CCC- week 10- CBT

Question 1

What is CBT?

Answer 1

A type of psychotherapy.

Developed since the 1960s- has flourished ever since.

Widely practiced in mental health care around the world.

Question 2

Who is CBT recommended by & what for?

Answer 2

NICE (National Institute for Health and Clinical Excellence).

It is widely available in the NHS and other healthcare systems around the world

First line treatment for:
- Depression
- Anxiety
- Trauma
- Eating disorders
-Schizophrenia

Question 3

What are the two models that are the focus for CBT?

Answer 3

Beck- Cognitive Therapy
Ellis- Rational Emotive Behavioural Therapy

Question 4

CBT- what principle is it based on?

Answer 4

“its not what happens to you but the view of it you take that matters”

Question 5

How are mental health problems understood in CBT?

Answer 5

In terms of how unrealistic or unhelpful beliefs (or schema) are.

They affect how we make sense of the world.

This influences our emotional reactions to events.

Question 6

What does CBT aim to break & build?

Answer 6

The cycles of patterns of unhelpful thinking.

Build a new more constructive or adaptive way of making sense of the world- with fewer negative health consequences.

Question 7

What influences peoples emotional responses to an event?

Answer 7

The meaning individuals attach to an event.

Different individuals attach different meanings to the same event- due to viewing the experience through different cognitive lenses.

E.g. in a supermarket- everyone is waiting in a queue. Some people will be happy/ tired/ anxious/ angry/ calm- everyone feels different despite being in the same place & experiencing the same thing.

Question 8

What is within the CBT ABC model?

Answer 8

Activating Event
Beliefs
Consequences (emotional, physical, behavioral)

Question 9

What do cognitive models say that thoughts are?

What is central to the change process in psychotherapy?

Answer 9

Thoughts are not the ‘cause’ of mental health problems- but an integral part of emotional distress.

Cognitive change

Question 10

Is there evidence supporting the cognitive account of emotional distress?

Answer 10

• People with depression/ anxiety report more negative thoughts (some evidence of content specificity & types of negative thinking.)
• Rehearsal of negative self-statements leads to negative mood in both clinical and non-clinical research participants. (reverse is true for positive self statements- although not for all people).
• Reduction of negative thoughts & thinking processes alleviates emotional distress (both in the lab & CBT)

Question 11

What is a way to reduce emotional distress?

Answer 11

Replacing negative self talk with positive self statements.

Question 12

What is wrong with the ABC model?

Answer 12

It is too simplistic-

Our beliefs about an activating event do influence our responses to it.

However- what we do also effects what we think, how we feel & may effect the situation itself.

Question 13

What model was introduced by Padesky in 1986?

Answer 13

“Hot cross bun” model

Question 14

Who was the “hot cross bun” model introduced by & what year?

Answer 14

Padesky in 1986

Question 15

What is the “hot cross bun” model & what does it show?

Answer 15

It diagrammatically shows how thoughts, body sensations, feelings and behaviours all interact with each other, within a situation/ experience.

Question 16

What does the hot cross bun model aim to do?

Answer 16

Its a map of a difficult/ challenging situation that is broken down into different categories so patients can understand and make sense of what is going on.

Question 17

What are the different categories in the hot cross bun model?

Answer 17

Thoughts
Body sensations
Feelings
Behaviours

Question 18

What does the CBT model of ABC recognize & acknowledge?

Answer 18

Acknowledges the interconnectedness

But, emphasizes the importance of our thoughts on how we feel and what we do

Question 19

Where do our thoughts come from?

Answer 19

We all hold beliefs, attitudes & assumptions about the world- which influence our thoughts & thinking processes.

Our immediate cognitions- influenced by our beliefs/ attitudes/ assumptions learnt from our life experiences & the interaction with our unique bundle of genetics & personality.

Question 20

What experiences result in our schemas to continually update?

Answer 20

Life long experiences.

Question 21

Can you draw the cognitive model?

Answer 21

Life experiences

Genetic factors & temperament/ personality

Core beliefs, attitudes, assumptions

Triggering event

Body sensations, thoughts, feelings, behaviour

Question 22

What happens when core beliefs (schemas) are activated?

Answer 22

They generate congruent thought content & attentional processes & direct our interpretation of events.

Where unrealistic or maladaptive beliefs, attitudes or assumptions have been learnt- this may lead to patterns of thinking that produce emotional distress (e.g. depression/ anxiety).

Question 23

What is Becks negative cognitive triad?

Answer 23

Depression - characterised by schematic structure- a negative cognitive triad- a biased view of oneself, of the world in general & of the future.

May be triggered by a sense of loss or rejection.

Question 24

How can you apply the cognitive model to depression?

Answer 24

Stimulus- Loss/ rejection
Belief- “Nothing I do is right.
Behaviour- social withdrawal

Question 25

How can you apply the cognitive model to Generalized anxiety disorder?

Answer 25

Stimulus- Uncertainty
Belief- “something bad is going to happen”
Behaviour- Avoid situation, seek reassurance, procrastinate, excessive planning.

