Cognitive Coping Therapy

Kenneth Sharoff

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134946051
• Topic: Psychology
• Subtopic: Cognitive Psychology & Cognition
• Index: Psychology

Cognitive Coping Therapy partners coping skills therapy and cognitive behavior therapy. It offers cognitive coping therapy, which essentially develops coping skills therapy, into a comprehensive model of care. It presents a practiced theory and underlying philosophy for the approach, along with methodology and guidelines for implementing it. It refines and further extends cognitive behavioral practice theory and, in doing so, offers case studies to illustrate how to use the model with a variety of disorders. A new coping skills slant for treating a variety of disorders.

1

Chapter

The Coping Response

Cognitive-behavioral therapy (CBT) has become one of the most popular and widely used treatment approaches of the past generation. There has been a mushrooming of interest in cognition, its role in mental disorders, and its influence on behavioral change. Over a generation ago Mahoney (1977) noted that psychotherapy has undergone a “cognitive revolution,” and today it is still going strong.

CBT consists of three approaches: cognitive restructuring, problemsolving therapy, and coping skills therapy (Mahoney and Arnkoff, 1978). Yet in Dobson’s two overviews (1988, 2001) of the approaches and innovative developments within the field of CBT, coping skills therapy did not even merit a chapter of its own. Cognitive restructuring has become the “senior partner” in CBT. It has developed a cohesive practice theory and a varied set of techniques that complements and extends the theory. By and large, therapists who use CBT first turn to cognitive restructuring to treat the presenting problem and then pull from coping skills therapy specific skills to fill out the treatment plan. Hence the latter operates as an adjunct treatment utilized on an as-needed basis.

Today, coping skills therapy remains a loose, heterogeneous collection of skills, a grab bag or patchwork of techniques. It has not developed beyond a handful of dominant skills, such as relaxation, communication, assertiveness, and social skills training. Yet there are many more skills that can be employed to resolve various disorders. There is a need for a much fuller understanding and elucidation of those skills. Coping skills therapy has not developed a practice theory of its own or a general methodology. Its theory of pathology is quite narrow, viewing patient disorders mostly as a coping skills deficit. Its methodology is simple: fill the holes in functioning. While there are other ways to understand mental disorder from a skills perspective, this has not been fully enumerated in the literature. Its theory of change and health are rudimentary. In summary, coping skills therapy remains stunted and unfulfilled as a treatment model, a “junior partner” to cognitive restructuring.

Cognitive coping therapy (CCT) is an attempt to rectify this problem. My hope in writing this book is to move coping skills therapy from a subordinate method into a mainstream model of care. CCT wants to develop coping skills therapy into a comprehensive, independent model of care and an alternative to cognitive restructuring. CCT is a highly active, directive, didactic, structured approach capable of treating patients in a short period of time. The book presents a practice theory and underlying philosophy for the approach, along with a methodology and guidelines for implementing it. The book refines and further extends cognitive-behavioral practice theory, offering a theory of pathology, health, and change. The chapters on case studies illustrate how to use the model with a variety of disorders. They present numerous coping skills that have not been presented or properly elucidated in other works. The name for this approach, cognitive coping therapy, gives credit to the central role of cognition in forming the skills necessary for managing life problems.

What are Coping Skills?

First, though, we need to present how this book defines coping skills. Quite simply, a coping skill is an organized response to a situation with the purpose of attaining a goal or resolving a problem. The goal-directed nature of a skill is what differentiates it from a spontaneous emotional expression or physical reaction. Snyder and Dinoff (1999) define coping skills as “a response aimed at diminishing the physical, emotional, and psychological burden that is linked to stressful life events and daily hassles” (p. 5). The dictionary defines coping as a way to maintain a contest or combat on even terms. The word skill means there is an ability to do something, a response that can accomplish something, a tool or a means to an end. It may be a natural talent or acquired proficiency. Coping skills deal with the issue of execution and carrying out of a plan or policy. Generally, they are maneuvers that are known and have been used in the past, so there is experience in employing them. The word skill does not necessarily mean someone is outstanding in that endeavor or is a master of that response. It merely means s/he can satisfactorily perform that response to obtain an end goal. In essence, the response allows someone to enter a problem situation and contend with whatever forces are allied against him/her.

A warning, though: when the term coping skill is used in this book, it is not meant to infer that a skill is always rational, realistic, adaptive, productive, good for the individual, or the best choice for resolving a problem. It is used in a value-neutral way. In actuality, someone’s characteristic way of responding to a problem may be counterproductive, dysfunctional, irrational, unrealistic, or maladaptive, considering his/her long-term best interests. The term is used only to make the point that people have achieved a level of proficiency in something that they believe allows them to cope. For instance, Michael, age twelve, nags, throws fits of temper, is an obstructionist, and acts oppositional. That is his way of coping, his way to get what he wants. In the process of living, he calls upon specialized, idiosyncratic responses that he believes have utility and value. He has proficiency in being that way, but that is hardly the best way for him to act.

