Cognitive+Therapy


 * Cognitive Therapy & Its Relation to Hopelessness **

Hopelessness experienced in depression is addressed in depth within cognitive therapy. Accordingly, the hopelessness experienced in depression decreases as a 'quick and early response' to cognitive therapy. As a result, cognitive therapy allows great outcomes for success for clients suffering with depression (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007).


 * Exposure-Based Cognitive Therapy (EBCT): Phases & Techniques **

More specifically, exposure-based cognitive therapy (EBCT) is an important and effective subsection of cognitive therapy that is used for clients suffering with depression. This particular subsection of cognitive therapy lasts for the duration of twenty to twenty-four sessions, which is further broken down into three consecutive phases. Furthermore, exposure-based cognitive therapy can generally be described as a guided exploration of the client’s depression, and is specifically intended to modify problematic cognitive, affective, behavioural, and somatic patterns (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007). //Phase One //

The first phase is named the ‘stress management phase’, which encourages motivation to increase healthy lifestyle habits. The healthy lifestyle habits include: engaging in proper sleep, proper diet, physical activity, regulated emotions, and effective problem solving. (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007). A study conducted on the prevention of depression for susceptible college students indicates that social support, healthy foods, increased omega-3’s (fish oil), physical exercise, sun exposure, and obtaining healthy sleep effectively reduced the risk of depression (Young, 2010).

Upon the end of the first phase, mindfulness-based meditation is introduced in order to allow clients with depression to cope with their thoughts and feelings. (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007). Mindfulness-based meditation can be highly beneficial for individuals suffering with depression in order to be content in the present moment. Mindfulness-based cognitive therapy derives from Buddhist spiritual practices, which was indicated to be highly effective for unipolar depression, general psychological health, as well as stress management (Marchand, 2012).

//Phase Two //

The second phase is named the ‘exposure-activation phase’, which encourages clients to explore their negative self-concept and feelings surrounding their hopelessness. With this, the clients particularly explore the antecedents that precede the onset of their negative self-concept, however, there is a high risk to stirring up the clients’ emotions during this process. Antecedents are essentially the factors that precede the behaviour, which is vital for clients to be aware and conscious of. Essentially, clients are then ‘exposed’ to the fear and sadness associated with their own hopelessness linked to their depression (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007).

//Phase Three //

The third phase is named the ‘consolidation and positive growth phase’, which encourages the importance of growing, adapting to new environments, and to compete with a negative view of self. This phase is vital for clients to transition into life without therapy. Precisely, clients learn to obtain a view of self that is ‘balanced’. Meaning, to see both positive and negative characteristics of self. Consequently, the struggle in this phase includes the clients’ fear of being disappointed after all their hard work, as well as trying to gain a positive outlook on life. Therefore, the long-term focus is maintaining a positive outlook and maintaining their emotional regulation in order to cope with future difficulties- both minor and major difficulties (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007).


 * Techniques Used **

The specific techniques used in exposure-based cognitive therapy are extremely effective and unique compared to other cognitive behavioural therapies. In addition, exposure-based cognitive therapy is highly relevant for treating depression.

An important technique in this particular therapy is that clients write a ‘narrative’ about their depressive experiences before each session. This provides the therapist and the client with insight regarding thoughts and feelings surrounding the issue and it is then dealt with during session. Also, this technique is useful in order to exposure the clients to their emotions between sessions and to monitor the impact of therapy on a weekly basis (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007).

Additionally, clients use breathing techniques from mindfulness-based meditation in order to cope with stress, thought processes, and disturbing emotions. This technique allows the client to address the avoidance piece, and to disengage from these patterns (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007).

Lastly, 'cognitive-emotional processing' explores the issues related to depression and includes a shift in the client's perspective, which is often engulfed in emotional and behavioural features (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007). The cognitive processing technique can be used to training the client to be 'tolerant' to their emotions, introduce ‘corrective information’, cognitive restructuring, as well as coming to new meanings about themselves. (Hayes, Beevers, Feldman, Laurenceau, & Cardaciotto, 2007) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">.
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Possible Limitations to Exposure-Based Cognitive Therapy **
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Certain clients could be resistant to altering their lifestyle, such as changing diet and engaging in physical activity, which are very difficult behaviours to alter
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Certain clients may not find meditation to be particularly enjoyable
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Certain clients may experience the suppressed emotions that are surfaced in the exposure phase, which could be problematic for highly sensitive individuals
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Clients may react defensively when their thoughts are being exposed and challenged


 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Cognitive Therapy Vs. Medications **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">A study conducted by DeRubeis et al. explores the effects of cognitive therapy and antidepressant medication initially in treatment for individuals suffering from moderate to severe major depression. The degree of effectiveness of the cognitive therapy however is dependent on how effective the therapist is. Therefore, the role of the therapist and the client-therapist relationship is imperative for cognitive therapy and treating depression. (DeRubeis, Hollon, Amsterdam, Shelton, Young, et. al., 2005).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Interestingly, the results of this study suggests that after eight weeks of treatment, there was a client response rate of 50% for medications (50 mg per day of paroxetine), and a client response rate of 43% for individual cognitive therapy. (DeRubeis, Hollon, Amsterdam, Shelton, Young, et. al., 2005).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Perhaps, each individual varies in preference for antidepressant medication and/or for individual psychotherapy. This is not to say that one method is more effective than another. Therefore, the preference will serve to motivate the client, and most likely increase the effectiveness of the approach used.

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