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Behavioral techniques according to some psychologists and thinkers: Beck (1979, 1985) indicates that in the early phases of cognitive therapy and, especially with the most depressed patients, it is usually necessary to establish the level of functioning that the patient had before the Depression.
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The low level of activity is related to the patient's self-assessment ("Useless", "Incapable"..) and with the depressed mood. The behavioral techniques used in CT have a dual purpose: (1st) To produce an increase in the level of activity, modifying the patient's apathy, passivity and lack of gratification and (2nd) to facilitate the empirical evaluation of their automatic thoughts and associated meanings (incompetence, uselessness, uncontrollability). The main behavioral techniques used in the approach to depression are:
- GRADUAL ASSIGNMENT OF TASKS: The therapist counteracts the patient's over-generalized belief of disability by putting it to the test ("Could we check your belief that you are incapable of…?. For this, with the patient, gradual objectives-tasks are established, adapting them to the patient's level of functioning and increasing their difficulty as they progress, this allows the patient to increase their expectations of self-efficacy (Bandura, 1976).
- COGNITIVE ESSAY: Sometimes, the patient needs as a previous step to carrying out a task, to be able to see himself facing them. The steps involved in a task can be rehearsed with the patient, imaginatively. This can allow the patient to decatastrophize or de-dramatize tasks that are perceived as very difficult.
- SCHEDULE OF DAILY ACTIVITIES: The therapist and the patient schedule daily tasks that can enable increased gratification (reinforcement) for the patient; or as distracting tasks from moments of discomfort (eg, exerting control of predictable and negative stimuli).
- MASTERY AND PLEASED TECHNIQUE: The patient values the mastery achieved in the programmed activities, as well as the pleasure achieved with their performance (eg 0-5 scales). This may allow the therapist to reschedule activities with the patient, so as to increase their mastery or liking, or to correct core cognitive distortions (eg maximization of non-mastered or unpleasant tasks and minimization of pleasant and mastered tasks).
- ROLE PERFORMANCE: Through role modeling and reversal, the therapist can generate alternative views to dysfunctional cognitions and problem-solving skills.
- ASSERTIVE TRAINING: Some depressed patients, due to their dysfunctional beliefs, tend to inhibit their behaviors in defense of their personal rights or their expressions of personal wishes and opinions. The therapist can present these "rights", ask for the patient's opinion on whether to carry them out, assess the advantages of doing so, and how to carry them out.
COGNITIVE TECHNIQUES
Cognitive techniques are intended (Beck, 1979, 1985): (1) To tender automatic thoughts that express cognitive distortions, (2) Check the degree of validity of automatic thoughts, (3) Identification of personal assumptions and (4) Check the validity of personal assumptions
COLLECTION OF AUTOMATIC THOUGHTS: The therapist explains the self-registration to the patient (normally it consists of three parts: situation-thought-emotional state; sometimes the behavioral element is also added when this component is relevant). It also explains the thought-affect-behavior relationship and the importance of detecting automatic thoughts. Instruct the patient to do it in times of emotional disturbance, and show how to do it.
TRIPLE COLUMN TECHNIQUE: About self-registration, the patient learns to question the evidence they have to maintain a certain automatic thought and to generate more realistic or useful interpretations. For this, a self-registration is usually carried out with three columns: in the first, note the situation that triggered the unpleasant feeling, in the second the automatic thoughts related to that situation and those negative emotions, and in the third alternative thoughts after evaluating the evidence for the thoughts. previous automatic ones.
IDENTIFICATION OF PERSONAL ASSUMPTIONS: During the interview with the patient or review of self-records, the therapist can develop hypotheses about the personal assumptions underlying the disorder. The most frequently used means are listening to how the patient justifies his belief in a certain automatic thought (eg "Why do you believe that?") Or listening to his response to the importance given to a fact (eg "Why is that? so important to you?).
VERIFY THE VALIDITY OF PERSONAL ASSUMPTIONS: The therapist designs behavioral tasks with the patient, as "personal experiments, aimed at checking the degree of validity of personal assumptions. For example, with the patient referred to in the previous section, it could be verified if she can be happy (having defined "her happiness" as clearly as possible), with activities outside the affective displays that she may receive from others. Other ways to handle this assumption would be to list its advantages and disadvantages and make decisions based on that list, or check if the disagreement of others necessarily produces unhappiness, etc.
This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
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