Mervin Smucker – Characteristics of cognitive therapy.

Cognitive therapy is based on a theory of psychopathology that links cognition with emotion, and which comprises a set of principles and therapeutic techniques that relate to hypothesis-testing and empirical evidence. There are a number distinctive characteristics that define the Beckian model of cognitive therapy:

• short-term, time-limited
• structured, directive, active
• assumes a sound therapeutic relationship
• relies on a collaborative effort between therapist and patient
• based on a coherent cognitive model and rooted in an individualized cognitive conceptualization of each patient
• problem-oriented, primary focus on here-and-now
• uses the Socratic dialogue and the process of „guided discovery“ to teach patients to be „scientific“ in examining the validity of their cognitions
• Educational Model, fosters self-help and skill practice outside therapy sessions (homework assignments)

Mervin Smucker (2013)

Mervin Smucker – Basic principles of cognitive therapy.

The core, basic principles of cognitive therapy can be summed up at follows:

• Cognitive influence mood and behavior
• Perceptions and cognitions mediate the effect of situation on mood and behavior
• Cognitions may include automatic thoughts, images, memories, beliefs, underlying assumptions, and core schemas
• Different emotional disorders have distinctive cognitive themes; that is, specific groups of automatic thoughts and/or images
• In disorders of mood and behaviour there are often underlying information processing biases or cognitive distortions
• Underlying specific thoughts and beliefs are general assumptions or schemas often learned or developed in early childhood
• Modification of cognitions leads to behavioural and mood changes.

Mervin Smucker (2013)

Mervin Smucker – The interaction of depression with the personality characteristics of and social dependence and autonomy.

All individuals are thought to have a relative stable personality structure that can predispose them to depression in response to a range of environmental stressors. A. T. Beck and colleagues have researched how the personality characteristics of autonomy and social dependence may interact with differential patterns of depressive etiology and manifestations. These personality characteristics reflect central value systems and are thought to be longstanding, stable characteristics developed at an early age. For the socially dependent individual acceptance, intimacy, support and guidance within the context of positive interchange with others is highly valued. An interruption of these „interpersonal ressources“ will be perceived as a major loss by such persons and likely contribute to the onset of a depressive reaction.  By contrast, the „autonomous“ individual is highly invested in independent functioning, mobility, choice, and achievement; the  interruption or blocking of these will be experienced as a major loss that could result in a depressive reaction.

Mervin Smucker (2013)

Mervin Smucker – Scoring and Interpretation of the Post-Imagery Rescripting Questionnaire-B (PIQ-B).

Scoring and Interpretation of the PIQ-B.

The PIQ-B is administered to the client immediately after the completion of an ADULT-CHILD imagery rescripting session only. When the client’s responses to all of the PIQ-B items have been recorded, the clinician notes the items with an asterisks [*] next to them. These are the “reversed” items and are converted to “real” scores in the following manner:

Where X equals the Client Rating Score (i.e. the actual number reported on a reversed item):  The Real Item Score  = 100 – X

The Real Item Score of each item without an asterisks is the actual number reported by the client. The total PIQ-B quantitative score is the sum of all individual Real Item Scores of items 1-10. (Items A and B are not tabulated in the total score.) The total score of the PIQ-B form ranges from 0 to 1000. The higher the total score, the more acute is the degree of internalized abuse-related dysfunctionality and affective distress. At the completion of Imagery Rescripting treatment, a significant drop in the total PIQ-B score should be noted. The PIQ-B appears to have good face validity, though psychometric data are not yet available.

Mervin Smucker (2012).

Mervin Smucker – Scoring and Interpretation of the Post-Imagery Rescripting Questionnaire-A (PIQ-A).

Scoring and Interpretation of the PIQ-A.
The PIQ-A is administered to the client immediately after the completion of an Imagery Rescripting session (including all three phases). When the client’s responses to all of the PIQ-A items have been recorded, the clinician notes the items with an asterisks [*] next to them. These are the “reversed” items and are converted to “real” scores in the following manner:
Where X equals the Client Rating Score (i.e. the actual number reported on a reversed item):  The Real Item Score  = 100 – X
The Real Item Score of each item without an asterisks is the actual number reported by the client. The total PIQ-A quantitative score is the sum of all individual Real Item Scores of items 1-10. (Items A and B are not tabulated in the total score.) The total score of the PIQ-A form range from 0 to 1000. The higher the total PIQ-A score, the more acute is the degree of internalized abuse-related dysfunctionality and affective distress. At the completion of Imagery Rescripting treatment, a significant drop in the total PIQ-A scores should be noted. Although the PIQ-A appears to have good face validity, psychometric data are not yet available.

Mervin Smucker (2012)

Mervin Smucker – Understanding the Specific Nature of Traumatic Events: Type I vs. Type II Trauma.

