This is the fourth question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses what is special about cognitive therapy, what is new theoretically in the field of CBT, and how cognitive behavior therapy has expanded. Dr. Beck explains his present notion of cognitive therapy – that it is based on a theory of psychopathology (information processing model), and the techniques that are utilized are those that can help to ameliorate the dysfunctional aspects of the individual’s beliefs, interpretations, and avoidance behaviors, as well as dysfunction in attention and memory. Dr. Beck mentions the main thrust of cognitive therapy will be to modify the dysfunctional cognitive processing. Please enjoy the fourth segment from this unique series:
Violence in schools, neighborhoods and communities has reached critically high levels in recent years. Exposure to community violence may profoundly affect children’s development from early childhood to adolescence and beyond.
Cooley-Strickland et al. evaluated the efficacy of a school-based anxiety prevention program among urban children exposed to community violence. Higher rates of community violence and crime are experienced by African Americans living in low-income, urban neighborhoods than urban European Americans. Persistent worry about one’s own health and safety, or the health and safety of a loved one, is likely to interfere with a child’s ability to function in developmentally appropriate, academically successful, and health ways. Furthermore, positive correlations between exposure to community violence and anxiety have been demonstrated in previous research.
In this study, 3rd-5th grade students from two Title 1 schools in Baltimore, MD participated in 13 bi-weekly, one-hour group sessions of a modified version of FRIENDS, a cognitive-behavioral anxiety intervention program. FRIENDS utilizes core components of CBT (exposure, relaxation, cognitive strategies) and targets the primary symptoms of anxiety (physiological, cognitive, behavioral). The goal of this study was to decrease anxiety symptoms and prevent the onset of severe anxiety disorders among the sample of low-income, urban African American children exposed to community violence.
The children who participated in the FRIENDS (experimental) group showed lower levels of victimization and fewer life stressors than the control group. The cognitive behavioral skills taught in the program coupled with an emphasis on utilizing healthy coping techniques for managing anxiety, may have contributed to this finding. While the intervention did not specifically target academic skills, the participants’ in the FRIENDS group showed improvement in standardized reading and mathematics scores, whereas the control group showed improvement in reading scores only.
CBT based therapies and interventions, such as the FRIENDS program, can be effective in reducing and preventing anxiety disorders in low-income children from urban public schools. Enhancing the coping skills of these children who experience greater life stressors and have less social support can help reduce the effects of community violence exposure. This can contribute to lower levels of anxiety and consequently higher levels of appropriate development and academic success.
Cooley-Strickland, M.R., Griffin, R.S., Darney, D., Otte, K., Ko, J. (2011). Urban African American Youth Exposed to Community Violence: A School-Based Anxiety Preventive Intervention Efficacy Study. Journal of Prevention & Intervention in the Community, 39(2), 149-166.
SEPTEMBER 2011: This week Beck Institute held its first ever Specialty Workshop: Cognitive Behavior Therapy for Active Duty and Veteran Military and their Families. Psychologists, psychiatrists, social workers, counselors, military service members, VA Hospital therapists and other professionals traveled from 23 states to receive training in Cognitive Behavior Therapy.
Participants received professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., and David Riggs, Ph.D., the Executive Director of the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Riggs discussed special issues in the subculture of active duty and veteran military and their families including: characteristics of the military culture; stressors that impact these groups at all levels of the deployment cycle; and special issues related to combat deployment.
Dr. Judith Beck discussed techniques CBT of depression for military service members, veterans, and their families. Dr. Beck’s lectures and role-plays emphasized the need for the therapeutic alliance, setting goals, structuring sessions, and therapist-patient collaboration.
One of the highlights of the workshop was watching Dr. Aaron Beck (left) conduct a role-play session with a workshop participant. Dr. Beck started the session with a mood check and followed with setting the agenda. Dr. Beck led a case discussion with workshop participants (see video clip below):
Dr. Aaron Beck explains how his curiosity and scientific nature led him to develop Cognitive Therapy. He also explains the first outcome study of cognitive therapy which he conducted with Dr. John Rush. Please enjoy the third video of this unique series:
Research has indicated that medical students tend to be more depressed than others their own age, which may have professional consequences. For example, a decline in mental health could have adverse effects on students’ levels of empathy and professionalism, and it could lead to burnout or fatigue.
