CBT Lecture

Question 1

What is CBT?

Answer 1

• Two schools of thought to make functional whole - cognitive and behavioural
• Cognitive derived from psychodynamic therapy
• Behavioural therapy from Pavlov, Skinner
• Present moment focus - present and what maintains the problem

Question 2

What is behavioural therapy?

Answer 2

• Behaviourism predicts and influences behaviour
• Respondent - learn from experience, conditioned learning eg food poisoning then avoid food
• Operant learning - learning by positive or negative reinforcement, eg police/guide dogs, trained via treats
• Good to treat simple phobias eg spider phobia - use exposure

Question 3

What is cognitive therapy?

Answer 3

• Developed by A Beck
• Seen as thoughts functioning on 4 levels - unconscious, pre, concsious and meta-conscious
• Focus on available thoughts
• Use socratic questioning - stimulate learning by guiding
• Don’t psychoanalyse
• Eg imagine see friend and they don’t say hello - examine thoughts

Question 4

Basic CBT formulation - hot cross bun

Answer 4

• Maintenance cycle
• See how problem is being maintained
• Behaviours can make thoughts worse, emotions worse

Question 5

What are safety behaviours?

Answer 5

• Designed to prevent feared outcomes or avoid/reduce distress
• Often disproportionate to actual risk
• Covert or overt
• Covert - can’t see, neutralise intrusive thoughts internally
• Feel only thing that is keeping them safe

Question 6

Principles of CBT

Answer 6

• Based on ever-evolving formulation of patients problems
• Sound therapeutic alliance
• Emphasise collaboration and active participation
• Goal orientated and problem focus
• Emphasizes present
• Time limited
• Structured sessions
• Teaches patient - to allow them to do it in world

Question 7

What is schema?

Answer 7

• Mental concept
• Pattern of behaviour based on previous experiences
• Cognitive structures that when activated directly influence persons pereceptions, interpretations and memories
• eg waiting room schema - have memory and know what to do

Question 8

Damaging safety behaviours

Answer 8

• Avoidance
• Seeking reassurance
• Using rituals - eg checking locks, washing hands
• Rumination - dwell on past events
• Distraction - divert attention from anxious thoughts/feelings

Question 9

What is formulation?

Answer 9

• Look at early experiences
• –> These inform core beliefs
• –> Core beliefs develop about self, others and world
• –> These form rules for living - eg please others, be perfect
• –> Find critical incident - often rule break eg lose job, divorce, activate negative core beliefs
• –> Negative automatic thoughts –> body sensations, emotions, behaviours

Question 10

OCD maintenance cycle

Answer 10

• Trigger causes intrusive thought –> belief about thought eg bad mother
• –> distress with urge to act
• –> Behaviour follows urge and belief about thought - ritual or avoidance (compulsion)
• –> Temporary relief
• –> repeat cycles

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Behaviour confims meaning, strengthens initial thought, gives power.

Question 11

What is exposure and response prevention?

Answer 11

• Treatment for OCD
• Exposing to intrusive thought and anxiety
• Response prevention - resist compulsions, tolerate stress
• Lasts 1hr - gives time to calm down with panic, learn that is not harming them

Question 12

Contextual formulation

Question 13

What is triad of PTSD?

Answer 13

• Re-experiencing
• Avoidance
• Persistent arousal

Question 14

Complex PTSD triad

Answer 14

• Emotional dysregulation
• Negative self appraisal
• Difficulty in relationships

Question 15

Factors influencing therapetic outcome

Answer 15

• Outside factors - needs to be right time of life, motivated and prioritise
• Therapeutic relationship
• Hope
• Model - schema

Question 16

CBT vs psychodynamic therapy

Answer 16

• Psychodynamic therapy - focuses more on unconscious mind and free association, unstructured sessions, focuses on present but explores where this has come from
• CBT - structured, focus sessions, focus more on present, do explore some previous experiences but more present focused

Question 17

How to decide therapy suitable for?

Answer 17

• If functioning is ok, small element of previous experiences influencing now - CBT probably best
• If more non-specific symptoms and affecting wide areas of life or previous had CBT and not worked - psychodynamic therapy, more complex underlying cause
• Also depends on person - if solution focused - prefer CBT, if exploratory and want to know why - psychoanalytic psychotherapy
• Also psychoanalytic therapy - makes worse before get better