A critical consideration in the treatment of PTSD is whether the traumatic event producing the PTSD reaction is a Type I or Type II trauma.  In short, a Type I trauma is an unexpected, isolated traumatic event of relatively short duration (such as, a motor vehical accident, a single incident of physical or sexual assault, a natural disaster), that often involves fear of dying during the event itself.  Recovery from a Type I traumatic event i soften relatively rapid, especially if the trauma victim does not suffer from any kind of permanent or lasting physical injury.  By contrast, a Type II trauma is more long-standing in nature and often involves a series of expected, repeated traumas, such as ongoing sexual or physical abuse or torture., that result in a negatively altered schematic view of oneself, others, and the world.  Type II traumas often develop into more complex and chronic PTSD responses that are linked to other psychological disorders, including higher rates of depression, anxiety and panic disorders, eating disorders, substance abuse, chronic relationship difficulties and long-standing characterological disturbances evidenced by emotional lability, suicidality, and self-abusive behaviors.

Mervin Smucker (2012).

Mervin Smucker – From Imagery Substitution to Imagery Rescripting

Mervin Smucker (2012).  From Imagery Substitution to Imagery Rescripting:  Therapeutic Applications of Imagery from Janet’s 19th Century Laboratory to 21st Century CBT Clinical Practice.

Since the mid-1990s, the use of imagery in CBT treatments has become more commonplace, especially as a means of treating PTSD and other anxiety disorders.  However, the use of imagery as a therapeutic agent is actually not a recent discovery, but has a long history that parallels the development of psychotherapy itself and shows up in the early works of Janet, Charcot, Freud, and Jung. Later Reichian and Gestalt Therapists also made use of imagery in ways that created a powerful experience for clients, but which were difficult to integrate within an academic framework. What is new about the emerging approach to imagery in the past decade or so is the use of CBT as a framework for theoretically integrating linguistic techniques with imagery interventions.  This visual-verbal cognitive interface is reflected in Beck’s early writings in which he contended that images were “visual cognitions” subject to examination and modification just as verbal cognitions are.

Imagery Rescripting & Reprocessing Therapy (IRRT) is an expanded cognitive model that has “liberated” CBT therapists to use imagery-based interventions in a scientific manner and to empirically validate their imagery treatments.  IRRT, which is the first and only manualized imagery rescripting treatment, uniquely emphasizes the integration of imagistic and linguistic elements, as well as the use of precise and skillful questioning, Socratic imagery rather than guided imagery, and the importance of having the client take the lead in the process of transforming traumatic imagery to adaptive imagery.

Mervin Smucker – Presentation of the Imagery Rescripting & Reprocessing Therapy (IRRT) Treatment Rationale.

After a specific intrusive traumatic memory has been identified and targeted for rescripting, a brief description of IRRT is offered to the client, which may be paraphrased in the therapist’s own words:

IRRT is designed to help you to process and master your traumatic memories and leave you feeling more in control of your life.  Much of our work will involve the use of imagery; that is, asking you to visually recall and re-experience the traumatic images, thoughts, and feelings that you experience during a flashback (or nightmare). You will then confront and transform the traumatic images into coping imagery. The aim is for you to replace your victimization imagery with mastery imagery, so that you can see and feel yourself responding to your trauma no longer as a victim, but as an empowered individual.  This, of course, does not change the traumatic event itself or what really happened, but it can change the images, thoughts, feelings, and beliefs that you have about the trauma.

Mervin Smucker (2012)

Mervin Smucker – Definition of Imagery Rescripting and Reprocessing Therapy (IRRT) .

IRRT is an imagery-based CBT treatment designed to alleviate PTSD symptoms and modify trauma-related images, beliefs and schemas. IRRT involves three phases of imagery:

1. imaginal reliving – visually recalling and re-experiencing the traumatic imagery along with the associated thoughts, affect, and bodily sensations accompanied by the creation of a detailed, descriptive, verbal narrative;
2. mastery imagery –  visualizing oneself as a competent and capable ADULT (today) successfully confronting and disempowering the perpetrator (back then) while rescuing the CHILD from the trauma scene;
3. self-calming/self-nurturing imagery  – visualizing oneself as an ADULT (today) calming, soothing, and nurturing the traumatized CHILD (back then).

Through this 3-phase imaginal symbolic “psychodrama” (on the “inner stage”), the trauma material is initially activated and experienced through the eyes of the “traumatized child,” and then challenged, modified, and reprocessed through the eyes of the “empowered adult” today.  Replacing victimization imagery with mastery imagery enables trauma victims to experience themselves responding to the traumatic event as an empowered individual today no longer “frozen” in a state of helplessness, uncertainty, and confusion.  In addition, the overwhelming emotional and physiological distress that often accompanies trauma memories is replaced with positive feelings of self-nurturing and self-calm. Thus, through the re-living, re-scripting, and re-processing of the trauma memory, successful emotional and cognitive processing of the traumatic event may occur, allowing the individual’s response to the traumatic event to normalize.

Mervin Smucker (2012)

You can find a presentation about IRRT here: Mervin Smucker IRRT Presentation