Chapter 3
COGNITIVE CONCEPTUALIZATION
- Cognitive conceptualization provides the framework for understanding a patient.
- To initiate the process of formulating a case, you will ask yourself the following
questions:
“What is the patient’s diagnosis(es)?”
“What are his current problems? How did these problems develop and how are they
maintained?”
“What dysfunctional thoughts and beliefs are associated with the problems? What
reactions (emotional, physiological, and behavioural) are associated with his
thinking?”
- Then you will hypothesize hoe the patient developed this particular psychological
disorder:
“How does the patient view himself, others, his personal world, his future?”
“What are the patient’s underlying beliefs (including attitudes, expectations, and
rules) and thoughts?”
“How is the patient coping with his dysfunctional cognitions?”
“What stressors (precipitants) contributed to the development of his current
psychological problems, or interfere with solving these problems?”
“If relevant, what early experiences may have contributed to the patient’s current
problems? What meaning did the patient glean from these experiences, and which
beliefs originated from, or became strengthened by, these experiences?”
“If relevant, what cognitive, affective, and behavioural mechanisms (adaptive and
maladaptive) did the patient develop to cope with these dysfunctional beliefs?”
- You begin to construct a cognitive conceptualization during your first contact with a
patient and continue to refine your conceptualization throughout treatment.
The cognitive model
- Cognitive behaviour therapy is based on the cognitive model, which hypothesizes that
people’s emotions, behaviours, and physiology are influenced by their perception of
events.
- The cognitive model:
, Situation/event
Automatic thoughts
Reaction (emotional,
behavioural, physiological)
- The situation itself does not directly determine how they feel or what they do; their
emotional response is mediated by their perception of the situation
- Cognitive behaviour therapists are particularly interested in the level of thinking that
may operate simultaneously with a more obvious, surface level of thinking
- At another level, however, you may be having some quick, evaluative thoughts. These
thoughts are called automatic thoughts and are not the result of deliberation or
reasoning. Rather, these thoughts seem to spring up spontaneously; they are often
quite rapid and brief. You may barely be aware of these thoughts; you are far more
likely to be aware of the emotion or behaviour that follows.
- You can learn to identify your automatic thoughts by attending to your shifts in affect,
your behaviour, and/or your physiology. Ask yourself, “What was just going through
my mind?”
- Having identified your automatic thoughts, you can, and probably already do to some
extent, evaluate the validity of your thinking.
Beliefs
- Beginning in childhood, people develop certain ideas about themselves, other people,
and their world. Their most central or core beliefs are enduring understandings so
fundamental and deep that they often do not articulate them, even to themselves. The
person regards these ideas as absolute truths – just the way things “are”.
- (At this point the author gives a case example regarding the information-processing
model. For detailed information see pp. 33 and figure 3.1.)
- Core beliefs are the most fundamental level of belief; they are global, rigid. And
overgeneralized. Automatic thoughts, the actual words or images that go through a
person’s mind, are situation specific and may be considered the most superficial level
of cognition.