Question 26

How can you apply the cognitive model to Obsessive Compulsive Disorder?

Answer 26

Stimulus- Public restroom

Belief- “I am at risk of contracting a deadly disease.”

Behavior- Avoid contaminated stimulus & engage in excessive compensatory behaviors.

Question 27

What evidence is there for the cognitive model?

Answer 27

“Hundreds of experimental, correlational and prospective studies have supported major tenets of the cross-sectional cognitive model, with moderate support also accruing for cognitive vulnerability”
(Clark & Beck, 2010, p. 418)

Evidence of the effectiveness of therapies that target a change in cognition also support this model.

However, evidence is open to critical evaluation, and in places inconclusive.

Question 28

Cognitive Therapy

Who was it introduced by & what year?

Answer 28

First described as an approach for depression by Beck in 1967.

Question 29

What does Cognitive Therapy aim to do?

Answer 29

Therapy helps the client to think & act in a more realistic & adaptive way.

Had been developed by many others over the last 50 years-applied to many types of mental health problems.

Question 30

What does CBT make people aware of/ evaluate & build?

Answer 30

Become aware of unhelpful patterns & thinking processes associated with current problems & make a link between how they think, feel & do.

Evaluate- how valid or helpful their beliefs about themselves/ people & world are- what evidence is there for their beliefs?

Helps build a new repertoire of more realistic & adaptive ideas about themselves & their world- is there evidence for alternative ideas?

Question 31

What does CBT look like in practise?

Answer 31

Active- is a talking therapy- very active-

Collaboration- between client & therapist (the two partners bring expertise & experience of practice- work together)

Scientific- is science/ evidence based- observe whats happening, whats the hypothesis- predictions of what will happen outside the therapy room- then test as part of therapy process.

Focuses on here & now problems- there current distress

Works towards specific goals-

Time- limited- Typically offered over 8-20 sessions.

Structured-

Question 32

How are CBT therapies carried out & how many sessions?

Answer 32

CBT has been adapted widely - offered in briefer courses for group therapy & self help therapies are also used (books, web platforms, apps etc.)

Traditionally- 1 to 1 therapies (8-20 sessions)

Question 33

CBT in practice

Why are thought records & models useful?

Answer 33

Model- used to understand different experiences & differences.

Clients can apply the models to their own experience- to understand their emotional experiences.

Thought records-help identify patterns of thinking associated with painful emotional experiences- invites participant to look through a magnifying glass & understand their triggers, the images that are present- how it makes them feel- and what their behavior is in response.

Question 34

What does CBT aim to break down/ slow down?

Answer 34

Slow down emotional experience & break it down.

Through breaking the experience down- you can see the emerging patterns of behaviour e.g. if you feel anxious when surrounded by people that you don’t know.

Question 35

Whats an example of the cognitive model put into practise?

An individual who doesn’t like crowded places, public transport, gigs?

Answer 35

Thoughts- “I’m going to pass out, I can’t cope.”

Body sensations- More breathless

Feelings- anxious/ panicky

Behaviour- breathe rapidly/ avoid going out

Question 36

What do you need to do to the thoughts in CBT?

Answer 36

Interrogate how realistic your thoughts are.

Collect & weigh up how evidence for unhelpful beliefs that are are exacerbating emotional difficulties.

Generative & alternative ideas & testing them out with behavioral experiments.

Question 37

What is the best way to deal with the issues you face- other than talking about the problems?

Answer 37

“Oh, do not ask, ‘what is it?’, let us go and take a visit” (T.S.Eliot, 1917)

No amount of talking about the situation will give the same evidence as doing it in the real world/ real situation.

Learning new experiences- can re shape our schema about ourselves, others and the world.

Question 38

What are the core elements of CBT?

Answer 38

Learning your ABCs
Making the link between thoughts, feelings and behaviour

Becoming aware of unrealistic or maladaptive patterns in thinking and acting

Exploring alternatives and developing a repertoire of more helpful ways of thinking and being

Collaborative empiricism- client and therapist doing science together

Guided discovery- becoming more aware through the process of questioning and reflection

Behavioural experiments- not just a talking therapy- also a doing therapy.

Testing out beliefs about self, world and other people, and learning from the results

Question 39

Does CBT work?

Answer 39

Does CBT help people experiencing distress to feel better and stay better?
Lots of Randomised Controlled Trials (RCTs) testing CBT against control conditions and comparison treatments
Similar or greater in its effectiveness to other psychological therapies and to medication (Cuijpers, 2017; Hoffman et al 2012)
On the whole- CBT does help more than other psychological approaches & medicine for many mental health problems.

Question 40

Efficacy for CBT- depression

What did the study - De Rubeis et al (2005) Study comparing cognitive therapy with antidepressant medication in adults find?

Answer 40

Found after 8 weeks- the highest response to treatment was the Antidepressant medication (50%)- for Cognitive Therapy (43.3% ressponded)

After 16 weeks- there was a more equal response to the treatment (58.3% responded to CT) and 57.5% responded to Antidepressant medication)