CBT

Question 1

Godfather of CBT

Answer 1

Aaron Beck developed CBT in 1960’s

Question 2

Based on what theory

Answer 2

Theory that we respond to life events through a combination of cognitive, behavioral, affective, and motivational responses.

Question 3

Deals with what?

Answer 3

deals with how people perceive, interpret, and place meaning into events

Question 4

Aim

Answer 4

adjust information processing and initiate positive change in all systems by acting through the cognitive system

Question 5

Collaborative?

Answer 5

CBT is a collaborative approach in which the therapist and the client work together to examine the client’s beliefs about himself, other people, and the world

Question 6

How is the scientific method used?

Answer 6

CBT is an experimental approach wherein the therapist and the client test maladaptive conclusions…testing hypothesis by examining alternative interpretations and to generate contradictory evidence that support adaptive beliefs and leads to therapeutic change (is common to disconfirm distorted cognitions).

Question 7

Schemas

Answer 7

Each system is composed of schemas…perceptions of themselves and others, their goals, expectations, memories, fantasies,

helps us make sense of our experiences (e.g. date schema, chair schema, etc.)

adaptive schema–> i enjoy challenges when they come

maldadaptive: the world is a terrifying place
simple: dog

Question 8

Bias

Answer 8

Depression – negative bias

Anxiety – bias toward catastrophizing…interpreting themes of danger

Question 9

Modes

Answer 9

networks of cognitive, affective, motivation, and behavioral schemas that compose personality and interpret ongoing situations.

Primal concerns - threat, loss, victim, self-enhancment

Question 10

When are automatic thoughts a problem

Answer 10

• when they are contrary to objective findings
• when they are dysfunctional
• when conclusion is distorted

Question 11

CBT Model

Answer 11

Event –> automatic though –> reaction (emotional, behavioral, cognitive)

Question 12

Automatic vs. deliberate thinking

Answer 12

CBT tries to have people think more deliberately, conscious goals, problem solving, and long-term planning

Conscious control to recognize and override maladaptive responses

Question 13

Strategies: Collaborative Empericism

Answer 13

Collaborative empiricism - therapist and client work together to explore dysfunctional interpretations and try to modify them. Patient is like a scientist who lives by interpreting stimuli but who has been temporarily thwarted by his or her own information-gathering and integrating apparatus.

• jointly determining goals for treatment, eliciting and providing feedback, and thereby demystifying how therapeutic change occurs.
• coinvestigators, examining the evidence to support or reject the patient’s cognitions.

build alternative hypothesis…
skills training…role play

Question 14

Socratic dialogue

Answer 14

MAKES THINGS THAT WERE IMPLICIT…EXPLICIT
therapist carefully designs a series of questions to promote new learning
- clarify or define problem
- assist in the ID of thoughts, images , and assumptions
- examine the meaning of events for the patient
- assess the consequences of maintaining maladaptive thoughts and behaviors

Question 15

Guided discovery

Answer 15

o Guided discovery – directed toward discovering what threads run though the patient’s present misperceptions and beliefs and linking them to analogous experiences in the past.
• Patient modifies maladaptive beliefs and assumptions
• Therapist serves as a guide who elucidates problem behaviors and errors in logic by designing new experiences (behavioral experiements) that lead to the acquisition of new skills and perspectives
• The therapist and patient collaboratively weave a tapestry that tells the story of the development of the patient’s disorder

Question 16

Immediate goal

Answer 16

shift information processing apparatus to a more “neutral”

Question 17

Three approaches to treating dysfunctional modes

Answer 17

1. deactivate them
2. modify content and structure
3. construct more adaptive modes to neutralize them

Question 18

Techniques

Answer 18

used to correct errors or biases in information processing and at modifying the core beliefs that promote faulty conclusions

• identify and test patient’s beliefs, explore their origins and basis, correction them if they fail an empirical or logical test, or problem solving
• CORE BELIEFS explored in a similar manner–clients who discover that these beliefs are not adaptive are encouraged to try a new set of beliefs to determine whether the new set is more functional
• behavioral techniques - skills training (relaxation, assertiveness training, social skills training), role playing, rehearsal, exposure therapy

Question 19

Cognitive Distortions

Answer 19

Arbitrary inference: drawing specific conclusion without supporting evidence or even in the face of contradictory evidence. E.g. working mother concludes after a busy day that she is a “terrible” mother

Overgeneralization: Abstracting a general rule from one or a few isolated incidents and applying it too broadly and to unrelated situations. e.g. does poorly on a science test…turned down on date…all men are the same, i will always be rejected

Magnification and minimization: seeing something as far more significant or less significant than it acutally is. A student catastorphized: “if i appear the least bit nervous in class, it will mean disaster.”

