Cognitive behavioral therapy

CBT models for depression often consist of four levels of treatment:

(1) behavioral procedures, such as contingent reinforcement, shaping, prompting, and modeling, to increase social interaction; (2) CBT interventions, which include pairing successful task completion with positive self-statements and reinforcement for those self-statements; (3) cognitive interventions, which are used with social-skills train- ing, role-playing, and self-management; and (4) self-control procedures such as self- evaluation and self-reinforcement.

Attention-Deficit/Hyperactivity Disorder

(1) sustained attention and effort, (2) inhibitory controls, and (3) the modulation of arousal levels to meet situational demands. She lists the most frequent behavior problems of children (from most common to least common): loss of temper, hyperactivity, fears, restlessness, sleep disorders, enuresis, food intake, nail biting, tics, and stuttering. Her review of the literature revealed that children with behavior problems such as hyperactivity, impulsivity, and aggression tend to (1) generate fewer alternative solutions to interpersonal problems, (2) focus on ends or goals rather than on the intermediate steps toward obtaining them, (3) see fewer consequences associated with their behavior, (4) fail to recognize causes of others' behavior, and (5) be less sensitive to interpersonal conflict. successful applications of CBT, such as self-assessment, self- instruction, self-reinforcement, and self-punishment. Cognitive treatments require children's active participation in learning to identify irrational thoughts, initiate internal dialogues, halt automatic thinking, change automatic thoughts to mediated ones, and use CBT to change unwanted behavior. CBT; she compares changing one's behavior with learning to ride a bicycle, use computers, or read and write. Ronen identifies three keys to such learning: (1) the knowledge of how to do it, (2) the desire to learn and practice, and (3) time to practice. Basically, our position is that good counselors should be able to teach children and adolescents almost any CBT skill that can be broken down into mediating steps that they understand and find meaningful to the events in their everyday lives.

Rational self- analysis

In Step 1, children write down what happened ("Jimmy called me a name because he doesn't like me."). In Step 2, children are asked to write, from the vantage point of a digital camera, what they would see and hear ("Jimmy didn't like it when I didn't choose him for my team."). With the increased objectivity obtained in Step 2, children are then asked In Step 3 to write down their thoughts about what happened ("It's terrible when people talk mean to me," or "If people get angry at me, I'm a bad person."). In Step 4, children are asked to write how they felt (hurt, angry) and what they did ("I hit him."). In Step 5, children are asked to find out if they have been thinking "smart" thoughts by testing their thoughts with the five questions listed in Step 6 (e.g., "Does my thought help me stay out of trouble with others?"). The answers are tabulated in the Step 5 box. If "no" wins, the children go to in Step 7 and list some of the feelings they want to feel (e.g., a child may prefer to feel sad or disappointed instead of hurt, irritated, or angry). In Step 8, children are asked to write "smarter" thoughts that would help them feel better feelings ("I don't like it when others get upset with me, but things could be worse, and I don't have to let oth- ers control how I act."). in Step 9 is reserved for a plan of action children can use the next time somebody does something to make them feel bad.

Process

The cognitive counselor helps the child learn how to shift out of the dysfunctional mode into a more functional way of thinking and doing, what calls power of realistic thinking. The counselor and client share responsibility for setting the agenda, describing problem situations, and providing in- formation about distressing emotions, behaviors, and associated thoughts. Again, the goals of cognitive therapy are to correct faulty information processing and to modify assumptions that maintain dysfunctional emotions and behaviors One way to introduce the cognitive model to children is to use a story about a situation in which people may be thinking differently, such as riding a roller coaster Stories, pictures, or other examples make the explanation more fun, engaging, and more connected to the child's world. "What goes through your mind when ______________________ happens?" "What goes through your mind when you feel ______________________?" Other suggested questions for understanding children's cognitions are as follows: "What do you make of this? What does it mean about you?" "Why do you think ______________________ happens? How do you explain it?" "What are your reasons for believing this? What is the evidence for that belief? What is the evidence against that belief?" "What is another way to look at what happened?" "How likely is it that ______________________ will happen?" "What are the advantages of looking at things this way? What are the disadvantages?"

