Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 177

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Cognitive therapists teach children that the way we think affects how we feel. If we can change the way we think about a situation, we will likely feel better. A therapist might use the cartoon of the elephant and the mouse to teach this concept to a young child with anxiety.

Therapist: How is the elephant feeling?

Child: He’s scared.

Therapist: Why?

Child: He thinks the mouse will hurt him.

Therapist: Will the mouse really hurt him?

Child: No. The mouse is so little.

Therapist: If the elephant had a different thought like, “Look at that cute little mouse,” would he feel differently?

Child: Yes. Maybe he’d be happy and want to play with the mouse.

Therapist: So the way we think about situations affects how we feel.

Child: Yes, just like the elephant.

A cognitive distortion occurs when someone twists reality to fit her negative worldview. For example, the girl with social anxiety might misperceive her classmates’ giggles during her speech as a sign of criticism. She might think, “They’re laughing at me. They think I’m stupid.” These distorted thoughts, in turn, might interfere with her ability to give a good presentation and lead to actual criticism from others, thus confirming her expectations. Similarly, the boy with depression might misperceive the fact that few friends sat with him during lunch as a sign that he is worthless. He might think, “No one likes me. I’m such a loser.” His distorted thoughts, in turn, might cause him to act mopey or avoid others, thus leading his classmates to reject him and confirming his negative view of himself (DiGiuseppe, David, & Venezia, 2018).

An initial goal of cognitive therapy is to help clients recognize the close connection between our thoughts, feelings, and actions. Although we usually have little direct control over our feelings, we can control what we think or do. If we change the way we think or act, we can often improve the way we feel. The From Science to Practice section demonstrates one way a cognitive therapist might teach the relationship between thoughts, feelings, and actions to a child (Beidel & Reinecke, 2016).

Cognitive therapists help clients identify and challenge biases and distortions and adopt more accurate ways of thinking. A primary technique in cognitive therapy involves asking clients for evidence to support their beliefs. For example, a therapist might ask the girl with anxiety, “How do you know that your classmates think you are stupid? What evidence do you have to support your belief? Is there any evidence to the contrary, that maybe they actually liked your presentation?” Similarly, a therapist might ask the boy with depression, “What’s the evidence that no one wanted to sit with you during lunch? I thought you said one boy did sit with you? If you saw a kid sitting alone during lunch, would you think he was worthless or a loser?” The goal of therapy is not to teach clients to think positively but rather to help them see themselves, others, and the world more realistically rather than in a biased or distorted fashion (Kendall, 2018).

A cognitive therapist would focus her attention on the thoughts associated with Anna’s bingeing and purging. Anna might feel lonely and think to herself, “I’m worthless. No one likes me.” The therapist might help Anna challenge this belief to determine whether it is true or whether it is a cognitive distortion. For example, the therapist might ask Anna, “What’s the evidence that no one likes you? Can you identify any friends who’d be willing to talk with you if you texted or called them when you’re feeling lonely?”

Anna might also think, “If I called someone and said that I was lonely and wanted to do something, they would probably laugh at me and say I was a loser.” The therapist might challenge Anna’s distorted belief by asking, “If another girl from school called you and said that she was feeling lonely and wanted to spend time together, would you make fun of her? Isn’t it more likely that you would help her and try to cheer her up? Don’t you think that your friends would do the same thing for you if you asked?”

Cognitive therapy emphasizes the connection between thoughts, feelings, and actions. As clients learn to think in more realistic, flexible ways, they may experience fewer negative emotions and behave in a more adaptive and flexible manner. Usually, cognitive therapists incorporate elements of behavior therapy into their treatments. Cognitive–behavioral therapy (CBT) refers to the integrated use of cognitive and behavioral approaches to treatment (Beidel & Reinecke, 2016).