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Principles and practice of cognitive behaviour therapy

The cognitive theories and treatments in use today have generally followed on from Beck’s original theories. Broadly speaking, cognitive approaches to emotional disorders focus on two main areas of a person’s experience; the appraisals a person makes while in a situation, and the information processing biases that occur. In anxiety, appraisals that are made generally reflect themes of danger and vulnerability.

Information processing biases are seen where certain types of information is noticed (or processed) over other types of information, for example, selective attention to threat cues. The initial assessment and focus of therapy is on the person’s automatic thoughts that reflect their ongoing appraisals of events in their lives. This is aided by the use of an assessment diary, whereby the person is taught and assisted to begin self-monitoring their emotional changes, allowing identification of the negative thoughts that preceded them (Figure 15.2). Two other areas of cognition play an important part: assumptions and schema. Assumptions are those underlying beliefs that a person has that are activated at times of emotional distress and are seen as more enduring than automatic thoughts and reflect more general themes of danger and vulnerability.

Wells describes assumptions as conditional in that they have an ‘If … then’ characteristic to them, for example, ‘If I feel anxious then that means there’s something wrong with me.’ An additional view of assumptions is that they reflect general attitudes or rules, for example, ‘Anxiety is dangerous.’ Schema are seen as more stable and rigid underlying cognitive structures that reflect a person’s early experience and are stated in very concrete terms, for example, ‘I’m inadequate’ or ‘I’m vulnerable.’ It should be noted here that the terms ‘assumption’ and ‘schema’ may be used to mean the same thing by some writers.

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