Topic 2: Cognitive Theories {by 9/14}

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 next summer!)  Your original post should be posted by the beginning of class 9/14.  Have your two replies posted no later than 9/16.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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41 Comments (+add yours?)

  1. Matthew Collin
    Sep 11, 2017 @ 14:37:55

    (1) Lazarus & Folkman:
    My understanding of Lazarus’s and Folkman’s theory of emotion and cognitive appraisal is that cognitive appraisal is the action in which an individual evaluates stressors (whether they are positive or negative), and his/her own evaluation of how successful he/she can deal with the stressor.
    How an individual evaluates a stressor is known as the primary appraisal process. This evaluation is highly dependent on an individual’s goals, values and overall relationship of how the event affects the individual. For instance, someone can evaluate a social interaction between the opposite sex as “this is good”, while another can evaluate the situation as “this is bad, and makes me highly anxious”.
    In tandem, the primary appraisal process is accompanied by the secondary appraisal process. This is the confidence an individual has at engaging the situation, and coming out with the best possible outcome. The secondary appraisal process can be broken down into two main categories. One is a positive appraisal. Going back to the previous example of someone engaging in a conversation with the opposite sex, someone who is going through a positive appraisal of the situation would be saying something like “I can do this” or, “even if there is no interest I’ll come out fine”. While someone who is negatively appraising the situation may say to themselves “I can’t do this” or “All I’ll do is make myself seem like a nincompoop”. This illustrates how an individual goes through the secondary appraisal process. The secondary appraisal process primarily appears to reflect the automatic thoughts in the CBT orientation.
    Lazarus and Folkman also go in depth about how these two types of appraisals (primary and secondary) are not unidirectional. Someone’s secondary appraisal process can affect how their primary appraisal process works, and vice versa. They also coexist at the same time, and one does not always have to happen before the other.
    Lazarus and Folkman also go into coping and how an individual attends to the stressor at hand, and how the cognitive appraisal process seems to affect how people attack particular stressor. They go into a variety of different coping mechanisms people use in stressful situations (confrontive, avoiding, problem solving, etc.). Although there may be some coping techniques that are better than others (problem solving), it all seems to depend on an individual’s evaluation of the stressor, the context of the stressor, and the coping style they use to engage the stressor. There is no one specific coping technique that will always provide positive outcomes for the individual.
    One last evaluation Lazarus and Folkman examine is the effect that psychological arousal or emotion plays a role in the appraisal process. Psychological arousal can elicit particular appraisal processes. For instance, if I encounter something that makes me highly anxious or in a panic state of mind, I may be more likely to evaluate that stressor as something that I can’t handle, and that the stressor is dangerous to my wellbeing. This may result in a type of avoidance coping strategy. Again, the appraisal process seems to be exceptionally congruent with the cognitive behavioral paradigm of how our expectations (primary appraisal), thoughts (secondary appraisal), emotions, and behaviors (coping strategies) all play a role in not only the development of pathological or abnormal behavior, but the ontology of “normal” behavior as well. There is a strong bidirectional emphasis on both models, and how the interaction between components determines a variety of outcomes. A will not always equal B. Much like in CBT, context, thoughts about the context, emotion and past conditioning all determine a person’s behavior.

    (2). My evaluation of my ability to execute the tasks of a CBT clinician:
    Aaron Beck goes over a lot in the chapters we were assigned to read. The first chapter was probably the most influential in understanding my confidence in my ability to be a cognitive behavioral clinician. He discusses the lack of common sense that a lot of other theoretical orientations represent. I chose to want to study disorders in the cognitive behavioral paradigm because it is – as Beck describes it – inherently sensible. I strive to produce the best possible outcomes for my future patients/clients. For that, empiricism has produced cognitive behavioral therapy. To me, this is the best first responder to almost every disorder labeled in the DSM. Cognitive behavioral therapy is malleable – in most respects – to a variety of symptoms. So what I mean to say is, I have confidence in the science and flexibility behind the theory I wish to practice, which gives me confidence in the profession I am pursuing.
    The theory also just makes sense to me. Although the pieces are never colorfully labeled in each client as to what the thoughts, core beliefs, and problematic behaviors they are experiencing are, I do believe that my impending training will give me the skills to identify and treat the majority of clients I’ll see.
    I also believe I am very intuitive. Despite my constant urge to joke, I do believe I have some sense of how to articulate feeling, and to feel what is appropriate to say or not say at any given time. I think I can help clients articulate their thoughts, feelings, and emotions – three main components that need to be identified in CBT. This would allow me to easily pick up what a client may be feeling, and collaborate ways in which he/she can cope with what’s distressing them.
    Another reason why I think I may possibly be a good CBT clinician is because I am an engaging person. I like how active and collaborative CBT is. Figuring out productive homework assignments, teaching skills like mindfulness, psychoeducation, and the overall working together in tandem with clients is what has drawn me to this theoretical orientation – I’m seen as a coach, not a mind reader and latent information decoder.
    My initial evaluation of my ability to conduct myself as a professional CBT clinician is fairly positive. I know that I will encounter things that are difficult on a regular basis, but there is research being produced for a reason. I want to make sure I keep myself relatively up-to-date with the developments in the CBT field (SCIENCE!). I also have the utmost confidence I will be educationally trained in a manner that will allow me to be a productive clinician.

    Reply

  2. Lindsey
    Sep 12, 2017 @ 22:39:40

    Hi Matt, I just want to say thank you for incorporating the word “nincompoop” into your response – two thumbs up for word choice and thoroughly recapping the Lazarus & Folkman articles. 🙂

    Reply

  3. Olivia Grella
    Sep 13, 2017 @ 20:25:59

    When doing the Lazarus and Folkman reading, I understood cognitive appraisal to be a way that someone interprets a certain type of situation or event. The interpretation that they form then influences how they respond or react to that situation. This interpretation they are making is typically influenced by past experiences when placed in a similar situation. The reading also differentiates between primary and secondary appraisals. I interpreted that a primary appraisal was when an individual took the event and interpreted it as something positive or something negative. In other words, they looked to see whether it would benefit them or end up hurting them. Whether it is viewed as helping or hindering them also includes what the individual may value. If it is something of higher value to them than they are going to try and stay away from any outcomes that would end negatively. However, if it was something that didn’t have much of a value to them, then a negative outcome may not really matter. Secondary appraisal, on the other hand, deals with the actual response the individual has. This piece involves how the individual would react or cope with a threat or what they could do to move on from it. Although it seems like this process would happen after a primary appraisal, it does not. A secondary appraisal can happen first and influence the primary appraisal or it could flip back to the other direction. Also, these processes could be occurring at the same time. These processes are seen in CBT because in order to make behavior change, these thoughts the individual is having need to be explored. By understanding the appraisal process, it can be understood how these thoughts the individual was having were influencing the response that was coming from it.
    Coping was also discussed in this reading and was also mentioned in the secondary appraisal process. Coping refers to how the individual responds to certain situations, typically ones that produce undesirable outcomes. It’s normally in situations that produce a lot of stress. Coping also changes a lot. As the individual continues to enter into similar situations, they learn what may or may not be working and they make changes. Also, no two situations are exactly the same so what may have worked in one situations may not work in another. Changes would need to be made for how the individual copes within that situation. This is related to CBT because multiple pieces influence the response an individual has to an event. This is because the individual is understanding other outside factors that may be influencing the outcome. By having this full understanding, they are able to make the appropriate changes.
    As for the other question, I really enjoyed the readings by Aaron and Judy Beck. I like how in the first chapter of the book by Judy Beck she explained how the skills to be a CBT therapist are not something that happens quickly. She explained how it can occur in three stages: you learn the basic skills, you slowly become more proficient with integrating those skills, and then it suddenly becomes natural after all the practice. I really liked this piece because I feel like everyone wants to come out being the best they could be and want to have those skills to almost do CBT without thinking from the start. However, having it be explained that it is process and it’s okay to slowly ease into it and not be able to automatically integrate the techniques into the conceptualization from your first session ever was helpful. With that being said, all of these readings made sense to me and I didn’t find myself pausing or wondering where that explanation came from. For example, when reading about collaborative empiricism in the Wright et al. chapters, it made sense to me because research was always a central focus of psychology during my undergrad so why wouldn’t you and the client work together to test out certain hypotheses. Overall, I think a combination of practicing these skills and having an appreciation for where the therapy originated can make someone an effective CBT therapist and do so consistently.

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    • Alana Kearney
      Sep 15, 2017 @ 10:00:39

      Hey Olivia!
      I like that a lot of our responses included the idea that CBT makes sense. It didn’t strike me until you mentioned it, but I also did not have to pause and contemplate what I was reading because it made so much sense. Often in psychology, I feel that I need to read theories multiple times to get a good grasp of it, but CBT seems so natural. I also had a slight emphasis on research in undergrad and it made me appreciate how valuable CBT can be for clients.

