Cognitive-Behavioral Therapy With An East Indian Family*

This article discusses the use of the cognitive-behavioral approach to family therapy with an immigrant Indian family residing in the United States. Issues of acculturation and the emancipation of a young adolescent female are addressed as conflicts arise between her and her parents. The use of cognitive-behavior therapy (CBT) is presented as a flexible mode of treatment because it allows for the modification of schemas in a way that is respectful to cultural underpinnings and allows the family the freedom to change in a manner that does not compromise their cultural values. Further discussion is directed toward the cultural variables that may be accommodated by the CBT approach and the elements that make the approach adaptable, particularly in cases involving Indian culture.The authors thank Eric Frey of Lehigh University for his assistance with the literature review.     

Changes in schemas of patients with severe borderline personality disorder: The Oulu BPD study

Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema‐focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ‐L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD.     

Virginia Satir: An Integrated, Humanistic Approach

This article traces professional and personal influences that helped Virginia Satir to shape her worldview. She was an integrative humanist who included body, mind, emotional, and spiritual processes to transform systems ranging from the molecular to the cosmic. Her theories and techniques offered a wellspring of hope and possibility to individuals as well as large assemblies. The presentation of a case with young, abused children demonstrates her use of self (through physical touch) by sensitively reframing the cycle of violence as an opportunity for safe, cooperative contact.     

An Examination of Early Maladaptive Schemas among Substance Use Treatment Seekers and their Parents

Early maladaptive schemas, which are cognitive and behavioral patterns of viewing oneself and the world that result in substantial distress, are gradually being documented as important vulnerabilities for substance abuse. Unfortunately, there is limited research on early maladaptive schemas among substance abusers and their family members. Research on this topic may carry important implications for family-focused substance use interventions. The current study examined similarities and differences in early maladaptive schemas among a sample of substance abuse treatment seeking adults (n?=?47) and at least one parent (n?=?58). Results demonstrated that the substance abusers scored higher than their parents on 17 of 18 early maladaptive schemas, with most differences falling into the large effect size range. There were some similarities in the specific early maladaptive schemas endorsed by both groups despite substance abusers scoring higher on all schemas. Implications of these findings for future research and family-focused substance use treatment programs are discussed.     

A Special Feature in Commemoration of Aaron T. Beck’s Contributions to the Science and Practice of CBT

This special feature in Cognitive and Behavioral Practice is a commemoration to Aaron T. Beck’s contributions to the science and practice of CBT. The fact that so many leading scholars participated, including several Past Presidents of the Association for Behavioral and Cognitive Therapies, speaks volumes about the high regard held for Beck. Included are papers that cover the Beckian model of depression, its refinement and application to obsessions, compulsions, hoarding, as well as how the model addresses interpretational biases in emotional psychopathology and has been adapted for youth. Additionally there are papers conveying how Beck’s phenomenological approach to understanding the client’s perspective is useful in attending to cultural differences, and in mitigating the mental health impact of marginalization and discrimination. Expert commentaries are extended to relational processes (case formulation, therapeutic relationship, collaboration and guided discovery, alliance, rupture repair, homework), change processes (cognitive reappraisal, dialectical thinking, acceptance and defusion, emotional schemas), and to important scientific advances (conceptualizing processes within techniques, data analytic advances that bridge the scientist-practitioner gap, and technology augmentation). Many of the contributions herein also include brief personal stories to help illustrate the enormity of Beck’s contributions.     

Sandtray Therapy: A Familial Approach to Healing Through Imagination

The application of creative techniques in counseling is often tailored to a unique problem, and limited by individual characteristics of the client. One intervention, sandtray therapy, a derivative of play therapy, has gained strong momentum as a creative technique. With greater flexibility for treating a much larger population, sandtray therapy is more applicable for families than other creative approaches. The purpose of the current article is to give an overview of sand tray therapy, as well as provide information regarding its use for working with families. Specifically, the authors discuss exactly how counselors can successfully incorporate sandtray therapy in the familial population setting, and describe its application through case study.     

The Sleeping Analyst,The Waking Dreams: Commentary on Papers by Richard A. Chefetz and David G. Mark

The discussion applies the basic psychological concepts of emotion schemas and the referential process to the case material presented by Drs. Richard Chefetz and David Mark. Emotion schemas are types of memory schemas that develop in an interpersonal field. They include subsymbolic processes, symbolic imagery, and linguistic codes, integrated to varying degrees. In treatment both participants come in with their emotion schemas, developed in the course of their lives, activated in the events of the day; communication between analyst and patient occurs on all levels in subsymbolic somato-sensory and symbolic verbal forms. The discussion of Dr. Chefetz's presentation emphasizes the relationships among multiple schemas of self and others, within the patient and between patient and analyst. The discussion of Dr. Mark's three cases focuses on connections and disconnections within the schemas as well as between them and emphasizes the pivotal role of imagery in connecting subsymbolic experience and words, and in the reconstruction of dissociated schemas in the context of the therapeutic relationship.     

