Cognitive Interventions




(7)
Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA

 


Cognitive-behavioral interventions are founded on the principle that individuals’ thoughts about their experiences and themselves influence their affect and behavior (Beck, 1967). When these thoughts are distorted, they can trigger maladaptive information processing, leading to the development of pathological symptoms. The central tenet underlying cognitive-based treatments is that therapeutic change occurs when individuals successfully transform their dysfunctional cognitions and behaviors (Curry & Reinecke, 2003). Cognitive restructuring methods are used to address dysfunctional cognitions, including expectations, beliefs, and self-statements (Beck, Shaw, Rush, & Emery, 1979).

Generally, cognitive restructuring techniques include a variety of procedures intended to modify cognitions and cognitive processes. These techniques are employed with the goal of encouraging the student to: (1) monitor automatic thoughts or cognitions; (2) identify the relationship between thoughts, emotions, and behaviors; (3) evaluate the evidence for and against distorted cognitions; (4) replace maladaptive thinking with more accurate cognitions; and (5) detect and modify those dysfunctional core beliefs tainting the perception of experiences and maintaining pathology (Beck et al., 1979). Following a brief outline of cognitive restructuring techniques (Beck, 1995), the efficacy of cognitive interventions for mental health disorders in children and adolescents is addressed.



Cognitive Restructuring Techniques



Eliciting Automatic Thoughts


An early step in implementing cognitive interventions is identifying thoughts that are often slightly outside of one’s consciousness and that occur in certain situations. If the student is challenged by this task, the therapist may assist by directly eliciting the thought, eliciting related imagery, role-playing with the student, or offering possible hypotheses as to the cognition, as appropriate considering the developmental needs of the student. This is either accomplished in session or between sessions, with the student noting their cognitions as they arise or following a pre-allotted period of time (Beck et al., 1979). This activity is conducted with greater ease as the student becomes proficient in detecting such thoughts and understanding situations that may elicit them (Beck, 1995). For example, consider a depressed 14-year-old girl. Her therapist asks, “I noticed your mood changed when we were talking about your math class. What was going through your mind?”


Relationship Between Thoughts and Feelings


Once accurately differentiated, the connection between cognitions and emotions is underscored. This is accomplished by eliciting those cognitions experienced in the context of affective states. The student then realizes that when a situation is interpreted negatively, this will lead to a negative feeling. The degree to which the student believes the thought is also important and can be assessed with a rating scale, further underscoring the connection between emotions and cognitions (Beck, 1995). For example, the therapist asks, “You said that when you think about your math class you have the thought, ‘I’m going to fail.’ How does having that thought make you feel?…On a scale from 1-10, how sad do you feel?”


Exploring Personal Meaning


In order to discover the student’s schema or their established pattern of thinking that shapes their understanding of events, the therapist delves into the automatic thoughts (e.g., “I’m going to fail,” in the above example) that are believed to stem from underlying beliefs. The therapist then elicits the personal meaning of the thought from the student. At times, this will result in the disclosure of the student’s intermediate beliefs (e.g., assumptions and rules) and core beliefs (Beck, 1995). For instance, in our example, exploring the personal meaning of the automatic thought might lead to disclosure of the beliefs, “I must not disappoint anyone,” and, “If I disappoint people, they won’t love me.”


Exploring Underlying Assumptions


The student and therapist collaborate to explore thinking patterns underlying the student’s negative thoughts, behaviors, and emotions across contexts (Beck, 1995). This can also be viewed as a unique set of rules the student applies to himself (e.g., “I should always get the highest grade in the class”) that likely result in negative affective states.


Development of Underlying Assumptions


The therapist promotes the exploration of the student’s developmental experiences and their contribution to underlying beliefs and assumptions. This is accomplished by examining and reframing the original experiences, which support the current dysfunctional beliefs, unearthing evidence invalidating the assumptions the student currently holds, and identifying core beliefs (Beck, 1995).


Recognizing Cognitive Errors


The therapist helps the student identify cognitive disorders or “thinking traps.” Twelve common cognitive errors exist, including catastrophizing, overgeneralizing, and dichotomous thinking, among others (see Beck, 1995, p. 119). The therapist applies interventions to such cognitive distortions with the purpose of modifying dysfunctional thinking, thus improving affective symptoms.