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  4. Sarah Hine
    Sep 13, 2017 @ 22:37:25

    1. Lazarus’ concept of cognitive appraisal can be understood as a person’s thoughts and interpretations about the environment and how it relates to that person. Cognitive appraisals vary from person to person and are necessary in an evolutionary sense for determining when and if danger is present in order to guarantee survival. These interpretations of external events determine how a person responds both behaviorally and emotionally to stressors. This concept is related to CBT’s approach to cognitions and their effects on behaviors and emotions. CBT understands behaviors, cognitions, and emotions occurring in a circular relationship. This is similar to Lazarus’ concept that cognitive appraisals affect and are affected by emotions and behaviors. Similarities can also be drawn between cognitive appraisals and CBT’s concepts of automatic thoughts, both of which are subjective, in the moment, and help individuals determine how to act and feel in any given situation. Automatic thoughts and cognitive appraisals can be consciously or unconsciously made, and actions that appear to be made automatically can still be found to have thoughts underlying them that help an individual determine what actions to take, even when there is a lack of awareness of the presence of these thoughts. Cognitive appraisals are also similar to automatic thoughts because they are learned through experience and can be altered through new experiences. As automatic thoughts can be changed and reworked in response to new experiences or behaviors, so can cognitive appraisals change in response to new information through the process of reappraisal.
    The concept of coping refers to the intentional management of behaviors and thoughts in situations that have been appraised as stressful. The relation between coping and cognitive appraisal is similar to the relationship between cognitions and behaviors and emotions in CBT. A person copes with stress in the environment based on cognitive appraisals, similar to how in CBT a person’s thoughts and interpretations about a situation impact emotions and behaviors. For example, both Beck and Lazarus would identify the significance of a person’s anxious feelings and pacing as responses to experiencing a situation they perceive to be stressful. These emotions and actions function as ways to not only relieve distress (emotion-focused coping), but also as ways to solve the problem at hand (problem-focused coping). Much like with CBT, these two ways of coping, both emotionally and behaviorally, can impact each other and either increase or decrease distress for the person. Cognitive responses to stress are important for understanding both Beck’s and Lazarus’ understanding of psychopathology. Psychological disorders develop from cognitive appraisals that result in unhealthy coping, such as becoming depressed from viewing life as hopeless. This is similar to CBT’s view that psychological disorders result from distorted thinking which affects emotions and behaviors in a negative, unhealthy way. A final similarity that is apparent between Lazarus’ idea of coping and CBT is the importance of beliefs. Lazarus stresses that ways of coping can be linked to a person’s beliefs, or lenses through which the world is interpreted (such as religion). Similarly, Beck stresses that reactive behaviors and emotions can be connected to core beliefs and that through adjusting these beliefs behaviors can be changed. Changes in beliefs over time lead to changes in how situations are evaluated and responded to, both behaviorally and emotionally.
    2. As we have been reading, many of the cognitive theories have different terms for understanding thoughts and behaviors. However, the same principle rings true for them all, that behaviors are dictated by thoughts, and dysfunctional behaviors and emotions can be addressed through changes in cognitions. When I consider the principles of CBT in particular, ideas such as automatic thoughts, distorted thinking, and core beliefs come to mind, each concept with a list of related terms and definitions. While I find I still have much to learn before fully grasping these concepts, they all support the idea that behaviors, emotions, and thoughts influence each other and can be addressed through treatment goals in therapy in order to promote change of dysfunctional thoughts and behaviors. With this basic understanding in mind it is no wonder why CBT is attractive in its ability to present dysfunctional behavior in a practical and “common sense” way. Beck’s view of people as natural problem solvers who can understand their thoughts and learn to become their own problem solvers with guidance from a professional will be helpful in being empathetic and collaborative with clients, and in teaching basic CBT concepts during therapy. I appreciate this direct and collaborative approach to therapy, as well as the “common sense” view of understanding human behavior.
    As a beginning therapist, the structure of CBT sessions seems as though it will be helpful when approaching therapy. Concepts and therapy in CBT are clear and structured, and goals that are established are meant to be challenging yet attainable. The structure and goals of each session are aimed at keeping the therapist and the client on the same page, maintaining a collaborative environment and opening the floor for honest and meaningful work between the pair. As a therapist, I imagine that keeping structure through the three stages of therapy will allow me to know how to proceed during a session, especially as I am just learning how to conduct therapy. This will also help the client feel like they are informed and part of the process. As explained in the readings, the overall goal of each session is to deal with the client’s mood in the moment and to help them create a plan for how to tackle the rest of the week. Beck’s thorough explanations of how to carry these goals are helpful and seem attainable through training and practice. Education and homework are practical ways of addressing therapy that I believe I will be able to incorporate into a session with a client because of their direct approach to dealing with a problem and their natural flow from a discussion of a problem. I also like the emphasis on positive ways of thinking, and in bringing strengths related discussion and planning into sessions. Overall, these concepts are straightforward and practical, and are ones that a therapist can readily apply in therapy and use to assist a client. They are even principles one can begin practicing for their own thoughts and behaviors. As Beck suggests, it would be helpful for beginning practitioners to identify automatic thoughts in their own experience. This would allow me, as a therapist, to have practical experience in addressing my own automatic thoughts just as I would expect my clients to do the same.
    A concept that stood out as being potentially difficult to apply in therapy is the process of identifying distorted thinking. While the concept of distorted thinking is important in order to clarify misperceptions and create behavior changes, I can imagine it may be difficult to bring up and discuss with a client, especially with someone who is reluctant to accept that they are distorting a situation or who is having difficulty identifying these distorted thoughts. This would be especially difficult in a collaborative setting where active work is expected to be done by both the therapist and the client. For a therapist, a client’s distorted way of thinking may be obvious, and while it may be much easier for the therapist to share this information with the client, the process of guided discovery can help a client identify these thoughts on their own, making them more meaningful and allowing them to learn how to identify distorted thoughts on their own in the future without the help of a therapist. The description of techniques such as guided discovery and Socratic questioning offer helpful, productive methods to approach difficult topics such as distorted thoughts. Even with a basic understanding of CBT, I am confident that CBT provides an approach that will be effective in treating clients, and I believe that through training and practice and a more complete understanding of the principles of CBT I will be able to be an effective CBT practitioner.

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    • Luke Gustavson
      Sep 16, 2017 @ 10:20:34

      Hello Sarah,

      You raised a lot of really great points about automatic thoughts and cognitive appraisals, particularly that since they are so similar, if one can change then so can the other. Do you think that automatic thoughts and cognitive appraisals are essentially the same constructs? Do you think they have differences but still overlap too much? I ask these questions because I came to the conclusion that the appraisal process differs from the development of automatic thoughts, and specifically that the appraisal process might come before the automatic thoughts, kind of as a guiding force. Thus, in Dr. V’s slides, I would place automatic thoughts in the position of ‘response’ in that Event -> appraisal -> response diagram.

      If both occur relatively automatically, are the mechanisms of change similar for both automatic thoughts and the appraisal process? Or are you simply pointing to individual appraisals that can be altered through reappraisal?

      Reply

  5. Noella Teylan-Cashman
    Sep 14, 2017 @ 01:35:15

    Cognitive appraisal as explained by Lazarus and Folkman, is an evaluative process during which an individual classifies an encounter, gauges its effect on their overall well-being, and formulates a coping strategy. This process if further broken down into sub-categories of “primary appraisal” and “secondary appraisal.” Lazarus and Folkman note that the labeling of the terms is misleading, as one process does not precede the other, but rather, each type of appraisal has a bidirectional influence on the other. Primary appraisal occurs when an individual interprets a situation as either irrelevant, benign-positive, or stressful (further broken down into the categories of harm/loss, threat, or challenge). It is important for CBT practitioners to examine this process in each of their clients, because it reveals the individual’s tendency to view situations from a negativistic or optimistic point of view and can relate to some of the automatic thoughts and core believes of the person. Secondary appraisal occurs when an individual decides if/what can be done about the situation at hand, and how pertinent it is to their life. Additionally, after individuals have determined which coping strategies will accomplish the goal at hand, then they must evaluate their ability to successfully implement those strategies. Secondary appraisal is extremely important in relation to CBT because it directly relates to the individual’s ability to effectively (or ineffectively) cope with a situation at hand.

    Folkman and Lazarus’ definition coping aligns well with the principles of CBT; they acknowledge that the process of coping entails both cognitive and behavioral exertions that are constantly changing in efforts to manage an external/internal struggle a person may be experiencing. Additionally, they assert that coping serves multiple functions and is influenced by the context of the stressful situation at hand. This conceptualization relates to CBT in various ways, largely in terms of the problem-focused forms of coping referenced in the reading, which share similarities to the cognitive restructuring that occurs during therapy.

    As Beck has highlighted in his work, CBT is a highly sensible, practical theory that can be supported by empirical evidence. Although the therapy was mainly used to treat depression during its early years of development, the underlying principles can be applied to every diagnosis. This resulted in CBT becoming a leading form of psychotherapy. Given the solid foundation on which CBT has been built and how highly regarded it is in the field, I believe that I will not only be able to understand the principles of CBT, but will also be able to confidently implement them into my work as a clinician. However, although CBT is both sensible and logical by nature, the application of the theory may not be so organized in practice; real-life circumstances are often very complex and may require a clinician to view an issue from multiple perspectives. I believe as therapists, we should be adaptable and flexible, while still integrating CBT into our sessions. For instance, it is important to understand that the CBT process might occur differently for every client, and although we are still using the same basic principles, our implementation style of those principles may vary. The challenge lies within finding the correct combination of CBT structure, while simultaneously meeting the specific needs of the client at hand. I think this is something that may be difficult for a beginning therapist to balance, but will come more naturally in time.

    Reply

    • Venessa Wiafe
      Sep 14, 2017 @ 13:21:07

      Hi Noella,

      I really admire how you included the reality of CBT’s implementation. It is indeed an effective and excellent form of treatment for battling various life events, but when it is applied to real-life events, it may not be a walk in the park. However , it is worth it Each client will come in with a different issue and it is the therapist’s responsibility to remain patient and flexible in order to utilize CBT accurately as well as meet each clients’ needs. Yes, it is up to the client to make the changes to help them live a better life, but we, as future therapists, must lead the way. Being able to apply CBT and help clients for the better is salient, but importance also lies in realizing that the way it is applied may be different for everyone as life events are indeed complex, as you stated. It is vital that each client gets the help they deserve and need.

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    • Sarah Hine
      Sep 16, 2017 @ 09:15:16

      Noella, you included great points of how cognitive appraisals and coping are relevant to therapy in CBT. Getting a sense of these concepts for each client will be essential for forming treatment plans and determining what kind of methods and approaches should be used in each session. Understanding individual differences in how a client copes with and views stress in their lives will also help a therapist understand that client’s individual strengths and weaknesses as it relates to problem solving. It is also important that you identify the importance of flexibility in incorporating CBT into practice. In order to be an effective therapist, it is important to guide methods and sessions around client needs, rather than trying to force every client into a specific approach. CBT appears to be flexible enough to fit the individual client’s needs and even leaves room for integration of other styles and therapies.