Socratic questioning

The counselor questions and questions and questions to get the client's complete knowledge about a topic. Incomplete or inaccurate ideas can be corrected in follow-up questions and the client can replace mis- interpretations with more realistic thoughts.

Drug Use

The protocols for CBT with adolescents with substance abuse include motivational interviewing, self- monitoring, contingency contracting, and refusal skills as well as coping, communication, and problem-solving skills explained that a CBT substance abuse prevention approach focuses on developing coping skills that can offset risk factors and serve as bufers to substances abuse. The skills are self-management, decision making, problem- solving, communication, assertiveness, and anxiety and anger management skills as well as cognitive skills. The effective programs use interactive skills training. She cautioned schools to use only evidence-based substance abuse prevention programs.

Cognitive behavioral theraphy

The sessions followed this sequence: 1. Introduction, explanation of treatment, information on stress and trauma; 2. Education on responses to stress and trauma, relaxation training; 3. Introduction to cognitive therapy, connecting thoughts and feelings, measuring fear, and the ways of fighting negative thoughts; 4. Fighting negative thoughts; 5. Coping strategies, fear hierarchy; 6. Exposure to troubling memories using imagination, drawing, writing; 7. Same as 6; 8. Social problem-solving; 9. Practicing social problem-solving; 10. Relapse prevention. In a meta-analysis of six studies of trauma-focused CBT, the researchers concluded the treatment was an effective intervention for PTSD in children who have been sexually abused (Macdonald et al., 2012). Similarly, Silverman and colleagues (2008) analyzed 21 treatment studies of cognitive therapy. They concluded that trauma-focused CBT met the criteria for a well-established treatment. They also determined that school-based group CBT met the criteria for probably efficacious approach for children exposed to traumatic events.

Schema

Together cognitive structures and content comprise what is known as a schema which grows from the processing of life experiences. A schema acts as a person's core philosophy, influencing expectations and screening information based on that core philosophy. The schema then affects the consistency in the person's cognition, behavior, and affect exist on a continuum of adaptive to maladaptive.

Automatic thoughts

a person's habits of the mind that are immediate, and self-talk, a person's private everyday commentary, are one level of the cognitive model. An example from a psychologically healthy person would be something like this: "I made a goal in the soccer match. I practiced really hard and all that work paid off." Automatic thoughts connect a situation and an emotion and reflect the meaning a person gives the situation.

Cogntive distortion -unrealistic thinking

a person's sense of self, environment, and fu- ture (the cognitive triad). causes either internal pain such as depression or anxiety or problem behavior such as aggression, therapeutic intervention is needed. recognize the theory of mode as particularly relevant to psychological disorders explain that in psychiatric disorders, distortions are apparent in each component. The ex- ample those authors provide is that depressed individuals view themselves as lacking personal competence, see their past and current failures as evidence of that incom- petence, and have little hope for a more pleasant future. Anxious individuals con- sider themselves unable to deal with their distress, see elements in the environment as dangerous and threatening, and look at the future with fear and apprehension People with externalizing disorders like conduct disorders see themselves as being treated unfairly or abused in some way, think other people are interfering with their personal goals, and that any future goal will be impeded by others. four major modes: anxiety mode with cognitive perception of danger; anger mode with the perception of being violated; sadness mode with a perception of loss; joy mode with perception of gain. The accompanying schemas are outlined in the following table MODE COGNITION: Core beliefs EMOTION: Core emotions MOTIVATION: Core impulses Anxiety Danger Violation Loss Gain Fear Anger Sadness Happiness Escape/avoid Attack Grieve Seek/approach

Three programs grounded in cognitive-behavioral theory were shown to be effective: ANGER

anger coping, social problem-solving, and parent training programs. identified common elements of evidence-based treatments for children's disruptive behavior problems as problem-solving cognitive-behavioral interventions. CBT for children and adolescents with externalizing disorder such as antisocial behaviors.

