《焦虑与抑郁的认知治疗 》(Metacognitive Therapy for Anxiety and Depression)文字版[PDF]
![《焦虑与抑郁的认知治疗 》(Metacognitive Therapy for Anxiety and Depression)文字版[PDF]](/Uploads/40/406/406062.jpg)
电驴资源
| 用户共享的电驴资源列表 | |
|---|---|
| [焦虑与抑郁的认知治疗.].Metacognitive.Therapy.for.Anxiety.and.Depression.pdf | 2.65 MB |
| 2.65 MB | |
电驴资源简介
| 资源介绍 |
| 语言: 英文 |
| 地区: 美国 |
| 图书fenlei: 健康/两性 |
| 中文名: 焦虑与抑郁的认知治疗 |
| 发行时间: 2009年 |
| 原名: Metacognitive Therapy for Anxiety and Depression |
| 资源格式: PDF |
| 版本: 文字版 |
简介:  内容介绍： © 2009 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, filesharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. Library of Congress Cataloging-in-Publication Data Wells, Adrian. Metacognitive therapy for anxiety and depression / Adrian Wells. p. ; cm. Includes bibliographical references and index. ISBN 978-1-59385-994-7 (hardcover: alk. paper) 1. Metacognitive therapy. 2. Anxiety disorders—Treatment. 3. Depression, Mental—Treatment. I. Title. [DNLM: 1. Cognitive Therapy. 2. Anxiety Disorders—therapy. 3. Depressive Disorder—therapy. WM 425.5.C6 W453m 2008] RC489.M46W45 2009 616.85′220651—dc22 2008029157Preface Cognitions count. By now it is well established that thoughts have a strong impact on emotional and psychological well-being. But consider the following: You had thousands of thoughts yesterday. Some were pleasant and some were less so. Where did all those thoughts go? Thoughts appear and disappear. A central premise of the approach described in this book is that psychological disorder is the extent to which some thoughts are extended and recycled and some are simply let go. This is a process of selection and control of thinking styles, which depends on metacognition. It is also a matter of how we relate to our own inner experiences. In cognitive-behavioral theories the content of thought has been given great importance as determining the presence of disorder. But how we think about an event, or how we think about a constellation of conversations, ourselves, and the world around us, is the more profound effect. In fact, how we respond to thoughts can, and all too frequently does, lead to emotional suffering. Over the past 40 years the cognitive-behavioral model has provided a robust understanding of the impact of cognition on psychological wellbeing, and led to techniques for treating anxiety, mood, and other disorders. Like this model, metacognitive therapy (MCT) assumes that psychological disorder results from biased thinking; however, it provides a different account of its nature and causes. Earlier approaches have said surprisingly little about the issue of what gives rise to unhelpful thinking patterns. It is incomplete to attribute such patterns to the presence of underlying beliefs about the self and world, such as “I’m vulnerable” or viii Preface “I’m a failure.” A negative belief, such as “I’m a failure,” can be the impetus for a range of responses, such as the deployment of strategies for becoming a success that might include learning from mistakes, working harder, developing new skills, or dismissing the belief as simply a thought that is irrelevant. Negative beliefs do not necessarily lead to disturbed thinking patterns and prolonged emotional suffering. Metacognitive theory proposes that disturbances in thinking and emotion emerge from metacognitions that are separate from these other thoughts and beliefs emphasized in cognitive- behavioral therapy (CBT). There is something significant about the pattern of thinking seen in psychological disorder. It has a repetitive, recyclic, brooding quality that is difficult to bring under control. Earlier theories have tended to say little or nothing of such qualities and instead have preferred to focus on the content of thoughts. Earlier approaches have focused on specific irrational beliefs or shorthand negative automatic thoughts, but this is only a small feature of cognition and might be of limited importance. For instance, most patients report long chains of uncontrollable cognitive activity that hardly fits the description of automatic thoughts. It is control of mental processes and selection of some ideas for sustained thinking that is at the heart of emotional suffering. Rather than identifying emotional problems with automatic thoughts, MCT views troublesome internal states as closely related to unhelpful processes of worry, rumination, and strategies of mental control. At the beginning of my journey leading to MCT, which has taken over 20 years, it seemed that what might be needed to advance the field was an account of the factors that control thinking and cause distressing thoughts to be enriched and extended. I believed that this would depend on extending the concept of metacognition and its assessment and using this to formulate the control of attention and mental processes in psychological disorder. Metacognition refers to the internal cognitive factors that control, monitor, and appraise thinking. It can be subdivided into metacognitive knowledge (e.g., “I must worry in order to cope”), experiences (e.g., a feeling of knowing), and strategies (e.g., ways of controlling thoughts and protecting beliefs).