CBTs Flashcards
1
Q
what are the 2 waves of CBT
A
first wave-behaviour therapy
2nd wave- cognitive therapy
2
Q
when was behavioural therapy developed? and what did it mainly address
A
Developed in 1950s and 1960s to mainly address anxiety difficulties (classical and operant conditioning, desenstization etc)
3
Q
behaviour therpay was interested in observable bhevaiours, not….
A
unobservable mental states
4
Q
what is classical conditioning and who first coined it
A
an unconditioned stimulus becomes paired with a fear response even though the stimulus itself is not harmful; BF Skinner
5
Q
what is operant conditiong and who first coined it
A
Operant conditioning (the consequences of a behaviour will either reinforce or
extinguish the behaviour over time; B.F. Skinner
6
Q
what is an important aspect of behavioral therapy
A
1.Systematic desensitisation (gradual exposure to feared or avoided stimuli)
7
Q
BT eventually used for a wide variety of issues beyond anxiety…like what
A
e.g. autism, ADHD, conduct disorder, addiction counselling, parenting work
8
Q
in cognitive-based therapy there was an Increasing recognition within BT that behaviour needs to be understood within…
A
context of thoughts and emotions
9
Q
fill in the following based on ancient Greek philosophies
people are disturbed not by things but..
A
the view which they take of them”
10
Q
who developed the rational emotive therapy (RET)
A
Albert Ellis developed RET in the 1960s
11
Q
why was RET developed
A
to confront clients’ irrational beliefs (eg “should” statements) that caused distress and unhelpful relational patterns
12
Q
what did Aaron Beck’s cognitive theory of depression (negative views of self, others, world) emphasise?
A
collaborative discovery of automatic negative thoughts and then solving them
13
Q
CBT emerged as an integration of what two theories
A
behavioural therapy and cognitive therapy
14
Q
what is the goal of 2nd wave CBT
A
work collaboratively with the client to ID and modify Automatic Negative Thoughts (ANTs)
15
Q
according to cbt what creates distressing feelings
A
not the situation itself, but irrational way we think about or make meaning about the situation
16
Q
why can Two people experience the same situation/events but respond to them in very
different ways
A
because they make different meanings about these experiences – the meanings we make affect how we feel and how we behave
17
Q
how are we constantly assigning meaning to our experiences
A
implicitly, automatically, without much conscious engagement with the meaning-making process
18
Q
fill in the blank:
Negative automatic thoughts arise … in the moment, without us reflecting or weighing them up; we don’t give them the same consideration as other thoughts,
because …
A
spontaneously
we just assume to be true
19
Q
if we do not consciously control our feelings and often aren’t consciously aware of them, then what do we do -
A
we just become aware of how they make us feel
20
Q
how do our unconscious feelings manifest
A
(often intense negative emotions like anxiety, shame, anger, guilt, despair)
21
Q
when you notice a strong negative feeling, what should u do
A
pay attention to what thoughts come to
mind in that situation
22
Q
provide 3 examples of ANTs
A
● I’ll never make it
● I’m useless
● I always mess things up
23
Q
name 2 examples of ANTs trigger situations
A
criticism, conflict
24
Q
if ANTs are not facts what are they
A
they are cognitive reflexes linked to core beliefs we hold about ourselves
25
give me 3 examples of ANTs associated with beliefs
● I mustn’t be too needy/demanding
● I have to be responsible for looking after everyone
● I can’t trust anybody
26
Often we are not cognitively conscious of these core beliefs, but with the help of a cognitive
therapist, what can we do
we can work backwards from out automatic thoughts to ID these core beliefs
27
name 5 out of the 10 Common Cognitive Distortions that Characterise ANTs
1. All-or-Nothing Thinking
2. Overgeneralisation
3. Mental Filter
4. Disqualifying the Positive
5. Jumping to Conclusions
28
what are two key aspects of all or nothing thinking as a Common Cognitive Distortion that Characterise ANTs
● See things in black and white categories -> imbalanced perspective
● If you fall even a little bit short of perfect, see self as total failure
29
define Overgeneralisation
● Make broad conclusions that a singular event represents a pattern of defeat
● Use words such as “always” and “never” + ignore exceptions
30
what is a mental filter
it is when one Picks out a single negative detail and dwells on it -> Focus on exception rather than rule
31
what happens when you Disqualify the Positive
-you Reject positive experiences by insisting they “don’t count” for some reason
- Because doesn’t fit with core belief
32
what does the term jumping to conclusions mean and what are the two subsets
Make negative interpretations even though there are no facts to support them
Two subsets:
1.Mind Reading = automatically assume people are reacting negatively to you
2.The Fortune Teller Error = you anticipate it and take it as fact that things will
turn out badly
33
explain the difference between magnify or minimise
● Exaggerate (magnify) importance of your mistakes or someone else’s achievements so
that, by comparison, you always look worse
● Inappropriately discount (minimise) your own desirable qualities or another’s
imperfections so that, by comparison, you look worse
34
what does emotional reasoning assume
Assume that negative emotions necessarily reflect the way things really are
35
what are “Should” Statements Attached to
certain outcomes or expectations about how things should be
36
fill in the blank
Labelling is Attaching a negative label to ...
yourself
37
what is Personalisation
is when one Holds oneself accountable for things that are beyond ones control
38
what is the root of ANTs in the following example
David had grown up in a household where his parents were very critical and placed great
emphasis on academic achievement. His brother did well academically but David always
struggled to meet his parent’s high standards. He has developed the core belief “I’ll never be
good enough” and the (protective) assumption “As long as I achieve, I’ll be loved”.
