Mindful Happiness

Anthony Quintiliani, Ph.D, LADC

  • Home
  • Dr. Anthony Quintiliani
    • About
  • Mindful Happiness
  • Mindful Expressions Meditation CD
  • Contact

February 16, 2017 By Admin

Details About Cognitive-Behavioral Therapy

Understanding Cognitive-Behavioral Therapy?

Cognitive-Behavioral Therapy (or Cognitive-Behavior Therapy, hereafter CBT) has been noted as the most common evidence-based therapy approach used in the United States.  That said, the most common “therapy” approach used here remains generic talk therapy with more or less psychodynamic characteristics. Given the absolute limited level of outcome-based evidence for effectiveness of generic “talk therapy,” it amazes me how many licensed therapists still use it. Perhaps there is a reciprocal – perhaps unconscious – emotional/attachment need satisfaction process between client and therapist. Most clients like this “talk therapy,” and they will continue to show up mainly because of the positive, accepting nature of the therapeutic relationship.  In some cases, the clinical alliance and therapeutic relationship may be qualitatively superior than in other therapies. However, in cases of severe co-occurring disorders (those that tend to make mental health-behavioral health treatment the most costly of all), the alliance is essential for progress but the relationship alone does NOT cure. It is interesting that systems paying for professional therapy services still fund this generic form of therapy.  Back to CBT.

A general way to understand CBT is to note it is present minded (a mindfulness characteristic), with ample skills learning AND PRACTICE in sessions, as well as in homework.  To get clients to pay attention to homework practices, best to begin them in the session. CBT is time-limited, solutions-oriented, and aimed at problem improvement/resolution and recovery processes. The behavioral components, those that are required to distinguish CBT from cognitive therapy, include behaviorally-oriented action learning.  Learning to do better, to live better, by DOING. CBT is collaborative, requires a good clinical alliance, includes ample psychoeducation, and importantly is skilled-based. It is by way of both insight and new cognitive-behavioral skills to cope better with life’s challenges/stressors that makes CBT so effective.  It must be done correctly, however, to be effective. Although effective CBT requires effective assessment of past causes and conditions, it remains present-to-future oriented in its intention and direction. Some uninformed therapists may think they are doing CBT, but without the behavioral components they are simply doing cognitive therapy.  Whereas CBT includes processes and skills from both cognitive and behavioral therapies, the earliest version was A. Ellis’ Rational-Emotive Behavior Therapy.  More on the cognitive components to follow below.

The process of CBT includes interactive, systemic cycles of repeated thoughts and behaviors.  The A-B-C model (quite behavioral) is often used. In this process model, events lead to thoughts/beliefs, which have emotional consequences.  The emotional consequences (good vs bad), lead to behavioral activations (some impulsive).  The thoughts and their related behaviors produce consequences.  CBT is a highly structured therapy, and one that includes verbal reviews of progress (from treatment), check-ins, clarification of the session plan, etc. Cognitive components of CBT include identification of idiosyncratic automatic negative thoughts (I call them “Red Ants’) and their correction via disputation techniques. Do not use the term irrational; it is outdated and insulting to clients. How would you feel if a person told you “your thoughts are irrational?” Clients are helped to recognize advantages and disadvantages of their self-defeating thought patterns (more meta-cognition than single thoughts) by examination of consequences for having such thoughts – often depression, anxiety, helplessness, hopelessness, and loss of motivation. Reattribution of responsibility for outcomes is also important, as is the reframing process often used to establish reattributions. A more balanced locus of control may be a goal. Thought records are used.  However, to do a better job using both cognitive and behavioral aspects, I suggest using an Experience Record that includes events, thoughts, emotions, sensations, behaviors (especially self-medication), consequences of behaviors and an evaluation of the helpfulness of the consequences.  Using the cost-benefits analysis grid may also be helpful. This approach includes a quadrant regarding actual good consequences about keeping the thoughts/behaviors; actual negative consequences about maintaining the thoughts and behaviors; expected good consequences about changing the thoughts and behaviors; and, expected barriers/roadblocks about making such changes.  CBT can include a harm reduction process in slowly improving thoughts and behaviors, especially in related substance misuse or self-harm aspects of problem solving. I suggest the most important parts of CBT are a solid therapeutic relationship, use of both cognitive and behavioral skills for modifying unhelpful thoughts and behaviors, and built-in behavioral reinforcement for any changes made by the client.  Now we go into the behavioral components of CBT.

