Abnormal Psychology

Foundations of Treatment 131

In the decades since behavior therapy and cognitive therapy emerged, clinicians

and researchers have found that attempting to change both cognitions and behaviors

can, for some disorders, reduce symptoms and improve quality of life more than

addressing either cognitions or behaviors alone. Behavioral and cognitive approaches

work together: When cognitive techniques change thoughts, changes in emotions and

behaviors often follow, and when behavioral techniques change behaviors, changes in

emotions, social interactions, and thoughts about oneself and the world often follow.

Consider exposure therapy: The behavioral technique also challenges the cognitive

distortion of catastrophic exaggeration. When patients see that horrible things do

not occur upon exposure to a feared stimulus, their cognitive distortions are modi-

fi ed (Emmelkamp, 2004). Moreover, new cognitions may be maintained through

principles of reinforcement or punishment (Roth & Fonagy, 2005).

Dialectical Behavior Therapy—CBT Plus More

CBT forms the nucleus of a relatively new type of therapy called dialectical behavior

therapy (DBT), which was originally developed specifi cally for treating people with

borderline personality disorder, an Axis II disorder (to be discussed in detail in

Chapter 13). Dialectical refers to the aim of helping patients to tolerate and inte-

grate contradictory feelings, beliefs, and desires. DBT, like CBT, employs particular

tools and methods to change specifi c thoughts, feelings, and behaviors. DBT was

Situation Emotion(s) Automatic thought(s) (ATs) Rational response Outcome

If I talk with her, I will somehow be

humiliated–either I will humiliate

myself or she will laugh at me for

reasons I won’t understand. (90%)

I needed to talk

to a colleague

about a work

problem.

Anxiety (85%) Anxiety

(60%)

Sadness

and

hopeless-

ness

(50%)

It is possible I may be

humiliated, but it is

unlikely. Even if I do or say

something inappropriate,

she may not even notice

or think it’s stupid. (60%)

I am so pathetic. I’m

afraid to do something

as trivial as talk to a

colleague.

Same

situation

Sadness and

hopelessness

(70%)

I may be

afraid to talk

to her, but I am

working on my

anxiety so that

the next time I’ll

be able to do it.

Actual event or

stream of thoughts

Rate (1–100%) ATs that preceded emotion.

Rate of belief in ATs (1–100%)

Write rational response

to ATs. Rate belief in

rational response (1–100%)

Rerate at

(1–100%)

Name: LeonLeon Day: MondayMonday Date: Oct 10Oct 10

Figure 4.4

4.4 • A Daily Record of Dysfunctional Thoughts Leon’s daily record can identify his train of irrational

automatic thoughts and the types of events that trigger those thoughts. By countering such thoughts with rational

responses, the thoughts seem less believable and the intensity of the emotions should decrease. (Format adapted from

Beck et al., 1979.)

Dialectical behavior therapy (DBT)

The form of treatment that includes elements

of CBT as well as an emphasis on validating

the patient’s experience, a Zen Buddhist

approach, and a dialectics component.