* *I should like to point out that there are important issues of cognitive architecture, the relative effects of levels of control of attention, and cognitive resource issues that are taken account of in the theory and are described elsewhere (Wells & Matthews, 1994, 1996). The metacognitive model assimilates theory and research in these important areas and offers an explanation of bias and attention effects on task performance. However, this will be of peripheral interest to most practitioners of MCT, and it is therefore not considered in detail in this book. Preface ix A central idea is that metacognitive factors are crucial in determining the unhelpful thinking styles seen in psychological disorder that give rise to the persistence of negative emotions. In its “hard” form, the metacognitive theory suggests that the irrational beliefs or schemas emphasized by Albert Ellis and Aaron T. Beck in their respective cognitive theories—or at least, their persistence and influence—are the products of metacognitions. Metacognitions direct attention, determine the style of thinking, and direct coping responses in a way that repeatedly gives rise to dysfunctional knowledge. This is a dynamic view of beliefs as created by more stable metacognitions. This view implies that metacognitions, and not their consequences, should be modified in treatment. In a “soft” form the theory suggests that metacognitive beliefs exist alongside other stored beliefs about the self and world, but as separate entities that are responsible for controlling cognition and making use of other more general beliefs and knowledge. In this form treatment might retain a component of challenging traditional beliefs, but it must also deal with the coexistent metacognitions. In both its hard and soft forms, the metacognitive approach has profound implications for treatment. It guides us toward strategies that enable patients to develop new relationships with their thoughts and beliefs. Rather than questioning the validity of thoughts and beliefs as in traditional CBT, it directs the therapist toward changing the metacognitions that give rise to maladaptive styles of difficult-to-control repetitive negative thinking. For example, the metacognitive approach to treating trauma assumes that metacognitive beliefs and control strategies that disrupt in-built self-regulation are the reasons symptoms do not naturally subside. The tendency to worry or ruminate, lock attention onto threat, and cope by avoiding thoughts interferes with a normal adaptation process and leads to sustained thinking about danger and a persistence of symptoms. It follows from this that treatment should consist of removing worry and rumination, abandoning attentional strategies of threat monitoring, and helping individuals to experience intrusive thoughts without avoiding or reacting to them with unhelpful suppression, or with ruminative or extended thinking strategies. This treatment differs from standard CBT in that it does not involve challenging thoughts or beliefs about trauma, or prolonged and repeated exposure to trauma memories. Instead, it consists of relating to thoughts in a different way, banning resistance or elaborate conceptual analysis, and suspending maladaptive thinking styles of worry, rumination, and inflexible threat monitoring. In MCT, beliefs are challenged—but the focus is on the person’s beliefs about cognition itself. In treating depression, MCT targets the process of rumination rather than the content of a range of negative automatic thoughts. Treatment x Preface consists of the attention training technique to interrupt repetitive styles of negative thought and regain flexible control over thinking styles. This is coupled with challenging negative metacognitive beliefs about the uncontrollability of depressive thinking, and challenging positive beliefs about the need to ruminate as a means of coping and finding answers to sadness. Inevitably, each person who approaches this book will have his or her own goals in reading it, and his or her own style of processing the material contained within. The book is a detailed treatment manual and is replete with therapy techniques grounded in theory. The reader will find interview schedules for developing case formulations, treatment plans, and measures to assist in assessment. Many of the ideas will be new, and it is likely to require experience in applying them to fully appreciate the nature of MCT. I have tried to omit as much technical terminology as possible, I hope without losing the scientific and conceptual integrity of the MCT approach. Anxiety Disorder Symptoms 内容截图： 
|
|
