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Cognitive Therapy: Basics and Beyond

Expanding the Boundaries of Cognitive Therapy Cognitive Therapy for Personality Disorders: A Schema-Focused Approach Young, Jeffrey E. Sarasota, FL: Professional Resource Exchange, Inc., 1990. (79 pp.) $11.70 (paperback). The author's primary aim for this book is to show how cognitive therapy can be adapted and expanded to address the unique challenges presented by clients with personality disorders. In the first section, a rationale for such an adaptation and expansion is provided. Young outlines seven basic assumptions associated with cognitive therapy and shows how many of these assumptions are violated when treating clients with personality disorders. More specifically, he points out that the high degree of rigidity, avoidance, and long-term interpersonal difficulties characteristic of this clinical population are significant obstacles to successful treatment when using the "short-term cognitive therapy" approaches pioneered by Beck and others. Young contends that more effective treatments require an expanded cognitive theory-one which can account for the salient themes and patterns exhibited by clients with personality disorders. The second section of the book is devoted to an outline of the conceptual underpinnings of Young's proposed expansion. Drawing upon schema theory in cognitive psychology, Young contends that any complete understanding of personality disorders must go beyond the three levels of cognitive phenomena identified with short-term cognitive therapy (automatic thoughts, cognitive distortions, and underlying assumptions) and include a focus on the "deepest level of cognition"-what he terms the Early Maladaptive Schema (EMS). According to Young, EMSs are "extremely stable and enduring themes that develop during childhood and are elaborated upon throughout an individual's lifetime. These schemas serve as templates for the processing of later experience." (p. 9) In brief relief, through the EMS construct Young presents a case for the developmental etiology of personality disorders. EMSs are characterized as unconditional and self-perpetuating beliefs about oneself and the world that are presumed to be the consequence of dysfunctional childhood experiences with parents. Young suggests that EMSs are typically activated by current environmental events related to the schema and are often associated with a high level of emotional arousal. In his most recent revised list of specific schemas (found in Appendix B of the book), Young identifies 16 distinctEMSs that are grouped into five categories (Impaired Autonomy, Disconnection, Undesirability, Restricted Self-Expression, and Insufficient Limits). A thorough understanding of the themes and issues associated with these "core" schemas is fundamental to the practice of schema-focused therapy. In the final and perhaps most significant section of the book, Young details the assessment and intervention aspects of his schema-focused model. Because the primary goal of assessment is to determine the predominant EMSs of the client, Young outlines an eight-step evaluation procedure and guides the reader through each step by way of a case example. EMS assessment is multifaceted and includes the use of questionnaire data (Lazarus' Multimodal Life History Questionnaire and Young's own Schema Questionnaire); procedures for "triggering" schemas both within and outside of sessions; ways of educating the client about schemas; techniques for identifying schema maintenance, avoidance, and compensation behaviors; and a methodology for distinguishing among primary, secondary, and associated schemas. Young presents a wealth of applied information at this juncture and does an excellent job of bringing the material to life through the case illustration and accompanying summary tables and appendices. Particularly noteworthy is the "Client's Guide to Schema-Focused Therapy" (Appendix D) which is designed to be used as a handout for orienting clients to the schemafocused approach. …

Cognitive Therapy for Personality Disorders: A Schema-Focused Approach

Mental imagery in emotion and emotional disorders.

A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders

The role of interpersonal functioning in the maintenance of eating psychopathology: A systematic review and testable model

Enhancing Motivation to Change

Recent evidence has suggested a specific role for core beliefs in the triggering of bulimic behaviors. However, less is known about the role of imagery in this link despite its role in other disorders. The present study aimed to investigate the potential roles of core beliefs and imagery in triggering self-induced vomiting. Thirty bulimic women took part in a semistructured interview focusing on their mental processes prior to vomiting and completed a self-report measure of core beliefs. The results showed that prior to vomiting, a clinically significant proportion of bulimic patients reported thoughts relating to defectiveness/shame, failure, and social isolation core beliefs and associated feelings of shame and anxiety. Most patients perceived these feelings as triggers to their vomiting. A large number of bulimic patients also reported experiencing visual images prior to vomiting, and those images tended to be recurrent and linked to adverse life experiences. Overall, the findings suggest that defectiveness/shame, failure, and social isolation core beliefs and recurrent negative images (linked to adverse life experiences) may play important roles in the triggering of self-induced vomiting in bulimic disorders.

/pdf/triggers-of-self-induced-vomiting-in-bulimic-disorders-the-snat9rux3t.pdf

Triggers of Self-Induced Vomiting in Bulimic Disorders: The Roles of Core Beliefs and Imagery

*Eating Disorders Service, South West London and St. George’s Mental Health NHS Trust, London. †Department of Mental Health, St. George’s Hospital Medical School, London. ‡Department of Psychology, University of Warwick, Warwick. §Department of Education, University of Southampton, Southampton. Department of Psychology, University of East London, London. ¶Department of Psychology, University of Birmingham, Birmingham, UK. Reprints: Professor Waller, University of London, Cranmer Terrace, London SW17 0RE, UK. E-mail: g.waller@sghms.ac.uk. Copyright © 2003 by Lippincott Williams & Wilkins DOI: 10.1097/01.nmd.0000082186.34597.66

Social comparison in the eating disorders.

Fundamentals of Treatment

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