Cognitive Therapy Cognitive therapy refers to a psychotherapy that is based on the cognitive approach (Knapp & Beck, 2008). It was originally developed by Aaron T. Beck through research studies to explain the psychological process that depression patients underwent. Accordingly, the patients depression was as a result of biased interpretations that the patients accorded to events in their lives which resulted from the negative representations that they accorded to themselves, their personal world and their future (Knapp & Beck, 2008). In particular, the patients dreams were characterized by a sense of defeat and failure (Kohut, 2013). Essentially therefore, cognitive approach relies on the information processing model which looks at the interpretation and eventual meaning that individuals assign to their daily experiences (Mathews, 2013). Individuals try making sense of their daily experiences for the sole purpose of attachment and survival and it is based on beliefs and past learning. As a result, the interpretation of the daily experiences by the individual varies from one individual to another (Mathews, 2013). The cognitive approach in therapy as well as in depression has been used for quite some time (Wells, 2013). It has however undergone some refinement throughout the years through some empirical testing (Knapp & Beck, 2008). The essential features of the cognitive approach have nevertheless remained notably the influence that distorted thinking and unrealistic cognitive appraisal of experiences have on individuals behavior and feelings (Mathews, 2013; Knapp & Beck, 2008). remove blank lines Nature of Cognitive Therapy: Aspects of Cognition Cognitive therapy main aim has been to change the individual s behavior and feeling by correcting the distorted individual s thoughts or interpretations (Knapp & Beck, 2008). The feeling and behavior exhibited by the individual result from the individual s thoughts (Mathew, 2013). According to the therapy model, any present events or rather circumstance generates rapid and spontaneous thoughts in an individual referred to as automatic thoughts (Mathew, 2013; Knapp & Beck, 2008). These automatic thoughts are often taken for granted and are different from the ordinary flow of thoughts that occur when individuals reflect on their own experiences and associate freely with other people (Mathew, 2013; Knapp & Beck, 2008). The distorted thoughts which cognitive therapy seeks to eliminate, contain deeper dysfunctional thoughts referred to as the core beliefs (Knapp & Beck, 2008). These core beliefs which are embedded in the cognitive structure of an individual largely determine how situations are conceptualized by an individual (Knapp & Beck, 2008). This is by determining how the current information and experience is processed. The core beliefs are acquired early in an individuals life. As the individual develops, these core beliefs are modified by personal experiences, situations and association with significant people. These three factors taken together may either facilitate the emergence and development of particular types of core beliefs or better still inhibit them (Knapp & Beck, 2008). Accordingly, the core beliefs of individuals who are well adjusted leads to realistic appraisal of reality and the contrary happens to those individuals who are maladjusted (Knapp & Beck, 2008). For this reason, patients suffering from depression always had fear and anxiety as they avoided other people for being criticized. Behavioral interventions however helped reduce the fear and anxiety experienced by the patients by changing the maladaptive core beliefs (Goetter & Marques, 2016, pp 211-225). These interventions impacted positively on the patients negative thinking as well as the negative emotions. Cognition has two other aspects vital in cognitive therapy besides do you mean besides these? the automatic thoughts and the maladaptive core beliefs (Mathew, 2013). Accordingly these two are maladaptive intermediate beliefs and logic errors (Beck, 2011). These two equally contribute to the self-defeating behaviors and the negative emotions exhibited by the patients by distorting the information processing leading to misinterpretations of current events and situations (Mathew, 2013). Maladaptive intermediate thoughts are rules or rather assumptions that guide how individuals interact with their environment as well as how they interact with others. They develop from the compensatory mechanism that individuals adopt as a way of preventing the maladaptive core beliefs from taking effect in the individuals life (Mathew, 2013). Essentially, emotional distress arises when individuals become aware of their maladaptive core beliefs and as a result, individuals adopt a compensatory mechanism to avert the maladaptive core beliefs. These intermediate thoughts may either take a positive