Traditional CBT approach to cognitive change. Contextual behavioral approach to cognitive change. But let s think about it 9/12/15

Transcription

1 Cognitive Change from a Contextual Behavioral Perspective Traditional CBT approach to cognitive change Jennifer & Matthieu Villatte WACBS Conference 2015 Contextual behavioral approach to cognitive change 3 waves, 3 ways of thinking about thinking 1 st wave: Behavior change happens through contingency learning. 2 nd wave: Behavior change happens through cognitive change. 3 rd wave: Thoughts play a role in psychological problems but solution is to change relationship to thoughts. But let s think about it What is a relationship to thoughts? Do we really not change thoughts in 3 rd wave therapy? And is it really a bad idea? Is Steve going to be mad at me if I say that? Back to the roots What is thinking, from a CBS perspective? Thinking = Language /Cognition = Learned behavior Building and responding to symbolic relations Jennifer & Matthieu Villatte 1

2 I don t like sharing my feelings. = Night butterfly Or even better Papillon de Nuit REJECTION What difference would this make in your relationship if you shared your feelings? My wife and I would have a closer, more meaningful relationship. We would be more intimate. DIFFERENCE DIFFERENCE RELATIONSHIP RELATIONSHIP INTIMATE CLOSER REJECTION WIFE REJECTION RELATIONSHIP MEANINGFUL The role of language/cognition in human psychology, from a CBS perspective Therefore Thoughts don t cause behaviors We don t change thoughts but the relationship to thoughts and we throw the baby with the water Jennifer & Matthieu Villatte 2

3 Cognition is a clinically relevant behavior The example of TRACKING IF IF The example of LIFE MEANING The example of the SELF Perspective taking Part of If-Then And And Contextual Behavioral Principles and Cognitive Change Strategies physical environment ANTECEDENT physiological BEHAVIOR emotional genetic and epigenetic CONSEQUENCE interpersonal cognitive development and learning history social and cultural Jennifer & Matthieu Villatte 3

4 Principle #1: Cognition is a behavior Strategy #1: Change cognition by altering the context in which it occurs Principle #2: Thoughts are learned and learning can t be undone Strategy #2: Change cognition by addition, not subtraction X Principle #3: Cognition requires coherence, which is determined by context and function Strategy #3: Resolve cognitive conflicts by orienting to what works = = 10 Jennifer & Matthieu Villatte 4

5 Principle #4: Cognition often leads to context insensitivity Strategy #4: Improve context sensitivity by linking cognition to experience EXIT Autonomy / Self efficacy Flexibility Individuality Warm up: But. Yes, and Warm up: Describe how client s thoughts are causing problems Show him that his thoughts are inaccurate Suggest more accurate thoughts based evidence Help him to replace with accurate thoughts Notice what happens Practice is Not Performance Play at Your Edge Hit Sour Notes Try it, Taste it Tweak it Jennifer & Matthieu Villatte 5

6 This is your 6 th session with Anne OCD with fears of contamination Avoids touching people or objects in public spaces Avoids restrooms other than her own, which has led to urinary and bowel problems Wears sanitized gloves and uses hand sanitizer to the point of mild tissue damage Tries to neutralizes thoughts by telling herself that there isn t any real risk of contamination Covert avoidance during in-session exposure Not engaging in exposure outside of session Practice: Improve context sensitivity by connecting cognition to experience perceptions sensations external environment thoughts emotions Mark doesn t feel respected 41 year old, teacher in highschool Subject to anger Slapped a student and was suspended Doesn t understand why he was suspended Decided to go to therapy to learn to manage his anger but thinks it s not fair that he has to make this effort It s not fair. Society is really messed up. Practice: Resolve cognitive conflicts by orienting to what works Help client become aware of his behaviors Help discover the context that influences his behaviors Orient to what matters and what works A B C Deliberate Practice Plan Want more? One thing you have learned about yourself as a therapist One thing you have learned about your client(s) One thing you would like to try When will you do it? How often? How will you know if you did it? How will you know it is working? Jenn villatte@uw.edu Matt matthieu.villatte@gmail.com Jennifer & Matthieu Villatte 6

7 Cognitive load Inhibition is a major drain on your cognitive resources Paradoxical effect suppression increases frequency, salience, sensitivity Ruining a good thing regulation skills become cues Don t kid yourself Implicit cognitions influence behavior even if you re not aware of them Mark is depressed 40 year-old; single; no children. Used to work in a bank. Lost his job 2 months ago. Spends days watching TV and sleeping on the couch. Believes that nothing is meaningful, that people lie to convince themselves that they are happy. Life is a cruel joke. Jennifer & Matthieu Villatte 7