Distancing from Thoughts


The therapist further prepares the student for engaging in cognitive restructuring techniques by underscoring the subjective nature of cognitions. The therapist discourages the student from viewing the cognitions as established fact (Stark, 2008). Various strategies are used to accomplish this, including eliciting feedback that one would give to a best friend were they in the same situation, using of metaphors to assist the student in getting perspective, and conceptualizing the cognition as a subjective and distorted one (Beck, 1995).


Examining Available Evidence


After identifying the automatic thought and underscoring its relationship to the affective symptoms, the therapist and student collaboratively discover evidence from the students’ experiences to either support or disconfirm the cognition. The therapist’s goal here is to help the student more accurately and objectively assess the situation (Beck, 1995). In our example, the therapist might ask the student, “What is the evidence that you will fail your math class?”


Searching for Alternative Explanations


The therapist uses the knowledge gained from the exploration of evidence for and against the dysfunctional thought to help the student consider more adaptive and accurate alternative explanations (Beck, 1995). This is done by asking such questions as, “What is another way of looking at it?” and “What is the new thought?”


Realistic Consequences of Negative Cognitions


The therapist, in an effort to address cognitive distortions and weaken the strength of negative thoughts, encourages the student to consider the realistic consequences of the cognition if it were true. The therapist may use such inquiries as, “So what if it is true?” and “What is the worst that could happen?” (Beck, 1995).


Testing Beliefs Prospectively


The therapist may use behavioral experiments with the goal of assessing of the accuracy of the student’s beliefs (Beck, 1995). Here, the therapist might elicit from the student predictions about the outcome of the experiment, reviewing the accuracy of the outcome after the experiment is over.


Adaptive Functional Value of Beliefs


The therapist encourages the student to assess how useful having the cognition is by considering the advantages and disadvantages of the dysfunctional thought. When the student better appreciates the negative consequences of the belief, the therapist helps in developing more adaptive cognitions (Beck, 1995).


Guided Discovery and Empiricism


The cognitive therapist embraces both guided discovery and empiricism throughout the use of these techniques. The therapist refrains from debating with the student or trying to convince the student to think differently. Rather, the therapist collaboratively guides the student in investigating beliefs, gathering evidence, and testing hypotheses. The student then, more independently, reaches increasingly adaptive conclusions (Beck, 1995).


Practicing Rational Responses


Collaboratively, in an effort to disturb certain patterns of thinking and improve the student’s mood, the therapist and student practice more adaptive responses to the student’s negative cognitions. This may be done by encouraging the student to talk back to the negative thought (Beck, 1995).


Recording Thoughts


The therapist encourages the student to record thoughts as they occur. With certain students, this can even be accomplished as homework between sessions. To assist with cognitive restructuring , the student monitors the thought, the context in which the thought occurred, the degree to which the thought was believed, the resultant feelings, and the intensity of those feelings. When the student more adeptly modifies thoughts, instruction is given in recording cognitive restructuring attempts and their outcomes (Beck, 1995).


Building a Positive Schema


While removing dysfunctional beliefs, the therapist also helps the student to develop positive, though realistic, beliefs about the self (Beck, 1995). The therapist and student work together to identify positive qualities supporting the student’s new beliefs about the self, world, and future.


Empirical Support for Cognitive Interventions


Cognitive restructuring is only one of the many techniques used in CBT. As cognitive restructuring techniques are mostly used alongside other related interventions in the context of CBT treatment, their individual effects are challenging to ascertain. Those studies that have attempted to address the effectiveness of cognitive interventions with children and adolescents are described below.

Kendall and Braswell (1982) evaluated a cognitive-behavioral treatment in which 27 8–12-year-olds were treated for concerns related to impulsivity, hyperactivity, and aggression and were randomly assigned for 12 weeks to one of three conditions. The attention-control condition incorporated psychoeducation and interpersonal contact, while the behavioral condition included modeling and contingency management; the cognitive-behavioral condition included, in addition to the above, a cognitive component, namely, cognitive modeling in problem resolution, as well as problem-solving training. Treatment did not impact parent ratings of behavior; however, both the CBT and behavioral conditions resulted in improvements in teachers’ ratings of hyperactivity. The CBT condition had the additional impact of improving teachers’ ratings of self-control. CBT and behavioral treatments, further, improved academic achievement, though only CBT resulted in improved self-assessment of self-concept. Results were maintained at ten-week follow-up but were no longer apparent at one-year posttreatment. This study provides some support for the inclusion of cognitive interventions, though the latter is confounded with the inclusion of a problem-solving component.

