2) The CBT Model Flashcards
What did Sigmund Freud believe? (4)
- Clients had no access to the unconscious mind
- Dreams were the pathway to the unconscious
- It is the unconscious that we have to reveal, and see what the meaning is behind the symptoms/symbols
- Not the symptoms themselves, but the meaning behind the symptoms
Provide brief historical development of psychotherapies (5)
- 1880 –1900: earliest attempts at clinical intervention.
o E.g., Wilhelm Wundt and Gall’s Phreneology. - 1900 –1920: the first ‘talking cure’ and psychoanslysis.
o E.g., Freud and Jung’s early works. - 1920 –1950: Behavioural therapy.
o E.g., Pavlov, Watson, WolpeSkinner, Thorndike. - 1950 –1970: Cognitive revolution.
o E.g., Beck, Ellis, Bandura, etc. - 1980 –2000: “Cognitive-Behaviour Therapy”.
o E.g., Meichenbaum; Mahoney, Beck (1993), etc.
o ACT, Mindfulness, Schema, etc.
What are the two main influences/revolutions in the history of psychology? (2;3)
(1) Learning theory and BT
- Classical and operant conditioning
- Behaviour therapy based on these principles
(2) Cognitive therapies
- RT, RET, REBT
- Beckian therapies
- Self-management therapies
What are the different levels of cognitions? (3)
Deep level: Core beliefs or schemas,
Intermediate level: Intermediate beliefs, conditional/dysfunctional/underlying assumptions
Peripheral: thoughts/images;
i.e., Negative automatic thoughts (NATs) or AT
Identify some processing biases (4).
cognitive distortions, logical errors, thinking biases, information processing errors/biases
What encompasses negative thinking? (3;4)
the 3 different levels of cognitions (core beliefs, conditional assumptions, NATs) and processing biases (cognitive distortions, logical errors, thinking biases, information processing errors/biases)
How are cognitive and behavioural activity related? Give an example of a behavioural intervention that has cognitive elements.
- Cognitive activity can impact on behaviour, which in turn can impact on cognitive activity.
- Neither is independent of the other.
- Even if differentiated within labs, difficult to separate in practice
Behavioural interventions have cognitive elements
E.g., exposure therapy – clients want to know rationale, evidence that it works, what to do should they experience symptoms
Identify what the ABC model of cognitive therapy is
A = antecedent
B = beliefs
C = consequences
In terms of ABC model, what do clients come in talking about?
Clients normally come in talking about (C)onsequences (i.e., the affect, emotions)
What do we as cognitive therapists target and why? (3)
As psychs, we don’t have enough tools to change emotions.
Instead, CT uses cognition as a way to change emotions.
We have to think about what thoughts align with the consequences
Which theory places an emphasis on having distinctions in beliefs?
Describe the theory and what distinctions it places. (i.e., 2 different types of distinctions)
Attribution theory.
Beliefs can be specific or global (e.g., I’m worthless and a failure vs. The world is an unfair place).
Attribution theory places importance on having a distinction between personal attributions and those projected to the world.
Attributions can be stable (personality traits) vs. temporary (I’m incompetent rn bc I haven’t been trained).
Define the cognitive triad.
Nihilistic expectation of the future i.e., no hope for the future, doesn’t believe anything will change
Negative expectations of others
Negative view of themselves
What thinking patterns are common in depression
Patterns of negative thinking
What is the relationship between beliefs, biases and automatic thoughts - draw out a flow chart.
Page 27-28 of notes
Identify the hierarchical structure of beliefs
Core beliefs = more general, less accessible, harder to change
Underlying assumptions
Automatic thoughts = more specific, more accessible, easier to change
Describe core beliefs. (7)
o Are at a deeper psychic/cognitive level
o Are more stable and enduring
o Are more likely to be linked to early childhood experiences
o Explain, influence, and subsume several intermediate beliefs
o Patients with different psychological disorders may share the same belief
“I am worthless” – found in depression (“if I’m a good mother, I’m worthy; if I’m not, then I’m unworthy”), eating disorder (“my body size makes me unworthy”), social anxiety
o May be targeted for change later in therapy
o Change can produce lasting effects and prevent relapses
Describe intermediate beliefs. (8)
o This is what Beck targeted
CT targets at a more intermediate level
o Are at a more superficial level
o Are less stable, less pervasive and more easily changeable
o May be influenced by stressors as well as early experiences
o Patients with different disorders often have different beliefs
o Are often targeted for change in early or middle stages of therapy
o Changes can produce significant symptom relief
Describe automatic thoughts (7)
o End-products (effects or consequences) of beliefs and distortions that emerge into consciousness
o Eg. Image of darkness
o Single thought can be the result of several cognitive distortions. Eg: I am incompetent
o Frequent and familiar, believable,
o Not attention-grabbing; unnoticed & implicit
o Discovery is not surprising
o Despite the term, may be visual images
o The kind of NAT often but not always reveals the type of CD (Eg: I’m going to die =>catastrophic thinking)
I’m a failure, useless, incompetent => overgeneralising
Describe thinking biases. (4)
o. Process/Mechanism that distorts interpretation of events leading to negative automatic thoughts and other symptoms
o Frequent and familiar
o Often unnoticed and implicit
o Discovery may evoke surprise, but often believable
What are the 3 categories of thinking biases?
filter biases/errors
evaluative or interpretative biases/errors
memory biases/errors
Define and describe filter biases. (3)
Identify 3 filter biases.
