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"Sad is How I Am!" Treating Dysthymia in Children and Adults
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Section 5
Roots of Cognitive Dissonance

CEU Question 5 | CEU Test | Table of Contents | Depression
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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Along with the difficulties in making decisions and concentration, patients dealing with depression also tend to have unproductive thought patterns. Do you agree?

The model of the cognitive triad was first developed by Beck to better understand depression. The triad helps to understand the interaction of the patient's negative views of self, world, or experience of the future.

As you know, these thought distortions tend to be an automatic response, a reflex reaction to everyday events and situations that expose the areas where your client is already plagued with self-doubts or memories of past negative experiences. These distortions are the thematic directional signals that point to, or suggest, the underlying schema, or internal representation of the world.

As an effective treatment for depression, cognitive therapy can help improve your client's impaired thought patterns. As you know, a reason that clients have difficulty dealing or coping with external stimuli is their lack of basic effective thought processing skills. The major goal of cognitive therapy is to increase the patient's skills so that he or she can more effectively deal with the demands of life and, thereby, have a greater sense of control and self-efficacy.

The following two CBT therapeutic interventions are based on the concept that the depressed client holds an erroneous belief about his or herself and their future. Even when contradicting data is presented, as you know, your client may hold on to his or her erroneous beliefs. However, by introducing "cognitive dissonance," you open up this closed system to corrective information.

ABC Cognitive Behavior Therapy Technique
As you know basic cognitive theory states...Thoughts carry a client from point A, a stressful or upsetting event, to point C, an unsettling or painful emotional state. Just as one can prevent an explosion by cutting the fuse that runs between a spark and a stick of dynamite, you can help your clients train themselves to fill in the B. Or, practice retracing the path their thoughts traveled. They can then learn to spot unproductive thoughts while they are thinking them. Thus, your client prevents new bouts of depression. I suggested this technique to a client of mine, David.

When David came in, he was experiencing point C, unsettling and painful emotions. He had been feeling anxious all day. At one point he said his chest felt so tight that he feared he was on the brink of a heart attack, and he had canceled his weekly racquetball game because of it.

As usual, he thought his emotional state had just "happened." After all, he said, "I had been 'keyed up' from the moment I had woken up that morning. But nothing unusual happened. The radio alarm clock went off at the usual time. A commercial was just ending, and the news announcer came on, gave the date, and made some comment about income tax day being right around the corner." At this point David abruptly stopped speaking. He had found point A.

David stated, "The radio announcer's reference to income taxes had reminded me that I had not prepared my tax return yet." I explained to David, "That was where your chain of thought began." David continued, "Hoping to motivate myself to get my tax return done, I gave myself a mini-lecture, and while I was at it, I reprimanded myself about a half-dozen other areas I had been neglecting: cleaning my messy apartment, replacing the threadbare tires on my car, updating my lesson plans, doing something about my social life, and my life in general."

As you can see, unintentionally, David had taken the need to complete one task and turned it into an impossibly crowded agenda, and concluded that as he stated, "Everything is totally out of control. I am on the verge of falling apart completely. Who wouldn't feel anxious and depressed about all of this?"

Where would you start with your David? Here was my plan. Since initially David knew he felt anxious and depressed, but did not know why, I started at point C and worked backward to pinpoint when he began feeling anxious and depressed and what was happening at the time these feelings began.

Is this technique of starting at point C, the unsettling and painful emotions, one you might use in your next session with your David? If so, try having your client recall a recent time when they felt upset. Have them identify their exact feelings. Review with them the events that came before the feelings until they find the one that probably triggered their anxiety and depression.

Or, you can have them start at point A. Have your client identify a recent stressful event, and then recall how they felt about it. To fill in point B, unproductive thoughts, ask them the following

4 Unproductive Thought Questions
#1. What did the event mean to you?
#2. What did you tell yourself during and after it?
#3. What were you expecting to happen that didn't, or what weren't you expecting that did happen? What did that mean to you?
#4. Did this situation remind you of something that had happened to you before and turned out poorly? Did it push a button, or hit a sore spot?

After your client has developed a general idea of what they were thinking, have them write down their train of thought in a notebook, replicating the sequence as closely as they can (that is, what they thought first, second, third, and so on). They may think this is close to impossible, and the first time they try to follow their thoughts, they may indeed discover that uncovering their hidden thought patterns presents quite a challenge. I assured David that the ABC Technique gets easier with practice and that practicing is worth the effort.

Three Benefits of the ABC Technique
--First with the ABC Technique, you can use it to explain any emotional state that baffles you. Depression not longer seems to "just happen" to you. Just realizing that you are not at the mercy of mysterious external forces will provide some relief.
--Second, the ABC Technique enables you to move from tracking you thoughts to paying attention to the thoughts while you are thinking them.
--And finally, it helps you recognize the types of unproductive thoughts that repeatedly bring on or intensify your depression. Once you have identified those habits and cognitive glitches, you can begin figuring out why you continue to experience them - and then do something to correct these unproductive thought patterns.

The next track will explain a technique to assist your client to further focus on the positive by changing the lenses through which they view their world.

Peer-Reviewed Journal Article References:
Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.

Levy, N., Harmon-Jones, C., & Harmon-Jones, E. (2018). Dissonance and discomfort: Does a simple cognitive inconsistency evoke a negative affective state? Motivation Science, 4(2), 95–108.

Schaerer, M., Schweinsberg, M., & Swaab, R. I. (2018). Imaginary alternatives: The effects of mental simulation on powerless negotiators. Journal of Personality and Social Psychology, 115(1), 96–117.

West, S., Jett, S. E., Beckman, T., & Vonk, J. (2010). The phylogenetic roots of cognitive dissonance. Journal of Comparative Psychology, 124(4), 425–432. 

Online Continuing Education QUESTION 5
In the ABC CBT Technique what concept does each letter stand for? To select and enter your answer go to CEU Test.

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