Jaycox, Reivich, Gillham, and Seligman (1994) assessed the efficacy of a depression prevention treatment with youth aged 10–13 years. The treatment was composed of two components. Based both on Ellis (1962) and Beck’s (1967) cognitive models, the cognitive component included the identification of negative attributions regarding problematic events and the evaluation of the accuracy of such beliefs. The second component included the instruction of social problem-solving and coping skills. One hundred and forty-three participants were randomly assigned to either the cognitive, social problem-solving, combined treatment, or control conditions. Results indicated that, when compared with control, all treatment groups were comparably more efficacious at reducing existing depressive symptoms, as well as diminishing externalizing conduct problems. The relative contribution of each component was not studied and, despite data that supported the use of a deconstructed version of the program, follow-up studies of the program continue to combine treatment components (Shirk & Karver, 2006).

In a trial of a group cognitive restructuring depression prevention program, Clarke et al. (2001) randomized at-risk adolescents to either usual care or usual care plus a 15-session cognitive restructuring therapy program. The experimental condition, an abbreviated version of a previously assessed depression prevention program (Clarke, Rodhe, Lewinsohn, Hops, & Seeley, 1999), involved numerous cognitive restructuring techniques, including having the adolescents identify and challenge irrational or unrealistic thoughts. Those in the experimental condition had a significant advantage in terms of being at a reduced risk for developing a depressive disorder up to 15 months following the completion of the prevention trial (Clarke et al., 2001).

Examining only those randomized controlled trials evaluating treatments of depressed youth, in an effort to parse their relative contribution, Weisz, McCarty, and Valeri (2006) compared the mean effect size of treatments that incorporated a cognitive change component to the mean effect size of those treatments that did not (e.g., relaxation training). The mean effect size of both groups, while significantly different from zero, were comparable and did not differ to a significant degree, leading the authors to conclude that treatment for youth depression may not require a focus on cognitive change (Weisz et al., 2006).

McCarty and Weisz (2007) conducted a meta-analysis of nine treatment studies of depressed children and adolescents, including studies with an effect size of 0.50 or greater. Frequently included components of the studies were cognitive behavioral with measurable goals: psychoeducation, self-monitoring, interpersonal skills, cognitive restructuring , problem-solving, and behavioral activation. As these components were combined in those studies examining effective treatments, it remains unclear which particular component directly influences treatment outcome, though the study provided preliminary support for the use of cognitive restructuring in the treatment of childhood and adolescent depression.

Rosenberg, Jankowski, Fortuna, Rosenberg, and Mueser (2011) explored the feasibility and efficacy of a manualized cognitive restructuring intervention for treating PTSD in adolescents. Nine adolescents engaged in 12–16 sessions of a primarily cognitive restructuring intervention; some psychoeducation about PTSD and relaxation training was also incorporated. Following treatment, the adolescents demonstrated statistically significant reductions in both PTSD and depression symptoms, with gains maintained at three-month follow-up. While not examining the role of cognitive restructuring as a stand-alone treatment, this study does provide some evidence for the use of cognitive restructuring as a major aspect of treatment for PTSD in youth (Rosenberg et al., 2011).

As such, in those few studies that have been conducted in which cognitive interventions are examined in isolation, results have been mixed, with cognitive interventions demonstrating a positive association with improved outcome in many, with others indicating no effect. The latter studies conclude that change is attributed to other factors, resulting in some questions about the importance of inclusion of cognitive interventions with child and adolescent populations. Overall, CBT interventions, including those incorporating a cognitive component, have demonstrated significant success in addressing concerns in youth populations (David-Ferdon & Kaslow, 2008; Silverman & Hinshaw, 2008; Silverman, Pina, & Viswesvaran, 2008).


Developmental Considerations


While CBT is widely used with children and adolescents, some uncertainty remains regarding the efficacy and effectiveness of cognitive components with children of a certain developmental level (Spence, 1994). Evidence suggests that, while the level of cognitive development plays a key role in the efficacy of CBT, CBT can be effective with use in younger children if treatment delivery is developmentally appropriate (Grave & Blissett, 2004). Methods of adapting CBT for youth include the use of simpler, less verbally based cognitive restructuring techniques, concrete examples (e.g., visual devices), frequent summaries and reviews, mnemonic aids, metaphors, experiential learning, and frequent practice (Grave & Blissett, 2004; Weersing et al. 2006).