or a negative form and in the stressful conditions the negative form prevails (Beck, 2011). An example of Maladaptive intermediate thoughts includes perfectionist approach adopted by patients where they think that perfecting their every way of doing things will make their weaknesses not to be easily noticeable by the rest of the people. Whereas this way of life is valuable in very many aspects it has the effect of limiting the individuals experience and interfering with the individuals achievement of value-based goals. Errors in logic are logical assumptions that individuals make in their interaction with current events and experiences. The most common logical errors include (Mathew, 2013); Mind reading; this is the assumption that other people are aware of what the individual is thinking without any evidence to support. Usually takes the negative form and fails to take cognizance of any other possible hypotheses (Knapp & Beck, 2008). You need to go into much more depth of information. Please find additional sources. Your literature review should have 80-100 sources and be 40-60 pages in length. Do not spend so much time on Cognitive Therapy as your topic is suicide. Have maybe 15 pages for cognitive therapy but the remaining pages of the lit review about suicde. Overgeneralization; this is the assumption that life in general is defined by specific events. The happening therefore of a specific event will lead to a certain outcome. Polarization; this is the assumption that events and circumstances in life are only in two mutually exclusive categories. Instead of perceiving both people and events in continuum, the individual view them in absolute terms. Personalization; this refers to the assumption of responsibility for the outcomes that are negative. This arises without taking into consideration other contributing factors. Catastrophic thinking; this is the assumption that worst possible outcomes will arise from the individual experiences and events. Accordingly, it will be unbearable and terrible for the individual. This assumption too disregards the possibility of other outcomes. Selective abstraction/ Tunnel vision; this is the assumption where an individual focuses on particular aspect of a complex situation. The other relevant aspects of the situation are completely ignored. Technique and Procedure of Effective Cognitive Therapy The cognitive therapy procedures in the treatment are not to be applied mechanically if meaningful results are to be obtained (Knapp & Beck, 2008). The approach to be adopted therefore is that of collaboration between the therapist and the patient as well as psycho-education. The collaboration between the patient and the therapist and the psycho-education is important in that it aids in evaluating the patients beliefs and accordingly modifying them to fit into the reality. This is by correcting and replacing the distorted thoughts and conceptualizations in the patients with cognitions that are realistic. The therapist should endeavor to address the distorted thoughts and interpretations in patients by effecting behavioral change in the patient. The competence of the therapist thus comes in handy to effect the cognitive procedures and techniques. This competence should in the minimum contain the therapeutic skills (Knapp & Beck, 2008). In addition to the therapeutic skills, the therapist must adopt an empathetic approach in treating the patient due to the negative perceptions that the patients harbor of themselves. Nature of Suicidal Behavior The causes of the suicidal behavior in individuals are not fully known and understood and this has resulted to many and varied causes being advanced (O Connor & Nock, 2014). Accordingly many risk factors i.e. psychiatric disorders have been identified which do not necessarily account for the tendency in people to terminate their lives (O Connor & Nock, 2014). Playing however a central role in trying to explain the suicidal behavior and thinking are the psychological factors (O Connor & Nock, 2014). Psychological Theories and the Suicidal Behavior Psychological theories of the suicidal behavior and thinking began in the 1950s and have witnessed substantial growth in the past 25 Numbers in APA format. See APA manual section 4.3. years (Ellis & Rutherford, 2008). These theories present the complex interplay of numerous factors that contribute to suicidal behavior and thinking. Mostly, these theories focus on cognition as well as the Diathesis-Stress model. The Diathesis-Stress model on the one hand emphasizes on the role that stress plays in the pre-existing vulnerability factors in suicidal thinking and behavior to bring about negative results (Nock et al, 2013, pp not APA format 97- 125). The cognition model on the other hand emphasizes on behavioral change in particular emotion regulation in suicidal behavior and thinking (O