Edward Erwin's clear analysis addresses some of the fundamental questions on behavior therapy that remained in 1978, when this book was first published.

Pt. I. Philosophy and cognitive-behavioral therapy (CBT) -- Ch. 1. The "philosophical origins" of CBT -- Ch. 2. The beginning of modern cognitive therapy -- Ch. 3. A brief history of philosophical therapy -- Ch. 4. Stoic philosophy and psychology -- Ch. 5. Rational emotion in stoicism and CBT -- Ch. 6 Stoicism and Ellis's rational therapy (REBT) -- Pt. II. The stoic armamentarium -- Ch. 7. Contemplation of the ideal stage -- Ch. 8. Stoic mindfulness (...) of the "here and now" -- Ch. 9. Self-analysis and disputation -- Ch. 10. Autosuggestion, premeditation, and retrospection -- Ch. 11. Preditatio malorum and mental rehearsal -- Ch. 12. Stoic fatalism, determination, and acceptance -- Ch. 13. The view from above and stoic metaphysics. (shrink)

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis (...) for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field. (shrink)

In this article, I am concerned with the ethical foundations of behavior therapy, that is, with the normative ethics and the meta-ethics underlying behavior therapy. In particular, I am concerned with questions concerning the very possibility of providing an ethical justification for things done in the context of therapy. Because behavior therapists must be able to provide an ethical justification for various actions (if the need arises), certain meta-ethical views widely accepted by behavior (...) therapists must be abandoned: in particular, one must give up ethical subjectivism, ethical skepticism, and ethical relativism. An additional task is to show how it is possible to provide a nonsubjective, nonskeptical, and nonrelativistic moral justification for an ethical statement. Although this is a monumental task, I provide a rough sketch of such a model, one that is congenial to the value judgments underlying behavior therapy. (shrink)

Suicidality, a significant problem in New Zealand for the past decade or so, has invited a substantial body of research into causes and prevention. However, given the effort, the prevention results do not appear to be sufficiently convincing when coroners’ views are considered. This paper focuses on two mainstream therapeutic approaches towards persons with borderline personality disorder, in which suicidal behaviour is a prominent feature demanding understanding and active attention. It is argued that dialectical behaviour therapy and psychoanalytically informed (...) therapies are lacking on two accounts. Firstly, the philosophical and methodological underpinnings of both approaches perpetuate what Heidegger refers to as the compound misunderstanding of ourselves as human beings. Secondly, what this translates into is a practice which forgets the human order and misunderstands the experience of the singular human present in despair. As an alternative approach towards dealing with suicide in practice, the author presents concepts central to Heidegger’s phenomenology of human existence and discusses how these may inform and enhance the treatment of suicidal patients. Indo-Pacific Journal of Phenomenology , Volume 7, Edition 2 September 2007. (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT (...) in Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

Although histories of cognitive behaviour therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article, we elucidate the conditions of possibility for the emergence of cognitive behaviour therapy for psychosis (CBTp) in England between 1982 and 2002. We present an analysis of policy documents, research publications and books, participant observation, and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s articulation of (...) social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional, and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott's systems approach to professions, we identify a number of historical factors that created a jurisdictional vulnerability for psychiatry while strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence played a significant role in adjudicating jurisdictional legitimacy, and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry. (shrink)

The first aim of the study was to identify when deliberate self-harm behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment. The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. (...) These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early and late responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority ceased their self-harming within the first year, and the average number of weeks was 15.5. Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT. (shrink)

Cognitive Behavioural Therapy (CBT), is a therapy based on cognitive manipulation which denies the existence of ontological truth. Merleau-Ponty warned of such a development which he labelled a “decadent psychoanalysis.” Merleau-Ponty believed in the existence of ontological truth, not as a matter of cognitive representation nor as something that can be designated by positive indices such as those of psychometric measures or statistical analysis, but as an ontological dimension of the pre-cognitive world. Openness to this pre-reflective truth differentiates (...) a therapy based on truth from one based on suggestion and manipulation. When a suicidal patient, approaches a psychotherapist for help and is told that he or she can feel better by adjusting his or her dysfunctional thinking in normative directions, this truth of lived experience is denied, and so is the opportunity for patient and therapist to recognise their shared ontological pre-reflective connection in which truth may find a way to express itself safely, that is, intersubjectively. (shrink)