Schemas,

are core beliefs, such as danger, violation, loss, and gain; emotional schemas are core emotions, such as anxiety, anger, joy, and sadness. Motivational schemas are the core impulses: to escape or avoid, to attack, to grieve, or to approach. Physiological schemas are the body's autonomic, motor, and sensory systems. Finally, behavioral schemas are core actions such as smiling, shaking, and crying.

Cognitive distortion

are the processes in the model. Distortions convert incoming information to keep cognitive schema intact. They use the assimilation process to maintain homeostasis. Miguel's schema reflects his perception of incompetence: he believes he cannot do anything well (schema) He feels anxious (emotion) He makes the honor roll one grading period (situation) and thinks the grades do not count because his classes are too easy (automatic thought). He is discounting his achievement (cognitive distor- tion). The information contrary to his core belief is canceled out by the distortion process, and he cannot identify any disconfirming evidence from his environment.

Core beliefs

are the significant ideas about ourselves from which many auto- matic thoughts and many intermediate beliefs grow. Judith Beck (2011) explained that core beliefs are global, overly generalized, and absolute but are not necessar- ily true. The beliefs may have started in childhood. Core beliefs reflect a person's view of the world, people, and the future as well as the sense of self and apply those across events in a person's experiences. Core beliefs can be modified and may be healthy such as "I am capable." Many negative core beliefs are either helpless beliefs ("I am a failure"; "I am weak") or unlovable beliefs ("I am not good enough"; "People will always abandon me"). As counselors hear automatic thoughts, they can begin to discern patterns of core beliefs and build hypotheses to be shared with the client when it is appropriate. Clients learn to consider core beliefs as ideas rather than as truth and to evaluate and change those beliefs if such modification is needed

Modeling and role-playing

are two common techniques in many forms of coun- seling. In modeling, the counselor shows the child how to do something and the child imitates the behavior. This can also be used to help parents learn positive behaviors with children. In role-playing, the child and counselor enact a situation and the child practices a newly learned behavior.

Behavioral Techniques

are used to modify automatic thoughts and maladaptive assumptions. The behavioral experiments are designed to challenge beliefs and promote learning. Behavioral techniques are also employed to expand skills with training exercises, to help clients relax with progressive relaxation, to make them more active with activity scheduling, or to pre- pare clients for something they fear with exposure therapy or behavioral rehearsal.

The counselor also emphasizes the issues of control, mastery, and responsibility for the client's own behavior change

believes that combining cognitive and behavioral interventions increases the potency of the intervention First: The change proceeds first in calming the child through the counselor's empathy and acceptance Relaxation techniques and verbal approval also are appropriate. In the second stage, children are given opportunities to experience and test the thoughts that are associated with their emotions. Next, the children examine their distortions and learn to discern rational and irrational ideas to shift their perceptions. The counselor uses modeling tailored to the needs of the children to demonstrate adaptive coping skills. Cognitive change and adaptive behaviors are communicated indirectly.

Goals

coping-skills therapies, cognitive-restructuring, therapies, and problem-solving therapies. Coping-skills therapies revolve around developing specific skills that help the client deal with stressful events; for example, skills like relaxation strategies or social skills like eye contact. Cognitive- restructuring therapies include modifying and replacing dysfunctional thoughts with more adaptive cognitive patterns. The assumption is that changing the thoughts will lead to positive behavior change. Problem-solving approaches combine those two components—modifying thoughts and creating strategies to promote behavioral change. CBT falls into the problem-solving category.

stress-inoculation techniques include relaxation training

deep-breathing exercises, and reframing exercises that help children replace their anxiety with relaxation. Such reframing exercises help children perceive anxiety-provoking situations in a less threatening light. Rather than having the child focus on school as a place of potential failure and frightening teachers, for example, the counselor teaches the child to focus on the friends and fun available at school.

Collaborative empiricism

defines the cooperative working relationship as focused on jointly determining goals and seeking feedback. Counselor and child are co-investigators of evidence supporting or rejecting cognitions by comparing them to observations, evidence, and facts gathered from everyday life.