      Reply

    • shay
      Sep 16, 2017 @ 14:07:25

      Noella, I liked how you spoke on having a balance of being structured in CBT, but also meeting the client’s individual needs. I imagine it’s easy to get caught up in being rigid in your process once you find a process that works successfully. Though I totally agree that it is so important to adapt your style based on what your individual client is working towards and what skills they have. I think CBT allows for some comfort in knowing that there is a foundation and skills already available to us, but I also think that if something isn’t working for a client a therapist needs to adapt accordingly. I do ABA therapy now, and I’ll never forget one of my coworkers was talking about another therapist. She said, “I don’t know. She’s seems to treat all the kids the same and work on the same things with them.” This stuck with me, because I remember asking myself if I do that too. We have program books for each kids that is filled with programs and skills that that individual child is working on. It’s easy to want to teach them something else, but each child needs to have their own reinforcement shchedule, their own reinforcers, and their own goals. Therapy with adults is the same way. It’s okay to have a certain style, but just because something works for one person doesn’t necessarily mean it’ll work for someone else. When I worked at a ropes course at Uconn, my boss always spoke about adaptability and how important it is in life when working with other people. He expected us to adapt to the group we were facilitating and what potentially their needs are. At my current ABA job, we refer to it as flexibility. No matter the name, it is a necessary skill to have in life, and as a therapist.

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  6. Luke Dery
    Sep 14, 2017 @ 07:17:48

    (1)
    Lazarus and Folkman define cognitive appraisal as a continuous evaluative process of categorizing experiences based on their potential impact on an individual’s well-being. It is a process by which we place meaning and importance on the events that happen to us. There are two appraisal processes: primary appraisal and secondary appraisal. Lazarus and Folkman point out that neither one of the two are more important than the other, and they do not happen in any given order.
    Primary appraisal involves evaluation of threat or benefit level of a stimulus. Essentially, something happens to us and we make a judgement on how dangerous this situation is to us. The three types of primary appraisal are irrelevant, benign-positive, and stressful. Irrelevant appraisal implies that there is no loss or gain from an interaction, and the individual places no values on it. Benign-positive appraisal is when an individual determines that an event is positive and bears some sort of reward, particularly an emotional payoff. Finally, stress appraisal involves evaluating loss or harm that is either has happened as a result of this interaction, or may happen in the future as a result. An example of primary appraisal could be an individual listening to a song that reminds them of a deceased loved one. They very well could appraisal this stimulus as stressful and expect a negative emotional reaction to listening to it. Secondary appraisal is the process of evaluating what could or can be done in response to a detected threat. It is an evaluation of one’s ability to respond, as available coping mechanisms, likelihood that coping mechanisms work, and our ability to apply these coping mechanisms are all taken into account before some response is formulated. It is important to note that past experiences play a huge role in the appraisal process and guide our understanding of what is stressful and what means we have of coping. Reappraisal can also occur, which leads to modifications of past appraisals based on new information gathered. Basically, we have new experiences that impact our future expectations.
    The appraisal process is important to CBT in that it manifests itself in automatic thoughts, which are a key component to the cognitive process. Appraisal involves an individual’s cognitive reaction to an event, and the work of CBT involves analyzing and modifying those appraisals with the hope of reducing self-defeating thought processes.
    Coping is an individual’s constantly changing cognitive and behavioral responses used to manage situations when the demands tax or exceed their available resources. Coping is how we think in behave in situations that are physically or emotionally draining. Coping is process oriented in that it focuses on what is actually thought and done by the individual, not what should or could be done. Coping is also contextual, meaning that different coping strategies can be employed based on the specific stressor that is appraised. Finally, coping is adaptive, meaning that it changes forms based on changes in the environment and its relationship with the individual. Coping can be emotion-focused, which involves the regulation of emotional responses. This usually occurs when the stressor is seen as unchangeable, and involves attempts to lessen emotional distress, cognitively reappraise the situations, or distract oneself. Coping can also be problem-focused, which involves managing or altering environmental circumstances that are causes distress.
    Coping is important to CBT in that CBT aims to help individuals develop healthier coping strategies to deal with life’s stressors. Often coping strategies, particularly emotion-focused coping, can lead to unhealthy understandings of the world or the distortion of reality (aka, cognitive distortions). CBT aims to identify unsuccessful coping strategies, reevaluate, and implement healthier frameworks of thought.
    (2)
    Although I haven’t had extensive practice in working through the entire CBT process with clients, I do have some experience using it that makes me confident in both my ability to apply the concepts and the practicality of using it. I currently work with individuals with substance abuse disorders, most of which have underlying psychological disorders. Many of them have distorted ways of thinking regarding their substance use, and their use of substances often functions as a faulty coping mechanism to handle stress, emotional pain, or symptoms of their disorders. An example of this distorted thinking regarding substance use is “I can have just one drink,” “I had a bad day so I deserve to use,” or “Drugs help me handle my emotions.” To address this, I do an exercise with my clients that involves taking the beliefs they have able using substances and challenging them. I’ve based this exercise on CBT concepts and techniques, such as Socratic questioning and finding evidence for and against a given thought, keeping thought records for urges, and either modifying these beliefs or trying to replace them with “sober truths.” While this isn’t “pure” CBT and certainly doesn’t touch on the whole CBT process, I’ve gotten a lot of positive feedback from clients about this exercise, which has given me a lot of confidence CBT tactics. The cognitive process seems to really resonate with people, even when they have never heard of it before. I also run a group therapy session based on this where we “put our thoughts on trial.” This is basically the exercise of finding evidence for an against a thought, but roleplayed in a trial with the defense finding evidence supporting the thought, the prosecution finding evidence against the thought, and the jury evaluating how factual the evidence is. Overall, noticing how well individuals respond to the subject matter, exercises, and collaborative nature has given me a lot of confidence in using CBT techniques. I really enjoy how it validates clients’ thoughts and emotions, but also creates an environment where critique of those thoughts and feelings is welcome and non-confrontational. I think the collaborative nature of CBT is a refreshing surprise to a lot of individuals who come in expecting the classic “tell me your feelings” therapist and instead get a very hands-on approach to working on their problems.

    Reply

    • Matthew Collin
      Sep 15, 2017 @ 13:18:29

      Hi Luke,
      I thoroughly enjoyed your response to question number two on this week’s response, and learning about some of the therapeutic activities you conduct at your job – this will surely give you a leg up on becoming a great CBT clinician. I liked how you even connect what you do to things Beck talked about like validating one’s feelings, and the autonomic thoughts that the population you work with typically have. I think it’s great how you are incorporating, and conceptualizing what you do at work in the CBT model.

      Reply

    • Stephanie Welch
      Sep 15, 2017 @ 22:55:21

      Luke,
      I liked your application of applying the principles of CBT to your work. I have not had much experience with applying CBT with clients. I am glad that you discussed how you apply CBT in your job. I especially liked your examples of distorted thinking and using Socratic questioning for those thoughts I think that your trial role play is great. Too often a person can get used to a maladaptive line of thinking that he or she never tests out the thoughts. I think that examining the evidence for or against the thoughts will help the clients change their thinking. The trial role play may be something I might want to consider for my clients. Thank you for sharing it.

      Reply

    • Chiara Nottie
      Sep 16, 2017 @ 09:04:37

      Hey Luke,
      I found your work experience very interesting, mostly because I don’t have experience in substance use counseling. Your line of work with individuals who have difficulties with substances is very relevant to our CBT readings these past couple of weeks. I even remember from last semester, we discussed substance use disorders in Abnormal. Like you have mentioned, addressing the ulterior mental illness individuals have, will assist in clearing up their trouble with substances. As you have noticed so far at work, utilizing CBT techniques will help you do that. The examples of internal dialogues you offered, (“I had a bad day so I deserve to use”) illustrate last week’s readings well and shows how clearly CBT can address these internal dialogues. I think the techniques you have used so far at work relate very closely to “pure” CBT techniques and you will have particular strengths in CBT when you reach the end of this program. (Bravo).

      Reply

  7. Stephanie Welch
    Sep 14, 2017 @ 08:55:28

    1) My understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT is the process of evaluating and reacting to a stressful situation. Cognitive appraisal refers to the perception and reaction to an environment. This is to determine whether or not the environment is dangerous to the individual. Lazarus and Folkman point out the sensitivity of individuals to certain environment. An individual who has experienced past anxiety in the situation will be likely to react with anxiety to a similar situation.
    Lazarus and Folkman also mentions the characteristics of an individual contributes to his or her evaluation of the environment. The individual who focuses too much on the outcome of the situation will become more anxious than an individual who focuses on the present situation. The evaluation of the situation is also critical. An individual who sees a situation as something to overcome will most likely preserve in the situation. However, an individual who views the same situation as dangerous will experience anxiety in the situation. The outcome of the situation depends upon the interpretation of the situation.
    Coping is the effect to manage the stressful situation. Coping is most effective if an individual possesses the resources to deal with the stressful situation. An individual who can evaluate a situation and determine how to approach the stress will be successful. The successful individual will be able to apply the most effect technique to the stressful situation. This could be evaluation the positive and negative outcomes of each of his or her reactions and picking the action with the best outcome.
    An individual who is anxious and panics will be be successful. This anxious individual is likely to repeat approaching stressful situations with anxious due to the previous experience. The anxious individual would need to learn how to deal with stress before becoming successful in stressful situations.
    2) My initial impressions in my ability to understand and consistently apply the basic principles of CBT as a therapist comes with practice. Judy Beck states the importance of the structure of CBT sessions and the gradual learning that an individual of applying the principles of CBT. I understand that applying CBT happens slowly. It takes years to become an effective therapist. Also, each client and his or her problems are different. The approach to the CBT therapy must be tailored to the client and that may be difficult for a beginner.
    Good therapy also is based on a good structure. If you have an idea of what you want to do during the therapy session, the session goes more smoothly. I think developing a structure such as discussing the previous session, talking about homework, discussing the client’s problems, and wrapping up with a summary and homework assignment will help to keep the principles of CBT consistent. Aaron Beck mentions that good therapy is based upon science. A good therapist forms hypotheses and conceptualizes the client’s problems. CBT replies on making a hypothesis about the client’s problems and constantly changing the hypothesis based on the information gained in sessions. Even with a structure, I would have to be ready to change my conceptualizing of a client’s problems and even the structure of the therapy if the client is in crisis.
    In this case, I know that it is okay to seek help from supervisors. It helps to talk to another person about the conceptualization of a client. It is also helpful to talk about ideas especially when approaching a reluctant client. Educating yourself about client’s cultures and problems is another good idea when dealing with clients. Learning about factors that influence the client’s problems are beneficial to approaching a solution to the problem. Aaron Beck points out the significance of using common sense with the development of the client’s problems. This common sense involves looking beyond the behaviors of the client in order to figure out how the client’s thoughts relate to their behavior and their problems. By practicing, conceptualizing a client’s problems, developing a structure to therapy, and seeking out help, I think that my ability to understand and consistently apply the basic principles of CBT as a therapist will develop over time.