Connor & Nock, 2014). From the psychological theories, there are numerous factors associated with the suicidal behavior and thinking. These factors have been grouped into four categories namely; not APA format Personality factors; these are factors relating to the state of an individual. They are relatively stable in adults and are affected by the environment in which the individual is in. In addition, these factors affect individual cognition and emotions. They include hopelessness (Mathews, 2013; Beevers & Miller, 2004), impulsivity (Watkins & Meyer, 2013) and perfectionism (Beevers & Miller, 2004). Cognitive factors; these factors are associated with the thought processes of individuals that lead them to suicidal behavior and thinking. In most cases the thought processes are deficient or dysfunctional. Among the cognitive factors that have been identified include; inflexibility (Mathew, 2013), rumination and difficulties in problem solving (O Connor & Nock, 2014). Social factors; these factors recognize that suicide behavior and thinking do not occur in a social vacuum. The mental disorder associated with suicidal behavior and thinking is capable of being transmitted down the family history. This increases the exposure of family members to suicidal behavior and thinking. Negative life factors; these relate to adversities that individuals experience in their life time. Such adversities include physical abuse, illness, death etc and have been demonstrated to lead to suicidal behavior and thinking (Dube, et al., 2001) Cognitive Factors and the Suicidal Thinking and Behaviors The four psychological factors responsible for suicidal behavior and thinking discussed above have further been categorized in one broad group of cognitive factors in recent years (Mathew, 2013). These cognitive factors are either cognitive content deficits or cognitive information processing deficits. Their explication follows; Cognitive content deficits Becks cognitive triad; the cognitive triad advanced by Aaron T Beck is the major cognitive deficits in suicidal behavior and thinking. According to the author depressed suicidal patients had a negative view of themselves. In particular, they viewed themselves worthless and undesirable. This defectiveness that the patients perceive themselves as having, make them become passive in their lives in particular handling the problems that face them. This may makes them to make spontaneous decisions which may be detrimental to them. Hopelessness; this is another factor responsible for suicidal behavior and thinking. Hopelessness is a result of lack of amicable solution to the problems that an individual is facing. This state of an individual leads to activation of negative beliefs and expectation which leads to suicidal thinking. Psychological pain and physical pain; physical and psychological pain have been shown to contribute to suicidal thinking and behavior (Mathews, 2013). Individuals commit suicide as a result of emotional and physical pain which the individual believe to be unbearable (Chiles & Stosahl, 2005). Cognitive information processing deficits Rigidity and dichotomy; these two have contributed to suicidal thinking and behavior. Basically, they refer to the inflexibility exhibited by individuals which inhibit the individual from considering other possible hypotheses or alternatives to problematic circumstances and events that an individual might be facing. Taken together, the two processes largely affect the problem solving abilities of individuals and as a result the reason why the depressed patient may revert to suicidal thinking and behavior. Attentional bias; this is another information processing deficits that is responsible for suicidal thinking and behavior among depressed patients. Patients with suicidal behavior and thinking tendencies will tend to focus on information that has a relationship with suicide. This focus will automatically narrow down the individual perspective regarding the current events and circumstances and as a result the individual reverts only to suicide as the way out. Attentional fixation; this information processing deficit is associated with selective abstraction, a cognitive distortions prevalent in depressed patients with suicidal behavior and thinking tendencies. Suicidal patients exhibit a state of mental disorientation characterized by selective abstraction. As a result of these mental distortions, the patients revert to suicide. Overgeneralization; this is the final information processing defect exhibited by depressed suicidal patients. Patients that had recently attempted suicide had vague recollections of their multiple past experiences and when prompted to provide the details of their past experiences, they gave generalized statement. This generalization and vague recollection of past events affects greatly problem solving which