Relationship

describe the cognitive-behavioral therapeutic relationship as collaborative, working with, not on a person. The counselor is a warm, empathic, and genuine person and appreciates the client's personal worldview. She is flexible, sensitive, and supportive She specifies problems, focuses on important areas, and teaches cognitive techniques. Counselors ask about the thoughts, images, and beliefs that occur within clients during situations as well as the emotions and behaviors that go along with the cognitions. The counselor finds sources of distress and dysfunction and helps the child clarify goals. In cases of severe depression or anxiety, the therapist will be very directive. Counselors explain any intervention by giving a reason for using the procedure. In CBT, the counselor asks the client for feedback about what has been helpful or not helpful, whether the client has concerns about the counselor, and whether the client has any questions. The therapist may also summarize the session or ask the client to recap their time together. Finally, counselors make frequent use of homework to allow the client opportunities to practice new skills and perspectives.

Depression

explained a cognitive triad that characterizes depression. The depressed person has a negative view of self, the world, and the future. The depressed individual considers self as inadequate, deserted, and worthless. Beck (2008) has also connected this psychological explanation of depression to its neurobiological correlates. His explanation combines the growing evidence of brain topography with the symptoms of depression and his call for further research will be answered to clarify those connections. Depressed children and adolescents experience distortions in attributions, self- evaluation, and perceptions of past and present events. Depressed children exhibit more external locus of control (an indication that they feel less capable) and low self-esteem resulting from a perceived inability to succeed academically and socially. Effective help for depressed children included training them in self-control, self-evaluation, assertiveness, and social skills. Their social skills training included initiating and maintaining interactions and conflict resolution. The specific cognitive- behavioral techniques included relaxation, imagery, and cognitive restructuring. Depressed children exhibit more external locus of control (an indication that they feel less capable) and low self-esteem resulting from a perceived inability to succeed academically and socially. Effective help for depressed children included training them in self-control, self-evaluation, assertiveness, and social skills. Their social skills training included initiating and maintaining interactions and conflict resolution. The specific cognitive- behavioral techniques included relaxation, imagery, and cognitive restructuring. Children are taught to distinguish between thoughts and feelings by teaching, role-play, and storytelling After children under- stand that difference, discussions about the situations that bring out positive and negative moods happen. The counselor helps the child see how thoughts may have influenced behaviors. At the same time, behavioral strategies such as activity planning, social problem-solving, or interaction skills may be used. The child practices cognitive restructuring both in and outside the sessions. Setting appropriate goals, identifying distorted thoughts, and learning to replace those cognitions with contructive thoughts and management skills, like relaxation, may be included.

four levels of cognition, according to Beck and Weishaar (2014)

four levels of cognition, or cognitive con- tent, within a person that are hierarchically organized based on a person's awareness of the thoughts and the stability of the thought: automatic thoughts, intermediate beliefs, core beliefs, and schemas.

Cognitive-behavioral practitioners

have an array of techniques and methods that can be taught to people from cultures favoring education and training that will, in turn, lead to empowering clients to solve problems and resolve conflicts.

Stress-inoculation training programs,

have four categories of self-talk designed to help people master difficult and highly stressful situations and events. The categories are: 1. Preparation for a stressor: "What is it you have to do? You can develop a plan to deal with it. Don't worry." 2. Confrontation and management of a stressor: "One step at a time; you can handle the situation. Relax, you are in control. Take a slow, deep breath." 3. Coping: "Don't try to eliminate fear totally; just keep it manageable. Keep the focus on the present; what is it you have to do?" 4. Reinforcing self-statements: "It worked; you did it. It wasn't as bad as you ex- pected. It's getting better each time."