    Reply

    • Venessa Wiafe
      Sep 14, 2017 @ 13:58:49

      Hi Steph,
      I liked your responses to each discussion question, but your statement, “good therapy is also is based on good structure” is phenomenal. Structure is everything. One can be the best therapist there is known to man, but a lack of structure can have everything come crashing down. A successful therapist must know what she wants to do each session with a client. A therapist shouldn’t just say to herself, “well I got my Masters in Arts in Clinical Counseling Psychology, so therefore, I know what I’m doing . I’ll just apply all I learned to each session and my client should be all set and feeling better in no time”. That will not be effective and such a mindset won’t help clients. It is good to apply all the knowledge learned in school, but there is more to assisting clients than just doing that. Each client is unique in their own way and they must be attended to in ways that meet their very own unique needs . Having structure and following the basic guidelines not only for CBT, but as a therapist will definitely assist with allowing each session to run smoothly. Therapists should take the initiative to get to know their clients well so that they can know how to structure each session to best meet their needs. I also like how you brought up cultural factors, as it is vital when assessing clients to make sure you are culturally appropriate, because a main goal is to establish rapport with clients. Thank you for reminding us that structure goes a long way!

      Reply

    • Liisa Biltcliffe
      Sep 15, 2017 @ 09:24:15

      Stephanie, thank you for your thoughtful response on being a CBT therapist in that it helped me to feel a little less nervous. I get so wrapped up in “am I going to be good enough” that I forget that I can have some structure to the sessions and that seeking out advice from supervisors and colleagues is okay. Your post reminded me of these aspects and I appreciate that. You have some good insight.

      Reply

  8. Alana Kearney
    Sep 14, 2017 @ 09:55:17

    1) According to the dictionary definition, appraisal is the act of assessing something or someone. Lazarus and Folkman take this idea a step further and define cognitive appraisal as the act of assessing a situation by means of activating mental activities such as judgment, discrimination, and choice of activity. They believe that this assessment is a process to evaluate whether or not certain situations in a person’s daily environment are beneficial to the individual, and furthermore, how they could be relevant to the person. Cognitive appraisal is broken into two steps, which can eventually lead towards a future reappraisal of a similar situation. The first step is primary appraisal, in which the individual assesses if he/she is in a situation that is troubling or beneficial for him/her at that moment or even in the future. The individual contemplates whether the situation either does not effect her, positively effects her, or poses a potential harm/loss, threat, or challenge for her. Following this initial appraisal of what the situation is and how it affects the individual comes the thought of “what can I do about this situation that I’m in?” At this stage, the individual determines is any action can be taken to avoid potential harm or increase the benefits of the situation. She can evaluate how different actions will lead to potential outcomes and then evaluate whether or not she believes she has the capability to perform these actions to achieve her desired outcome. In CBT, this process is very important to understand how the client perceives certain situations. It allows the therapist to find the root of the client’s automatic thoughts, and most importantly the negative thoughts that guide undesired behaviors. Perhaps a client is misinterpreting the situation, which occurs in the primary appraisal period, or she has core beliefs that she does not have the ability to produce desired outcomes, which occurs in the secondary appraisal period. This will guide how the therapist moves therapy in the future because it will show how the core beliefs are affecting the client’s behaviors.
    When clients feel that they are in stressful situations, they seek to reduce their stress through coping skills. These skills change the person’s cognitive and behavioral efforts with the hope of trying to manage the difficult situations. There are two kinds of coping emotion-focused and problem-focused. The former is used in situations that seem unchangeable and is meant to regulate emotional response to the problem in order to lessen distress, maintain hope, and get through the current situation, even if it is not a long-term solution. The latter is a technique to manage or alter the distressing relation between the person and the environment by changing either the person or the environment. Since this strategy is meant to solve problems through change, it offers more benefits in the long term. Clients will often use emotional coping to avoid problems, whereas CBT seeks to utilize problem-focused so that the client can deal with the situation in a healthy manner in multiple situations over time.
    2) On the first day of 504, we were asked what, if anything, we knew about CBT. I had taken a CBT class two semesters before, but all I could rattle off was a few names and a few basic techniques. In every class since then, we’ve been reminded that practice is completely different from the theory. However, we all chose a CBT based program so there must be something that drives us all to appreciate this type of therapy. As Beck discussed, CBT is a sensible and practical theory, which is empirically supported. It makes sense that our thoughts affect our behaviors, so a logical solution is to address the problem at its core. I have always been fascinated by the fact that people think so differently and it is so difficult to understand other people’s thoughts because we do not think the same way. Since no two minds think the same, it makes sense that there cannot be a single solution to every problem. Although Beck describes ten basic principles of CBT, this general type of therapy provides a plethora of techniques and strategies in order to understand clients’ cognitions and behaviors. Which is why I appreciate how flexible and adaptable CBT professionals must be, and yet there are guiding principles to keep therapy focused and useful. I think after all the classes we will have had by next summer, we will be well versed in CBT principles and I believe that, even now, we have learned enough that I feel capable of applying basic principles in presented situations. However, that does not necessarily take into account the fact that these situations are on paper and that a real client will react to things I will have to say or suggest. This can only be improved with real life clinical experience and further training.

    Reply

    • Matthew Collin
      Sep 15, 2017 @ 13:09:42

      Hi Alana,
      I really like how you touched upon how flexible cognitive behavioral therapy is. I also like how you touched upon how none of us (I assume) have really put these techniques into practice, and how it’s one thing reading research and textbooks about how efficacious it is, but another when actually conducting CBT on a client of our own. As discussed in class this week, we can’t just be robots and follow a unified protocol for all clients. We all will have to develop our own style of therapy, but also constantly applying the CBT techniques and conceptualizations.

      Reply

      • Noella Teylan-Cashman
        Sep 15, 2017 @ 17:17:59

        Alana and Matt,

        I appreciate this discussion of the flexibility of CBT; I feel like I also touched upon the topic in my own initial blog post and am happy that others have made similar observations. It is important for us as clinicians to remember that “practice is different than theory” (as Alana put it) and not get too caught up on a specific notion of how therapy is “supposed” to happen. Of course, being trained professionals, clinicians should aim to maintain a level of structure and direction within sessions, but do so in a way that suits the client and situation at hand.

        Reply

    • Stephanie Welch
      Sep 15, 2017 @ 23:09:57

      Alana,
      I liked that you mentioned the flexibility of CBT. While we expect our sessions with clients to go a certain way, it does not always happen that way. Whether it be that a client is in crisis or says something unexpected, the CBT professional must be ready to adapt to the situation. I also think that you made a good point in saying that people think differently and it is difficult to understand another person’s thoughts because they are not the same as our thoughts. I think that it is easy to forget that point and that CBT should be made to fit the client.

      Reply

  9. Chiara Nottie
    Sep 14, 2017 @ 10:54:44

    1. Lazarus and Folkman
    In the previous discussion post we investigated the idea that thoughts come before emotional responses. Added to that concept is the concepts of appraisal and coping. In the articles, we read this week we learned that appraising a situation and utilizing coping skills follows an emotional response (which is what establishes behaviors). Emotional response or disturbance depends on whether he perceives events as adding to, subtracting from, endangering, or impinging upon his domain (Beck, 1979, 56). “emotion is the process which starts when something is perceived and appraised. We decide that it is good or bad for us” (Arnold, 1960, as cited by Beck, 1979, p. 56). Richard Lazarus, a fellow experimental psychologist, like Arnold, connected thinking and emotion. Lazarus like other experimental psychologists did not outright define specific kinds of appraisals that lead to specific emotions. Perhaps this is not clearly delineated because as Arnold claims, appraisal depends upon perception, and humans vary in how they perceive negative and positive qualities, based on their cultural background and personal experiences. Anxiety can be used as an example to further conceptualize the appraisal process. As Beck reported emotional responses are due to events adding to, subtracting from, endangering, or impinging upon personal domain. Anxiety tends to question how endangered or impinged our personal domain is. Lazarus has established a “primary appraisal” and “secondary appraisal” in regards to anxiety (Lazarus, 1966, as cited by Beck, 1979). Primary appraisal refers to identifying a situation as a threat and assessing the probability, imminence, and degree of potential harm, while secondary appraisal refers to an estimate of “counter-harm” resources. Counter-harm resources means the ability one has to neutralize or cope with the potential danger. It is thought that the negative factors from the primary appraisal and the positive factors from the secondary appraisal as leading to an ultimate determination of an appropriate amount of anxiety. After one appraises a situation and responds emotionally to it, they need to utilize coping skills if their emotional response is negative or overwhelming. According to research coping come as a process that happens in stages. Most research has investigated the coping process children utilize during times of stress, anxiety, or sorrow (Lazarus, & Folkman, 1984). It is thought that adults expand upon coping skills that first emerged during childhood years, and customize them to fit into their own personal domain. Coping is thought to be a problem-solving strategy, confronting a loss of equilibrium of emotional feeling, or thinking.
    2. CBT
    The topics reviewed in the articles this week really emphasized the importance of the therapeutic alliance. As discussed in the articles each individual, due to different influences appraises situations differently. Counselors have a lot of information they need to gather from their clients before they can start to really strategize the majority of their treatment plan. Since counselors need to gather so much information from their clients they need to establish a great rapport to gain access to necessary information. Necessary information to know is how a client typically appraises situations they are in, what they consider to be a good situation verses a bad situation, how they cope with bad situations, and how happy or bothered they are by their coping mechanisms. Figureing out the strengths and weaknesses in clients’ coping strategies can help guide a counselors’ treatment plan. Depending on the coping strategy’s strength can help determine if more effort towards altering thoughts, behaviors, or feelings should be made. The articles tied in the theory behind CBT, in that everything is bidirectional in nature and connected. CBT understands that thoughts may trigger feelings or behaviors, but feelings and behaviors can influence thoughts in return (Beck, J, 2011). Understanding what situations a client becomes involved in and how they interpret said situations, cognitively, emotionally, and behaviorally can isolate where to begin change.

