CBT - Depression Flashcards
Describe the First Wave: Behaviour Therapy
First “empirically based” therapy… based on behavioural research how we “learn” to behave and react emotionally (behavioural learning theory –classical, operant)
The Behavioural View
A - antecedent
B - behaviour
C - consequence
Classical/Pavlovian Conditioning: (poor Little Albert)
Second Wave: Cognitive Behaviour Therapy
Empirical study of how thinking (cognitions) affected emotions and behaviour.
It is not the situation = emotion, but rather the way in which the situation is interpreted.
Interpretation = emotion
Interpretation of a specific situation mediates emotional response.
A (Activating Event)»_space;> B (Belief)»_space;> C (consequence)
The way we think affects the way we feel and act
Third wave CBT (e.g., ACT, mindfulness, DBT)Third wave CBT (e.g., ACT, mindfulness, DBT)
Acknowledges the importance of behaviour
Still acknowledge the importance of cognition
Still empirically based
Trying not to just change what we think but how we think.
more emphasis reacting to thoughts in a new ways
placing them in context, rather than getting caught in arguing with the content of negative thoughts.
Borrowing from eastern traditions e.g.,mindfulness
Incorporating more explicit work on values
Operant Conditioning
how is it KEY TO ANXIETY:
Behaviours become more or less likely to occur as a result of the consequences of the behaviours.
Positive and Negative Reinforcement: increase frequency of behavior.
- receiving pay is positive reinforcement for working
- avoiding traffic is negative reinforcement for going to work early
Punishment and Extinction: decrease the frequency of behaviour.
- Punishment: Actively applying a stimulus that decreases likelihood of behavior
- Extinction: Non-reinforcement of response leading to a decrease in the behaviour
KEY TO ANXIETY: Negative Reinforcement: Anxiety.. (phone checking)
TREATMENT: Extinction… (lack of expected response)
and negative feedback loops
What is Beck’s Cognitive Model that indicates that depression may come form early experience?
What are the symptoms of this cycle?
Early experience >>> Dysfunctional Assumptions >>> Critical Incident >>> Assumptions activated >>> Negative Automatic Thoughts (+++Cognitive Triad and assumptons)
Symptoms Include: Behavioural, Motivational, Affective, Cognitive, Somatic
the cognitive appraisal of internal or external
stimuli
What are the parts of Beck’s cognitive model that become the target of CBT?
Schemas and Core beliefs: Filters / lens;
Often inflexible; Self, others, world
Rules and Assumptions: (“should”);
Beliefs apply across situations;
If ….. Then…..
Automatic thoughts (or images): Unplanned –not as a result of thinking or introspection; The most accessible thoughts; Specific to the situation * can be difficult to articulate for the client
Beck’s Theory of Depression- the cognitive triad
cognitive triad negative view of self, the world, and the future
Self - I am a Failure
World - people judge you according to your success
Future - things will get worse
ANT (Automatics negative thoughts)
cognitive errors –faulty thinking accompanied by negative and unrealistic faulty thinking accompanied by negative and unrealistic representations of reality
Schemas ; pattern of maladaptive thoughts and beliefs pattern of maladaptive thoughts and beliefs
Depression and Attributions
Negative events interpreted as:
Internal, stable and global
Positive events interpreted as:
External, unstable and specific
What are some Behavioural Aspects of Depression
Depression is maintained because there are benefits for depressed behaviours
◦Avoidance of stressful tasks
◦Defer responsibility to others
◦Individual with depression has withdrawn from behaviours and activities that used to provide pleasure and success
◦Therefore receives less reward for autonomous behavior
◦Poor coping skills
What does the research say about CBT for depression?
◦The single most investigated psychosocial treatment for depression.
◦16-20 sessions delivered over 12-16 weeks
◦Over numerous studies, CT is shown to be of equivalent efficacy to antidepressants, and superior to pill-placebo.
◦This finding holds even when dosage is allowed to vary at discretion of prescribing physician.
What works: ◦Behavioral activation ◦Automatic thought identification, evaluation, and restructuring ◦Deeper level schema work ◦Relapse prevention
What are some things that CBT TREATMENT includes?
What does treatment for depression include?
Thought monitoring Cog restricting (ABC model) Experience (CBT) Problem solving skills Behavioural activation Pleasant event schedule
establishment of the therapeutic relationship
behavioral change strategies
cognitive restructuring
the modification of core beliefs and schemas
The prevention of relapse and recurrence.
What are some strategies for Modifying Automatic Negative Thoughts
Generating rational alternatives
Decatastrophising (what’s the worst that could happen, will it matter in 5 years)
Identifying cog errors
Prob solving
Foster acceptance
Focus on utility of thought
What is Behavioural Activation? Examples?
A procedure that engages a client in one or two actions that can alter how they feel (lift their mood)
Provide psychoeducation about behavioural model of depression (negative cycle of depression)
Select actions (e.g., going for a walk, do something with a friend, go shopping for ingredients and cook a nice meal) that are realistic for client
What is Activity Scheduling? What are some examples? And why does it help?
People with depression tend to under report experiences that are positive or enjoyable, and focus heavily on events that were not positive (remember cognitive profile of people with depression)
monitoring and maybe schedule
RATE ACTIVITIES pleasure and mastery