Stress-Inoculation Training (SIT) per Meichenbaum



Patrick Pössel and Allison D. Barnard8


(8)
Department of Educational & Counseling Psychology, Counseling, and College Student Personnel, University of Louisville, Louisville, KY, USA

 


Description of the Stress-Inoculation Training (SIT)


Meichenbaum’s (1975) Stress-Inoculation Training (SIT) is a cognitive intervention for overcoming anger, anxiety, pain, and stress. The general treatment goals of SIT are to increase a student’s skills that help him/her to cope with stressful situations by allowing for a normalization of emotional and psychological adaptation and to increase his/her self-confidence to master stressful situations. SIT provides the therapist with a set of principles and clinical procedures and includes three flexible interlocking phases: the conceptual-educational phase, the skills acquisition and consolidation, and rehearsal phase, and the application phase (Meichenbaum, 2008).


Theoretical Underpinnings of SIT


SIT is based on two perspectives of stress, transactional and strengths-based. The transactional approach maintains that the best way to cope with some stressors is to change the stress-generating situation. For example, if a specific classroom situation creates the stress for a student, the best way to reduce the stress may be to work collaboratively with a teacher to change the situation. Cohen, Mannarino, and Deblinger (2006) used this approach to treat sexually abused children by working with the nonoffending parents.

“Inoculation” as the core idea of SIT is rooted in the strengths-based approach. In other words, the theoretical consideration underlying SIT is that the exposure to mildly stressful situations can make the student stronger. Teaching the student how to use coping skills in mildly stressful situations increases the coping skills used in more severe stressful situations. Further, by gradual exposure and rehearsal in imagination and real life, the self-confidence to master stressful situations is bolstered. A more detailed description of the theoretical underpinnings of SIT can be found in Meichenbaum (2007).


Mechanics of SIT


Meichenbaum recognized that only some stressful situations can be changed or avoided. Further, some of the remaining stressors cannot be mastered with active problem-solving strategies. Thus, the coping skills trained in SIT , and therefore, the length of SIT, vary widely. Meichenbaum (2008) includes versions that range from 20 min (preparation of patients for surgery) to 40 sessions (patients with chronic medical and psychiatric conditions), but in most cases SIT includes 8–15 sessions plus booster sessions. The length of SIT in empirical studies with students ranges from 8 to 15 to sessions and a duration of 20–60 min per session (Table 12.1).


Table 12.1
List of empirical studies applying SIT to students in schools




















































Authors

Sample

Measures

SIT conditions

Outcomes

Hains (1992)

6 males, 15–17 years old, 5 European A, 1 Asian A

STAI; STAXI; CSEI; RADS; APES

15 individual sessions (40 min), multiple baseline design

Pre-post-intervention: 5 of 6 youths showed decrease in anxiety

Pre-3-month follow-up: lower levels of anxiety scores for 3 youths

Hains and Ellmann (1994)

21 youths (16 girls, 5 boys), 9th–12th grades, 19 European A, 1 Hispanic, 1 Asian A

STAI; STAXI; RADS; APES; health problems; school absences; GPA

13 group and individual sessions (50 min)

Pre-post-intervention: high emotional arousal youths decrease in trait and state anxiety and depression

SIT vs. control: lower trait anxiety in high emotional arousal youths in SIT at post-intervention

Hains and Szyjakowski (1990)

21 males, 16–17 years old, 20 European A, 1 African A

STAI; Anger Inventory; CSEI; BDI

Each phase began with a 60-min group session followed by two individual sessions (30–40 min)

Pre-post-intervention and pre-10-week follow-up: decrease in trait anxiety and anger and increase in self-esteem

SIT vs. control: lower anxiety and anger and higher self-esteem in SIT at post-intervention

Kiselica, Baker, Thomas, and Reedy (1994)

48 European A (26 male, 22 female), 9th grade students

STAI Trait Anxiety Scale; Symptoms of Stress Inventory; GPA

SIT + assertiveness training, 8 sessions (60 min)

Pre-post-intervention: decrease in anxiety and stress in SIT

SIT vs. control: lower anxiety and stress in SIT at post-intervention and 4-week follow-up

Walker and Clement (1992)

6 1st/2nd grade boys, diagnosed with ADHD, 5 African A, 1 Hispanic

Behavioral observations; Pupil Evaluation Inventory

8–10 sessions (20 min), half individually and half in group, multiple baseline design