Cognitive-behavioral therapists

have three fundamental assumptions. One is that cognitive activity impacts behavior. The next is that cognitive activity can be monitored and changed. The third idea critical to CBT is that a desired change in behavior can be accomplished through changing cognitions cognitive-behavioral counselors work to help the child become aware of their distorted thinking, identify ways the distorted thinking relates to negative feelings and behaviors, and then change their thoughts and behaviors

Theory of counseling

identify the principles of cognitive therapy. It is based on the premise that changes in thoughts will lead to changes in feeling and acting. Treatment requires a strong collaborative relationship between client and counselor. Treatment is usually short, problem-focused, and goal oriented. It is an active, structured approach to counseling that focuses on the present. Counselors carefully assess, diagnose, and plan treatment based on that information. Counselors use a range of strategies to help clients evaluate and change their cognitions, particularly Socratic questioning and inductive reasoning. The model promotes emotional health and prevents relapse by teaching clients to identify, evaluate, and modify their thought explain that cognitive therapists see personality as a re- flection of the person's cognitive organization and structure, which are both biologically and socially influenced. Within the constraints of each person's neuroanatomy and biochemistry, personal learning determines how a person develops and responds. The

Cognitive behavior counseling methods

include relaxation and stress-reduction techniques, assertiveness training, anxiety management, modeling, role-playing, and goal setting.

Redefining

includes making a problem more concrete, specific, and restated in terms of the client's behavior. For example, a lonely person would switch "Nobody likes me" to "I need to reach out to people"

Socratic dialogue

is a type of questioning designed to promote new learning. Questions are used to clarify or define, to assist in identifying thoughts, to examine meanings, and to test the consequences of thoughts and actions. Counselors avoid questions for which they already have answers. Friedberg and McClure (2015) explain that Socratic method includes systematic questioning, inductive reasoning, and constructing universal definitions. The method helps counselors uncover the database for children's beliefs but must be modified based on the children's responses and level of distress. Counselors use a gentle, curious stance rather than allowing the questions to become more like an inquisition. The purpose is to encourage children to test their inferences, judgments, conclusions, and appraisals. The categories for the questions are these: What's the evidence? What's an alternative explanation? What are the advantages and disadvantages? How can I problem solve? The outline for Socratic dialogues includes a five-part process. 1. Counselors elicit and identify the automatic thought. 2. Next, the thought is tied to the feeling and behavior. 3. Counselors then link the thinking-feeling-behavior sequence together with an empathic response. 4. Counselors collaborate with clients on the first three steps and reach an agreement to proceed. 5. The fifth step is to test the belief. Guided discovery occurs when the counselor coaches the child in a voyage of self-discovery in which the child does his or her own thinking and draws his or her own conclusions. Guided discovery has many ingredients that vary from child to child. Those parts may be empathy, Socratic questioning, behavioral experiments, and homework. The process is designed to cast doubt on the certainty of children's beliefs and to encourage them to discover more adaptive and functional explanations for themselves. It requires patience and artful questioning to allow clients to build new appraisals for themselves

De-catastrophizing

is also called the "what if" technique. Clients state their feared consequences and identify problem-solving strategies to cope with the concerns.

Assessment

is gathered through many sources such as interviews, objective self-reports, objective parent and teacher checklists, observations, and test data such as cognitive functioning, academic skills, and others The self-report inventories are screening measures for anxiety, anger, disruptive behavior, and self-concept.

Cognitive-restructuring

is used to reduce, modify, or replace a person's cognitive distortions. It can be done in many ways such as challenging the distortion, examining the logic, testing the truth of the thoughts, and finding alternative explanations for situations. The counselor may want to use a sheet that has two columns, one for "evidence for" and the other column for "evidence against" the thoughts. This cognitive technique helps in testing automatic thoughts by direct evidence or by logical analysis.

Socratic questioning

is widely used. The counselor questions and questions and questions to get the client's complete knowledge about a topic. Incomplete or inac- curate ideas can be corrected in follow-up questions and the client can replace mis- interpretations with more realistic thoughts.

