Recent applications of metaphor research in cognitive behaviour therapy

2020 ◽  
Vol 10 (2) ◽  
pp. 199-213
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
Maria Stubbe
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Self Report ◽  
Therapy Process ◽  
Behaviour Therapy ◽  
Early Therapy ◽  
Metaphoric Language ◽  
Cognitive Behaviour ◽  
Shared Language ◽  
The Impact ◽  
Therapy Sessions

Abstract Metaphors are common in psychotherapy. The last decade has seen increasing interest in the use of metaphor in cognitive behaviour therapy (CBT), with attention to client metaphors being asserted as a way of enhancing CBT. However, prior to this current research there was very little research on the use of metaphor in CBT sessions, and no studies have examined how to train therapists in this skill. This article discusses four studies that provide a preliminary empirical basis for the exploration of metaphors in CBT. The first study evaluated the reliability and utility of an approach to metaphor identification. The second study explored how clients and therapists co-construct metaphors, contributing to development of a shared language in early therapy sessions and identified a range of responses to each other’s metaphors. The third study explored the effect of training CBT therapists to intentionally bring client metaphors into case conceptualisations in terms of building therapeutic alliance and collaboration, along with an exploration of preference for metaphoric language. The fourth study explored the impact of the metaphor training on therapist confidence, awareness and use of metaphors, based on therapist self-report ratings and reflections on their ongoing application of learning over a three month period. These findings suggest that it is possibly to conduct empirical research on metaphor in CBT, with metaphor having potential as an important therapy process1 variable.

The metaphoric dance: co-construction of metaphor in cognitive behaviour therapy

2015 ◽  
Vol 8 ◽  
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
Janet D. Carter ◽  
Maria Stubbe
Keyword(s):  
Iterative Process ◽  
Cognitive Behaviour Therapy ◽  
Cognitive Linguistics ◽  
Similar Rate ◽  
Behaviour Therapy ◽  
Recent Advances ◽  
Cognitive Behaviour ◽  
Shared Language ◽  
Therapy Sessions ◽  
Client Responses

AbstractAttention to client metaphors has been asserted as a way of enhancing cognitive behaviour therapy. Metaphors can be part of the shared language that is co-constructed between clients and therapists. Recent advances in cognitive linguistics have provided the most clearly operationalized method yet to identify metaphors in conversations, allowing analysis of how shared language develops. This study aims to explore how metaphoric shared language develops in early cognitive behaviour therapy sessions. Based on 12 transcripts of early cognitive behaviour therapy sessions, an iterative process led to the identification of a range of therapist and client responses to each other's metaphors, and identification of whether therapists or clients initiated metaphoric exchanges. Types of responses to therapist or client metaphors within three speaking turns were found to be: repetition, rephrasing, exploration, elaboration/extension, or agreement. Bursts of metaphoric exchange were initiated and taken up by therapists and clients at a similar rate. To conclude, therapists need to attend to the occurrence of metaphors and be aware of the range of potential responses that can engage the client in the ‘metaphoric dance’ (co-construction of shared metaphors). This has the potential to enhance engagement and outcomes though more salient reformulating of the problem for the client.

Intensive Cognitive-Behaviour Therapy for Depression: Preliminary Findings with Four Country Residents

1988 ◽  
Vol 5 (1) ◽  
pp. 28-31 ◽  
Author(s):  
Dieter Schlosser ◽  
David J. Kavanagh ◽  
Peter H. Wilson
Keyword(s):  
Cognitive Therapy ◽  
Cognitive Behaviour Therapy ◽  
Extended Period ◽  
Traditional Schedule ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Group Treatments ◽  
Intensive Program ◽  
The Impact ◽  
Therapy Sessions

Clients who are unable to attend regular therapy sessions over an extended period present a challenge for treatment. This paper describes a brief intensive program of cognitive therapy for depression that was designed for four residents of country towns. Effects were highly consistent with the impact of group treatments delivered on a more traditional schedule. If confirmed in a controlled group study, these results suggest that cognitive therapy may be applied more economically and more widely than was previously realized.

A Controlled Comparison of Cognitive—Behaviour Therapy, Diazepam and Placebo in the Management of Generalized Anxiety

1989 ◽  
Vol 17 (1) ◽  
pp. 1-14 ◽  
Author(s):  
K. G. Power ◽  
D. W. A. Jerrom ◽  
R. J. Simpson ◽  
M. J. Mitchell ◽  
V. Swanson
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Psychological Treatment ◽  
Subsequent Treatment ◽  
Self Report ◽  
Response To Treatment ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Treatment Interventions ◽  
Group Response ◽  
Cognitive Behaviour

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

Depression, Mastery and Number of Group Sessions Attended Predict Outcome of Patients with Panic and Agoraphobia in a Behavioural/Medication Program

1994 ◽  
Vol 39 (5) ◽  
pp. 283-288 ◽  
Author(s):  
Rudy Bowen ◽  
Maxine South ◽  
Don Fischer ◽  
Terah Looman
Keyword(s):  
Group Therapy ◽  
Cognitive Behaviour Therapy ◽  
Demographic Variables ◽  
Personal Knowledge ◽  
Predictors Of Outcome ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Poor Outcomes ◽  
Therapy Sessions

From a list of 214 patients suffering from panic and agoraphobia and who had been treated with cognitive behaviour therapy, 30 patients who had very good outcomes and 32 who had poor outcomes were selected. The groups were selected by the nurse therapist and psychiatrist on the basis of personal knowledge of the patients. The distinction into good and poor outcome groups was confirmed by the results of a follow-up questionnaire completed by the patient. Of several clinical and demographic variables which had been hypothesized, to be predictors of outcome, only depression, as measured by the Beck Depression Inventory, mastery, as measured by the Pearlin Mastery Scale and the number of group therapy sessions attended predicted outcome. Levels of depression and mastery might be clinically modifiable variables which affect the outcome of treatment for patients with panic and agoraphobia.