Common behavioral components of CBT include the use of learning theory, reinforcement, and conditioning. These clinical skills are not easy to use. As clients learn to use new behavioral coping skills they actively monitor and track their situations, their thoughts, and especially their behaviors. It is common to use an activity schedule to help clients engage more fully with helpful behaviors that may slowly come to replace older unhelpful (rewarding) behaviors. Clients learn how to recognize and monitor both external conditions and internal states of being in response to the external conditions. Of course, there are also internal conditions that may be monitored as well: depression, anxiety, fear, dread, sensation-emotion links, etc.  Relaxation and mindfulness training (MBSR or ACT may be best) are used to help client cope better with
real and imagined (in session) challenging causes and conditions.  Such stress reduction and equanimity skills are taught and practiced in sessions. Sometimes a behavioral hierarchy may be used (task analysis, exposure hierarchy, etc.). In this highly organized setting, clients practice related relaxation/mindfulness coping skills as they slowly make progress up the hierarchy; the process is matching effective coping skills with imagined or real life challenges along the way. It is common to use SUDs measures: from zero to 100 how much discomfort exists right now? Since SUDs scores tend to be used with negative situations, I have developed a SUPs scale. In SUPs: from zero to 100 how pleasant is this situation right now?In such learning, clients come to recognize how conscious and unconscious cues and stimuli may trigger internal negative states; such states have in the past caused maladaptive responses, thus making bad situations worse. A very powerful intervention is to enhance self-efficacy. As clients become more skilled and competent to deal effectively with life problems and challenges, they develop an inner sense of “can-do-it-ness.” This change has dramatic impact on both self-esteem and courage to carry on. In more advanced practice of CBT, many mindfulness-based interventions may be added. I refer to this as CBT-M. For effectiveness all mindfulness skills must be practiced, personally, by the therapist. Both cognitive an behavioral aspects of CBT are used in relapse prevention practices, where new insights (cognitive) may lead to new skill applications (behavioral).  CBT, when effectively delivered and experienced, can produce highly positive changes in long-term problematic cycles of thinking and behaving.

For more information refer to Meichenbaum, D. (1977). Cognitive-Behavioral Modification: An Integrative Approach. New York: Plenum Press. Beck, A.T., Rush, A. J., Shaw, B. F. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press. Wilson, G. T. and Franks, C. M. (Eds.) (1982). Contemporary Behavior Therapy: Conceptual and Empirical Foundations.  New York: Guilford Press. Persons, J. B., Davidson, J, and Tomkins, M. A. (2001). Essential Components of Cognitive-Behavior Therapy for Depression. Washington, DC: American Psychological Association. Padesky, C. A. and Greenberger, D. (1995). Clinician’s Guide to Mind Over Mood. New York: Guilford Press. Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: W. H. Freeman. Germer, C. K., Siegel, R. D. and Fulton, P. R. (2005). Mindfulness and Psychotherapy. New York: Guilford Press. Freeman, C. and Power, M. (2007). Handbook of Evidence-Based Psychotherapies: A Guide for Research and Practice. Hoboken, NJ: J. Wiley. I have noted some classics because their details are far more specific and explicit than some more current publications.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Clinical Practice, Clinicians, Cognitive Behavioral Therapy, Featured, Practices, Therapy Tagged With: CBT, CLINCAL, COGNITIVE BASED THERAPY

Twitter

Mindful Happiness -Currently in Production

Mindful Happiness Posts

Self-Help in Mind-Body Medicine In this brief post we will review several specific ways that may improve your psychological and physical health. The post will be short, sweet, and simple to encourage participation. Here it is. Affirmation – “I am learning to love myself just the way I am.” Repeat this mantra sub vocally over […]

Meditations and Mantra: Try Them Out in Your Practice There are many forms of meditation.  In most cases, the common meditation forms fall into one of two categories: Mindfulness and Insight.  There are also demanding concentration meditations, chakra meditations, and mantra meditations. Here we’ll deal only with the two forms noted above and the use […]

Happiness #3 – More Characteristics Here I will continue the discussion on common characteristics of personal happiness. As you read these posts, please do your best to experiment with these characteristics.  See if you can experience more happiness without a frantic search for it. Ultimately it is about a special form of human love. Here […]

Vipassana Meditation and Introduction Vipassana meditation, as taught by S. N. Goenka, has been practiced in India, Europe, the United States and in many other parts of the world. There are various claims for effectiveness when used as a form of meditative treatment with various populations (often correctional and substance using populations); however, there is […]

In The Dhammapada the Buddha includes an important section on the topic of happiness.  How to be happy in a life of changing joy, suffering, and neutrality? How to be happy in a world of attachment/craving for desired pleasures and avoidance of all suffering?  Attachment, impermanence and unhelpful experiences – all cause suffering.  It is quite […]

Self-Care to Reduce Compassion Fatigue First let’s begin with what some people do to counteract the stressors of living in a hurried,“over-technologized” world. Technically, “technologize” is not a popularly accepted word, but it is a sad  reality. We live in a time when texting while driving may become the new addiction-based cause for many, many […]

Mindfulness and Concentration –  Experience Differences In this post I will explain some basic differences between mindfulness and concentration, both of which are required for effective meditation practice.  This will be the first of three posts dealing with what mindfulness and concentration are, how to experience them briefly in a body-based activity, and how to […]

How to be Happier in a Relatively Unhappy World In today’s fast-paced, digitized, unstable world – with it uncertainty, childish tweets from on-high, and general dissatisfaction with things as they are – how may one become a happier person. It is clear that isolation will not work; it is clear that aggressive actions in opposition […]

