Meichenbaum cogbeh therapy Essay

This essay has a total of 2847 words and 13 pages.


Meichenbaum cogbeh therapy





Donald Meichenbaum: The Clinical Application of
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is based on the concept that behavior change may be
achieved through altering cognitive processes. The assumption underlying the cognitively
based therapeutic techniques is that maladaptive cognitive processes lead to maladaptive
behaviors and changing these processes can lead to behavior modification. According to
Mahoney (1995), an individual’s cognitions are viewed as covert behaviors, subject
to the same laws of learning as overt behaviors. Since its inception, cognitive-behavior
modification has attempted to integrate the clinical concerns of psychodynamic
psychotherapists with the technology of behavior therapists (Mahoney, 1995).
Cognitive-behaviorists have demonstrated an interrelationship among cognitive processes,
environmental events, and behavior, which is conveyed in the context of one’s social
behavior. Psychotherapists in North America endorse cognitive-behavioral interventions as
the second most widely used treatment approach (i.e., with an eclectic approach being
endorsed as first) (Bongar & Buetler, 1995).

The cognitive processes that serve as the focus of treatment in CBT include perceptions,
self-statements, attributions, expectations, beliefs, and images (Kazdin, 1994). Most
cognitive-behavioral based techniques are applied in the context of psychotherapy sessions
in which the clients are seen individually, or in a group, by professional therapists.
Intervention programs are designed to help clients become aware of their maladaptive
cognitive processes and teach them how to notice, catch, monitor, and interrupt the
cognitive-affective-behavioral chains to produce more adaptive coping responses (Mahoney,
1994). Donald Meichenbaum is one of the founders of cognitive-behavioral modification and
was voted one of the "top ten most influential psychotherapists of the century" in a
survey reported in the American Psychologist (interestingly, four of the ten therapists
were cognitive-behaviorists) (Bongar & Buetler, 1995). Meichenbaum is a clinical
psychologist who has invented and utilized some of the most operationally defined
techniques of cognitive-behavioral therapy. Meichenbaum’s most famous piece of work,
Cognitive-Behavior Modification: An Integrative Approach is considered a classic in the
field of CBT. Meichenbaum bridged the gap between the clinical concerns of
cognitive-semantic therapists (e.g. Albert Ellis and Aaron Beck) and the technology of
behavior therapy. He was greatly dissatisfied with behavior therapy techniques because
they overemphasized the importance of environmental events (antecedents and consequences)
and therefore underemphasized, and often overlooked, how a client perceives and evaluates
those events (Meichenbaum & Cameron, 1974). The disorders successfully treated by
cognitive-behavioral methods include: depression, anxiety disorders, social phobias,
bulimia nervosa, conduct disorder in children, schizophrenia, relapse prevention with
substance abuse, marital distress, and Post Traumatic Stress Disorder (PTSD) (Bongar &
Buetler, 1995). As an expert in the treatment of PTSD, Meichenbaum has treated all age
groups for trauma suffered from violence, abuse, accidents, and illness.

Meichenbaum describes seven essential tasks encompassing a cognitive-behavioral
therapeutic approach, which he finds crucial for a successful outcome in all forms of
psychotherapy. These tasks are described sequentially and they take place over the course
of therapy; being addressed as the client and the therapist sample techniques from them as
needed. Most CBT clients are able to complete their treatment in just a few weeks or
months - even for problems that traditional therapies often take years to resolve, or are
not able to resolve at all.

According to Meichenbaum (1996), the quality and nature of the therapeutic alliance
between the client and the therapist accounts for more variance in treatment outcome
studies than does any other set of variables (except client characteristics). It is
essential that the first task of therapy be to develop a therapeutic alliance and
encourage clients to tell their stories (Meichenbaum, 1996). The development of a
therapeutic alliance and a working collaborative client-therapist relationship is critical
in all forms of psychotherapy. A genuine, compassionate, empathic, emotionally-attuned,
nonjudgmental, stance by the therapist facilitates a healthy therapeutic alliance and
encourages the clients to tell their story at their own pace. Meichenbaum (1977) believes
that a therapeutic relationship is the glue that makes the therapeutic procedures work.
Following the client restating his/her story, the therapist highlights what exactly the
client did to cope, survive, and even thrive despite the ongoing stress resulting from the
experience.