Dichotomous thinking: Categorizing experiences in one of two extremes: for example, complete success or total failure. If I don’t impress them, I’m a failure

Question 20

Cognitive Profile of psychological disorders

Answer 20

depression –> neg. view of self, experience, and future

anxiety –> sense of physical or psychological danger

panic disorder –> catastrophic interpretation of bodily/mental experiences

phobia –> sense of danger in specific, avoidable situations

obsessions –> repeated warning or doubts about safety

compulsions–> rituals to ward off perceived threat

Question 21

Cognitive Triad

Answer 21

Beck (1967)

1. Negative view of self (I am unlovable)
2. Negative view of future (nothing will work out)
3. Negative view of world (world is hostile)

negative schemas maintain depression

Question 22

Cognitive Model of Anxiety Disorders

Answer 22

• Conceptualized as excessive functioning or malfunctioning of normal survival mechanisms.
• Basic mechanisms for coping with threat are the same for both normal and anxious people.
o Physiological responses prepare the body for escape or self-defense
o These physiological responses occur in the face of psychosocial threats as in the case of physical dangers.
• Perception of danger is either based on false assumptions or exaggerated (normal response based on more accurate assessment of risk and the magnitude of danger).
• Anxious individuals have difficulty recognizing cues of safety and other evidence that would reduce the threat of danger.
• Cognitive content revolves around themes of danger, and the individual tends to maximize the likelihood of harm and minimize his or her ability to cope.

Question 23

Panic Disorder

Answer 23

• Prone to regard any unexplained symptom of sensation as a sign of some impending catastrophe
• Cognitive processing system focuses their attention on bodily or psychological experiences
o Shapes these sources of internal information into the conviction that disaster is imminent.
• A crucial characteristic is the conclusion that vital systems (cardiovascular, respiratory, or central nervous system) will collapse.
• Because of this fear, these patients tend to be overly vigilant toward internal sensations and thus to detect and magnify sensations that pass unnoticed in other people
• Patients with panic disorder show a specific cognitive deficit – an inability to view their symptoms and catastrophic interpretations realistically.

Question 24

Advanced cognitive model

Answer 24

adverse developmental experiences
–> schemas (dysfunctional attitudes) of herself, others, world, future
core belief (cognitive)
e.g. she’s flawed, loser, people are losers

• -> activation by stressful events
• -> pervasive cognitive bias

Question 25

Depression assessments

Answer 25

BDI
Hopelessness Scale
Social Phobia Inventory

Question 26

How do we know if they respond to CBT?

Answer 26

Jeremy Saffron suitability criteria scale

• identify and differentiate emotions
• accept responsibility for change
• cognitive model makes sense

Question 27

Agoraphobia

Answer 27

• Patients who have had one or more panic attacks in a particular situation tend to avoid that situation.
o EX. People who have had panic attacks in supermarkets avoid going there. If they push themselves to go , they become increasingly vigilant toward their sensations and begin to anticipate having another panic attack.
• This anticipation of an attack triggers a variety of autonomic symptoms that are then misinterpreted as signs of an impending disaster (e.g., heart attack, loss of consciousness, suffocation)
o Can lead to full-blown panic attack
• Patient with panic disorder that goes untreated frequently develop agoraphobia.
o May eventually become housebound
o Or so restricted in their activities that they cannot travel far from home and require a companion to venture any distance

Question 28

Phobia

Answer 28

• Anticipation of physical or psychological harm in specific situations
• As long as patients can avoid these situations, they do not feel threatened and probably relatively comfortable.
• If entered into these situations, they experience the typical subjective and physiological symptoms of severe anxiety.
o As a result of this unpleasant reaction, their tendency to avoid the situation in the future is reinforced
• Social Phobia
o Fear of disparagement or failure in social situations, examinations, and public speaking.
o Behavioral and physiological reactions to the potential “danger” (rejection, devaluation, failure) may interfere with the patient’s functioning to the extent that they can produce just what the patient fears will happen