“I’m a complete failure”, characterized by the ‘all or nothing thinking’ error.
39
what is the difference between CBT with Psychodynamic Therapy? name 3 points
1. CBT recognizes (but doesn't focus on) an unconscious realm that is completely unknown to the client
2. It does focus on core beliefs about self and others that often underlie our ANTs (they are repressed and unconscious)
3. Recognizes the importance of early history in setting up core beliefs (maintaining current difficulties and how to shift this)
40
what is meta-cognition
it is the process of developing an awareness and understanding of our ways of thinking;
tracking and identifying our ANTs and cognitive distortions
41
what is the goal of meta-cognition
to take a step back, review the basis for the conclusions that we habitually, automatically draw, and explore alternative meanings/conclusions that may be more helpful
42
what is one example of how we can become more aware of how we think and how this
influences the way we feel and behave?
keeping a thought record
43
according to Gaudiano what is Contemporary (Third Wave) CBT Approaches
A ‘family’ of related interventions with similar components
44
name 5 elements to Contemporary (Third Wave) CBT Approaches
● Time limited
● Goal-oriented + focused on current problems
● Emphasis on collaboration and active participation
● Emphasis on values + life goals rather than just ‘fixing faulty thinking’
● Behavioural techniques to address unhelpful avoidant behaviours and encourage
behaviours that are consistent with client’s goals + values
45
name 4 skills that empower a client in the therapeutic space
○ Coping skills (cognitive coping, emotion regulation)
○ Problem-solving skills (addressing most important life problems in a systematic
way; can include a focus on economic + livelihood solutions)
○ Relational skills (to address interpersonal difficulties + enhance social supports)
○ Mindfulness skills (accepting + non-judgemental awareness of the present
46
name 4 diagnosis-specific approaches
1. behavioural activation therapy (BA) -> for depression
2. Trauma-Focused CBT (TF-CBT) -> for trauma disorders e.g. PTSD
3. Motivational Interviewing (MI) -> for substance abuse
4. Dialectical Behaviour Therapy (DBT) -> for borderline personality + complex trauma
47
name the focus in Behavioural Activation Therapy (BA)
○ Focus is on replacing negative/avoidance behaviours with new rewarding
behaviours (linked to valued goals) that are self-reinforcing
48
name the focus in Trauma-Focused CBT (TF-CBT)
process traumatic memories, and the feelings and beliefs that accompany them, in more helpful ways
49
name the focus in Motivational Interviewing (MI)
Focus on exploring client’s ambivalence about changing their behaviour +
strengthening their motivation for, and commitment to, change in accordance
with the person’s values + beliefs
50
name the focus on Dialectical Behaviour Therapy (DBT) -
Focus on developing better emotion regulation + interpersonal skills
51
name 3 types of transdiagnostic approaches
● Acceptance and Commitment Therapy (ACT)
● Problem Solving Therapy (PST)
● Common Elements Treatment Approach (CETA
52
what is the focus of acceptance and commitment therpay
Focus is on developing psychological flexibility and IDing personal values that
can guide behaviour
53
what is the focus of problem solving therapy
Focus on IDing most important current problems that CAN be addressed and
then generating, evaluating, and implementing solutions
54
what is the focus on Common Elements Treatment Approach (CETA
Combines evidence-based treatments for a range of mental health difficulties
into a single model and applies these in a modular, flexible way to meet each
client’s specific needs
55
how well does CBT work ?
In high income countries (HICs), CBT approaches have the largest randomised control trial (RCT) evidence base of all psychotherapies, largely due to being easy to package into standardised manuals
○ It’s short + everyone gets the same components of treatment
56
what is CBTs effectiveness on anxiety disorders (4 marks)
○ CBT consistently more effective than passive control conditions
○ Often more effective than active control conditions
○ More sustainable treatment gains in the long term than medication
○ Increases treatment gains when supplements medication (vs medication alone)
57
what is CBTs effectiveness on depression? (4 marks)
○ Consistently better than no intervention
○ Not always more effective than other therapies or medication
○ In some studies, CBT with medication is better than CBT alone for depression
○ But CBT is better than meds at preventing relapse in the long term
58
fill in the blank
Overall, treatment gains for anxiety + depression are maintained after ...year
○ Though not all studies include .. follow-ups
-1 year
-long term
59
true or false:
CBT is effective in individual and group formats
true
Groups = cost-effective
60
true or false (justify your answer):
CBT-based interventions (including task-shifting interventions) has not been found to be effective for treating common mental disorders in a range of LMICs
false
-they have been found to be effective
-For example, a review of therapies for depression in LMICs found that most were
CBT-based and that these actually had a better effect in LMICs than HICs
● A review of PTSD treatments for refugees in LMICs found that most treatments were
CBT-based and these were effective in significantly reducing PTSD symptoms
61
therapies for depression in LMICs found that most were CBT-based and that these had a better effect in LMICs than HICs-why may there be this difference?
