Core cognitive techniques

At the core of most of the cognitive therapies used with young people are techniques for eliciting and monitoring cognitions and for correcting distorted conceptualizations and beliefs about the world.

At all ages there is an emphasis on self-monitoring, that is on charting thoughts and on recording the relationship between thoughts and other phenomena such as behaviours or recent experiences. In older adolescents cognitions can be elicited using much the same techniques as in adults. In younger children it is often necessary to use more developmentally appropriate methods. For instance, cartoon drawings such as the Thought Detective(24) can help to communicate the idea that the child is actively involved in the understanding of thinking and behaviour.

Cognitive restructuring forms an important part of many CBT programmes. The first step is to identify the thought. The thought itself should be noted down. Next, arguments and evidence to support the thought should be considered. Then arguments and evidence that cast doubt on the thought should be identified. Finally, patients should reach a reasoned conclusion based on the available evidence, both for and against their thinking.

Problematic thoughts are often underpinned by characteristic attitudes and assumptions about the self or about the world. Typical examples include the view that in order to be happy the patient must be liked by everyone, or that aggression is a legitimate way of dealing with interpersonal conflicts. These attitudes cannot usually be identified using the approach used to identify problem thoughts because they are not fully articulated in the patient's mind. Rather, they are implicit rules that often can only be inferred by the person's behaviour. In the later stages of therapy with older adolescents it may be possible to encourage the patient to look for patterns in his or her reactions to situations that betray these underlying assumptions. These techniques may be particularly useful in preventing relapse.

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