Cognitive Behavioural Therapy Flashcards
Cognitive behavioural therapy
- short-term, goal oriented form of treatment
- addresses thought and behavioural processes to help solve individual’s problems (behaviour or cognitive based)
- effective in helping problems of anxiety, depression, ocd, addictions
- CBT uses techniques/concepts from behavioural therapy, social learning theory, cognitive therapy, social skills training, mindfulness and task-centered models
behaviour aspect: focus on defining/addressing people’s problem behaviour
cognitive aspect: focus on addressing problem in how thoughts affect behaviour
3 Principles of CBT (Payne)*
1) Access hypothesis: all thinking is knowable to us, nothing remains in the unconscious
2) Mediation hypothesis: Our rational minds manage our emotional responses; we do not have solely emotional responses to experiences – implies that emotional responses incorporate “decision-making”
3) Change hypothesis: We are able to modify our reactions to what happens to us. Understanding reactions and using cognitive strategies to manage them make coping easier.
CBT is rooted in a number of theories (5)
- cognitive theories
- behaviour theories
- social learning
- social skills training
- mindfulness
CBT ideas
• focus on how thinking processes generate behaviour patterns – person’s thoughts (reactions to experiences) cause feelings
• Process of teaching, coaching and reinforcing useful behaviours
o Assertiveness training enables people to practice behaviours so that they can gain confidence in their behaviours and thus improve their overall social confidence
o Modeling is a form of social learning in which people understand and copy useful behaviours from a valued role model
o Mindfulness techniques focus on paying attention to important issues in our lives
• Motivational interviewing may be used to engage challenged clients (clients who are not necessarily on board with treatment)
5 forms of cognition distortion
1) selective perceptions (noticing selective aspects of child’s behaviour - only bad behaviour, not realizing when child is cooperating)
2) distorted attributions (you only did that favour in order to control me)
3) inaccurate expectations (or predictions of what will happen - if i tell him how i feel, he’ll break up with me)
4) inappropriate/inaccurate assumptions (general beliefs about people and their relationships - “men don’t have a need for emotional attachment)
5) unrealistic standards (I must maintain a 4.5 gpa throughout my entire undergrad degree)
Operant conditioning
- behaviours are strengthened or weakened by altering the consequences that follow them. Focus on changing contingencies that were affecting behaviour, leading to new consequences
extinction - important basis for treatment
condition response fades or loses connection to antecedent event
counterconditioning
systemic desensitization
e.g.: relaxation and support techniques are taught, unwanted stimulus is slowly reintroduced -> school phobia
reinforcement
strengthens behaviour
punishment
reduces behaviour
positive vs negative punishment
positive: doing something
negative: taking something away
social learning theory
- origins in behaviourism
- ability to learn new responses through observing and imitating others
- theory that problematic interactions are learned (30% of children)
modeling
- form of social learning where people understand and copy useful behaviours from a valued role model
Motivational interviewing
- used to engage difficult (perhaps involuntary) clients
- “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (miller and rollnick)
- use of empathy, points out discrepancy between client’s values and behaviours, deals with resistance and supports self-efficacy
- designed to address ambivalence in clients
5 basic questions of motivational interviewing
1) why would you want to make this change?
2) how might you go about it in order to succeed?
3) what are the three best reasons for you to do it
4) how important is it for you to make this change
5) so what do you think you’ll do?
mindfulness
paying attention in a particular way: on purpose, in the present moment, and non-judgementally
- used to focus on paying attention to important issues in our lives
assertiveness training
people to practice behaviours to feel comfortable and gain social confidence
rational emotive behaviour therapy
- based on cognitive theory
- client is encouraged to make distinctions between objective fact in environment, and inaccurate, negative and self-limiting interpretations of one’s behaviour/life
cognitive restructuring
reveal faulty logic in client’s pattern of thinking, replace with rational and logical thinking
- major endeavor of rational-emotive therapy
attributions
explanations for relationship events/behaviours that have already occurred
- we make attributions about both positive and negative characteristics in each other
expectancies
predictions about other’s future ehaviour
relationship between attributions and expectancies
intent that one partner attributed to the other’s actions contributes to dysfunctional cycle.
-> aaron wants to sleep because he doesn’t want to hang with me
schemas
cognitive structures that organize thoughts and perceptions - core beliefs about the world
- people are not always aware of their schemas, can learn to identify and report them
goals in CBT
1) what are the schemas, what do they mean to you?
2) how did schemas become entrenched?
3) looking at benefits of changing now
4) helping people manage their schemas
5) moving on
Strengths of CBT
- strong research evidence (successful intervention for anxiety, depression, ocd)
- brief and structured, gets to core of what client wants to solve
Limitations of CBT
- does not allign with SW values of self-determination, agency, collaboration
- lies at centre of EBP debate (used with involuntary or unwilling clients - elderly, incarcerated)
- imposing social expectations on clients reflects authoritarian position
- technical nature - jargon and formal procedures may result in dehumanizing treatment
- opposite of standpoint theory - one’s personal experience/perception of the world is not validated
- Western model - emphasis on change at the level of the individual -> not at structural level (does not account for social problems - depression - caused by racism, sexism, ableism, etc)