COVID-19 Brings Higher Stress and Emotion Dysregulation The Book of Job notes “Man is born unto troubles as the sparks fly upward.” Current stress surveys indicate Americans are stressed out due to COVID-19 concerns, work stress (money needs), imbalance in life-work experience, and lack of support (social, emotional, financial).  The 2020 American Psychological Association national survey […]

Drink a Cup of Tea with Thich Nhat Hanh According to the article “A Perfect Cup of Tea” by Noa Jones, The Great Meditation Master offers this sage advice about the best way to enjoy a great cup of tea. I suppose if you would rather drink coffee, the same suggestions may apply. Recognize that […]

What Consciousness Really Is Considering that we have been to the moon and back, and more recently surveyed important moons of Saturn, science is still a very long way from understanding how the human brain works – and even further away from having a clear, agreed-upon interpretation of human consciousness.  Consciousness is the “stuff” of […]

Gratitude Practices to Improve your Emotional Mood The following fourteen suggestions may improve your emotional mood.  One reward from practicing gratitude is that we tend to feel a little better no matter what our causes and conditions are at the time.   Here is the list. Make a habit of thanking people.  “Thank you.” Appreciate […]

Anahata – Heart Chakra Meditation Practice Rumi noted that to reach the sky we must use our hearts. The Heart Chakra is a very popular focus of meditation practice.  Here we will simply review some characteristics and then move on to a meditation practice. Specific characteristics: Green color, YAM sound (say at least three times […]

So Many Ways to Self-Medicate –  It Just Brings More Suffering Very often poor child-parent (child-caretaker) object relations, attachment with care takers, and attunement by care takers negatively impact young children early in their lives.  The well-documented scientific fact that environmental conditions play a more important role in gene-expression than pure genetics implies clearly that […]

Advanced Meditations – Middle Way -Wisdom Path Between Extremes These meditation practices are advanced, and combine complex ideas from Nagarjuna (Indian Master), T’ong-Kha-Pa (Tibetan Master), and The 14th Dalai Lama (Tenzin Gyatso).  In keeping with the mixed secular nature of my meditation center, I have decided to present these complex ideas with several of my […]

In-Depth Means to Discover and Be Your True Self Henry David Thoreau reminded us that it is not what you look at, but it is what you see that matters. How do you SEE yourself?  John Muir reminded us that the sun shines in us as well as in our souls. Do you find “the […]

Concentration Vs Mindfulness? Many people new to meditation often confuse the differences between mindfulness or accepted bare attention to whatever arises in the moment and concentration or strong penetrating awareness on one thing without distraction.  Concentration is a more intensely focused and engaged form of mindful attention.  Concentration is sustained, powerfully focused, one-pointed attentional awareness. […]

Advanced Buddhist Practices Abiding in Emptiness The various impediments (enemies) to abiding in emptiness are noted below. We have strong attachment to objects of mind and our sense door pleasures. We experience strong desire and cravings as our norms. We over-attach to forms of affection. We may become stuck in grief related to our experienced […]

Polyvagal Interventions for Anxiety S. Porges and his Polyvagal Theory may provide innovative interventions for both anxiety and depression. Many people become trapped in ruminating about the past or worrying about the future; they cannot seem to keep their mind and body in the present moment.  Some strong, fear-based, bodily defenses may not respond well to […]

Basic Self-Compassion Process Practice: To practice self-compassion as needed, follow these specific self-compassion steps. Sensitize your mindfulness skills to become aware of your immediate experience of suffering. Hold a strong intention to respond with self-kindness. Use self-talk to be kind to yourself. Begin by softening your body. Relax your muscles, tendons, joints. Hold a natural […]

Mindful Happiness Tags

ACTIVITY SELF PRACTICE VIPASSANA SELF CARE BRAIN BUDDHISM ELEANOR R LIEBMAN CENTER SELF MEDICATION VERMONT EXERCISES SUFFERING MINDFULNESS TRAINING EMPTINESS COMPASSION MEDITATION PRACTICE BREATHING MBSR ANTHONY QUINTILIANI MINDFUL TRAINING MINDFUL ENLIGHTENMENT SELF COMPASSION THERAPY. TRAINING PRACTICES WALKING MEDITATION MINDFUL MEDITATION HAPPINESS CLINICAL SUPERVISION CONSCIOUSNESS COVID-19 SELF ESTEEM THICH NHAT HANH MEDITATION TRAUMA DR ANTHONY QUINTILIANI PSYCHOTHERAPY MINDFULNESS VIPASSANA MEDITATION MINDFUL HAPPINESS WISE MIND JOURNALING ACTIVITIES ADDICTION

Mindful Categories

Mindful Happiness Pages

  • About
  • Contact
  • Dr. Anthony Quintiliani
  • Mindful Expressions Meditation CD
  • Mindful Happiness
  • Site Map

Copyright © 2021 · Mindful Happiness