Clinical Psychology

Thus, a depressed 45-year-old man might be prone
to be highly self-critical (and often feel guilty, even
when it is not appropriate), to view the world as
generally unsupportive and unfair, and not to hold
much hope that things will improve in the future.
The following cognitive therapy (CT) techniques
might be used in the treatment of his depression
(Beck, Rush, Shaw, & Emery, 1979):

1. Scheduling activities to counteract his relative
   inactivity and tendency to focus on his
   depressive feelings.


2. Increasing the rates of pleasurable activities as
   well as of those in which some degree of
   mastery is experienced.


3. Cognitive rehearsal: Have the patient imagine
   each successive step leading to the completion
   of an important task (e.g., attending an exercise
   class) so that potential impediments can be
   identified, anticipated, and addressed.


4. Assertiveness training and role-playing.


5. Identifying automatic thoughts that occur
   before or during dysphoric episodes (e.g.,
   “I can’t do anything right”).
   6. Examining the reality or accuracy of these
   thoughts by gently challenging their validity
   (“So you don’t think there isanythingyou can
   do right?”).
   7. Teaching the patient to reattribute the“blame”
   for negative consequences to the appropriate
   source. Depressed patients have a tendency to
   blame themselves for negative outcomes, even
   when they are not to blame.
   8. Helping the patient search for alternative
   solutions to his problems instead of resigning
   himself to their insolubility.
   This is an abbreviated, illustrative sample of the
   techniques used in Beck’s cognitive therapy of
   depression. Box 14-6 presents the major features
   of cognitive therapy for depression. It is worth
   repeating that cognitive therapy has proven to be
   one of the most effective techniques available for
   treating depression (Chambless et al., 1998;
   Chambless & Ollendick, 2001; Hollon & Beck,
   1994, 2004). In addition, cognitive therapy has
   been adapted for use with patients suffering from
   anxiety disorders (Beck & Emery, 1985), eating

BOX14-6 Focus on Clinical Applications: Features of Cognitive Therapy for Depression

Aaron Beck’s cognitive therapy for depression is an

empirically supported treatment (Chambless et al.,

1998; Chambless & Ollendick, 2001) that is active,

structured, and time limited. It is characterized by the

following features (Butler & Beck, 1996).

Focus

CT focuses on the connection between thinking pat-

terns/styles, emotions, and behavior.

Length

Typically 14 to 16 sessions. Many patients show a

remission of symptoms in 8 to 12 sessions.

Role of the CT Therapist

The CT therapist is an active, supportive collaborator.

Through psychoeducation, guided discovery, Socratic

questioning, role-playing, and behavioral experiments,

patients are helped to address and change

maladaptive ways of thinking that lead to or maintain

depression and other negative affects.

Structure of a Typical Session

Mood symptoms are checked, an agenda for the ses-

sion is set, the previous session is summarized, home-

work assignments are reviewed, issues on the agenda

are discussed, new homework is assigned, and the cur-

rent session is summarized and evaluated by both

therapist and patient.

Phases of Treatment

In the first phase (about 8 sessions), the cognitive

model is introduced, skills are acquired, and some

mastery is achieved. Reduction in depressive symptoms

occurs. In the remaining sessions, dysfunctional beliefs

that may lead to relapse (e.g.,“This good feeling won’t

last”) are evaluated and modified, relapse prevention

skills are taught, and termination issues are discussed.

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