Cognitive therapists

look for these patterns and connections among events, thoughts, emotions, and behavior. They attempt to identify a person's internal picture of self and situation to understand how the person's feelings and actions make sense. Psychological disorders have profiles that reflect and maintain biases in information processing. • Catastrophizing: expecting disastrous events o "I'll mess up the speech and everyone will laugh at me." • Mental filtering: seeing an entire situation based on one detail with all else ignored Ŋ "I got a bad grade. I'm going to fail my course." • Blame or assigning internal responsibility entirely to external events Ŋ "If I had a good instructor, I'd be a great gymnast." • All-or-nothing thinking: the person thinks in terms of two opposite categories Ŋ "If I don't get to be team captain, I'm a total failure." • Discounting the positive: person says positives do not count Ŋ "I played a good game but that doesn't mean anything. I just got lucky." • Overgeneralization: a sweeping negative conclusion that goes beyond facts Ŋ "All teachers hate me." cognitive-behavioral counselors begin by developing an understanding of the case. That case formation is a dynamic process that requires the counselor to generate and test their hypotheses.

Decentering

occurs most often with anxious clients who think they are the focus of everyone's attention. The logic is examined and behavioral experiments are designed to test the beliefs. provide is of a student who was afraid to speak in class because he thought his classmates always watched him and saw his anxiety. When he focused on them, he saw students look- ing at the teacher, taking notes, and daydreaming. He decided they had concerns other than him.

cognitive structures

of a person represent the organization of information stored in memory serve as filters, screening the ongoing experiences of life.

stress-inoculation training -SELF TALK

one of the most successful cognitive-behavioral procedures. Stress-inoculation methods combined with role-playing to provide an example of a cognitive-behavioral technique. In cases of test anxiety, the client might be asked to practice the following examples of self-talk: (1) "Tests are no fun, but all I want is to do the best I can"; (2) "Though it would be nice to make an A, it is not required for me to be a good and worthwhile person"; (3) "All I need to do is prepare for the test and do the best I am able to do. If I fail, it will be inconvenient and no fun at all, but that is all it will be. For the moment, I just will not be getting what I want." Combining the self-talk with taking practice tests and visualization practice of the steps in the client's test-taking stimu- lus hierarchy (systematic desensitization) represents a typical CBT treatment plan.

Five part formation dynamic process

problem list-is a comprehensive inventory of the difficulties that are explained in concrete behavioral terms. Five to eight problems may be listed in a variety of areas such as psychological, interpersonal, school, and leisure. The connections between the problems may become apparent as the list is constructed. Counselors may use a structured interview along with the child's explanation of the problem to compile the problem list. diagnosis,- or the issue which predominates. The diagnosis will be linked to the treatment plan. working hypothesis- allows the counselor to connect the issues on the problem list. Subsections of the hypothesis are the core beliefs, precipitating or activating situations, and origins. Core beliefs are the person's negative thoughts about self, the world, others, or the future. Precipitating situations refer to the external events that caused the symptom or problem, and origins refer to history that might be related. strengths and assets- are the positive parts of the person's situation, what is not a problem. Things like good friends, health, a sense of humor, school success, and a strong family bond may be assets. treatment plan- is the product of case conceptualization. It is related to the problem list and working hypothesis. The treatment plan describes the sequence and timing of interventions. It contains the goals for counseling, the obstacles to those goals, and the strategies to be used. These elements of case conceptualization provide a recipe for putting together a plan for the counseling process, giving a guide to adapting techniques for the individual child

biased information-processing system

produces thinking errors, inaccurate meaning, content, and information. According to Beck's model, maladaptive schemas develop in childhood and may not interfere with a person's thinking until a trigger is encountered in adulthood. The risk for negatively biased schemas includes genetic influences (Gibb, Beever, & McGeary, 2013) and environmental effects that shape attention and interactions.

Intermediate beliefs

reflect the absolute rules and attitudes that influence a person's automatic thoughts. For the example above, an intermediate thought might be that working hard pays dividends or a less healthy approach would be "I got lucky."

Cognitive content

relates to the information that is stored—the substance of cognitive structures.

Self-monitoring

requires the client keep a log of their thoughts, emotions, and behaviors in response to events.