Link between early maladaptive schemas and defense mechanisms

IntroductionDefense mechanism and early maladaptive schemas are two concepts distorting the perception of reality.ObjectiveThe aim of this study was to explore the link between two reality-distorting concepts from two theoretical models: early maladaptive schemas from the cognitive and behavioral model and defense mechanisms based on the psychoanalytic model.MethodTwo hundred thirty-two non-clinical participants completed the Defense Style Questionnaire and the Young Schema Questionnaire (short version). Then a Bravais Pearson correlation analysis connecting these two concepts, and a multiple regressions analysis using early maladaptive schemas as predictors for defense style mechanisms levels were conducted.ResultsThe results indicate that 2 early maladaptive schema domains (i.e. other-directedness as well as over-vigilance and inhibition) predict the frequency of use of the neurotic defense mechanism, and 3 schema domains (i.e. disconnection and rejection, impaired autonomy and performances as well as impaired limits) predict the frequency of use of the immature defense mechanism.ConclusionTo conclude, two psychological concepts based on two different theoretical models (psychoanalytic and cognitive and behavioral therapy) seem to share an important link justifying the use of integrative therapies such as schema therapy.     

Cognitive and coping mechanisms in the interplay between intimate partner violence and depression

This study examined the association between intimate partner violence, maladaptive cognitive schemas, coping, and depression in a sample of 298 battered women. The results indicated that maladaptive cognitive schemas were associated with less use of primary and secondary engagement coping, and higher use of disengagement coping. In particular, cognitive schemas reflecting disconnection and rejection accounted for the association between psychological abuse and percentage of disengagement coping. In addition, disengagement coping partially mediated between cognitive schemas and depressive symptoms. Finally, the role of cognitive schemas as personal constraints that affect the choice of coping and the implications for interventions with victims are discussed.     

Thérapie cognitive et schémas cognitifs : un aspect du paradoxe

On one hand, schemas responsible for psychopathologies are said to be slowly formed during the childhood which means they become stable, rigid and practically non-modifiable structures. On the other hand, cognitive therapy aims at modifying these schemas, sometimes a few appointments are enough for the shortest techniques. To explain this paradox, we have measured the activity of 13 early maladaptive schemas among 36 patients (20 men and 16 women), suffering from panic disorders with agoraphobia, before and after a 10 weekly session group therapy—the symptoms being totally reduced. We compare these measures with those made on subjects free from any psychiatric disorders. Our results indicate that if therapy modifies symptoms, it has no immediate effect on early maladaptive schemas.     

An exploration of psychological and physical injury schemas in civil cases

Civil plaintiffs often seek compensation for their psychological injuries. Yet little is known about jurors' preconceived notions (or schemas) for a prospective plaintiff's pain and suffering. The present studies examined (a) whether jurors have psychological injury schemas (Studies 1 and 2), (b) whether their existence and development vary by the type of civil case (Studies 1 and 2) or its severity (Study 2), and (c) how psychological injury schemas compare with physical injury schemas on a number of theoretically and legally relevant judgments (e.g., injury severity, availability, and plaintiff credibility; Study 2). Study 1 (N = 233) presented undergraduate mock jurors with 2 negligence incidents (car accident and slip and fall) and 2 intentional tort incidents (sexual assault and kidnapping) and asked them to report the typical incident and injuries that would result from the defendant's conduct. Results supported the sparse existence of psychological injury schemas but found that they were more developed in the kidnapping and sexual assault incidents than in the car accident and slip and fall incidents. Study 2 (N = 288) additionally manipulated incident schema severity (mild vs. severe) while having participants separately report and rate their psychological and physical injury schemas on judgments of legal and theoretical interest. Results indicated that although mock jurors' psychological injury schemas contained fewer injuries than their physical injury schemas, the reported psychological injuries were rated as more severe than physical injuries. We discuss how schemas may underlie the disparate treatment of psychological and physical injuries by legal decision‐makers.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Commitment First,Communication Later: Dealing with Barriers to Effective Couples Therapy

Teaching communication techniques to couples is a common way for therapists to begin treatment. In many cases, couples then use these newly acquired skills to express negative or even hostile information to each other, sometimes doing more harm than good to the relationship. Based upon years of clinical experience with hundreds of couples in treatment, this article presents the idea that having the couple see themselves as an entity first, not as two individuals, may be necessary before clear communication can be maximally therapeutic. The article outlines the Couple Power model of treatment, suggesting that four basic tasks—commitment, cooperation, communication and community—need to be accomplished in that order, postponing the teaching of communication skills until later in therapy. Theory behind the tasks and suggestions for effective techniques to achieve the “Four C’s” of Couple Power are presented and discussed.     

