2) The CBT Model

Question 1

What did Sigmund Freud believe? (4)

Answer 1

• 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

Question 2

Provide brief historical development of psychotherapies (5)

Answer 2

• 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.

Question 3

What are the two main influences/revolutions in the history of psychology? (2;3)

Answer 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

Question 4

What are the different levels of cognitions? (3)

Answer 4

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

Question 5

Identify some processing biases (4).

Answer 5

cognitive distortions, logical errors, thinking biases, information processing errors/biases

Question 6

What encompasses negative thinking? (3;4)

Answer 6

the 3 different levels of cognitions (core beliefs, conditional assumptions, NATs) and processing biases (cognitive distortions, logical errors, thinking biases, information processing errors/biases)

Question 7

How are cognitive and behavioural activity related? Give an example of a behavioural intervention that has cognitive elements.

Answer 7

• 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

Question 8

Identify what the ABC model of cognitive therapy is

Answer 8

A = antecedent
B = beliefs
C = consequences

Question 9

In terms of ABC model, what do clients come in talking about?

Answer 9

Clients normally come in talking about (C)onsequences (i.e., the affect, emotions)

Question 10

What do we as cognitive therapists target and why? (3)

Answer 10

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

Question 11

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)

Answer 11

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).

Question 12

Define the cognitive triad.

Answer 12

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

Question 13

What thinking patterns are common in depression

Answer 13

Patterns of negative thinking

Question 14

What is the relationship between beliefs, biases and automatic thoughts - draw out a flow chart.

Answer 14

Page 27-28 of notes

Question 15

Identify the hierarchical structure of beliefs

Answer 15

Core beliefs = more general, less accessible, harder to change

Underlying assumptions

Automatic thoughts = more specific, more accessible, easier to change

Question 16

Describe core beliefs. (7)

Answer 16

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

Question 17

Describe intermediate beliefs. (8)

Answer 17

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

Question 18

Describe automatic thoughts (7)

Answer 18

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

Question 19

Describe thinking biases. (4)

Answer 19

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

Question 20

What are the 3 categories of thinking biases?

Answer 20

filter biases/errors

evaluative or interpretative biases/errors

memory biases/errors

Question 21

Define and describe filter biases. (3)

Identify 3 filter biases.

Explain in terms of:
Specific phobia of spiders
Panic disorder
Social anxiety disorder

Answer 21

• 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)

Question 22

Define and describe evaluative/interpretative biases. (1)

Identify and describe some evaluative/interpretative biases (3; 3; 2; 1)

Answer 22

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)

Question 23

Describe how memory biases work. (1)

Answer 23

Memories are vulnerable to distortions as one retrieves and re- stores memories.

Question 24

Why is CBT so popular? (6)

Answer 24

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

Question 25

What does the research say about CBT? (3)

Answer 25

• 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.

Question 26

What disorders does CBT have clear evidence of efficacy? (9)
What about some limited support for efficacy? (3)

Answer 26

Depression, Panic/Agoraphobia, GAD, specific phobias, social phobias, OCD, PTSD, Bulimia, (Some) personality disorders

Anorexia, Schizophrenia, Bipolar disorder

Question 27

CBT is the treatment of choice for all ____ disorders, with _____ often being recommended as the 2nd choice

Answer 27

anxiety; medication

Question 28

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)

Answer 28

Medication

Symptom relapses after drug cessation

Depression, OCD, Social Phobia, PDA

Question 29

There is some preliminary support for positive effects for CBT (modified) in: (2)

Answer 29

o Personality Disorders
o Psychotic Conditions

Question 30

Identify and define the different NHMRC levels of evidence.

Answer 30

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

Question 31

Identify and define the CBT principles (6)

Answer 31

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

Question 32

Draw out the hot cross bun method

Answer 32

situation –> thoughts; emotions; behaviour; physical reactions

Question 33

Identify and describe, when appropriate, the Cognitive Therapy characteristics (8)

Answer 33

• 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

Question 34

What are some myths about CBT?

Answer 34

• 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”

Question 35

What are some Third Wave therapies? (5)

Answer 35

o Mindfulness and mindfulness-based approaches
o Schema therapy
o Acceptance and Commitment therapy (ACT)
o Dialectical Behaviour therapy (DBT)
o Metacognitive therapies