    Reply

    • Olivia Grella
      Sep 14, 2017 @ 21:55:17

      Chiara, I really liked how well you incorporated appraisals and coping into your answer to the second question for this post. You demonstrated your understanding of the topic really well and made connections that I didn’t previously think of. I completely agree with you on how understanding those concepts can really influence the relationship you have with your client. Having that understanding can build a solid foundation for future sessions with them.

      Reply

  10. Luke Gustavson
    Sep 14, 2017 @ 11:48:12

    DISCLAIMER: The following post is lengthy and likely raises more questions than it answers. You have been warned.

    1.
    Lazarus’ and Folkman’s conception of cognitive appraisal states that before we respond to an event, we cognitively (and, it seems, automatically) appraise the event; that is, we take stock of what has happened. This appraisal is a mental process that mediates our response to the event. This process is informed by not only the event itself but also previous experiences and the individuals’ own judgment and ability to discriminate between threat and benign event. Essentially, this is a way for the individual to check both the event and themselves to assess whether or not this has been beneficial to the self or harmful to the self in some way.
    For an example, we can turn clearly to the nature of adolescent American boys. This particular group is known for trading insults as good-natured humor (though it might look harmful to outsiders; I’ll leave my “here’s how I think gender works” argument to the side). However, even within the group, one particular epithet could be a challenge or an actual insult as opposed to one intended for humor. From the outside, it is almost as if an individual “just knows” that this has happened. However, using Lazarus and Folkman’s framework of cognitive appraisal, we can infer that a sort of mental formula is at work. I will come back to this example in a moment.
    Cognitive appraisal is further broken down into a primary appraisal and a secondary appraisal. Primary appraisal is how an individual determines whether the event is beneficial to them or not and when. There are five general primary appraisals that Lazarus and Folkman put forth: irrelevant, or no implication to the self; benign-positive, or generally beneficial to the self; stressful-harm/loss, damage already sustained; stressful-threat, or damage has not yet occurred but are expected; and stressful-challenge, which is a positive appraisal whereby gain or growth could occur as a result.
    Going back to our adolescents, a particularly stinging remark has put one of the boys into cognitive appraisal (though this would happen, one assumes, every time). This is not an irrelevant encounter: the proper response could mean he is part of the group and “manly,” while the improper response would mean a loss of status and potential ridicule. This similarly does not seem to be a benign-positive event as the outcome clearly hinges on his response. Skipping harm/loss, my conclusion is that for this adolescent, he is likely appraising the event (if he is a normative American adolescent) as being either stressful-threat or stressful-challenge. It could even be both.
    How? Well, the boy stands to lose something. This loss is averted with the correct response, however. This is a potentially unpleasant event. However, at the same time he also might view himself as challenged in a positive way, bringing the associated positive emotions with it. As a result, this could be a mixed (negative and positive) appraisal, which Lazarus and Folkman account for. This also calls to mind the idea that, much like what is seen in Beck’s CBT framework, individuals who are depressed (or prone to being “easily threatened”) might be more likely to view a particular ambiguous (threat or challenge) event as a threat. In line with much of what I know of development and adaptive functioning, individuals who are geared to perceive that event as a challenge have better cognitive and emotional outcomes.
    Secondary appraisal, on the other hand, seems to follow and question the primary appraisal. This involves a calculation of prevention and risk. I point to this process “questioning” the primary appraisal, as it seems to be focused on a way either to prevent a negative outcome or to change it into a positive outcome. This includes a very quick mental calculation of strategy effectiveness. This is about where Albert Bandura and his concept of efficacy and outcome expectations comes into play, as these indicate whether the individual determines their strategy with be effective or not. I wonder, then, if an individual with, say, social anxiety would be more likely to think a strategy would be ineffective in social situations and thus throw their cognitive appraisal process off the rails.
    Reflecting further, I find myself wondering whether cognitive appraisal is part of what drives automatic thoughts. We know they seem automatic and appearing-from-nowhere, but is their genesis driven, in part, by a cognitive appraisal system that is thrown off kilter? My conception is that the cognitive appraisal process sits directly after the event and directly before the response. Is an automatic thought part of the response, then? Could a faulty (irrational) cognitive appraisal process be part of what drives cognitive errors?
    If the cognitive appraisal process is automatic, and if it can be geared, through its sources of information, to lean one way or another, then I suppose it might also be one source of cognitive errors. After all, if you appraise an event (incorrectly) as a threat, are you not technically maximizing the issue? Are we, as CBT practitioners, attempting not only to correct illogical cognitions but also to correct an illogical appraisal system that has led us to appraise things incorrectly? Now that I am asking more questions than I am answering, I will move on.
    Lazarus and Folkman also cover the coping process, which is how an individual responds, cognitively and behaviorally, to the event as dictated by the secondary appraisal and the ongoing changes to the environment and individual. In other words, coping is the process by which the individual manages the situation when they perceive the situation as threatening. An individual’s ability to cope seems directly tied to maladaptive functioning, as coping strategies could be insufficient, inappropriately utilized, or mostly absent.
    There are two general coping processes, both with their benefits and drawbacks. Emotion-focused coping is about, as the name implies, the regulation of emotion in response to an event. This is (or should be) utilized when something is viewed as unchangeable. Some of the strategies utilized are lowering emotional distress through avoidance or “silver lining” type thinking; cognitive reappraisal, which is when the meaning of a bad situation is changed; and distracting, which is literally where an individual distracts themselves from the problem in various ways. My own anecdotal evidence shows many of the men I have encountered engaging in emotion-focused coping by means of distraction, even when the situation is changeable.
    Problem-focused coping seems to be more externally-focused than emotion-focused coping, as instead of regulating the self, an individual conducting problem-focused coping is attempting to regulate another person, their environment, or the specific situation at hand. However, this does not mean this style of coping is necessarily external: there are a number of self-directed strategies that individual can engage in. However, the exact makeup of these problem-focused strategies changes depending on what the problem is.
    One thing that struck me as I was reading Lazarus and Folkman’s chapter on coping is that it seems that emotion-focused coping is what many people tend to believe defines coping in addition to the typical strategies utilized by people experiencing problems. On the other hand, I view problem-focusing coping as being generally in line with CBT. This does not mean that a CBT practitioner would not assist with emotional coping as needed, rather their focus is likely to be on altering what is alterable. I believe that Lazarus and Folkman point to two processes that are extremely important to CBT in theory and practice: how we appraise an event affects how we respond to that event and what coping strategies we use, if any. When these processes become illogical or irrational, we are likely to experience cognitive distortions, maladaptive coping, and other cognitive or emotional problems that are then likely to influence our behavior.
    2.
    I cannot make claim to being the most rational or objective human being existence. Strong emotional forces often move me. I enjoy Albert Ellis’ approach to therapy perhaps a bit too much – it resonates. I take a certain joy in helping others see their inconsistencies and illogical patterns (for all the good it does me personally). Still, when I sit down to read the assigned text or I get an idea stuck in my head that I toss around and annoy my fiancée with, I feel as though something has changed; a switch flips. In such a moment, the years fall away, the mind wipes itself clean, the emotions scrubbed. I work as if possessed.
    One thing that 600 taught me (despite it not being much) was that I felt extremely comfortable in the therapist chair and much less comfortable in the client chair. Sitting, reflecting, focusing on what was said and how afforded me ample opportunity to realize that maybe, just maybe, I was not completely wrong in my choice of intended profession. It felt natural, normal. No anxiety, no worry, no fuss. Maybe RP just comes easy to me; I credit D&D.
    In terms of understanding, I cannot see how CBT is particularly difficult for me to grasp. I had to read Jaan Valsiner’s work, and if you know anything of semiotics or semiotic mediation, you will know how thick that subfield is. Beck’s readings felt like I was rehashing my own understanding that certain cognitions link to emotions and that these emotions on their own might have some king of meaning. In fact, I am certain I have read an overview of CBT at least three times now. There is nothing about the readings or the theory that boggles or irks me. In terms of an initial assessment of understanding, I honestly cannot see how I will have trouble learning or understanding this. After all, I completed quite a lot of independent research while obtaining my B.S. Learning this material seems to come naturally.
    I say this because CBT thus far has followed an extraordinarily rational and straightforward approach, much unlike psychoanalysis. If we wish to change irrational thoughts, we must confront or disprove them. We could also change one’s behavior to do so. Looking at people through a cognitive framework is something I am quite used to doing.
    In terms of the application of CBT principles, that is much harder to assess. After all, I have yet to do such a thing. However, my time in 600, as previously mentioned, has afforded me the opportunity to feel myself being, at least partially, in the role of therapist. In terms of whether I feel my base personality is congruent with CBT, I largely feel it is irrelevant. Certainly, a CBT practitioner (or any psychotherapist) should possess certain qualities such as empathy, self-insight, a particular brand of social intelligence, and communicative abilities that can change to suit the needs of the individual client, to name a few. As to whether I possess these qualities, I will state that they have been evolving over time and that there is always room for improvement.
    Otherwise, I strongly feel that my own personality should be malleable in the therapeutic setting. I can be as curmudgeonly as John Adams from time to time but is this useful in therapy? Probably not, and that is why Therapy-Luke (and his varying permutations) is entirely different from School-Luke or Home-Luke. Certainly, my penchant for listening more than I speak will serve me well, as will my New England Yankee manners (if you can call the backwoods of Spencer “country”). I like to think that I possess a tendency to think logically and a wish to examine the veracity of things and that this may be helpful.
    One thing that particularly draws me to REBT and CBT is how problem-focused they are. For myself, I see little point in dithering about with free association or digging into one’s past (unless wholly necessary and applicable). This is also true of CBT’s action-oriented nature. It means there will always be something to confront or assist with and that therapy will keep moving. I cannot imagine I would ever become bored of psychotherapy but it means I will not have a client for 3 years endlessly rehashing their relationships with their parents.
    I view my application of the principles of CBT to be a function of my growing skills and knowledge and not much else. That is, ultimately, what my approach to learning this material and becoming a psychotherapist is about; are my skills beyond sufficient and is my knowledge current? I speak of skills in a broader sense, meaning they range from particular CBT skills to basic counseling skills to the training of my own mind and behaviors to be more congruent with the therapeutic process of CBT. I am of no good to a client if I am not a disciplined psychotherapist and person. In short, I believe psychotherapy is both art and science. It is easy to appreciate the art, but applying the science is more difficult.