The second task of cognitive-behavioral treatment is to educate clients about the
presented clinical problem (Meichenbaum, 1996). For example, if a client seeks therapy
because of anxiety, the therapist would explain to the client what anxiety behaviorally
looks like and would inform the client of the cycles of anxiety. The client must then
become an observer of his/her own behavior. Through heightened awareness and attention,
the client may monitor his/her thoughts, feelings, physiological reactions, and
interpersonal behaviors (Meichenbaum 1977). The tests that are administered and reviewed
with the clients, the self-monitoring procedures used by clients, the information provided
to the clients about their presenting problem, and the information conveyed about relapse
prevention (coping techniques and warning signs) are all elements of the educational
process (see Appendix A). Although this is only the second task of CBT, it is revisited
throughout the therapeutic process as the client continues to be educated about his/her
presenting problem and learns new adaptive coping skills.

During the third task, the therapist helps the clients reconceptualize their problems in a
more hopeful fashion. In this step, the therapist enables his/her clients to reorganize
their thought processes of their predicaments in problem-solving-oriented terms that will
lend them to helpful solutions. Meichenbaum (1996) stresses the important role of hope by
observing that clients seeking cognitive-behavioral treatment demonstrated a 60% to 80%
symptomatic alleviation of depression within the first four therapy sessions due to
reconceptualizing their stories. This occurred well before the usual introduction of
techniques specific to the treatment of depression, such as cognitive restructuring.
However, reconceptualizing or reframing a problem alone rarely helps clients achieve the
functional level they seek (Meichenbaum, 1996).

The fourth task of therapy is ensuring that clients attain the necessary coping skills. In
this step, the therapist teaches clients a variety of intrapersonal and interpersonal
coping skills to help them manage problematic situations. These skills include:
self-monitoring, relaxation retraining, self-instructional training, cognitive
restructuring, assertiveness training, and relapse prevention skills. Cognitive
restructuring procedures are designed to modify the client’s thinking and the
premises, assumptions, and attitudes underlying the client’s thoughts (Meichenbaum,
1977).

The goal of self-instructional training is to teach impulsive clients to spontaneously
provide themselves with inhibitory cues at incipient stages (Meichenbaum, 1977).
Meichenbaum and Goodman (1971) provide evidence that cognitive self-instructional training
was successful in decreasing impulsive responding, confirming that when a client utilizes
self-instructions, behavior change occurs and treatment effectiveness is enhanced. If
standard behavior therapy procedures are augmented with a self-instructional package;
greater treatment efficacy, more generalization, and greater persistence of treatment
effects are obtained (Meichenbaum & Goodman, 1971). The first step in Meichenbaum’s
approach of self-instruction is to help the client identify his/her negative statements
that the client makes to him/herself. Next, the client learns self-talk to counteract the
negative self-statements in the presence of stressful situations. Third, the client is
taught to self-instruct the steps for taking appropriate action. Finally, the client is
instructed to make self-reinforcing statements immediately after he/she has successfully
coped with the stressful situation (Martin & Pear, 1999). These learned skills will
inevitably bolster the client’s self-esteem and sense of self-worth. Psychologists
can depend on their subjects to talk, even if only to themselves; whether relevant or
irrelevant, the things people say to themselves determine the rest of the things they do
(Meichenbaum, 1977).

The fifth task is for the therapist to encourage clients to perform personal experiments.
Each client needs to gather data that demonstrates an empowering and enabling
self-concept, which can confirm positive change due to the therapeutic process
(Meichenbaum, 1996). This is accomplished through working with clients so that they will
view their automatic thoughts as hypotheses worthy of testing, rather than as God-given
assertions. Clients are encouraged to adopt the stance of a scientist so that they can
view their coping efforts as experiments that are designed to provide them with evidence
that can be used to unfreeze their maladaptive thoughts about themselves and the world
(Meichenbaum, 1996). For example, a therapist can have clients write out their predictions
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