Extensively updated to include clinical findings over the last two decades, this third edition of A Practitioner's Guide to Rational-Emotive Behavior Therapy reviews the philosophy, theory, and clinical practice of Rational Emotive Behavior Therapy. This model is based on the work of Albert Ellis, who had an enormous influence on the field of psychotherapy over his 50 years of practice and scholarly writing. Designed for both therapists-in-training and seasoned professionals, this practical treatment manual and guide introduces (...) the basic principles of rational-emotive behavior therapy, explains general therapeutic strategies, and offers many illustrative dialogues between therapist and patient. The volume breaks down each stage of therapy to present the exact procedures and skills therapists need, and numerous case studies illustrate how to use these skills. The authors describe both technical and specific strategic interventions, and they stress taking an integrative approach. The importance of building a therapeutic alliance and the use of cognitive, emotive, evocative, imaginal, and behavioral interventions serves as the unifying theme of the approach. Intervention models are presented for the treatment of anxiety, depression, trauma, anger, personality disorders, and addictions. Psychologists, clinical social workers, mental health counselors, psychotherapists, and students and trainees in these areas will find this book useful in learning to apply rational-emotive behavior therapy in practice. (shrink)

Whilst individuals deal with divergent sorts of stimuli from the environment, they also tend to display some regularity in the way they respond to related patterns. These consistent responses can be conceptualised as cognitive schemas. A paramount component of Cognitive Behaviour Therapy (CBT) is the notion of cognitive schemas as they are a favoured point of therapeutic intervention. CBT as articulated by Beck in the 1960s owes intellectual acknowledgment to Merleau-Ponty and Heidegger and their notions of “atmosphere” and “clearing” (...) respectively. This essay explores the notion of cognitive schema and atmosphere as applied to emotional pathology. It suggests that the well-known influence that phenomenology had on existential psychology could be extended to empirical clinical psychology, like CBT. The strategy adopted in this paper is to use Dreyfus’ ontological and epistemological distinction in psychopathology and then make a similar distinction, albeit using different terminology, in the CBT tradition. Some empirical findings from the literature are examined which render support to the existence of cognitive schemas and their crucial contributory role in the aetiology and maintenance of emotional disorders. It is noted that some of the features of these cognitive schemas were espoused well before Beck by Merleau-Ponty and the phenomenological-existential tradition. Indo-Pacific Journal of Phenomenology , Volume 4, Edition 1 July 2004. (shrink)

The continuing and expanding successes of behavior therapy in the treatment of psychological problems raise important questions about their scientific and philosophical bases. In this paper I examine the claims of Edward Erwin that behaviorism cannot provide an adequate philosophical basis for behavior therapy, contemporary learning theories which exclude cognitive factors as causes of behavior cannot provide an adequate empirical basis for behavior therapy; and learning theories have played only a heuristic role in (...) the development of behavior therapy. And I argue that Erwin's claims rest on two doubtful logical empiricist assumptions about scientific theory and explanation. Using different assumptions, I argue that some of the regularities involving cognitions which seem to govern behavior therapy techniques are analogical extensions of operant learning principles. On this basis I suggest some modifications of Erwin's claim about the philosophical foundations of behavior therapy. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised (...) to treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

A lesson from cognitive behavior therapy (CBT) is that it is possible for people to change their beliefs and attitudes in ways that enhance mood. This chapter discusses mainly how the ideas from positive psychology combined with the therapeutic methods developed in CBT might provide ways of helping individuals to enhance their mood and increase happiness. The best single perspective from which to gain an understanding of positive psychology is that of evolutionary psychology, even though it is underdeveloped (...) and contentious. Evolutionary psychology bridges the gap between individual history and the general features of the human condition that helps to explain both our capacity for happiness and some of the barriers to achieving it. The modern general evolutionary view of emotions is that they help animals in regulating their effort: how they behave at any one time and how they apportion their time and energy between different types of behavior. (shrink)

