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

The Failed “War on Drugs” – Let’s Try Treatment On Demand and Fund It The New York based Drug Policy Alliance (drugpolicy.org) and other sources have provided some important information about our failed drug and alcohol policies. Here are a few astounding facts.  The United Stares has about 5% of the world’s population, but it […]

The Meaning of the Present Moment in Mindfulness & Meditation Many mindfulness and meditation experts have commented on the meaning of the present moment.  Below I have noted some of the ideas presented by Eckhart Tolle.  In some cases I have added my own interpretations. What is the Present Moment?  What is the experience about? […]

Liberation of the True Self Socrates is reported to have noted that “the secret of change is to focus all of your energy, not on fighting the old but on building the new.” In Buddhism there are clear relationships between “no-self” and the force of impermanence, that reality that ensures constant change and thus personal […]

Pathways for Coping with Loss and Grief Jeanne Cacciatore, a Zen priest and bereavement specialist, offer sound advice on the process of loss and grieving.  In her book, Bearing the Unbearable: Love and the Heart Breaking Path of Grief (2016), she presents the process as a series of contractions and expansions; contractions are the inward path of […]

Mindful Walking Meditation: How to Walk by Thich Nhat Hanh – A Powerful Short Book of Wisdom In my opinion, Thich Nhat Hanh and The 14th Dalai Lama are the two most important and wise teachers of mindfulness, meditation, compassion, and Buddhism in the 21st century.  Below I will offer my interpretation of Thich Nhat Hanh’s […]

-Steps to Mind Training Anthony R. Quintiliani, Ph.D., LADC To pacify your mind you need to train your mind. Mind training leads to liberation from brain-mind-heart-body automatic processes and reactions. A well-trained mind allows you to utilize executive functions (attention and concentration) to alter auto-reactions of the brain, body and heart. A trained mind liberates […]

In Times of Uncertainty; Clinical Practice H. Colodro and J. Oliver provide sound advice in their new book, A Guide to Self-Care for Practitioners in Times of Uncertainty. This 2020 New Harbinger publication is loaded with helpful suggestions on surviving, even thriving, in our time of struggle. Their core questions include: What do my clients need most […]

  How Most People Learn in Psychotherapy It is highly important that clients learn from their therapists.  In most cases this includes alternative ways of thinking, emoting, and behaving. So what can we learn from educational research on how people learn? Of course we all know it begins with a solid therapeutic alliance – the […]

Mindfulness in the NFL Yes, mindfulness as part of sports psychology programming is being used in the NFL.  Yes, big and physically tough football players are being helped via a mindfulness component of sports psychology. There are some important roots here. Dogen, the famous ancient Japanese Buddhist meditation master, brought Chan Buddhism from China to […]

Calming Your Self-Critical Self with Mindfulness A core problem for many people is their incessant self (or other) criticism. This is a major part of our psychological mind suffering today. In the past life for most people was more difficult, so human basic needs were the energized priorities; today so many of us have been […]

Your  Regular  Practice:   Impact  on  Yourself  From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont Compassion Training:  Here is a quick self-assessment process to see if your regular compassion practice has had positive effects on you.  Review the questions below and decide  what  your  answers are. I hope you have noted pleasant […]

Practice Approaches to for Mindful and  Enhanced Emotion Regulation Brought to us by way of  The Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont Mindful Approaches for Enhanced Emotion Regulation; here are some approaches to practice. 1)In some ways you could understand the progression from auto-pilot mind to greater stability and equanimity of […]

Using Lectio Divina to Improve Your Self-Esteem LectioDivina is an ancient form of Christian (Benedictine) meditation. This meditative prayer is sometimes called “Sacred Seeing.” Lectio Divina follows specific steps as a process: lectio or reading a passage; Meditatio  or meditating on the passage or image; Oratio or praying (I add – in your own way); […]

Zen Buddhist Practices – Egolessness In our practice we often inquire, and sometimes experience, the no-self and/or egolessness. What is egolessness? Who and what do we think we are? Some say that when we die the essence but not the ego lives on into new experiences. Karma and re-birth are givens in this spiritual view. […]

Overcoming the Hindrances of Ill-Will and Aversion Although regular daily practice and sincerely following of The Eight-Fold Path in one’s life may be the best ways to overcome various hindrances, there may be some additional practical suggestions to consider on the path.  We will begin our discussion with common human pain and suffering; we will […]

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 […]

 A Practice To  Help Prevent Alzheimer Disease Kirtan Kriya meditation is part of the ancient Kundalini yoga tradition.  Current clinical research dealing with prevention of Alzheimer disease supports its use in medical meditation.  As G. Harrison (The Beatles fame) noted: As you move attention beyond yourself, you may find peace of mind is there.  Sanskrit root […]

Secular Meditation and Addictions Treatment Today we have ample research evidence (NIH, NIDA, SAMHSA, etc.) that mindfulness, meditation, yoga, and mind training all have some effectiveness in improving addiction disorders. In recent meta-analyses the primary effect was through improved emotion regulations, whereas there was a more direct positive impact on chronic pain, depression, and anxiety. […]

“Ignorance” of Requirements Could End Your Clinical Career Recently various insurance, Medicaid, and Medicare fraud cases have been in the national headlines. Although these fraud cases grab headlines, the truth is that many clinically licensed helpers still do not understand clinical/legal documentation requirements.  In Buddhism, “ignorance” gets in our way; we never approach true liberation […]

Helper Burnout in Today’s Healthcare System Helper burnout is a very common problem in all healthcare services and at all levels of professional training and experience. Helpers from recovery-oriented peer counselors, state employed case managers, and licensed counselors/therapists all the way to physicians are reporting record high levels of reactive stress and compassion fatigue. Psychiatrists are […]

Mindful Happiness Tags

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

Mindful Categories

Mindful Happiness Pages

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

Copyright © 2022 · Mindful Happiness