    Reply

    • Noella Teylan-Cashman
      Sep 15, 2017 @ 14:21:40

      Luke,

      I really enjoyed reading your example of the encounter between adolescent males (and agree that the structure of “how gender works” poses an entirely different conversation- which I think would be equally as interesting). I felt that this example accurately depicted how the primary appraisal process works in every-day-life occurrences and highlighted how one might perceive a situation as both a threat and a challenge.

      Furthermore, I liked how you made the possible connection between a faulty appraisal process and negative automatic thoughts. As you went on to both raise questions, and answer those questions in your response, I resonated with your thought process and felt that it made a lot of sense. I agree that as CBT practitioners, we should identify the source of our clients’ automatic thoughts and aid them in restructuring their appraisal techniques, if proven faulty.

      Reply

  11. Shay Young
    Sep 14, 2017 @ 11:58:16

    1)My understanding of Lazarus and Folkman’s idea of cognitive appraisals begins with the recognition that there is an interaction between the person and the environment in which they interact with, and further the evaluations/ judgements that are made in response to the interaction. Situations, people, settings or events are all cognitively appraised through the eyes of the person experiencing or observing these things. The cognitive appraisal is derived by a process in which a person will evaluate the relevance and significance of an event or environment to his or her well-being. Individuals will categorize an interaction or event based on meaning. Lazarus and Folkman understood that people differ in their ability to handle certain information. Some people are more sensitive and vulnerable to certain events. Everyone interprets and therefore reacts to situations differently. The text gives an example of the Nazi camps, and how individuals responded and coped in different ways. I think this is extremely interesting to think about. There are a number of movies or televisions shows that demonstrate this representation nicely. I can think of an example from an old favorite show of mine, One Tree Hill. One episode showcased a school shooting. This event that everyone experienced was appraised and interpreted differently by every person in the school. Some were angry, some were scared. Some cried, and some sought revenge. Some thought of the shooter as a villain, while others were sorry that the aggressor felt so depressed and isolated that he wanted to end his own life as well as others. In times of intense stress, some manage to be braver and more courageous, while others cower back. Lazurus and Folkman would argue that these interpretations, and then coping strategies are mediated by how the events are appraised. It is believed that there are two types of appraisal; primary and secondary. The primary appraisals deal with potential outcomes. The person wants to know whether there is any potential benefit of harm now or in the future. Secondary appraisals looks at the possibility to improve the situation or in other words, the goal is reduce harm and gain benefit. Secondary also takes into account which coping mechanisms are available. These two forms of appraisals will converge to determine if the event is important for well-being and if it is potentially threatening. Things can also be appraised negatively or positively. Negative appraisals may reflect perceivably challenging or threatening events, whereas positive appraisals reflect joy, happiness, peace or capability.
    Though mentioned lucidly, it is important to draw a strong line connecting both appraisals and coping skills. The coping process is mediated by the cognitive appraisals. Coping is the person’s ability to adapt their cognitions and behavior in order to deal with situations that are appraised as exceeding their resources. For example If a woman who is concerned about her attractiveness decides that their hair is the most attractive thing about her, and suddenly is diagnosed with cancer, she may have a more difficult time coping with her hair loss. This may be due to her appraisal or belief about the importance of her hair and how it manifests in her identity of being attractive. Her ability to cope with the situation may be more difficult, than for say a cancer patient who did not care much about their hair or care about attracting anyone. Appraisals can also determine emotions. For this patient, the emotional sadness or anger she feels over losing her hair is a byproduct of the appraisals she has.
    I think appraisals have a strong place in CBT, because practitioners understand that how things are construed can impact clients reactions, emotions and behaviors. There is also the idea of irrational appraisals. Sometimes unrealistic appraisals will overrule or become excessively used over realistic/rational appraisals. Due to this, a person would experience inappropriate emotions and behaviors. A CBT practitioner would want to work on adjusting or reappraising these situations, thoughts and events.

    2) My initial impression of CBT as a practice is overall good. I think knowing Assumption was CBT oriented, made me all the more excited to come to the school. I understand the basics of CBT. Essentially the main idea is that behavior, thoughts and emotions all influence one another in a cyclical fashion or bidirectional. Psychopathology in CBT is attributed to negative thinking domains and poor cognitive conceptualizations. The main goal is to reduce or reverse dysfunctional thinking, negative appraisals, distorted thinking, cognitive errors, intrinsically negative core beliefs as well as poor automatic thoughts. I like that Beck rose to the occasion, and created and orientation that pulled the best components out of existing therapists. He was influenced by Adler, Horney and Sullivan. He was also influenced by Kelly’s theory of personal constructs as well as Ellis’ rational-emotive therapy. Some may find that unoriginal or uncreative, but I think that because of the seriousness of mental health it doesn’t matter as much how we arrived at an effective treatment. More importantly it matters that empirical treatment exists. In the CBT Model: Key principles of Cognitive Behavioral Therapy article, I liked the quote “The major schools within this domain share certain characteristics: a conviction of the ultimate truth of their own system, disdain for opposing theories, and a steadfast emphasis on purity of doctrine and technique.” To me CBT represents this soundness. I also liked that Beck was influenced by his work, and learned while doing free association. I thought it was cool he had this epiphany about trains of thoughts and began to see that although clients were reporting and talking excessively, that still many were not even aware that they had other thoughts in the moment. I also found it helpful to see examples Beck gave of his work with clients and how he uncovered the true feelings. Like for one example he gave, he spoke of a woman who claimed a movie made her anxious. When Beck questioned her, she said the aggression in the movie made her anxious. He then asked her to think about, and she remembered before she spoke about the movie plot, she had the thought that Beck would think she was a loser for wasting time at the movies, and that is when her anxiety was triggered.
    I also like that CBT is goal-focused. It is important that the clients set goals, but also that they have a strong self-efficacy regarding their ability to implement their skills post termination. It is important that patients have an active role in the process and are active agents of change. CBT also is more structure than some other therapeutic orientations. Being that CBT seems effective and is a more empirically based treatment, I feel that I will be passionate about my pursuit to be a highly-regarded CBT clinician. If I didn’t believe in its foundation and the principles behind CBT, I do not think I would want to pursue mastery or understanding in this orientation. For me, if I am passionate or interested in something, I work much harder to become knowledgeable in that subject area. That being said, I will certainly put all my effort forward to be an effective CBT therapist. I recognize that hard work alone does not make a good therapist, but I think being diligent about learning the orientation is a good place to start. I think practicing problem solving with friends or family and practicing framing good open ended questions is something to implement in daily life. I don’t necessarily mean I will practice therapy with close family (as I know that is advised against) I just mean I can practice skills in conversation. I also do ABA currently, while I know is not entirely the same, it has some similarities in that it’s a behavioral therapy. Because I am working with autistic kids who have neurological deficits it can be helpful to pay attention to the cognitions, especially with the older kids. I think ABA can be a good stepping stone to CBT.
    At this stage in my educational journey, I feel that by the practicum and internship I will have the skills necessary in order to be a respectable and knowledgeable CBT-oriented clinician. I may not be entirely effective at implementing these skills right away, but as time progresses and practice ensues, I believe I will eventually be an effective clinician. Of course I’ll still be nervous, but I think the professors of the program, as well as the readings assigned have helped lay a great foundation and expectancies for what is to come.

    Reply

    • Julie Crantz
      Sep 15, 2017 @ 13:30:56

      Hi Shay,
      I enjoyed reading your blog post about cognitive appraisal and coping. I appreciate how you explained the concepts and also provided specific examples of appraisal and coping. It is interesting how people have different ways of appraising the same situation. It can be very difficult for clients when they bring irrational thoughts into the appraisal process. Your emphasis of how a CBT practitioner would want to work with a client on reappraisal of events, situations, and thoughts where irrational thinking came into play is very important.

      Reply

    • Luke Dery
      Sep 15, 2017 @ 20:42:58

      I can definitely relate to feeling confidence and comfort given the empirical evidence that back’s CBT. Knowing that the work I’m doing with clients, if done correctly, has an overwhelmingly-good chance of helping them gives me a lot of comfort. Of course, many other factors in therapy can affect the potency of CBT work, but knowing that I’m doing work with lots of empirical backing makes me feel like I’m approaching my career in the right way.

      Reply

  12. Liisa Biltcliffe
    Sep 14, 2017 @ 12:09:17

    My understanding of cognitive appraisal is that it is evaluative, automatic and continuous (while a person is awake). It is a person’s understanding of a what is happening in his or her life/environment. There are three types of appraisal (primary, secondary, and reappraisal) and in primary appraisal, there are three types, which are irrelevant, benign-positive, and stressful (and within stress appraisals there are three aspects, which are harm/loss, threat, and challenge). What confused me about phenomenology was the aspect of “reality” and whether the person perceived his or her cognitive appraisals as reality or not. This would be important to understand. If the person is perceiving his or her appraisals as reality when in fact these are influenced by a number of different factors, then this would be important to know. In Judith Beck’s book, it seems to say that clients understand their automatic thoughts as fact/reality. They believe them; sometimes they are accurate and sometimes they are not. In Wright et al. (2006), it says that with clients who are depressed or have other emotional disorders, the automatic cognitions are usually inaccurate. That was my understanding. Cognitive appraisals are pertinent to CBT because CBT has to do with automatic thoughts and how they affect a person. The therapist helps the client to focus on what automatic thoughts are happening throughout the day that may be triggering his or her emotions and maladaptive behaviors.

    Coping ability varies from person to person based upon a number of variables, such as how one appraises a situation, the resources at one’s disposal (and how one accesses those resources), personal constraints, environmental constraints and level of threat. There are two functions of coping, which are problem-focused and emotion-focused, and they are often used in conjunction with each other. Emotion-focused coping is related to being able to lessen one’s emotional distress through avoidance, minimization, etc. There are two types of problem-focused coping groups, which are those related to the environment and those related to the self. My takeaway about coping is that it is all quite individual and will vary greatly. For example, in the section on personal constraints it states that cultural norms play a part in how a person copes, however, how much a person adheres to cultural norms makes a big difference. In other words, it is fine to have a blueprint from which to start in talking and thinking about coping styles, however, when working with individuals in therapy, one will not know how a person copes until actually working with and learning about that individual, and there will be infinite combinations of coping styles for how many individuals one works with. In CBT, it is also very individual in that each person is unique. Again, there is a blueprint from which to begin, however, the therapist then is able to apply that blueprint however it fits with each unique client.

