CCC- week 10- CBT Flashcards
What is CBT?
A type of psychotherapy.
Developed since the 1960s- has flourished ever since.
Widely practiced in mental health care around the world.
Who is CBT recommended by & what for?
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
What are the two models that are the focus for CBT?
Beck- Cognitive Therapy
Ellis- Rational Emotive Behavioural Therapy
CBT- what principle is it based on?
“its not what happens to you but the view of it you take that matters”
How are mental health problems understood in CBT?
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.
What does CBT aim to break & build?
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.
What influences peoples emotional responses to an event?
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.
What is within the CBT ABC model?
Activating Event
Beliefs
Consequences (emotional, physical, behavioral)
What do cognitive models say that thoughts are?
What is central to the change process in psychotherapy?
Thoughts are not the ‘cause’ of mental health problems- but an integral part of emotional distress.
Cognitive change
Is there evidence supporting the cognitive account of emotional distress?
- 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)
What is a way to reduce emotional distress?
Replacing negative self talk with positive self statements.
What is wrong with the ABC model?
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.
What model was introduced by Padesky in 1986?
“Hot cross bun” model
Who was the “hot cross bun” model introduced by & what year?
Padesky in 1986
What is the “hot cross bun” model & what does it show?
It diagrammatically shows how thoughts, body sensations, feelings and behaviours all interact with each other, within a situation/ experience.
What does the hot cross bun model aim to do?
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.
What are the different categories in the hot cross bun model?
Thoughts
Body sensations
Feelings
Behaviours
What does the CBT model of ABC recognize & acknowledge?
Acknowledges the interconnectedness
But, emphasizes the importance of our thoughts on how we feel and what we do
Where do our thoughts come from?
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.
What experiences result in our schemas to continually update?
Life long experiences.
Can you draw the cognitive model?
Life experiences
Genetic factors & temperament/ personality
Core beliefs, attitudes, assumptions
Triggering event
Body sensations, thoughts, feelings, behaviour
What happens when core beliefs (schemas) are activated?
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).
What is Becks negative cognitive triad?
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.
How can you apply the cognitive model to depression?
Stimulus- Loss/ rejection
Belief- “Nothing I do is right.
Behaviour- social withdrawal
How can you apply the cognitive model to Generalized anxiety disorder?
Stimulus- Uncertainty
Belief- “something bad is going to happen”
Behaviour- Avoid situation, seek reassurance, procrastinate, excessive planning.
How can you apply the cognitive model to Obsessive Compulsive Disorder?
Stimulus- Public restroom
Belief- “I am at risk of contracting a deadly disease.”
Behavior- Avoid contaminated stimulus & engage in excessive compensatory behaviors.
What evidence is there for the cognitive model?
“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.
Cognitive Therapy
Who was it introduced by & what year?
First described as an approach for depression by Beck in 1967.
What does Cognitive Therapy aim to do?
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.
What does CBT make people aware of/ evaluate & build?
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?
What does CBT look like in practise?
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-
How are CBT therapies carried out & how many sessions?
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)
CBT in practice
Why are thought records & models useful?
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.
What does CBT aim to break down/ slow down?
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.
Whats an example of the cognitive model put into practise?
An individual who doesn’t like crowded places, public transport, gigs?
Thoughts- “I’m going to pass out, I can’t cope.”
Body sensations- More breathless
Feelings- anxious/ panicky
Behaviour- breathe rapidly/ avoid going out
What do you need to do to the thoughts in CBT?
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.
What is the best way to deal with the issues you face- other than talking about the problems?
“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.
What are the core elements of CBT?
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
Does CBT work?
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.
Efficacy for CBT- depression
What did the study - De Rubeis et al (2005) Study comparing cognitive therapy with antidepressant medication in adults find?
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)
