10 Principles of Anxiety Disorder Therapy: Part 3 of 3
♦ Principle 8: Cognitive Therapy is Based on an Educational Model
A premise of cognitive therapy is that one develops anxiety not because of unconscious motivations but because one has learned inappropriate ways of handling life experiences. This premise suggests that with practice, one can learn more effective ways of leading one's life.
One of the therapist's functions is to educate. J. Singer has expressed a similar view of psychotherapy: "In some ways the psychotherapist can be viewed as a teacher, as well as a technician. This does not mean that he gives formal lectures, for even good teachers know that they are not always the best method of influencing their pupils" (1974, p. 23). It is helpful for the therapist to view himself as a teacher of anxiety-management skills.
Cognitive therapy, in addition to providing corrective experiences for a patient, incorporates didactic techniques such as providing information, assigning reading, listening to audio tapes, written homework, and suggesting that the patient attend a lecture.
Learning to Learn
Let's now talk about strategies for the client reluctant to be taught by therapy. The client has to consent to learn before therapy can develop. The reluctant client may argue with you or tune out what you are saying. When I spot this problem, I need to address it. Here's how... I ask Lorraine if she has ever been in a class where she made up her mind that she was not going to let the teacher teach her anything. I then ask Lorraine to compare this experience with the class where she gave the teacher permission to teach her.
Part of this problem is related to the amount of trust Lorraine had in me. Thus, the first therapeutic order of business may be to develop trust in the patient by setting up a system for feedback from her and by continually erring on the side of honesty with her. The second step I ask Lorraine is how she could benefit by allowing herself to learn.
For example, one thirty-five-year-old-man, John, lived with his mother and had only a few dates in his life. He needed to learn ways to deal with the opposite sex. The therapist focused on first learning how to learn. The patient had to go places where he could meet women, but with the goal of learning as much about his reactions as possible. He first had to find out how he was preventing himself from learning his experiences.
The therapist needs to help the patient learn how to remove or transcend the blocks that have prevented him from learning from his experiences.
♦ Principle 9: Inductive Method
The theory and techniques of cognitive therapy rely on the inductive method. In other words, the emphasis throughout therapy is on the client's "getting the facts."
♦ Principle 10: Homework is a Central Feature of Cognitive Therapy
The therapist should explain to clients the practical reason for doing homework. The reason I give is that once-a-week visits are insufficient for overcoming long-held anxieties. Further, the rationale for particular assignments has to be explained, because clients are unlikely to carry them out if there is any doubt about their potential usefulness. I like to present homework as an experiment to prove or disprove a hypothesis, such as the patient's belief that a traumatic experience will occur if he faces the feared situation.
Peer-Reviewed Journal Article References:
McGovern, C. M., Arcoleo, K., & Melnyk, B. (2019). COPE for asthma: Outcomes of a cognitive behavioral intervention for children with asthma and anxiety. School Psychology, 34(6), 665–676.
Newman, M. G., & Fisher, A. J. (2013). Mediated moderation in combined cognitive behavioral therapy versus component treatments for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81(3), 405–414.
Robichaud, M. (2010). Review of Cognitive therapy of anxiety disorders: Science and practice [Review of the book Cognitive therapy of anxiety disorders: Science and practice, by D. A. Clark & A. T. Beck, Eds.]. Canadian Psychology/Psychologie canadienne, 51(4), 282–283.
Rubel, J. A., Hilpert, P., Wolfer, C., Held, J., Vîslă, A., & Flückiger, C. (2019). The working alliance in manualized CBT for generalized anxiety disorder: Does it lead to change and does the effect vary depending on manual implementation flexibility? Journal of Consulting and Clinical Psychology, 87(11), 989–1002.
Zalaznik, D., Strauss, A. Y., Halaj, A., Fradkin, I., Ebert, D. D., Andersson, G., & Huppert, J. D. (2021). Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder. Journal of Counseling Psychology.
Online Continuing Education QUESTION
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