation to Lazarus and Folkman’s readings of cognitive appraisals has shed a new light onto how I can begin to learn this orientation. The key surrounding automatic thoughts, core beliefs, and cognitive appraisals is truly getting to know your client and being empathetic. If you cannot understand where they are coming from, there is no way you can aid them in recovery. Therefore, forming a strong therapeutic alliance seems like another principle I feel a little more confident in attempting now that I know more of the type of questions to ask.

    Reply

    • Sarah Mombourquette
      Feb 03, 2018 @ 19:17:22

      Hi Teresa, I like how you connected cognitive appraisals to core beliefs and automatic thoughts. Because cognitive appraisals require us to process the particular situation first, it would make sense that, depending on how the situation is evaluated, a person could establish core beliefs and automatic thoughts. I also think that your point about coping as becoming either adaptive or maladaptive is very important. Sometimes people can align coping with avoidance. However, CBT shows us that coping can be an effective and adaptive way to deal with particular stressors. Lastly, the approach within CBT of working backwards can seem complicated. When you look at it in the way you described, however, it is easier to see how working backwards can be beneficial for both the client and the clinician. Similarly, I agree with what you said about the importance of being empathic and how essential that is to the therapeutic alliance.

      Reply

  8. Abbey Lake
    Feb 01, 2018 @ 14:18:37

    1.) Lazarus’ and Folkman’s conceptualization of cognitive appraisal seems to be centered on the idea that individuals may react to specific events differently from one another due to his/her unique conceptualization of a specific event and this conceptualization is regarded as responsible for causing an emotional response. In other words, cognitive appraisals impact reactions in individuals and may differ from one individual to another due largely to an individual’s unique past experience as this has potential to influence how one perceives a specific situation or event. Cognitive appraisal is not just an individual’s immediate reaction to a specific event, but rather a cognitive process that stems from an immediate cognition and it is this process that ultimately determines the degree of the emotional reaction. My understanding is that this process may include primary appraisal, secondary appraisal, and reappraisal. Primary appraisal refers to how an individual perceives that a specific event or situation will impact his/her well-being. Secondary appraisal refers to how an individual decides to respond based on his/her evaluation of that specific event or situation. Reappraisal is essentially just a modified appraisal. In relation to CBT it is important to understand cognitive appraisal, because it gives us a better understanding of why an individual may respond to a particular event or situation in a certain way. Understanding the individual’s thought process may aid in identifying where faulty cognitions arose and help to gain a deeper understanding of a client’s emotions.
    Lazarus’ and Folkman’s conceptualization of coping in relation to CBT is that coping is how an individual attempts to handle situations that elicit an appraisal that causes stress or overwhelms an individual. It is important to understand that primary appraisal and secondary appraisal account for variability in coping among individuals as they play an important role in coping according to the results of the intraindividual analysis determined by the study conducted by Folkman, Lazarus, et al. My understanding is that an individual may not necessarily have the resources to handle a particular emotional response to a situation. Some examples of resources may include social skills, social support, or problem solving skills. Lazarus’ and Folkman stress the idea that coping is process oriented, contextual, and adaptive and that in terms of reducing stress long-term problem focused coping tends to be more effective than emotion-focused coping. However, both emotion-focused coping and problem- focused coping are important to understand in regards to CBT. Therapists may determine which type of coping a client is struggling with most and which form of coping is needed first in a particular situation is also significant. Lazarus’ and Folkman make an important point that coping is not just problem solving but that it includes other functions too depending on the context. A major component of CBT involves the therapist working with the client to help change automatic thoughts and learn healthy coping strategies for different situations.

    2.) This semester is only my second semester in the clinical counseling psychology program, however, I am confident in what I have learned about CBT thus far. I think that it is imperative that a CBT therapist has considerable expertise and as Judy Beck discusses in our reading from this week, the cognitive model is quite straight-forward but each client is unique. Changing behaviors and beliefs and teaching new coping skills are all aspects of CBT that may be quite challenging due to the fact that life is always changing and people and situations are constantly evolving. I knew when I applied to this program that it was a CBT based program but I feel as though I am only now starting to truly understand just how important that is. CBT teaches clients in a fairly short amount of time skills for handling problems that will benefit them for a lifetime. I am excited to start my practicum/internship this summer because I am eager to gain a deeper understanding of the process of CBT and be able to apply what I have learned thus far from readings and lectures. I think I will gain a lot more confidence in myself once I start my practicum and gain some clinical experience in applying the principles of CBT.