Pre-post-intervention: effect size collapsing observations and peer evaluation = 1.07

Wolmer, Hamiel, and Laor (2011)

1,488 Israeli students, 4th–5th grades, exposed to continuous rocket attacks

UCLA-PTSD Reaction Index; Stress/Mood Scale

14 sessions (45 min), delivered by teachers regulation

Pre-post-intervention: decrease in PTSD symptoms and stress/mood in SIT among intervention group

SIT vs. control: less PTSD symptoms and stress mood in SIT at post-intervention


Note. APES = Adolescent Perceived Events Scale; BDI = Beck Depression Inventory; CSEI = Coopersmith Self-Esteem Inventory; RADS = Reynolds Adolescent Depression Scale; STAI = State-Trait Anxiety Inventory; STAXI = State-Trait Anger Expression Inventory

As mentioned above, SIT consists of the flexible interlocking conceptual-educational phase, skills acquisition and consolidation, and rehearsal phase, and application phase (Meichenbaum, 2008). The conceptual-educational phase includes multiple steps and purposes. The aims of this phase include (a) to disaggregate global stressors and to describe the stressful situation in behaviorally relevant and specific terms, (b) to identify the determinants of the problem or stressors, (c) to motivate the student to observe himself/herself to identify his/her stress responses and to learn the associations between his/her own cognitions, emotions, behaviors, and responses from others, and (d) to identify which difficulties are related to deficits in coping skills versus performance failures. The main purpose of this phase is to collect the necessary information about the stressful situation and the student’s coping skills and to cognitively prepare the student for the therapeutic work to come. To reach these aims, the therapist uses different strategies including interviews with the student and relevant others (e.g., caregivers, teachers), student’s imaginative reconstruction of a typical stressful situation, and psychological and behavioral assessments.

In the skills acquisition and consolidation, and rehearsal phase, the therapist tailors the SIT by considering what coping strategies the student already uses, how they can be used in the problematic stressful situations, and what prevents them so far from being used. Further, during this phase emotion-focused (including acceptance skills, cognitive reframing, perspective taking) and problem-focused coping skills (including assertiveness training, problem-solving, social support) are trained and rehearsed using imaginative and behavioral exercises. Finally, generalization procedures are developed and possible barriers of using the trained coping skills are anticipated and addressed.

In the application phase, the student is encouraged to apply the trained coping skills to gradually more demanding stressful situations. Another important element of the application phase is to bolster the student’s self-efficacy. Ideally, the student uses self-attributions for improvements and she/he coaches someone with a similar stressful situation. This also helps the student to generalize the learned strategies to other stressful situations in their life. Finally, relevant others (e.g., caregivers, teachers) are involved in the treatment to allow for a restructuring of environmental stressors. Please see Meichenbaum (2007) for a detailed description of the mechanics of SIT and some examples with adult clients. At this point, we are not aware of published example cases in students.

In schools, SIT was implemented in group and individual settings (Table 12.1) and seems appropriate for Tier II (targeted) or Tier III (intensive) interventions (Ysseldyke et al., 2006). Tier II interventions address “specific academic or social-emotional skill or performance deficits” in students that do not benefit from programs offered to all students in a school (Ysseldyke et al., 2006, p. 13). Thus, SIT may be offered to students that academically struggle in group sessions. As Tier III interventions target individual students, SIT may be administered by a school psychologist to a specific student in one-to-one sessions. As with any intervention, school psychologists are obligated to consider if SIT is the most appropriate approach to help students to be successful in the general education program and to use data-based problem-solving processes to plan the implementation of SIT, monitor its effects, and modify SIT if necessary (Jacob, Decker, & Hartshorne, 2011).


Research Support


Meichenbaum (1993) identified approximately 200 published empirical studies using SIT with populations as different as psychiatric patients (e.g., addiction, anger-control problems in students and adults, PTSD), medical patients (e.g., cancer, childhood asthma, hypertension), individuals having a stressful occupation (e.g., nurses, soldiers, teachers), parents of children with cancer, and many more. However, studies in the school setting are much less common. Our own search revealed only six published studies with SIT in schools. Besides the limited number of studies, further limiting is that only three of the six (Hains & Ellmann, 1994; Hains & Szyjakowski, 1990; Wolmer et al., 2011) include a control group, only three studies provided follow-up data (Hains, 1992; Hains & Szyjakowski, 1990; Kiselica et al., 1994), and the small sample size in five of the six studies. Thus, while it seems clear that SIT is effective in children and adolescents outside the school setting (Maag & Kotlash, 1994) and it is likely that SIT is similarly effective in schools, the lack of empirical findings of SIT within schools is unsatisfactory, and no final conclusions about the effects of SIT implemented in schools can currently be drawn.