What Are the Main Differences Between Behavioral and Systems Therapy with Couples? A Critical Account

This paper describes the main differences between behavioral and systems therapy with couples. To improve clinical decision making for a given case, the theoretical assumptions of the chosen treatment approach need to be clearly understood. Contrasting the two approaches will assist couple therapists in providing clinical services that better reflect the chosen theoretical framework. This paper reviews the common elements that can be found across models. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

The Use of Worked Examples as a Substitute for Problem Solving in Learning Algebra

The knowledge required to solve algebra manipulation problems and procedures designed to hasten knowledge acquisition were studied in a series of five experiments. It was hypothesized that, as occurs in other domains, algebra problem-solving skill requires a large number of schemas and that schema acquisition is retarded by conventional problem-solving search techniques. Experiment 1, using Year 9, Year 11, and university mathematics students, found that the more experienced students had a better cognitive representation of algebraic equations than less experienced students as measured by their ability to (a) recall equations, and (b) distinguish between perceptually similar equations on the basis of solution mode. Experiments 2 through 5 studied the use of worked examples as a means of facilitating the acquisition of knowledge needed for effective problem solving. It was found that not only did worked examples, as expected, require considerably less time to process than conventional problems, but that subsequent problems similar to the initial ones also were solved more rapidly. Furthermore, decreased solution time was accompanied by a decrease in the number of mathematical errors. Both of these findings were specific to problems identical in structure to the initial ones. It was concluded that for novice problem solvers, general algebra rules are reflected in only a limited number of schemas. Abstraction of general rules from schemas may occur only with considerable practice and exposure to a wider range of schemas.     

The embodied nature of medical concepts: image schemas and language for pain

Cognitive linguistics assumes that knowledge is both embodied and situated as far as it is acquired through our bodily interaction with the world in a specific environment (e.g. Barsalou in Lang Cogn Process 18:513–562, 2003; Connell et al. in PLoS One 7:3, 2012). Therefore, embodiment provides an explanation to the mental representation and linguistic expression of concepts. Among the first, we find multimodal conceptual structures, like image schemas, which are schematic representations of embodied experiences resulting from our conceptualization of the surrounding environment (Tercedor Sánchez et al. in J Spec Transl 18:187–205, 2012). Furthermore, the way we interact with the environment and its objects is dynamic and configures how we refer to concepts both by means of images and lexicalizations. In this article, we investigate how image schemas underlie verbal and visual representations. They both evoke concepts based on exteroception, interoception and proprioception which can be lexicalized through language. More specifically, we study (1) a multimodal corpus of medical texts to examine how image schemas lexicalize in the language of medicine to represent specialized concepts and (2) medical pictures to explore the depiction of image-schematic concepts, in order to account for the verbal and visual representation of embodied concepts. We explore the concept pain, a sensory and emotional experience associated with actual or potential tissue damage, using corpus analysis tools (Sketch Engine) to extract information about the lexicalization of underlying image schemas in definitions and defining contexts. Then, we use the image schemas behind medical concepts to consistently select images which depict our experience of pain and the way we understand it. Finally, such lexicalizations and visualizations will help us assess how we refer to pain both verbally and visually.     

Unique Contributions of Positive Schemas for Understanding Child and Adolescent Life Satisfaction and Happiness

Much research has examined negative cognitive schemas as associates of psychopathology. Although some research has established relations between positive cognitive schemas and psychopathology, little research has examined positive cognitive schemas in the context of well-being among children and adolescents. In the current study, contributions of positive schemas to two indicators of well-being, namely happiness and life satisfaction, were examined. Specifically we examined how positive schemas predict well-being beyond negative schemas, whether age and gender moderate the relations between positive schemas and well-being, and the contributions of specific positive schema themes to well-being. 282 child and adolescent boys (n = 122) and girls (n = 160) aged 8–18 (M = 13.37, SD = 2.18), completed measures of positive schemas, negative schemas, life satisfaction, and happiness. Results indicated that positive schemas related to life satisfaction and happiness beyond negative schemas, supporting the importance of examining positive schemas in models of well-being. Positive schemas were more strongly tied to happiness in older adolescents versus younger children, but the relations between positive schemas and life satisfaction did not vary as a function of age. Gender effects indicate that the relation between positive schemas and life satisfaction and happiness was stronger for females than for males. When the relative contributions of positive schema themes (i.e., trust, worthiness, optimism, success, self-efficacy) were explored in the prediction of life satisfaction and happiness, worthiness emerged as the strongest predictor. Results emphasize the importance of considering positive schemas in models of well-being among children and adolescents.     

图式治疗理论与实践

由于传统认知行为疗法治疗人格障碍面临许多问题和挑战,Young在认知行为疗法的基础上创建了图式治疗。图式治疗关注患者的早期适应不良图式和适应不良的应对方式,并通过一系列治疗策略,帮助患者改变早期适应不良图式,形成更健康的行为方式。图式治疗是在传统认知行为疗法的基础上,结合依恋理论、客体关系理论、格式塔理论和建构主义理论的整合治疗模型,其整合的优势为今后的发展带来很大空间     

A Cognitive Therapy Approach to Increasing Father Involvement by Changing Restrictive Masculine Schemas

Cognitive therapists may be able to help fathers increase their involvement with their children by identifying and changing restrictive masculine schemas that interfere with men's parenting roles. In this paper, we (a) discuss the development of restrictive masculine schemas, (b) explain how these schemas may affect men's involvement in fathering roles, (c) offer a cognitive therapy approach for enhancing father involvement, and (d) illustrate the approach with a case example.