A study at the Northwestern University Feinberg School of Medicine required medical students to use a cognitive behavioral approach to (1) identify a behavior they wished to improve or change, (2) monitor that baseline behavior, (3) learn about recommendations for the targeted behavior, (4) set goals for themselves, (5) implement a self-improvement plan, and (6) perform a self-assessment of effectiveness and identify factors that either promoted or hindered their goals. The types of behaviors that the students identified were related to nutrition, exercise, sleep, work/study habits, and mental/emotional health. Data was later evaluated to determine (1) whether students reached their goals, (2) what factors helped or hindered success, and (3) if the students planned to apply behavioral change techniques in the future.
Results of this study indicate that just 2.6% of the students chose to focus on direct improvement of their mental/emotional health. This may be attributed to confidentiality concerns or the inexact nature of measuring improvement in this area. Following participation, however, 80% of the students felt they were healthier as a result of completing this cognitive behavioral exercise. Students also showed insight into what factors helped and hindered achievement of their goals, and more than 80% indicated that they would be inclined to use a cognitive behavioral approach to address problems in the future.
CBT has shown to be useful in helping medical students develop skills necessary to assess personal well-being and maintain solid health habits throughout their lives. By maintaining their own health via self-care methods, medical students will hopefully be able to provide better care to their patients.
Dyrbye, Liselotte N. and Shanafelt, Tait D. (2011). Commentary: Medical Student Distress: A Call to Action. Academic Medicine, 86, 801-803.
I just came across an article(1), in which neurophysiological processes in Borderline Personality Disorder were compared with normal controls. Basically, what the authors found was that borderlines, responding to aversive stimuli showed the usual activation of the amygdala. However, when they were asked to reframe the response (“it is not real, it’s only a picture?” or, react as an observer rather than as a participant), the borderlines showed an attenuated response in the dorsolateral prefrontal lobe and a sustained amygdala response. This is a rather graphic illustration of what we see in borderlines, specifically they have difficulty reframing their responses. So the picture is something like this: they are ultrasensitive to all kinds of events and respond with anxiety set as anger, etc (they score high on almost all of the dysfunctional attitudes on the DAS). They also have really poor impulse control. What this adds up to is that the best way to calm them down emotionally (the amygdala) is through the kind of strategies, suggested by Linehan and other DBT people, specifically self-soothing, acceptance, relaxation, and meditation. These are more likely, at least at the beginning, to reduce amygdala activity. Such strategies also help with engagement. After the patient is well into the self-soothing it may be possible to experiment with reframing. It might be best to start off with examples and see how the patient responds to them. The patient might be given an example not quite relevant to her and can practice alternative explanations, looking for evidence, etc. This is the kind of approach that we use with delusional patients. As the patient practices on the reframing of pseudo-examples, then it is possible to try some examples, from the patient’s own repertoire. Do let me know what you think of this approach.
Best, Dr. Beck
Dr. Amy Cunningham wrote:
Hi Dr Beck, Thank you so much for this! I completely agree that people with BPD struggle significantly with cognitive restructuring and reframing emotionally evoking situations. I often find that the patients experience the suggestion of reframing as invalidating the extent of their pain. I agree with your remark about their ultrasensitivity – I often explain the sensitivity as pains to patients comparable to an “emotional burn victim”. I completely agree that validation and self-soothing allow the person to be in a place where she can start to examine her cognitive distortions and search for more flexible ways of thinking about the situation. I find psychological flexibility, to be a central goal for my work with people with BPD. I also find it helpful to start with validation of their extreme emotional response, as it greatly assists with engagement, and allows the person to be willing, instead of willfully defending her position. I am very much looking forward to working with CTT and Women’s Space in helping them provide more effective services to people with BPD.
Schulze, L., Domes, G., Kruger, A., Berger, C., Fleischer, M., Prehn, K., Schmahl, C., Grossmann, A., Hauenstein, K., & Herpertz, S.C. (2011). Neuronal Correlates of Cognitive Reappraisal in Borderline Patients with Affective Instability. Biological Psychiatry, 69, 6, 564-573.
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