    Reply

    • Aleksa Golloshi
      Feb 03, 2018 @ 15:59:21

      Hi Abbey,

      I like the fact that you mentioned people are constantly changing and evolving, which means that therapy might have to change along with the client. I think this is an important concept because if a significant event happens in our client’s life we need to alter our therapy or action plan to reflect that change. I believe therapy should be flexible so that our clients understand that we are going to help them regarding any disruption. I too am eager to start my practicum so that I can apply what we’ve learned in class to actual clients.

      Reply

  9. Aleksa Golloshi
    Feb 01, 2018 @ 14:43:45

    1. Lazarus and Folkman describe how cognitive appraisal acts as a mediator between an event that occurs and the response to that event. In order for an individual to cognitively appraise a situation they must decide if this specific encounter is relevant to their well-being and if they decide that it is, they also need to decide in what ways is it relevant. Lazarus and Folkman explain the role of cognitive appraisal containing three sections. The first section is primary appraisal and involves the individual asking himself or herself, “Am I in trouble or being benefited, and in what way?” The individual must use their judgment, discrimination, and choice of activity to assess the situation properly. Doing so will help the individual recognize if a situation is irrelevant, benign, or stressful. Lazarus and Folkman also discuss how a threat is different than a challenge but both may occur at the same time. The second portion of cognitive appraisal involves evaluating what can be done to overcome or prevent harm from a threat, or what can be done to improve a certain situation. When a person believes a certain behavior will lead to a certain outcome, this is referred to as outcome expectancy. If the person is convinced that they can successfully execute the behavior that is required in order to produce the desired outcome this is referred to as efficacy expectancy. Both of these concepts are important in terms of secondary appraisal. The last concept Lazarus and Folkman discuss is reappraisal. This term refers to changing appraisal based on gaining new information from the environment. These concepts are important in relation to CBT because they involve asking oneself important questions that need to be answered. One of CBT’s focuses is improving a maladaptive behavior so that it is not interfering so heavily with a client’s life. Asking a question such as “Am I being benefitted?,” which is discussed in the first section of cognitive appraisal, can help a client come to a realization and alter a relationship or a situation that is upsetting them or causing then to act in a negative way.

    Lazarus and Folkman also discuss coping, which they described as one’s cognitive and behavioral efforts that help them manage specific internal or external demands that might be too overwhelming for them. The two go into more detail and discuss three concepts that are imperative to coping. One must focus on what they think and do when in the stressful situation, consider the appraisal of the demands during this stressful situation, and lastly, focus on adapting. This changes the coping from one form to another as the relationship between the person and environment alters. Coping is an important skill to practice with certain clients as a CBT practitioner. CBT focuses on controlling emotions and behaviors so that a more adaptive live can be lived and by understanding what a person does during a stressful situation and learning to alter this behavior they can live a healthier life.

    2. My first semester really helped me understand the underpinnings of CBT and how the process appeared from a client’s and counselor’s prospective. I fully understand that each client and their reasons for seeking help are unique and individual to them so treatment plans and goals that are set should have these values as well. I know of the principles and mannerisms the therapy involves but I have yet to use them in practice. Jesse Wright and colleagues emphasize the importance of empathy, warmth, and genuineness, which are traits I think I’ve mastered, but of course there is always room for improvement, which I am completely open to. Wright and colleagues also discuss how humor is beneficial to the therapeutic relationship because it normalizes and humanizes the treatment alliance. This is a new concept to me and was really interesting to learn about. Like I previous mentioned, I currently do not have experience in the field but I am eager to start my practicum so that I can put into practice what I’ve learn and improve my CBT skills.

    Reply

    • Cassie McGrath
      Feb 03, 2018 @ 16:08:47

      Hi Aleksa,

      I think that you did a good job of explaining the process of coping and how it relates back to cognitive appraisal. You also did a good job of relating it back to CBT and how it can impact therapy and how therapy should have some impact on it as well. I also think that your comment about how unique every client is is very important. It is important to understand the techniques of CBT but being able to identify that every client is different and what works for everyone is different. I think that this is an extremely important factor and it is great that you are already considering how it may affect treatment. I think that there is room for growth for each of us in this program and even for the professionals in the field, but I also think that you are in a great place right now and are identifying important features of CBT and therapy.