Being in a romantic relationship is characterized by a high degree of intimacy and affective involvement. Affective behavior indicates the emotional content in couple interactions and therefore promotes an understanding of the evolution of romantic relationships. When couples are also parents, their affective behavior reflects their romantic and coparental bonds. In this paper, we present an observation of parent couples’ affective behavior during a coparenting conflict discussion task to document whether and how much it improved during couple (...) therapy. Two contrasting cases of affective behavior change are included. Observational coding of affective behavior within pre- and post-intervention coparenting conflict discussion tasks was carried out to compute means and CIs for each partner in both cases. In addition, the partners’ coparental and romantic satisfaction were evaluated through validated self-report questionnaires in pre- and post-intervention assessments; this helped document whether the partners’ coparental and romantic satisfaction were dissimilar between the two cases. Finally, a clinical analysis of both cases was realized with the contribution of the therapists to investigate possible differences within therapy sessions. Statistical analyses revealed negative means of affective behavior for couple A in the pre-intervention assessment and positive means in the post-intervention assessment. Partners from couple B had negative means of affective behavior in the pre- and post-intervention assessments. Results concerning coparental and romantic satisfaction differed: Couple A’s coparental satisfaction slightly increased and the romantic satisfaction somewhat decreased, whereas couple B’s coparental satisfaction remained stable and the romantic satisfaction slightly increased between the pre- and post-intervention assessments. The clinical analysis revealed that the interactional quality of couple A slightly improved within therapy sessions and that both partners succeeded in working together as coparents, notwithstanding their romantic distress. Couple B conveyed coparental distress and exhibited poor interactional quality throughout therapy sessions (e.g., repeated criticism and contempt). This study contributes to enriching the more traditional empirical research methods in the field of couple psychotherapy, as it takes into account microlevel affective changes within parent couples’ interactions in addition to self-reported data. Furthermore, the analysis of therapy sessions supports the importance of working with affective behavior in couple therapy. (shrink)

Behavioural experiments are one of the central and most powerful methods of intervention in cognitive therapy. Yet until now, there has been no volume specifically dedicated to guiding physicians who wish to design and implement behavioural experiments across a wide range of clinical problems.The Oxford Guide to Behavioural Experiments in Cognitive Therapy fills this gap. It is written by clinicians for clinicians. It is a practical, easy to read handbook, which is relevant for practising clinicians at every level, (...) from trainees to cognitive therapy supervisors.Following a foreword by David Clark, the first two chapters provide a theoretical and practical background for the understanding and development of behavioural experiments. Thereafter, the remaining chapters of the book focus on particular problem areas. These include problems which have been the traditional focus of cognitive therapy, as well as those which have only more recently become a subject of study, and some which are still in their relative infancy. The book also includes several chapters on transdiagnostic problems, such as avoidance of affect, low self-esteem, interpersonal issues, and self-injurious behaviour. A final chapter by Christine Padesky provides some signposts for future development.Containing examples of over 200 behavioural experiments, this book will be of enormous practical value for all those involved in cognitive behavioural therapy, as well as stimulating exploration and creativity in both its readers and their patients. (shrink)

Maternal insightfulness or the capacity to see things from the child’s point of view, is considered to be a crucial construct for therapeutic change. In the present study, we aimed to implement the knowledge gleaned from the studies on attachment theory and maternal insightfulness into clinical practice to create an intervention program for mothers of children-at-risk due to inadequate parental care. We used drama therapy to “practice” maternal insightfulness in more “experiential” ways, because the use of creative expressive means (...) may be accessible and effective for the target population of the study and help improve maternal care. We used a manualized 10-week drama therapy-group intervention, focusing on the core concepts of maternal insightfulness: insightfulness, separateness, complexity, and acceptance. We used various dramatic means to explore and experience these components of maternal insightfulness. Forty mothers of children-at-risk took part in eight groups of parental insightfulness drama therapy. To evaluate the efficacy of the intervention, we used the Insightfulness Assessment interview, which produces 10 scales and a final classification of PI and non-PI. The Child Behavior Check List was used to evaluate a change in children’s behavior problems. The assessment took place at three time points: before the intervention, right after the end of the intervention, and 6 months following the intervention. Results at T2 showed a significant improvement compared to T1 in some of the maternal insightfulness scales, but not in the maternal insightfulness categorical classification. At T3, there was a significant change in the classification of the mothers, from non-insightful to positively insightful. At T3, there was also a significant decline in the children’s externalized and general behavioral problems. The results of this study contribute to an evidence-based practice of using drama therapy in the treatment of mothers and children at risk. (shrink)