Problem-solving

starts when the client and counselor create a problem list that is described with concrete, clear, and goal-oriented terms. The counselor teaches problem-solving skills to children and eventually encourages them to generate their own strategies. Socratic questioning, a problem-solving worksheet, and role-playing are used to help problem-solving. The basic steps in problem solving involve first (Step 1) identifying the problem in specific, concrete terms and then (Step 2) generating solutions to the situation. This brainstorming phase helps the child produce several alternatives. Step 3 involves evaluation of the option by looking carefully at short-term and long-term consequences of each possibility. Recording those ideas on paper makes them more concrete for the child. After deliberating the options and consequences of each solution, the counselor and child develop an implementation plan for the best option. The final step is the child rewarding himself or herself for trying out the solution

Problem-solving

starts when the client and counselor create a problem list that is described with concrete, clear, and goal-oriented terms. The counselor teaches problem-solving skills to children and eventually encourages them to generate their own strategies. Socratic questioning, a problem-solving worksheet, and role-playing are used to help problem-solving. The basic steps in problem solving involve first (Step 1) identifying the problem in specific, concrete terms and then (Step 2) generating solutions to the situation. This brainstorming phase helps the child produce several alternatives. Step 3 involves evaluation of the option by looking carefully at short-term and long-term consequences of each possibility. Recording those ideas on paper makes them more concrete for the child. After deliberating the options and consequences of each solution, the counselor and child develop an implementation plan for the best option. The final step is the child rewarding himself or herself for trying out the solution

Reattribution

tests automatic thought by considering alternative reasons for the events. Clients may see themselves as the cause of a situation, an unreasonable assumption since a single person is rarely the sole reason for something happening. Reattributions use reality testing and appropriate assigning of responsibility by ex- amining all the factors that affect a situation.

organization of schemas

that connects beliefs, memories, reflections, and self-evaluations. That network of cognitive, affective, motivational, and behavioral components are used in the pursuit of goals. Modes represent those connections across the network. These systems have overlapping components such as the cognition of danger, the emotion of fear, the mo- tivation to escape, and the behavior of fleeing—all of these components form the anxiety mode. The thoughts with which people consider their circumstances powerfully influence their emotional-motivational-behavioral response

Cognitive behavioral therapy

the child works through stages of introduction and orientation, assessment, middle, and termination phases. The introduction allows counselor and child to identify each other, and the orientation outlines the process of counseling. Assessment may occur by asking "What goes through your mind when ___?" During the middle stage, the therapy is focused on increasing the child's self-control and sense of accomplishment as well as learning different responses to situation Through play activities, such as using puppets to model, and cognitive strategies like disputing irrational beliefs and making positive statements about self, children can learn about counseling indirectly (Knell, 2009). The child learns new skills with the counselor's instruction. The counselor uses praise and interpretation to help the child learn new behaviors and increase understanding of his or her thoughts. The counselor also provides strategies for developing more adaptive thoughts and behaviors. The behavioral techniques used by the counselor may include systematic desensitization, contingency management, self-monitoring, and activity scheduling. Cognitive techniques include recording thoughts, cognitive change strategies, coping self-statements, and bibliotherapy. To accomplish the educative process, counselors use techniques such as modeling, role-playing, and using behavioral contingencies

Anger control

the cognitive distortions of angry or aggressive young people: all-or-nothing thinking, mental filtering, emotional reasoning, and personal codes. All-or-nothing thinking is a distortion that allows only absolutes so that no medium area is considered—for example, people are either for or against them, love or hate them. Mental filtering refers to their focus on the negative or potentially hostile parts of the situation. They jump to conclusions without considering all factors in the situation. A too common example is a young man who gets pushed while walking in a crowded hall. He immediately thinks the push was deliberate and meant to provoke him They outlined types of aggressive behavior and the need for effective interventions in the schools

collaborative empiricism.

the situation experienced by the child is tested next to the child's interpretation of self, the world, and the future. Counselors listen for and challenge words like always, never, and should CBT may be structured through the use of a manual. Sessions start with a check-in, a brief report of the child's emotional state. Counselor and child set the agenda or discuss what will be covered during their time together. Next, they review homework and examine any obstacles that interfered with completing the assignment. Goal setting for the current session often follows the review and a new skill is taught and practiced. The skill comes from what was learned previously and is taught by didactic methods, role-playing, and other methods. The session content or therapeutic techniques fill the rest of the time. Homework assignments give children ways to find evidence, face challenges, or practice skills they have learned. Finally, the counselor asks for feedback about the child's reaction and concerns.