this difference may be due to weaker control conditions in LMICs but, even so, CBT is at
least as effective in LMICs than HICs
62
name 2 ways to culturally adapt CBT interventions
○ Community-based participatory research should be used to identify aspects of
the interventions that need to be adapted for each cultural context
○ Cultural adaptations can be surface-level (e.g .language, terminology) or deep-level (e.g. including culturally-based explalanguagenations and healing rituals, or using cultural insiders as task-sharers
63
give 3 examples of where the following is true:
"Several RCTs have found CBT approaches to be highly effective in reducing depression, anxiety and substance use in SA and in other African countries when used within a task-sharing approach in primary health care (nurses) or community-based settings (CMHWs; community mental health workers)
■ MI + PST for substance abuse in South Africa (Sorsdahl et al., 2015)
■ Friendship Bench: PST delivered by grandmothers to adults with common
mental illnesses in Zimbabwe (Chibanda et al., 2016
■ CMHW-delivered group CBT for depression at primary health care
clinics in South Africa (Petersen et al., 2014)
64
name 3 aspects to the Research Study of Trauma-Focused CBT for SA Adolescents with Multiple Trauma Exposure
1.Emphasis on home-based practice of skills
2.We reduced it from original 12-16 sessions to 8 sessions
3.Each session split between adolescent and caregiver, but last session is conjoint
○ family strengthening goal
65
name 5 components to the Research Study of Trauma-Focused CBT for SA Adolescents with Multiple Trauma Exposure
○ Parenting skills with caregiver (+ homework exercises)
○ Safety assessment and planning (at each session)
○ Relaxation skills to down-regulate
○ Identifying and managing feelings
○ Cognitive coping
66
fill in the blank:
After treatment, and... later, adolescents in the TF-CBT group had greater
reductions in PTSD and depression symptoms than the TAU group
3 months
67
name 3 aspects of CBT-Based Digital Mental Health Interventions (DMHIs
● Include web-based online therapy, web-based self-help therapy, and mobile apps
● ‘Low-intensity interventions’, not targeted at managing mental health crises, active
abuse situations, or severe mental illness
● The digital divide: although mobile phones are very prevalent in LMICs, internet
connectivity and data costs are currently barriers to large-scale DMHIs
68
name 3 ways the CBT-Based Digital Mental Health Interventions (DMHIs) can be used
Can be used to deliver mental health promotion, psychoeducation, mental health
screening
69
fill in the blank
-Across ... studies making direct comparisons, internet-delivered CBT had equivalent
effectiveness to in-person CBT for anxiety and depression
● Across ... RCTs, smartphone apps, which were mostly CBT-based, significantly
outperformed control conditions (waitlist, psychoeducation and supportive therapy) in
improving anxiety, depression, stress, and quality of life
-13
-66
70
in the CBT-Based Digital Mental Health Interventions (DMHIs), what increased effectiveness even more
Some level of counsellor guidance/support and engagement reminders/prompts
increased effectiveness even more
71
true or false: AI automated smartphone apps (delivering engagement reminders/prompts,
support/empathy and coping skills in real time based on each person’s needs) can be as
effective as those that include some human support/contact?
true
The preliminary evidence
suggests it can, but the WHO says that, for ethical reasons, AI interventions should
never be the sole provider of healthcare
72
true or false :
CBT-based WhatsApp mental health interventions show no promise
false
it does show promise (e.g. reducing depression and anxiety amongst adolescents living with HIV in Kenya), but more research is needed
73
briefly explain CBT-Based DMHI Example: PTSD Coach
-PTSD Coach:A free, low-data usage digital intervention called PTSD Coach, available as both an online and smartphone app with self-managed and counsellor-supported options, demonstrated effectiveness in reducing PTSD and anxiety symptoms in pilot studies in Egypt and South Africa, with a preference for some counsellor guidance among participants.
74
briefly explain CBT-Based DMHI for University Students: Woebot
A CBT-based conversational chatbot designed to help individuals with depression and anxiety, with adaptations for substance use, was developed and successfully reduced depression in a population of university students in the USA through mood check-ins, psychoeducational videos, identification of Automatic Negative Thoughts (ANTs) and core beliefs, collaborative exploration of alternatives, and skills development, but it is no longer available in South Africa.