Explain in terms of:
Specific phobia of spiders
Panic disorder
Social anxiety disorder
- Selective attention; a zoom-in bias; selectively attend to certain events/things
- Before events happen, client is using glasses that are expecting it to happen
- Derive from selective attention to some aspects of a situation and ignoring of others
- Selective abstraction, discounting the positive, binocular error
o E.g., Specific phobia of spiders – hypervigilant of spiders or attending to anything that could be a spider
o Panic disorder – selectively attend to physiological symptoms (e.g., elevated HR)
o Social anxiety disorder – selectively attend to things that may embarrass them (e.g., red face, shaky hands, a yawn in the audience)
Define and describe evaluative/interpretative biases. (1)
Identify and describe some evaluative/interpretative biases (3; 3; 2; 1)
Derive from inaccurate evaluation or judgment of the attended event
Negative conclusions without any justification
o Arbitrary Inferences
Mind reading
Personalisation
Jumping to conclusions
Overgeneralisation (amplification of a negative)
o Time: from one instance in present to past/future (e.g., People always reject me)
o Specific to general/global attributions: From one instance of behaviour to a stable trait (e.g., I’m boring, I’m a loser)
o Catastrophic thinking
Overgeneralisation that is extreme leading to an event that would be considered tragic by most (e.g., I’m going to die)
Probability Estimation
o Common in anxiety disorders
o Overestimating likelihood of negative consequences (e.g, People will get AIDS if they don’t wash)
o What-If chain
Flexibility of thinking
o Absolutistic thinking or Black & White thinking
o Mustabatory thinking (Too many shoulds)
Emotional reasoning
o Using emotions as a basis to interpret reality; mistaking a feeling for a fact (e.g., I must be bad because I feel guilty; it must be dangerous because I feel anxiety)
Describe how memory biases work. (1)
Memories are vulnerable to distortions as one retrieves and re- stores memories.
Why is CBT so popular? (6)
o It is a simple and parsimonious theory.
o Wide applications: Can be used to explain how several disorders are maintained.
o Extensive empirical support for the efficacy of therapy.
* Has easily accommodated empirical research on learning, information processing and memory.
* Has clinical appeal as it has predictive power within an individual once patterns of beliefs and responses are known
* Funding in the health systems around the world tend to support empirically validated therapies
What does the research say about CBT? (3)
- CBT is by far, the most researched psychotherapy.
- CBT is no longer on trial.
- Demonstrated efficacy for a wide variety of conditions including anxiety, depressive, eating, somatoform, sexual, addictive, and other disorders.
What disorders does CBT have clear evidence of efficacy? (9)
What about some limited support for efficacy? (3)
Depression, Panic/Agoraphobia, GAD, specific phobias, social phobias, OCD, PTSD, Bulimia, (Some) personality disorders
Anorexia, Schizophrenia, Bipolar disorder
CBT is the treatment of choice for all ____ disorders, with _____ often being recommended as the 2nd choice
anxiety; medication
Despite similar effects, CBT is often used in lieu of or in combination with _____ because it helps reduce: (1)
What pattern does this apple to for disorders? (4)
Medication
Symptom relapses after drug cessation
Depression, OCD, Social Phobia, PDA
There is some preliminary support for positive effects for CBT (modified) in: (2)
o Personality Disorders
o Psychotic Conditions
Identify and define the different NHMRC levels of evidence.
Level I = A meta-analysis or a systemic review of level II studies that included a quantitative analysis
Level II = a study of test accuracy with: an independent, blinded comparison with a valid reference standard, among consecutive persons with a defined clinical presentation
Level III-1 = a pseudorandomised controlled trial (i.e., alternate allocation or some other method)
Level III-2 = a comparative study with concurrent controls:
- non-randomised, experimental trial
- cohort study
- case-control study
- interrupted time series with a control group
Level III-3 = a comparative study without concurrent controls:
- historical control study
- two or more single arm study
- interrupted time series without a parallel control group
Level IV = case series with either posttest or pretest/posttest outcomes
Identify and define the CBT principles (6)
Cognitive = interpretation of events is important
Behavioural = behaviour has impact on thoughts and appraisal
Continuum = psychopathology exists on a continuum (not categorical) - from normal to dysfunction/deviance
Here-and-now = commence from present problems. It may not be necessary to delve into the past to resolve the current problem
Empirical = important to evaluate theory and therapy
Interpersonal = therapist is informed, engaged and active
Draw out the hot cross bun method
situation –> thoughts; emotions; behaviour; physical reactions
Identify and describe, when appropriate, the Cognitive Therapy characteristics (8)
- Approach to CT: collaborative empiricism
- Structured and promoting active engagement
- Time limited and brief
o Mild: up to 6 sessions
o Mild to Moderate: 12 sessions
o Moderate to severe or co-existing personality disorders 12-20
o Severe problems with co-existing Axis 2: >20 - Empirical in approach
- Problem-oriented in approach
- Use of guided discovery
o Characteristic of Beckian therapies
Disputation was characteristic of Ellis’ Rational Therapy - Use of a wide variety of behavioural and cognitive techniques
- Regular use of homework exercises
What are some myths about CBT?
- Therapeutic relationship in not important
- CBT is mechanistic
- CBT is about positive thinking
- CBT disregards the past
- CBT deals with superficial problems, hence symptom substitution is likely
- CBT is adversarial
o Can be directive; adversarial = bad CBT - CBT is for simple problems
- CBT is interested in thoughts not emotions
- CBT is only for clients who are psychologically minded/high intelligence
- CBT is quick to learn and easy to practice
- CBT is not interested in the unconscious
o Research on attentional biases relate to “unconscious processes”
What are some Third Wave therapies? (5)
o Mindfulness and mindfulness-based approaches
o Schema therapy
o Acceptance and Commitment therapy (ACT)
o Dialectical Behaviour therapy (DBT)
o Metacognitive therapies