Question 29

Obsessions and Compulsions

Answer 29

• Patients with obsession introduce uncertainty into the appraisal of situations that most people would consider safe.
o The uncertainty is generally attached to circumstances that are potentially unsafe and is manifested by continual doubts – even though there is no evidence of danger.
• Obsessives:
o Continually doubt whether they have performed an act necessary for safety
o May contamination by germs and no amount of reassurance can alleviate the fear.
o A key characteristic of obsessives is this sense of responsibility and the belief that they are accountable for having taken an action (or failed to take an action) that could harm them or others.
o Therapy modality views such intrusive thoughts as universal
• It is the meaning assigned to the intrusive thought that causes distress (patient has done something immoral or dangerous)
• Compulsions:
o Attempts to reduce excessive doubts by performing rituals designed to neutralize the anticipated disaster
o They are compelled to remove the source of danger

Question 30

Goal reasonable goal

Answer 30

• ->early success in therapy –>better outcomes

- -> agreeing goals –> better outcome

Question 31

Theory/Goals

Answer 31

• Goals are to correct faulty information processing and to help patients modify assumptions that maintain maladaptive behaviors and emotions.
• Cognitive and behavioral methods are used to challenge dysfunctional beliefs and to promote more realistic adaptive thinking.
• Initially addresses symptom relief, but ultimate goal is to remove systematic biases in thinking and modify the core beliefs that predispose the person to future distress.
• CBT fosters change in patients’ beliefs by treating beliefs as testable hypotheses to be examined through behavioral experiments jointly agreed upon by patient and therapist

o Therapist does not tell the client that the beliefs are irrational or wrong or that the beliefs of the therapist should be adopted.
o Instead therapist will ask questions to illicit meaning, function, usefulness, and consequences of the beliefs.
o The patient ultimately decides whether to reject, modify, or maintain all personal beliefs, being well aware of their emotional and behavioral consequences

Question 32

Different levels of cognitive change

Answer 32

voluntary thought
automatic thought
assumption/core belief (contained in cognitive schemas)

Question 33

Cog Technique: Automatic thoughts

Answer 33

o Tested by direct evidence or by logical analysis
o Evidence can be derived from past and present circumstances, but must be as close to fact as possible
o Data can also be gather in behavioral experiments:
• EX. go out and survey people….
• Allows patients to think in a more objective way

Question 34

Booster Session

Answer 34

Decreases relapse

Gearing (2013)

Question 35

Cognitive Technique: Maladaptive assumption

Answer 35

• Maladaptive assumptions:
o Usually much less accessible
o Most patients find difficult to articulate assumptions
o Appear as themes in automatic thoughts
o Therapist might draw conclusion from data and then present his conclusion to patient
o Patient always has right to refute and modify
o Once identified, it is open to modification
• Ask patient whether assumption seems reasonable
• Have patient generate reasons for and against maintaining the assumption and presenting evidence in contrary to the assumption

Question 36

Decatastrophizing

Answer 36

• Decatastrophizing
o “What if?”
o “What’s the worst that could happen?”

Question 37

Reattribution

Answer 37

• Reattribution
o Test automatic thoughts and assumptions by considering (ALTERNATIVE) causes of events
o Particularly helpful when patients personalize or perceive themselves as the cause of events
o Encourage reality testing and appropriate assignemtn of responsibility by requiring examination of all the factors that impinge on a situation

Question 38

Decentering

Answer 38

o Primarily used in treating anxious patients who wrongly believe they are the focus of everyone’s attention.
o After they examine the logic behind the conviction that other would stare at them and be able read their minds, behavioral experiments are designed to test these particular beliefs.
• Student who is anxious about people watching him instructed to observe others and found no one watching him.

Question 39

Gathering information about imagery:

Answer 39

o Spontaneous images provide data on the patient’s perceptions and interpretations of events
o Imagery can be modified
• Attacker shrinking in size (can help directly reduce impact of trauma)
• Point of restructuring such images in not to deny what actually happened but to reduce the ability of the image to disrupt daily functioning.
o Imagery can be used in role-plays
• Carried the ability to access emotions
• Experiential techniques
• Dialogues between one’s healthy self and one’s negative thoughts
o Used to mobilize affect and help patients both believe and feel that they have the right to be free of harmful and self-defeating patterns.

Question 40

Behavioral Techniques

Answer 40

Homework

• Give opportunities to apply cognitive strategies between sessions
• Typical assignments - self observation and self management

Hypothesis testing
- both cognitive and behavioral technique

Exposure Therapy
o Serves to provide data on the thoughts, images, physiological symptoms, and self-reported level of tension experienced by the anxious patient
o Specific thoughts and images can be examined for distortions
o Specific coping skills can be taught
o Patients learn that their predictions are not always accurate, and they hten have the data to challenge anxious thoughts in the future

Behavioral rehearsal & role playing:
o Used to practice skills or techniques that are later applied in real life.