Changing Unhealthy Patterns of Thinking—An REBT Approach



Mark Terjesen


(9)
Department of Psychology, St. John’s University, Jamaica, NY, USA

 


Conceptual Model of Rational Emotive Behavior Therapy


Rational Emotive Behavior Therapy (REBT), like other cognitive-behavioral approaches (CBT), is based on the notion that unhealthy affect and behavior are influenced by an individual’s cognitive processing and that a modification of maladaptive cognitive processes can promote healthier emotional and behavioral responses (David & Szentagotai, 2006). While the different CBT approaches are in conceptual agreement about the role of cognitive variables in the development of cognitive, emotional, and behavioral problems (Hyland & Boduszek, 2012), there are variations in the intervention approaches of each model.

The REBT approach is based on Ellis (1962) ABC model : individuals experience undesirable activating events (A), and they have beliefs/cognitions (B) about these events that may be irrational/dysfunctional or rational/functional. The model proposes that these beliefs in turn lead to either dysfunctional or functional behavioral or emotional consequences (C). For example, a child receives a poor grade on a school assignment (A) and thinks, “My teacher thinks I am stupid” (B), which, in turn, may leave the child feeling sad and/or lead to negative behaviors in the classroom (C) (these are examples of dysfunctional emotional and behavioral consequences, respectively).

Rational beliefs are healthy, pragmatic, flexible, logical, and empirically consistent with reality. Irrational beliefs are rigid and absolutist, dysfunctional/non-pragmatic, and, in general, not consistent with reality (Hyland & Boduszek, 2012; Szentagotai & Freeman, 2007). The REBT model proposes that if a child holds healthy, logical, rational beliefs about a negative activating event they experience, this increases the likelihood that they will experience “healthy” negative emotions (e.g., concern, frustration, sadness) and will engage in adaptive behaviors in response to stressors (Hyland & Boduszek, 2012). Alternatively, if a person holds irrational beliefs about the negative activating event , they are likely to experience unhealthy negative emotions (e.g., anxiety, anger, depression) and to engage in maladaptive behavioral responses (Hyland & Boduszek, 2012). Core to the treatment model is the identification and replacement of these unhealthy, maladaptive thoughts to reduce emotional difficulties experienced and the problematic behavior of children and adolescents (David, Szentagotai, Eva, & Macavei, 2005).


Cognitive Restructuring in REBT


Ellis identified 11 types of irrational beliefs that he proposed were endorsed by clients (Ellis, 1962). Subsequently, the model has been refined, and these beliefs were then organized into four primary belief categories: (1) demandingness of self or others (demands) (e.g., “I have to succeed”; “She must treat me with respect”), (2) frustration intolerance (e.g., “I can’t stand homework”), (3) awfulizing or catastrophizing (e.g., “It would be horrible if I made a mistake”), and (4) global evaluations of human worth of self or others (ratings of worth) (e.g., “If I fail the test, I am a loser/failure”) (DiGiuseppe, Doyle, Dryden, & Backx, 2013; Ellis & Blau, 1998).

A key component of the REBT model is helping the student to identify and challenge these irrational beliefs and assist children in adopting a new set of beliefs that are functional, rational, and logical (Sava, Maricutoiu, Rusu, Macsinga, & Virga, 2011). There are a number of strategies used to facilitate this change to reduce both the influence of their irrational beliefs and the emotional and behavioral problems experienced (Hyland & Boduszek, 2012). The replacement of these maladaptive thoughts has been proven effective in reducing emotional disturbance and problem behavior in children and adolescents (David et al., 2005; Esposito, 2009; Gonzalez et al., 2004).

Challenging these irrational beliefs is at the core of the cognitive restructuring component of REBT; this process is called “disputation .” Disputation debates or challenges the irrational beliefs that a student is holding to allow for the newer, healthier belief system to have an opportunity to develop. These disputation strategies can be cognitive, imaginal, and/or behavioral in nature (DiGiuseppe et al., 2013) and are described below as they relate to specific beliefs that students may endorse.

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Jun 29, 2017 | Posted by in PSYCHOLOGY | Comments Off on Cognitive Interventions

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