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How CBT Already Targets Faulty Prospection
At least four CBT maneuvers already target prospection, and there is evidence that CBT improves future-thinking (Andersson, Sarkohi, Karlsson, Bjarehed, & Hesser, 2013; MacLeod, Coates, & Hetherton, 2008). First, therapists work to change clients' pessimistic predictions: They help clients spot future-focused distortions like catastro- phizing and fortune-telling, and they use Socratic questions to coach them in creating accurate predictions (Beck, 1995). Second, therapists train clients in goal setting and planning, and goals are inherently future-directed (Malouff, Thorsteinsson, & Schutte, 2007; Wright, Basco, & Thase, 2006). Third, therapists use cognitive rehearsal to plan how to overcome obstacles (Beck, Rush, Shaw, & Emery, 1979). Fourth, therapists use behavioral activation to help clients schedule pleasant, mastery-inducing experiences in the future (Jacobson, Martell, & Dimidjian, 2001).
In addition to these four specific techniques, good therapy may promote better prospection generally. Therapists generate hope. Technique aside, clients can start envisioning a brighter future simply because they are taking steps to feel better and they have found support. Further, good therapists likely promote better prospection by shifting focus from the past and the present to the future (Ellis, 2001).
Several treatment packages combine various techniques to systematically target future-thinking. These include future-directed therapy (Vilhauer et al., 2012), hope therapy (Cheavens, Feldman, Gum, Michael, & Snyder, 2006), solution-focused therapy (de Shazer, 1985), goal-setting and planning (MacLeod et al., 2008), and future- oriented group training (van Beek, Kerkhof, & Beekman, 2009). These interventions need more randomized controlled evaluations before being considered empirically supported treatments, but their initial findings show promise.
Future-directed therapy (FDT) is a 10-week "full clinical intervention intended to reduce symptoms of depression and improve well-being by promoting a paradigm shift from dwelling on the past, or highlighting one's limitations in the present, toward creating more positive expectancies about the future through the use of a comprehensive and well-defined set of skills" (Vilhauer et al., 2012, p. 103). These skills include generating positive expectancies, practicing mindfulness, identifying and working toward values, simulating outcomes and processes, and solving problems. In a non-randomized pilot, FDT produced greater improvements in depression than treatment as usual (Vilhauer et al., 2012).
Hope therapy is "a treatment protocol designed to increase hopeful thinking and enhance goal-pursuit activities as described in hope theory" (Cheavens et al., 2006, p. 64). It focuses on five skills: setting goals, finding multiple paths to goals, increasing motivation, monitoring progress, and flexibly modifying goals and pathways. In the initial randomized controlled trial, hope therapy reduced depression symptoms better than a waiting list control (Cheavens et al., 2006).
Solution-focused therapy (de Shazer, 1985) is built on the premise that future orientation is necessary for positive change. This therapy encompasses a whole suite of techniques and has demonstrated positive outcomes in treating depression (Bozeman, 2000).
Goal-setting and planning is a manualized well-being intervention focused on developing and pursuing positive goals, rather than solving problems or directly targeting depressive symptoms. It has been tested in group-based and individual self-help formats and found to decrease depression in both (Coote & MacLeod, 2012).
Future-oriented group training (van Beek et al., 2009) is a unique intervention specifically targeting suicidality. It is intended as an addition to other treatment. Over the course of 10 workshops, participants learn how to change their future-oriented thinking and behavior and work toward goals that will make life worthwhile. Results of the initial trial have yet to be published.
These treatment packages are not radical departures from standard CBT. Instead, they use strategies that emphasize fixing faulty prospection and they merit further investigation in randomized controlled trials. There is clearly a need to develop new future-oriented treatment techniques, which we will speculate on in the following section.
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