The application and efficacy of metaphors in the process of cognitive behavioral therapy for depressive patients

Gh.Naziry , Ph.D. , H.Ghassemzadeh , Ph.D., M.Katefvahid , Ph.D., S.A.Bayanzadeh , Ph.D. Introduction: Recently, cognitive approaches to therapy have been facing and incereasingly constructivist orientation, in which persons are viewed as actively constructing their own reality from their deep/tacit/unconscious know ledge representation . The use of metaphors is suggested as a therapeutic tool to access and change tacit / unconscious level of cognitive representation (Goncalves and craine , 1990). The ppositive effects of usage of metaphors in psychotherapy can be attributed to their unique characteristic.Metaphor as a multidimensional script involves many cognitive emotional and motivational processes that unify different aspects of human communication in a compact, condensed and easy to understand form.Imagery has an important role in this pattern and provides the sequential analysis of the logical ordering of the events (Ghassemzadeh ,1999).Kopp (1995, 2001) suggest a threedimensional theory of cognition. He discusses about three
*.Ph.D. in clinical Psychology , Assistant Professor of Shiraz university (chief ator). **. Ph.D. in Clinical Psychology, Professor of Tehran university of Medial Sciencs, Department of Psychiatry. ***. Ph.D. in clinical Psychology , Assistant Professor of Iran university of Medical sciences. ****.Ph.D. in Psychiatric Rehabilitation . Assistant Professor of Iran university of Medical Seiceces

typs of cognition :Logical/prepositional cognition, imaginal cognition and metaphoric cognition . Metaphoric cognition is expressed in language through verbal metaphors word pictures in which an image is employed as a word to convey meaning. Also, the efficacy of metaphors in process of psychotherapy can be explained through different theoretical approaches for example The Interacting Cognitive Subsystems (ICS) model (Teasdale, 1993). It differentiate between two levels of meaning, a specific and a more generic level. ICS propose that generic level of meaning which represented by patterns of implicational code, is the antecedent to emotion. This distinction ultimately result to distinction between two kind of belief, intellectuall and emotional and two way of knowing , knowing with the head and knowing with the heart. It can be postulated that metaphors because of implicational meaning that have become embedded in them and their position in high generic level of processing , have an important role in emotional processing or more exactly in knowing with heart. The purpose of present study was to compare two modes of CBT: propositional (traditional) Cognitive Behavior Therapy (PCBT) and Metaphorical Cognitive Behavior Therapy (MCBT) . In MCBT , logical of treatment and concepts were explained in a metaphorical way . For examlle the cognitive errors were described as computer s viruses which can disturb information processing . Also specific metaphor therapy techniques adapted from koop (1995) were added to treatment programs . In these techniques therapist focuses on client generated metaphors . METODE Tow approaches (PCBT and MCBT) were compared in single case study with multiple baseline design subject were
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8 depressive outpatients who refFerED for psychological intervention . They selected through semi structrul interview on the basis of DSM-IV criteria and having at least score 17 in BDI-II. Two Thrapists (one man and one woman ), both PH.D. in clinical psychology with at least 10 years experience in CBT seperatly under took the therapies of patients . Measures consisted of :1- Beak depression Inverntory_ persion (BDI-II ) (Ghosseemzadeh, submittedfor review ). 2 _ Automatic Thought Questionnarie (ATQ-persion) (Ghassemzadeh , etal, inpress) 3 _ Dysfunctional Attitude scale (Imber and etal , 1990) 4 _ sentence completion task (CST) (TEsdale and etal , 1995- and 5 Semantic Differential Test (SDT) (ozgood and etal , 1957).As usuall tratdition in single case studies gathering data from baselines compared to their reduction during and in the end of treatment sessions . Also by use of a foamula have suggested by hersen and Barlow (1976) total change precent in each of treatment variables computed. Results: The prestest, midtest and post test assessments that MCBT was more efficaious indicated in reduction of depressive symptoms and change of negative and dysfunction thoughts , attitudes and under lyning assumptions (tabel1) Table 1 : Precent of total change in treatment variables
Approach BDI-II ATQ DAS SCT SDT

PCBT %52 MCBT %68

%59 %61

%60 %68

%36 %75

%41 %68

Discussion The superiority of MCBT in the study can be attributed to metaphor properties such as its motivational and epistemological characteristics, (Martin and etal1992),its imagery component and its analogical and implicational representation (Gassemzadeh ,1999). These results ae consistent with perivious research which show usage of ,netaphor in psychotherapy improve the efficacy of treament (ie. Angus and Rennie , 1988; Angus and Korman , 2002 ; Levitt , Korman and Angus , 2000 ; Martin , Cummings and Habberg , 1992 ;Mcmullen , 1985; Mcmullen , 1989, Macmulen and conway , 1996).

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