      Reply

    • Sarah Mombourquette
      Feb 03, 2018 @ 19:16:34

      Hi Aleksa, I thought that your breakdown of appraisal was very good because you gave examples of what might be going through a person’s mind as he or she is appraising a situation. This is important because the process of the appraisal is what a clinician can focus on during therapy. I also think that your description of coping was effective because you emphasize the thinking that is involved. Because CBT places so much emphasis on cognitions of maladaptive behaviors, it is also important to focus on more adaptive cognitions such as coping. Lastly, I can relate to not having direct experience in a clinical setting. Like you said, however, having an understanding of the skills is what will make us feel more confident moving into practicum and internship. Similarly, we can only improve if we are able to continuously practice the skills, something this program will allow us to do.

      Reply

  10. Matthew L
    Feb 01, 2018 @ 14:46:41

    1) What is your understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT?

    In many respects Lazaru’s and Folkman’s conceptualization of cognitive appraisal and coping bears a heavy resemblance to cognitive behavioral therapy. The central idea behind cognitive appraisal is that the emotional response a person exhibits is a result of how they appraised a given situation and not the situation itself. Similarly a central concept to cognitive behavioral therapy is that the automatic thoughts and perception a person has about their life and situations are what causes their mental health issues. In both cases is reality is being disordered by a perception and the perception is what dictates the response from a person. Cognitive appraisal also states that past experiences influence the future appraisals and emotional responses made by a person. The same idea is also present in cognitive behavioral therapy in the form of core beliefs. Core beliefs are central ideas within a person that are developed during their earlier stages of life. These beliefs act a guide for how a person will respond to a given situation and are the produces for automatic thoughts. So much like in cognitive appraisal were past experiences influence future appraisals; early-created core beliefs give rise to automatic thoughts which dictates how a person reacts to situations. Lastly Lazaru’s and Folkman had the idea of developing coping skills, which could be utilized in situations where person feels overwhelmed and is unable to deal with their emotions at hand. Cognitive behavioral therapy also stresses the importance of learning coping skills however they function in a different way. For Lazaru’s and Folkman coping skills are reactive and are used when a person’s has been met with a troubling situation and needs them. For Cognitive behavioral therapy coping skills can be reactive but are mainly proactive and help to control for automatic thoughts preventing negative situations from happening.

    2) What are your initial impressions in your ability to understand and consistently apply the basic principles of CBT as a therapist?

    Given what I have learned about cognitive behavioral therapy thus far I feel I have a strong understanding of the basic principles and ideas. The theory and framework makes a lot of sense to me and when I review it in my mind I can see how it would function and work in a therapeutic setting. Though I feel I currently have a strong theoretical understanding I have little confidence in my practical application. I am currently at a level where I am working on mastering the very basics therapy techniques so I am not yet at a point where I can begin really apply the specific skills needs for a certain therapeutic discipline such as cognitive behavioral therapy. Another area I feel I am lacking in is the understanding of how to develop skills and actions to modify core beliefs. While this is a very practical skill and I have already mentioned I lack those at this level I feel there is a degree of theoretical understanding I might be missing in this particular area.

    Reply

    • Louis D’Angelo
      Feb 02, 2018 @ 13:42:42

      Hey Matt,

      I really like how you mentioned core beliefs when discussing cognitive appraisals and how these are the very irrationally held past experiences that influence our automatic thoughts and eventually our cognitive appraisals of the situation. In the aspects of our ability to correct core beliefs, I do think that we aren’t there yet as students and more applications and skills of cognitive restructuring is nessisary to understand a method for doing this. For me, thinking about my forecasted ability to apply these cognitive restructuring techniques, I’m worried that I will take on more of a stance from Ellis and directly telling a client that these beliefs are irrational and maladaptive instead of leading them to make the conclusion themselves in a collaborative fashion. I’m afraid I will fall victim to the righting reflex in telling a client that this is what they are doing and this is why it is maladaptive, these are things you should change. In our practicum in CBT, I believe we will get much more practice in applying basic principles of client-centered therapy and the collaborative aspects of the therapy and avoiding this righting reflex. But until then, it will be difficult to asses our abilities in this regard.