•	Diversion techniques
o	Used to reduce strong emotions and to decrease negative thinking
•	Physical activity
•	Social contact
•	Work
•	Play
•	Visual imagery

• Activity Scheduling
o Provides structure and encourages involvement
o Ratings – degree of mastery and pleasure experienced during each activity of the day achieves several things:
• Patients see mood fluctuations (may believe symptoms are at a constant level)
• Evidence contradicts beliefs that they are not good at anything or don’t enjoy anything

• Graded task assignment
o Calls for patient to intiate an activity at a nonthreatening level while the therapist gradually increases the difficulty of assigned tasks.
• Talk to one person
• Then three people
• Then big group
• Etc until patient is spending more time with people

Question 41

Evidence

Answer 41

• Butler et al. (2006). Meta-analyses
• Search gave way to 16 methodologically rigorous meta-analyses
• Focused on effect sizes that contrast outcomes for CBT with outcomes for various control groups.
• Overall, found large effect sizes for unipolar depression, generalized anxiety disorder panic disorder with or without agoraphobia, social phobia, PTSD and childhood depressive and anxiety disorder.

Question 42

Task Force on the Promotion and Dissemination of Psychological Procedures
Well-established interventions

Answer 42

• At least 2, well-conducted, between-group design experiments demonstrating efficacy in one of the following ways:
o Superior to pill or psychological placebo or to another treatment
o Equivalent to an already established treatment in experiments with adequate sample size
• The experiments must be conducted using a manual
• Sample characteristics must be detailed
• At least two different investigators or teams must find treatment effects
Probably efficacious

Question 43

Efficacy for Depression

Answer 43

o David-Ferdon & Kaslow (2008)
o Evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998.

Treatment for Adolescents with Depression (2006) TADS

CBT and medication together were found to be more effective than medication alone; and treatment with medication was superior to both placebo and CBT alone. Longer follow ups of participants have suggested that CBT either alone or with medication reduced suicidality (TADS, 2007). A further major trials (TORDIA; Brent Emslie, Clarke, Wagner, Asarnow, & Keller, 2008) showed CBT and medication to be superior to medication alo

Question 44

Effective for disruptive classroom behaviors

Answer 44

Ghafoori & Tracz (2001)…Effect size .29 (large),

Twenty-seven articles about studies using cognitive-behavioral therapy and a teacher measure of disruptive behavior were analyzed critically, and appropriate outcome measures were included in the analysis. Meta-analysis of these studies revealed that children who received cognitive-behavioral therapy displayed fewer disruptive behavior problems than did children who did not receive a cognitive-behavioral intervention. Cognitive-behavioral therapy used in conjunction with teacher-implemented contingencies was not found to be more effective in reducing disruptive behavior than cognitive-behavioral therapy alone.

Question 45

Effective for OCD

Answer 45

Watson & Reeve (2008) Meta Analysis that of 13 RCT = EF .48 (large)

Question 46

Effective for PTS

Answer 46

Kawalik et al (2001) CBT PTSD sig different between CBT & Control group on the CBCL

The purpose of the review by Kowalik et al. was to calculate an estimate of the overall efficacy* of CBT in the treatment of PTSD in children. Randomized controlled trials were selected if they compared CBT to an active control group (e.g., supportive unstructured psychotherapy, nondirective supportive treatment, and child-centered therapy). The authors used somewhat particular search terms: PTSD OR posttraumatic stress disorder OR sexual abuse.

The total CBCL, internalizing and externalizing scores showed statistically significant differences between CBT and active control groups, in favor of CBT. There was no significant difference between the groups with regard to competency.

Question 47

Assumptions

Answer 47

1. Abnormal behavior is caused by abnormal is caused by abnormal thinking process
2. We interact with the world through out mental representation of it
3. If our mental representations are inaccurate or our ways of reasoning are inadequate then our emotions and behaviors may become disordered

Question 48

Differences between CBT and REBT

Answer 48

Albert Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. In contrast, Beck stresses the quality of the therapeutic relationship.

REBT is often highly directive, persuasive and confrontive. Beck places more emphasis on the client discovering misconceptions for themselves.

REBT uses different methods depending on the personality of the client, in Beck’s cognitive therapy, the method is based upon the particular disorder.