When coping skills are viewed from a treatment standpoint, though, each person’s responses have to be judged pragmatically to determine if they are counterproductive or lead to the desired end result. Intricately concerned with the issue of health, rationality, and utility, CCT wants to know how successful or viable a given skill is. Can it be modified to become viable? Is the coping skill rational or adaptive? Does it contribute to or alleviate the presenting problem? In essence, is it good for that person?

Origin of Coping Skills

How do coping responses originate? What transforms spontaneous emotional expressions or behaviors into a skill? So many skills are employed and developed due to genetic tendencies. In that case the skill is dispositionally driven. Personality traits influence the selection and the development of a coping response. Coping skills occur naturally as part of ego functioning. The psychodynamnic perspective maintains that coping skills are built-in defense mechanisms to manage unconscious sexual and aggressive conflicts. They are a way to protect the self against internal instinctual forces (Freud, 1964) or external, environmental threats (Adler, 1929).

Coping skills also develop as a consequence of learning. As young children show their feelings, they soon realize that certain feelings expressed in a certain way are efficacious while others are not. They learn, through trial and error and subsequent reinforcement, which behaviors have instrumental capability. CCT assumes that the nature of people is pragmatic: to search out and select responses that can attain a desired goal. Once a coping skill has been deployed and is successful (in varying degrees), it rewards a person while avoiding a painful circumstance. Reinforcement has a powerful, immediate shaping effect on spontaneous response. There is no such thing as a purely spontaneous emotion or behavior once it recurs repeatedly, because reinforcement will influence the future expression of it. Once an expression of self is reinforced positively, it will then be incorporated into the coping skill armamentarium.

Coping skills develop through social learning (Bandura, 1969; Dollard et al., 1939). Observing the distribution of rewards, the observer gains information that certain actions are beneficial. People learn vicariously that a response has coping skill potential. If the skill appears useful to a role model, it is enlisted as a means to handle situations (Bandura, 1969a). Successfully imitating the response of a model demonstrates a skill can yield reinforcement that strengthens the use of that response in the future. Furthermore, a coping skill is more salient if used by a highly regarded role model. People want to be like their role models, which means copying their solutions or skills.

Coping skills can result from explicit knowledge given to a person by others (i.e., teachers, parents, peers, supervisor). In this regard skill development is taught as part of a didactic format. Rules and procedures are dispensed and incorporated into a knowledge bank.

Finally, coping skills can be developed by the creative mind of the individual. As autonomous beings, people are assumed to be capable of acting independently of operant conditioning and can generate their own responses, based on what they believe will lead to success. Human beings cannot not reflect on themselves, augmenting and modifying their emotional expression in turn. Any natural response will be appraised and potentially utilized for its instrumental capacity. A coping response is originated to deal with an event that has been appraised as threatening, potentially harmful, or challenging, or is believed to be exceeding the resources of the person (R. Lazarus and Folkman, 1985). Agreeing with the constructivist perspective (Guidano, 1988), CCT assumes that people are autopoietic systems, meaning they have self-productive or self-renewing capacity. They have “self-organizing abilities … to assimilate incoming information and to cope with perturbations arising from its exchanges with the environment” (Guidano, 1988, p. 309). Coping skill development is part of a cerebral process. Problem solving is used to calculate which responses are instrumental.

Formation of Coping Skills

Coping skills are not formed by a single pathway however. They are formed from a complex interplay between genetic predisposition, self-creation, reinforcement, instruction, and social learning. At some point in a person’s development, a spontaneous expression becomes a skill, an adaptation and capacity to attain an end result. To make this point, consider the following vignettes:

• Jill is mad about how her husband is treating her. Her eyebrows rise and her jaw tightens; she looks sad and is about to cry. She pleads for him to change.
• Joe becomes irritated when his sons engage in sibling squabbles. He breathes deeply as his mouth opens and he bares his teeth. He explodes with rage and yells at them.
• Christie, age six, feels lonely and bored. She wants her parents to play with her. Her lips puff out and her forehead wrinkles. She looks sullen, dejected, and sad as she breaks off eye contact with her parents and stares at the floor intently.

In each vignette, the emotional expression can simply be viewed as a discharge of instinctual energy. There is expressive motor behavior, especially spontaneous facial expressions to an activating event t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• 1. The Coping Response
• 2. Cognitive Influence in CBT
• 3. Catalogue of Coping Skills
• 4. Limitations of Cognitive Restructuring
• 5. Theory
• 6. Methodology
• 7. Treatment of a Dependent Personality Disorder
• 8. Treatment of Major Depressive Disorder
• 9. Treatment of Generalized Anxiety Disorder
• 10. Treatment of Borderline Personality Disorder
• References
• Index