      Reply

  11. Louis D'Angelo
    Feb 01, 2018 @ 14:56:10

    1. The theory of cognitive appraisals specifically emphasizes individual differences from person to person and their experiences influencing how we asses, interpret, and react to our environment and is largely emotional and influenced by past experiences. For example, a victim of domestic violence may appraise a fighting couple as much more threatening than an individual who had experiences no domestic violence before. Two parts of cognitive appraisal include primary, involving the assessment of potential harm, positivity, or irrelevance of a stimulus, and secondary, involving one’s perceived control over the situation and what can be done in response. This involves many of Bandura’s concepts previously discussed including control, expectancies, and self-efficacy. Ginker and Siegel write that cognitive appraisal involves judgment, discrimination, and results in a chosen activity or responce. They specifically stress that this process in a cognitive process and requires an emphasis on mental activity when studying this phenomenon. These core concepts of cognitive appraisal including past experiences, judgments, expectancies, perceived control, and mental activity all tie to common concepts in CBT. For example, many of these appraisals results from immediate and emotional reactions when assessing harm or threat. In CBT, we have learned that automatic thoughts are also immediate emotional response based on a previously established core belief also build past experiences. These automatic thoughts of inadequacy and failure may result in irractional secondary appraisals on how we can effectively change our environment in relation to poor self-efficacy. Cognitive restructuring attempts to take this emotionally biased appraisals and implement more logical and rational assessments of the environment to elicit more adaptive responses and coping strategies. Coping strategies are defined as cognitive and or behavioral changes one makes in response to internal or external stresses that are taxing or go beyond an individual’s resources. These can be both adaptive or maladaptive behavioral patterns in response to certain contingencies. For example, an adaptive coping strategies could be going for a jog after getting into a fight with a partner. This is adaptive because it allows for a healthy means of escape and distance, it gives time for reflection, and endorses behavioral activation a catharsis. A maladaptive response to the same taxing situation that may seen beyond one’s ability to handle would be the abuse of a substance, this coping strategy involves unhealthy escape from the situation and lowers behavioral inhibition and judgment of the situation. CBT can identify these form of coping mechanisms as either a sign of resiliency or possible pathological problems. In tackling cognitive reappraisal, restructuring, and client centered therapy, an individual can take these perceptual changes and apply more adaptive coping mechanisms to create positive change to their environment.

    2. In short, after spending much time studying psychology and CBT academically, I believe my understanding of both the theoretical and evidence based research in CBT is much stronger than my impression of my ability to consistently apply it. This is almost entirely due to my current lack of clinical experience and lack of real life exposure to applying concepts and techniques. Through education, I believe I have a firm foundation of CBT including concepts like automatic thoughts, irrational thinking, and maladaptive behaviors; guidelines of diagnoses of depression, anxiety, and substance abuse; interview techniques such as the brief negotiate and motivational interviewing; and noteworthy theories that paved the way of psychology such as Abraham Maslow, Aaron Beck, Carol Rogers, and Sigmund Freud as well as their respective perspectives. I believe I’ll have a much better understanding of my ability to apply my knowledge once the upcoming practicum and internship placements this summer begins. This will finally give me the opportunity to evaluate my self efficacy in the field and ability to consistently apply these concepts and techniques of CBT in a wide range of real life scenarios and clinical experiences with people who could benefit from CBT. In relation to the learning model, without clinical application experience, I would say that I am still in the unconscious incompetence level in that I’m not sure what I don’t know and what my abilities are in the field. I’m hoping that through the practicum I will move to conscious incompetence where I will learn what my abilities are, what I need to work on as a therapist, and generally what level of knowledge I have in the field.

    Reply

    • Matthew L
      Feb 03, 2018 @ 17:50:02

      Hi Louis,

      I really liked the example you used when discussing appraisal. Due to my work experience it really helped me connect with the concept. I also really enjoyed the point you brought about both adaptive and maladaptive coping mechanism. I find that when discussing coping mechanisms most people generally think of the positive ones developed from a therapeutic session and not the negative ones create by a person in response to a trauma. Lastly I agree that we won’t be able to truly assess and apply our knowledge in CBT until we start our internships and gain some real world experience. I’m interested to see how those experiences will shape us versus our expectation. Perhaps we will find ourselves leaning to a style of theory that we had not expected.

      Reply

    • Allexys Burbo
      Feb 03, 2018 @ 18:36:35

      Hey Louis,

      I think you make great connections to cognitive appraisals and the concepts of control, expectancies, self-efficacy, and automatic thoughts emphasized in CBT. The mental events that occur during these cognitive processes all unfold in a similar fashion – that is, there is a stimulus, an assessment of the stimulus, a meaning assigned to the specific event, and a behavior to follow. Dependent on the evaluation of the stimulus and the meaning assigned, expectancies and efficacy will vary. Cognitive appraisal, in this instance, is significantly connected to the same concepts highlighted in CBT. The judgment, discrimination, and result relationship emphasized through cognitive appraisals are parallel to CBT in that the assignment of meaning to a specific event will directly influence the outcomes. In essence, the action and behavior are dependent on the cognitive process and the response is a reflection of this.

      Reply

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Adam M. Volungis, PhD, LMHC

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