The Impact of Health Anxiety in Multiple Sclerosis: A Replication and Treatment Case Series

2017 ◽  
Vol 46 (2) ◽  
pp. 148-167 ◽  
Author(s):  
Neil Carrigan ◽  
Leon Dysch ◽  
Paul M. Salkovskis
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Physical Disability ◽  
Cognitive Behaviour Therapy ◽  
Health Anxiety ◽  
Case Series ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
The Impact

Background: Multiple sclerosis (MS) is commonly associated with psychological complications. Previous research by Hayter and colleagues (2016) found that in patients with MS, health anxiety (HA) can account for part of the variance in quality of life (QoL) independent of physical and cognitive impairment caused by the disease. MS patients with HA perceived their intact physical and cognitive performance as impaired relative to those without HA and attributed the impairment to MS. These misperceptions might be useful targets in the treatment of HA in MS using cognitive behaviour therapy (CBT). Aims: Study 1 sought to replicate the main findings from Hayter et al. (2016). Study 2 examined the impact of HA-focused CBT in a case series. Method: In Study 1, twenty participants with MS were screened for HA and assigned to either a high or low HA group. They completed assessments of cognitive and physical functioning before rating their performance on these tasks, followed by measures of QoL, mood and physical disability. Four participants in the high HA group subsequently received six sessions of CBT using a consecutive AB case series in Study 2. Results: Study 1 replicated the main findings from the earlier study. In Study 2, three of the four patients who received treatment showed substantial improvements in HA and mood and all showed improvement in QoL. Conclusion: Given the high rates of HA in MS patients and its impact on QoL, this case series suggests that a brief CBT intervention could significantly improve patients’ wellbeing.

Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language

2017 ◽  
Vol 45 (6) ◽  
pp. 577-589
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
Paul Merrick ◽  
Maria Stubbe
Keyword(s):  
Role Play ◽  
Similar Degree ◽  
Behaviour Therapy ◽  
Metaphoric Language ◽  
External Expert ◽  
Cognitive Behaviour ◽  
Before And After ◽  
Case Conceptualizations ◽  
The Difference ◽  
Therapy Sessions

Background:There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this.Aims:This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations.Method:Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play ‘clients’ and an external expert rated the quality of the sessions and of the shared conceptualizations.Results:There were significant increases in some ratings of alliance, based on role play ‘client’ ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and ‘client’ on a measure of preference for producing metaphor, the lower the rating of the session by the ‘client’ on theBondfactor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically.Conclusion:This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.

Keeping metaphor in mind: training therapists in metaphor-enhanced cognitive behaviour therapy

2018 ◽  
Vol 11 ◽  
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
James Bennett-Levy ◽  
Maria Stubbe
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Self Report ◽  
Training Workshop ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Mind Training

AbstractOver the last decade, there has been increasing interest in the use of metaphor in cognitive behaviour therapy. However, to date, there has been only very limited research on the use of metaphor in CBT sessions, and no studies which have examined how to train therapists in this skill. The present study is the first in the literature to explore how we might train therapists in metaphor-enhanced CBT. Twelve therapists attended two half-day training workshops, 2 weeks apart. Details of the content of the training workshop are provided. The therapists rated the workshop quality and provided structured self-report ratings and reflections on their ongoing application of learning over a 3-month period which were compared with pre-training ratings. Therapists reported significantly increased awareness of metaphors, with increased confidence in responding intentionally to client metaphors and bringing them into shared conceptualizations. In addition, there were significant increases in reported time spent elaborating on client metaphors, and use of metaphors when conceptualizing with clients. Barriers and solutions to application of learning are discussed.

scholarly journals A pilot randomized controlled trial of time-intensive cognitive–behaviour therapy for postpartum obsessive–compulsive disorder: effects on maternal symptoms, mother–infant interactions and attachment

2017 ◽  
Vol 47 (8) ◽  
pp. 1478-1488 ◽  
Author(s):  
F. L. Challacombe ◽  
P. M. Salkovskis ◽  
M. Woolgar ◽  
E. L. Wilkinson ◽  
J. Read ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Successful Treatment ◽  
Cognitive Behaviour Therapy ◽  
Control Group ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
Healthy Control ◽  
The Impact

BackgroundThere is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive–compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting.MethodA total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive–behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother–infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants (n = 37) underwent the same assessments as a benchmark.ResultsiCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31–1.90). However, mother–infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group.ConclusionsiCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.

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