The Goal Of

The goal of C-CT is to teach, generalize, and maintain critical skills that prevent relapse and promote remission and recovery (Jarrett & Kraft, 1997). In short, cognitive therapists not only treat depressive symptoms but also teach new coping strategies. As in A-CT, therapists work to decrease, eliminate, and prevent the symptoms and syndrome of depression by teaching patients compensatory skills that include (1) understanding relations between cognition and other behavior, (2) self-monitoring emotions and cognition, (3) restructuring automatic thoughts via logical analysis, (4) restructuring automatic thoughts through hypothesis testing, (5) identifying schemas, (6) restructuring schema through logical analysis, and (7) testing alternative schemas through experimentation. During C-CT, hypothesis testing draws heavily on contingency-based strategies described as "behavioral activation" (Martell, Addis, & Jacobson, 2001) and emphasizes pairing cognitive changes with practical, daily behavioral changes (e.g., What does a future that looks more promising mean about one's job search this week? What goals has the patient set for homework? How does homework [i.e., cognitions, behaviors] relate to overall and weekly goals for therapy?). It is assumed that for cognitive changes to have a prophylactic effect (i.e., result in relapse prevention after sessions are discontinued) behavioral changes are required. Ideally, each patient will have mastered all these skills during ACT; realistically however, not all patients, even those who respond to A-CT, accomplish this. When therapists must decide which skills to eliminate (or to teach last), skills 1-3 and/or 4 represent the "basics" (and homework assignments focus throughout on associated behavioral changes). Table 6.1 provides a sample of available CT compensatory skills used to teach patients and assess their mastery throughout the course of treatment.

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