requires detail of past problem solving. This deficiency in problem solving is the one that leads to suicidal behavior and thinking tendencies. Cognitive Therapy and Suicide Prevention Cognitive behavioral therapy has been tested as treatment model in preventing suicide through Randomized Control Trial (Stanley et al., 2009; Mathews, 2013). The earlier trials main focus were on problem solving and failed to register a reduction in suicidal behavior and thinking when compared with the usual treatment (Mathews, 2013; Reinecke, 2006). The recent Randomized Control Trials on cognitive behavioral therapy have tried to incorporate more treatment elements in preventing suicide and have resulted in reduced suicidal thinking and behavior in individuals (Mathews, 2013). One such Randomized Control Trials incorporated the following key treatment elements; proximal thought identification, identification of core beliefs prior to the suicide attempt (Brown et al., 2005). Taken together the two treatment elements looked at individual hopelessness and problem solving capabilities of the individuals and the appropriate strategies to remedy them (Brown et al., 2005). This Randomized Control Trials reduced suicidal thinking and behavior. The patients who were under investigation in the Randomized Control Trials reported lower likelihood of repeating suicide attempts. Another recent study demonstrated positive effects of cognitive behavioral therapy in preventing suicide (Stewart et al., 2009). This study despite the positive effects focused on the predictors of suicide attempts such as hopelessness, suicidal ideation and patient satisfaction as opposed to the suicide attempts themselves (Mathews, 2013). Despite however of the positive effects in the three predictors of suicide, the patients under study failed to show any improvement in problem solving capabilities (Mathews, 2013). Conclusion The literature reviewed in the chapter provides great optimism that cognitive therapy can be effective in reducing suicidal behavior and thinking among the individuals. The Randomized Control Trials that have been undertaken to date have not incorporated all the major concepts of cognitive therapy advanced by Aaron T. Beck. They have concentrated on the predictors of suicide attempts as opposed to the suicide attempts with only one trial focusing on the restructuring of the individual cognition and problem solving. Further research however need to be conducted to come with the most treatment elements of cognitive therapy that will reduce suicidal behavior and thinking in the individuals. References Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd Edition). New York: The Guildford Press. Beevers, C. G., & Miller, I. W. (2004). Perfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation. Suicide and Life-Threatening Behavior, 34(2), 126-137. Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. Jama, 294(5), 563-570. Chiles, J. A., & Strosahl, K. D. (2006). Safety interventions. Textbook of suicide assessment and management. Washington DC: American Psychiatric Publishing, 442-443. Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Jama, 286(24), 3089-3096. Ellis, T. E., & Rutherford, B. (2008). Cognition and suicide: Two decades of progress. International Journal of Cognitive Therapy, 1(1), 47-68. Goetter, E. M., & Marques, L. (2016). Cognitive Behavioral Therapy for Posttraumatic Stress Disorder. In The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy (pp. 211-225). Springer New York. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models, applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64. Matthews, J. D. (2013). Cognitive Behavioral Therapy Approach for Suicidal Thinking and Behaviors in Depression. Mental Disorders-Theoritical and Empirical Perspectives, 23. Nock, M. K., Deming, C. A., Fullerton, C. S., Gilman, S. E., Goldenberg, M., Kessler, R. C., ? & Stanley, B. (2013). Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry, 76(2), 97-125. O Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behavior. The Lancet Psychiatry, 1(1), 73-85. Reinecke, M. A. (2006). Problem Solving: A Conceptual Approach to Suicidality and Psychotherapy. Stanley, B., Brown, G., Brent, D., Wells, K., Polling, K., Curry, J., Hughes, J. (2009).Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model,Feasibility and Acceptability. Journal of American Academy of Child and AdolescentPsychiatry, 48 (10), 1005-1013. Watkins, H. B., & Meyer, T. D. (2013). Is there an empirical link between impulsivity and suicidality in bipolar disorders? A review of the current literature and the potential psychological implications of the relationship. Bipolar disorders, 15(5), 542-558. Wells, A. (2013). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. City, ST: John Wiley & Sons.
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