    Sometimes I am concerned about my ability to be a CBT therapist, but mostly this stems from self-doubts in general, not so much about my ability to apply the concepts of CBT. What I learned in PSY 600 was a bit daunting, such as the techniques and when to do what, etc. I really like this program because we practice and that helps me quite a bit. When I picture myself as a therapist, the aspect I see me having the most trouble with is knowing what to say at what time. I tend to be shy and introverted, however, I have a strong desire to help people. I do know that it will take some time to become more comfortable in the therapist role and I have heard from numerous people who are therapists that the discomfort/anxiety is normal at first. I feel good knowing that CBT is empirically strong, as well as feeling more comfortable with a relatively more structured therapy. I also feel as if there is so much to know. Even though it is all laid out in a fairly straightforward manner, especially in Judith Beck’s book, I worry sometimes about my ability to retain all this information and apply it as necessary. I love how in her book she says that it will take time to become comfortable and more at ease working with clients and to allow for this. It is as if it is permission to have the feelings of unease and awkwardness at the beginning. As for the genuine regard, the empathy and listening, I think I do fairly well. It may be difficult on some days, but is that not true for everyone?

    Reply

    • Olivia Grella
      Sep 14, 2017 @ 22:04:50

      Liisa, I really appreciate your honesty in how the thought of being a CBT therapist can be nerve-wracking. I also think back to PSY 600 last semester and wonder how incorporating all those skills together will actually turn out for the first time. I agree that Judy’s book is a great resource and it’s almost comforting to have her say that it takes time to develop these skills and do so well. Like you said at the end, some days may just be more difficult than others, but continually working on these skills and moving through those rough patches will only make us more effective therapists.

      Reply

    • Chiara Nottie
      Sep 16, 2017 @ 09:13:48

      Hi Liisa,
      I agree with your thoughts about phenomenology. Respecting how real a client considers an experience is, before putting it into perspective of being “real” or not will likely be something we address as counselors all the time. I think it will be easy to be sympathetic to this concept of phenomenology, because I think we have all experienced an interpretation as feeling “real” even if it does not have a strong basis in reality (particularly in early life years, like adolescence). While I was reading about phenomenology this past week, I kept wondering whether it would be more or less difficult to address these unreal, “real” perceptions in older aged clients or younger. So far I assume with younger clients, their lesser knowledge of the world will be the primary challenge, while with older clients the familiarity with their inaccurate appraisals will be the primary challenge (meaning the longer they’ve perceived things in a certain way the more used to or “real” it may seem). I’m glad you mentioned this aspect of our readings!

      Reply

  13. Venessa Wiafe
    Sep 14, 2017 @ 12:42:54

    1. Lazarus’ and Folkmans’ conceptualizes cognitive appraisal as stress that is viewed as a two way system, where stress can be produced as a result of the environment forming these stressors and how an individual responds to the stress she faces. Individuals are able to basically examine the significance of the stress they encounter in their lives. Cognitive appraisal also comes with two parts, a primary appraisal and a secondary appraisal. The primary appraisal is when the individual tries to assess the stressor(s) and figure out what the stressors indicate and how it may influence him. An individual can respond pessimistically to the stressor, if the stressor may cause harmor be a form of threat in the present or the future, or optimistically if the stressor will not be a challenge and won’t have an individual run into any major issues. An example would be if Lucia noticed that it was starting to snow heavily outside. If Lucia appraised this in a positive manner, she wouldn’t be threatened by the heavy snowfall because it could prevent her from having to go into work today after having a stressful day of work the day before. If Lucia appraised the heavy snowfall in a negative manner, she would be stressed about the snowfall because she will not be able to make it to the library to do her school work, which she would need to do, due to the fact that her roommate is very distracting to her. The secondary appraisal occurs at the same time as the primary appraisal and can actually be the reason why the primary appraisal occurs. It involves how an individual feels in regard to dealing with the stressor(s) or the stress that can be produced. The secondary appraisal can also be done in a optimistic manner or a pessimistic manner. An example of a positive appraisal would be if Alycia decided to keep trying to pass her LSAT exam even after failing two times. She would say statements to herself such as, “I will not give up. No matter how many times I failed, I know I can do it no matter what”. This indicates that Alycia isn’t taking failure as an option or allowing herself to give up, no matter how stressful studying for the exam is. Alycia would be negatively appraising the situation if she should say statements to herself such as, ” I already failed twice. Third time’s not a charm for me. My chances of passing are extremely low. I can not do it.” Alycia allows her stress to take a toll of her and doesn’t give herself a chance to even study and try one more time. She would believe her thoughts and turn it into a reality instead of trying to take the exam again, and hopefully passing.
    Lazarus’ and Folkmans’ conceptualization of coping is that it comes from one’s appraisal and the fact that a situation may occur that goes beyond what an individual can handle. Coping includes both the behavioral as well as the psychological attempts utilized to control an individual’s environment, both internally and externally, when there is apparent tension among how one views their ability and the assets needed to face cognitive stress. Lazarus and Folkman discovered the two ways individuals dealt with stressful encounters, which are problem-focused (changing the person and environment) and emotion-focused (controlling the emotional pain). Problem-focused coping aims at altering the relationship between an individual and the environment by taking action on the individual or the environment, and furthermore utilizing plans to help with coping such as having control over one’s self, an individual being held liable for his actions, and utilizing positive re-appraisal. These forms of coping can result in positive conclusions and emotional changes. Coping strategies work differently with different types of people with opposing personalities. One’s amount of stress can also dictate how well coping strategies can work for them. However, taking the initiative to commence the coping process is a great start.
    Lazarus’ and Folkmans’ conceptualization of cognitive appraisal relates to CBT heavily because of the fact that individuals can place negative meanings on situations or events, then start to believe them and act as if their negative thoughts are their reality, when it isn’t. Individuals appraise situations negatively and then act as if what they are thinking is true, just like how depressed individuals are viewed when being assessed during CBT. They are stuck with their negative thoughts and aren’t able to see what may come next in any given situation they face due to their negative thoughts and behaviors. Their conceptualization of coping also relates to CBT because during CBT, individuals can believe that they aren’t sure if they can handle the stressors in their life that is causing their depression, for instance. They think that they don’t have the adequate resources to help them cope with the stress, because the stress seems to over power them. Just like in their theory of coping, CBT allows individuals to have a sense of control over their issues and not let their issues lead them astray. They have the chance to rethink their situations over and practice strategies such as positive reappraisal to alter their negative thoughts and replace them or reappraise them with positive, more rational, and much healthier thoughts in order to face stress.

    2. Cognitive Behavioral Therapy (CBT) is an excellent and effective source of treatment for individuals battling mental health disorders such as depression and anxiety. This form of therapy is based on a cognitive model that states that an individual has a situation that leads to him having automatic thoughts about the situation, which occur rapidly and abruptly, and then the individual reacts to the thoughts. The reactions can be emotional, behaviorial, and even psychological. This form of psychotherapy is not only able to tackles one’s thoughts and behaviors, but also get to the root of the the cause behind one’s thoughts and behaviors. The way one perceives a situation or event has a major impact on how one conducts himself. It is the pessimistic meanings individuals place on their thoughts that causes certain negative behaviors to play out. An example can be when a woman named Anna falls into depression avoids going to classes in college because she tells herself that there is not point in getting up and going to class because nothing will even go right since she feels terrible about herself and feels hopeless. Anna believes her own thoughts and decides to email her professors to let them know that she has suddenly come down with a terrible cold that has unfortunately prevented her from attending her classes in the evening. Anna won’t be able to know what will happen if she was to actually get up and go to class because she is stuck in her own prediction. Anna also won’t ever know if her prediction was actually wrong. Instead, she stays in her dorm room and continues to talk negatively to herself, causing her to feel worse instead of feeling better. As a therapist, I hope to be able to help my clients by assisting them with dealing with their numerous immense issues in a much more positive light. I also hope to deal with their issues and situations one at a time, as I know they can be extremely overwhelming. I will have my clients engage in thinking and talking about their thoughts and emotions so that they can view and comprehend them for themselves. I will active listen to my clients and form an amazing therapeutic relationship with each and everyone one of them so that unconditional positive regard is formed, compassion is present, and rapport is fully established. Once their current issues are brought to the light, I can aid my clients in altering their irrational, negative meanings that are being placed on their thoughts, and have them instead place more positive and appropriate meanings on them. This will be able to ameliorate one’s mindset everyday and basically modify their behavior and thinking that is dysfunctional and unhelpful. I will also assign homework to my clients in between sessions. CBT is a rather transient form of therapy, so I want to help in the best way possible. I will have my clients try what they learned in therapy during each session at home. I’ll have clients alter their negative thoughts and replace them with positive ones. I’ll have them finish processes they never thought they could, such as finishing up a job application and fighting their fears of thinking they can’t get the job, because one will never know until he tries.

    Reply

    • Julie Crantz
      Sep 15, 2017 @ 13:15:38

      Hi Venessa,
      I really appreciate your blog post regarding your future as a CBT therapist. It was very helpful to read your example about Anna who suffers from depression. It is clear how passionate you are about being a therapist and your message is filled with compassion. You mention how overwhelming it is to deal with life’s issues and how important it is to tackle each issue one at a time with a client. There is no doubt you will establish a strong therapeutic alliance with your clients. I like how you conclude with another example of how you will help future clients with completing processes they have doubts with.

      Reply

    • Luke Gustavson
      Sep 16, 2017 @ 10:05:23

      Hello Vanessa,

      The examples you used in your post helped to ground the theory in reality. That is incredibly helpful. Further, it sounds as though you have a fairly decent grasp on how you would conduct a therapy session – Probably more than I do at the moment.
      Anna’s particular case as you have presented her seems fairly steeped in the cognitive tradition. However, might there be behavioral principles at work here? For example, when Anna doesn’t want to get out of bed and go to class – and feels worse as a result – is this a cognitive-only event or has her vegetative behavior and poor mood been behaviorally reinforced much like an individual with a fear of snakes avoiding snakes?

      Out of curiosity, what kind of therapeutic treatments (that you’re currently aware of) would you recommend for Anna?