Cognitive therapy sessions

typically follow an established framework according to even though the content of the session will change depending on the client. For the initial session she suggests these steps: • Build an agenda that has meaning for the client • Ascertain and measure the intensity of the person's mood • Identify and review presenting problems • Ask about the client's expectation for counseling • Teach the person about cognitive therapy and the client's role in it • Give information about the person's difficulties and diagnosis • Establish goals • Recommend homework • Summarize • Obtain the client's feedback

primary goals

use the innate feelings of pleasure and pain as guided throught life, people perceive, interpret, and learn from experiences they draw conclusions, make predictions and generate goals refers to the ways people use to understand their environment and themselves, such as their perceptions, sensations, learning, memory, and other psychological processes. if humans did not have the capacity to take in relevant information, synthesizing it, and building a plan of action based on the synthesis, they would not survive. which is a theory, set of techniques, and system of strategies, focuses on people's thinking as the primary pathway to change. Using the innate feelings of pleasure and pain as guides throughout life, people perceive, interpret, and learn from experiences. Cognitive therapists acknowledge that children have different temperaments that push them in diverse directions. Therefore, children and adults are more likely to perceive the same event differently.

Cognitive counselors

use verbal techniques to extract automatic thoughts, analyze the logic behind the thoughts, identify the assumptions underpinning the thoughts, and examining the validity of those assumptions. Socratic questioning, previously described, problem-solving, cognitive restructuring, self-monitoring, modeling, and role-playing.

Cognitive counseling

usually starts with the automatic thoughts and moves to identifying, evaluating, and changing intermediate and core beliefs, then to modifying schemas.

adaptive functioning

well to life situations, our ability to function in our various roles is not impaired by errors in thinking, emotional distress is not disproportional to our realistic problems, and our behavioral strategies facilitate rather than impede attainment of our goals. Our cognitive, affective, motivational, and behavioral systems function to meet basic needs and equip us with strategies to protect from physical or interpersonal harm. The affective system provides the emotional fabric of our lives: affection to forge and maintain relationships, pleasure to reward enhancing activities, anxiety to signal danger, sadness to underscore loss or defeat, and anger to counter offense

Anxiety

which involves 16 sessions and includes psycho-education, self-monitoring, relaxation, and cognitive coping skills train- ing. Coping Cat has been the most widely evaluated program for a broad range of childhood anxiety and has significantly positive results Five principles for the child are to: 1. Learn to recognize anxious feelings and physical reaction related to anxiety 2. Identify unrealistic expectations and distorted thoughts in the anxious situations 3. Develop a plan to cope with the anxiety-producing events 4. Be gradually exposed to the anxiety-provoking situation 5. Evaluate performance with self-reinforcement strategies identified school-based interventions for anxiety disorders. They taught children about identifying their somatic reactions to anxiety, modifying their anxious self-talk, problem solving, and contingency management. After skills were mastered, the CBT counselors used graded exposure or gradual contact to the feared situation, object, or event so that students could practice their new coping skills. These authors also suggested training teachers and other school personnel ways to reduce children's anxiety.

Counseling Methods

• Base counseling on an ever-evolving understanding of the person and his or her problems in cognitive terms • Build a strong therapeutic alliance • Stress collaboration and active participation • Be goal oriented and problem focused • Begin by highlighting the present • Teach the client to be his or her own counselor and emphasize relapse prevention • Try to be time-limited • Structure sessions • Teach clients to name, evaluate, and respond to their dysfunctional thoughts and beliefs • Use a variety of techniques to change thinking, mood, and behavior