目录: Contents Chapte r 1 Theory and Nature of Metacognitive Therapy 1 The Nature of Metacognition 4 Two Ways of Experiencing: Modes 7 The Metacognitive Model of Psychological Disorder 9 The CAS 11 Consequences of the CAS 13 Positive and Negative Metacognitive Beliefs 15 Summary of the Metacognitive Model 17 A Reformulated A-B-C Model 17 A Note on Process-versus Content-Focused Therapies 21 Conclusion 22 Chapte r 2 Assessment 23 Operationalizing the A-M-C Model 24 Behavioral Assessment Tests in Anxiety 26 Questionnaire Measures 27 Rating Scales 32 A Seven-Step Assessment Plan 34 Conclusion 35 Chapte r 3 Foundation Metacognitive Therapy Skills 36 Identifying and Shifting Levels 36 Detecting the CAS 39 Using a Metacognitive-Focused Socratic Dialogue 41 Metacognitively Focused Verbal Reattribution 48 Metacognitively Delivered Exposure 50 Conclusion 55 xiv Contents Chapte r 4 Attention Training Techniques 56 Overview of the ATT 57 Rationale for the ATT 59 Credibility Check 60 Self-Attention Rating 60 Basic Instructions for the ATT 61 Patient Feedback 63 Homework 63 Troubleshooting 64 Outline of the First ATT Session 65 Case Example 66 Situational Attentional Refocusing 68 Conclusion 69 Chapte r 5 Detached Mindfulness Techniques 71 Aims of DM 74 Elements of DM 74 An Information-Processing Model of DM 75 DM and Other Forms of Mindfulness 77 Ten Techniques 80 Reinforcing DM Using Socratic Dialogue 86 Homework 86 Application of DM in MCT 86 Conclusion 87 Chapte r 6 Generalized Anxiety Disorder 89 The Ubiquity of Worry 91 Is Worry Controllable? 91 The Metacognitive Model of GAD 92 The Model in Action 95 Structure of Treatment 96 Case Conceptualization 97 Socialization 102 Bridging from Socialization to Metacognitive Modification 104 Questioning Uncontrollability Beliefs 105 Detached Mindfulness and Worry Postponement 106 Challenging Uncontrollability Beliefs 108 Challenging Danger Metacognitions 110 Behavioral Experiments 115 Challenging Positive Metacognitive Beliefs 117 New Plans for Processing 121 Relapse Prevention 123 GAD Treatment Plan 123 Contents xv Chapte r 7 Posttraumatic Stress Disorder 124 CAS in PTSD 125 Metacognitive Beliefs 127 The Metacognitive Model of PTSD 128 The Model in Action 130 Structure of Treatment 132 Case Conceptualization 133 Socialization 136 Presenting the Treatment Rationale 137 Detached Mindfulness and Rumination/ Worry Postponement 138 Application of DM and Rumination/ Worry Postponement 143 Generalization Training 145 Eliminating Other Maladaptive Coping Strategies 145 Attention Modification 146 Residual Avoidance 151 New Plans for Processing 151 Relapse Prevention 152 PTSD Treatment Plan 153 Chapte r 8 Obsessive–Compulsive Disorder 154 Overview of MCT: Object Level versus Meta Level 154 Two Types of Metacognitive Change 157 The CAS in OCD 157 Metacognitive Beliefs 160 Stop Signals 161 The Metacognitive Model of OCD 162 The Model in Action 165 Structure of Treatment 167 Case Conceptualization 167 Socialization 172 Presenting the Treatment Rationale 174 Engagement: Normalizing and Destigmatizing 174 Detached Mindfulness 175 Increasing Compliance with ERP and ERC 179 Challenging Specific Metacognitive Beliefs about Thoughts 180 Behavioral Experiments 182 Contamination Fears: A Special Case? 186 Modifying Beliefs about Rituals 188 Behavioral Experiments and Beliefs about Rituals 191 New Plans for Processing: Stop Signals and Criteria for Knowing 192 xvi Contents Relapse Prevention 194 OCD Treatment Plan 194 Chapte r 9 Major Depressive Disorder 195 Rumination and Depressive Thinking 196 The CAS in Depression 198 The Metacognitive Model of Depression 199 The Model in Action 201 Structure of Treatment 203 Case Conceptualization 203 Socialization 208 Enhancing Motivation 209 Helping Patients Understand the Role of Behaviors 210 Attention Training 211 Detached Mindfulness and Rumination Postponement 211 Implementing DM Techniques 212 Modifying Negative Metacognitive Beliefs 213 Modifying Positive Metacognitive Beliefs 217 Modifying Threat Monitoring 218 Maladaptive Coping with Mood Fluctuation 219 New Plans for Processing 219 Relapse Prevention 221 Fear of Recurrence 221 A Note on Suicidality and Self-Injury 222 Depression Treatment Plan 222 Chapte r 10 The Evidence for Metacognitive Theory and Therapy 223 The Existence and Consequences of the CAS 223 Metacognitive Beliefs 228 Interim Summary 232 Causal Status of the CAS and Metacognitions 233 Does Metacognition Contribute to Disorder above Ordinary Cognition? 234 Model Testing: Data from Path Analyses and Structural Equation Modeling 236 Summary of Evidence on Theory 238 The Evidence on Treatment 239 Conclusion 246 Chapte r 11 Concluding Thoughts 247 Specifications of a Transdiagnostic Treatment 250 A Universal Formulation 251 Neurobiology and MCT 255 MCT in a Wider Context 256 Closing Remarks 258 Contents xvii Appendices 259 Metacognitions Questionnaire 30 (MCQ-30) 261 Meta-Worry Questionnaire (MWQ) 264 Thought Fusion Instrument (TFI) 265 Attention Training Techniques Summary Sheet 266 Self-Attention Rating Scale 267 CAS-1 268 Generalized Anxiety Disorder Scale—Revised (GADS-R) 269 Posttraumatic Stress Disorder Scale (PTSD-S) 271 Obsessive–Compulsive Disorder Scale (OCD-S) 273 Major Depressive Disorder Scale (MDD-S) 275 GAD Case Formulation Interview 277 PTSD Case Formulation Interview 278 OCD Case Formulation Interview 279 Depression Case Formulation Interview 280 GAD Treatment Plan 281 PTSD Treatment Plan 283 OCD Treatment Plan 286 Depression Treatment Plan 289 New Plan Summary Sheet 292 References 293 Index 303 |