      Reply

  14. Julie Crantz
    Sep 14, 2017 @ 13:42:20

    1. Cognitive appraisal is the process of classifying and assessing an experience and the details surrounding the experience with regard to how they impact one’s well-being (Lazarus & Folkman, 1984). Cognitive appraisal is an intervention between what a person encounters and the person’s reaction to the encounter. There are two equally important components of cognitive appraisal which are primary appraisal and secondary appraisal. During primary appraisal, one evaluates whether the experience is troublesome or beneficial, one reviews the timing of the experience as being either impactful in the present or in the future, and one inquires as to what makes the experience troublesome or beneficial. In secondary appraisal, one asks if there is anything that can be done about the experience and its impact (Lazarus & Folkman, 1984). There are occasions when a person may go through a reappraisal where the original appraisal is altered based on new information presented from the environment. Cognitive appraisal is an important process that is necessary for helping people endure hazardous situations and thrive in favorable conditions (Lazarus & Folkman, 1984).

    Coping refers to the process of continually adjusting cognitive and behavioral efforts to handle challenges that are determined to be stressful or surpassing an individual’s resources (Lazarus & Folkman, 1984). Coping may involve minimization, avoidance, tolerance, or acceptance of stressful conditions. Coping may also include attempts at mastery to improve the situation and to better manage the environment. A form of cognitive coping is defensive reappraisal, which refers to a reevaluation of the past in a more positive fashion, or to consider a present day harmful or threatening situation as less harmful or damaging (Lazarus & Folkman, 1984). Coping is a dynamic process of continuous appraisals and reappraisals of the fluctuations between people and their environment. Coping resources may include health, energy, positive beliefs, problem-solving skills, social skills, social support, and material resources (Lazarus & Folkman, 1984).

    Cognitive appraisal and coping are important concepts for CBT. Cognitive appraisal is a principal element of the cognitive-behavioral model (Wright, Basco, & Thase, 2006). Cognitive appraisal is an ongoing process for people to assess the importance of environmental events and also events that occur within them such as memories of past events or bodily sensations. In CBT, a client will work with a therapist to closely examine the thoughts involved with the cognitive appraisal process which will ultimately lead to improved and adaptive coping skills. In CBT, clients will learn how to think about their own thinking, bringing awareness to automatic thoughts. This will help clients ultimately take control of their thoughts, leading to beneficial changes regarding emotion and behavior (Wright, Basco, & Thase, 2006).

    2. The more I read and learn about the history, theory, and principles of CBT, my eagerness and excitement of my future as a therapist continues to grow. Although I have a great deal to learn about CBT in this graduate program, I am confident that I will be able to consistently apply the principles of CBT as a therapist. I appreciate the writings of Aaron T. Beck in his book, Cognitive Therapy and the Emotional Disorders (1979), and how he stresses the common sense principles behind CBT. I feel the approach of CBT is empowering for clients and gives them the opportunity to understand their thoughts and to take corrective action to make lasting, positive changes regarding thoughts, emotion, and behavior. Although I know I will experience some nervousness working with clients initially, I am confident in my abilities to establish a solid therapeutic alliance with my future clients, and to help them lead happier and healthier lives. I am also inspired to explore how mindfulness techniques can be integrated with CBT to provide clients with additional tools to assist them.

    Reply

    • Sarah Hine
      Sep 16, 2017 @ 08:59:45

      Julie, I appreciate your description of cognitive appraisal as an “intervention”. It suggests that appraisals act as mediators and emphasizes the importance of the mind as a guiding force between the world and the personal experience. I can also relate to your excitement after reading through these assignments. I think because Beck places an emphasis on a common-sense approach, and because his principles and methods are straightforward and clear, it allows people to understand the purpose of therapy and gives them a sense of involvement. As you stated, clients will feel empowered because in CBT, unlike other forms of therapy, they are given a sense of control over their own treatment. It is exciting to think that as therapists, we can assist in empowering people and in helping them change their own lives.

      Reply

  15. Lindsey
    Sep 14, 2017 @ 14:52:41

    1. In relation to CBT, Lazarus & Folkman’s conceptualizations of cognitive appraisal and coping were ahead of the curve when these theories were unveiled. They basically acknowledge the psychological equivalent of Newton’s third law of motion, stating cognitive processes take place for every action or encounter and thus, generate a reaction (coping/emotional response). Yes, there is the argument of nature versus nurture; however, Lazarus & Folkman’s cognitive appraisal and coping theories are more complex. The internal and external conditions that affect the appraisal process comprise of hormones, neurotransmitters, interactions within the environment, and a number of other factors. Understanding how these conditions can impact our cognitive appraisal and coping skills provide a foundation for CBT therapists to identify appropriate treatment methods. Subjective perceptions are constrained by reality-based appraisals, despite the variability of cognitions and interpretations of objective reality. These interpretations or appraisal-related processes influence an individual’s reactions. For example, a job interview can be viewed as a challenge for one person and a threat to another. Just as beauty is in the eye of the beholder, so is stress. Primary appraisals such as stress appraisals pertain to the perception of harm/loss, threat, and challenge. These appraisals are separate but equal in that they generate distinct emotions (positive or negative) yet are able to cooccur. Secondary appraisals focus on the evaluative component, including the assessment of which coping mechanisms are available. Bandura referred to these as efficacy and outcome expectancies. Ultimately, a CBT therapist must assess how the client’s thinking patterns effect (impinge?) on the client’s value/need/commitment to the associated encounter/transaction. If a client exhibits signs of emotional disturbance, a CBT therapist might dedicate more time exploring the maladaptive thinking patterns or automatic thoughts, appraisal processes, and how it relates to the client’s core beliefs. Extensive research proves the cognitive appraisal processes affect stress response so if a CBT therapist is able to shift maladaptive thinking into more adaptive thinking, the cognitive appraisals will follow suit, resulting in stress reduction.
    2. I am excited about my future as a CBT therapist because I genuinely believe it works! The Common Sense & Beyond article states basic CBT principles comprise of introspection, insight, reality testing, and learning; these principles will help clients attend to their thinking patterns and develop more adaptive attitudes. What better way to learn if these techniques work than to apply them on yourself? Tapping into my own “internal dialogue” can enhance my decision making and emotional reactions in personal or situational contexts. Based on the readings, I think completing a thought record could be helpful in enhancing personal awareness. As CBT therapists, I think it is wise to have a taste of our own medicine so to speak. In Chapter 2: Tapping the Internal Communications, the literature states a person who is trained to track their personal thoughts can repeatedly observe “that his interpretation of a situation precedes his emotional response.” If we expect our clients to be committed to the therapeutic process, we should be committed to knowing/understanding what that process feels like from the client’s perspective. Our awareness to the client-experience can increase empathy and decrease unconscious biases that might exist within the client-counselor relationship. Overall, I have a decent understanding of basic CBT and look forward to learning how to put the theories into practice.

    Reply

    • Liisa Biltcliffe
      Sep 15, 2017 @ 09:17:14

      Lindsey, I liked what you said about applying some of the CBT concepts to ourselves as therapists, utilizing these techniques to gain a better understanding not only of ourselves but of what our clients go through. I have been through some personal therapy so I do understand being “on the other side”, however, if one has not experienced this then completing a thought record of one’s own and/or just as you suggested, being aware of one’s own internal dialogue would help with empathy.

      Reply

    • Alana Kearney
      Sep 15, 2017 @ 10:09:04

      Hi Lindsey,
      I truly appreciated how you made a connection between cognitive appraisal and Newton’s physics theory. Often times psychology is under appreciated and cast to the side because of its “lack” of scientific basis. However, most things in the world are interrelated. It is important to understand that the way we understand the physical world is also a strategy to understand the human mind and body, and furthermore how the two interact with each other. After all, the way that primary and secondary appraisal work together and separately proves how complex the human mind is, and the way these appraisals take form in human behaviors has external effects on the world.

      Reply

    • Luke Dery
      Sep 15, 2017 @ 20:54:07

      I liked your comment about applying CBT to ourselves and “getting a taste of our own medicine.” Thinking about it now, it would be very silly to educate clients about CBT and not use it in our own lives in some capacity. I think that my personal practice in challenging my own thoughts and just monitoring my own thoughts and emotions has given me confidence in the effectiveness of CBT. Research can tell us about treatment efficacy, but seeing it work before our own eyes is a different experience entirely. We don’t have to share these experiences with clients, but I think that knowing how effective CBT has been to us personally can result in us being more confidence in our CBT work with others.

      Reply

  16. shay
    Sep 16, 2017 @ 13:51:45

    Lindsey I entirely agree with you. I think that it’s important to get into the clients frame of mind and understand what it might be like to undergo CBT so that you can empathize with them. It may also be helpful to understand what type of questions may be helpful and prompt more exploration than others. Reading your post reminded me of when I worked as a facilitator at a ropes/challenge course as an undergrad at uconn. This challenge course was based on experiential learning. Before each school year our boss required that we go through a training to prepare for the year. Funny enough, the training almost made me turn down the job because I didn’t want to be expected to go up to campus two weeks earlier in August. I’m glad I accepted the position as it turned out to be one of the best and most fulfilling jobs I’ve ever had. The reason I bring this up is because each training the staff would be expected to participate and do every element (challenge) on the course. This included trust falls, balancing on wires, swinging on tires swings etc. My boss had a reason for making us go through every element. He said, “I want you to know what it’s like to be a participant on this course. I want you to know what it is like to be asked to do some of these challenges so you can empathize with and understand when participants come.” I would get anxious each training about balancing on the wires, because I was not great at balancing. Putting that in perspective, some people were afraid of heights and could not do the trust fall from the highest platform. Some people were self-conscious about their weight and did not want to go through an element called the spiderweb. Going through the training, made it so much easier to understand the process from a participants view. It also made debriefing the experience so much better so that I knew how to challenge ideas and provoke exploration. Even though I wasn’t always thrilled about training, it made me a better facilitator. I can expect that therapy relates the same. I think that’s why it is so often recommended that therapist go through therapy so that they can relate to the process. I also personally find it hypocritical, obviously with some exceptions, when someone challenges someone to do something that they personally haven’t even done. I think to fully be empathetic; a therapist must first practice what they preach.

    Reply

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Adam M. Volungis, PhD, LMHC

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