Cognitive Behavioural Therapy Flashcards
Who developed CBT?
Aaron Beck (1979)
What observations is CBT based on?
Common thinking styles and themes in depression sufferers, and common behaviours
Key ideas of CBT summarised
What you think and do affects the way you feel
Skinner (1953)
Reinforcement Positive reinforcement Negative reinforcement Punishment Frustration
Skinner reinforcement
The notion that the way in which we behave can be reinforced by positive or negative reinforcement
Skinner positive reinforcement
Rewarding good behaviour
Skinner negative reinforcement
Behaviour leads to the removal of a negative stimulus or feelings
E.g. crying when hungry and getting fed reinforces crying behaviour
Skinner punishment
Adverse consequences for bad behaviour, attempts to stop behaviour
Skinner frustration
If you expect a reward for a behaviour and that reward does not come, you may become unmotivated to perform that behaviour
Ferster (1973)
The depressed person’s activities function as avoidance and escape from aversive thoughts, feelings or external situations
Reduced access to pleasure and satisfaction are consequences of avoidance
Lewinsohn (1974-76)
Social reinforcement theory
Lack of social reinforcement of adaptive behaviour
Depressive behaviours can also become reinforced (sympathy, help)
Who developed the first behavioural treatment for depression?
Lewinsohn
Ellis (1957)
Emotions influenced by appraisals Irrational beliefs cause suffering's A - antecedent B - beliefs C - consequences
Beck (1979)
Focus on modifying cognitive biases and maladaptive behaviours that maintain emotional disorders
Beck (1979) cognitive triad beliefs (depression)
Core beliefs about the self (I am useless)
Core beliefs about others (Others are better than me)
Core beliefs about the future (No matter how hard I try I will never amount to anything)
How does the cognitive triad work in depression?
Core beliefs about self, others and future feed into conditional beliefs which are rules that help us navigate interpersonal relationships and interactions (If I get close to others, they will eventually reject me)
This then feeds into automatic thoughts (I will make a fool of myself, people will think I’m the odd one out, nobody will talk to me, I’ll feel awful)
Can be triggered by social situations (being invited to the office party)
Beck (1979) cognitive triad beliefs (generalised anxiety)
Core beliefs about self (I am unable to cope and protect myself)
Core beliefs about others (others are threatening, the world is dangerous)
Core beliefs about the future (terrible things can happen at any moment)
How does the cognitive triad work in generalised anxiety?
Core beliefs about self, others and future feed into conditional beliefs which are rules that help us navigate interpersonal relationships and interactions (If I leave the house something bad will happen)
This then feeds into automatic thoughts (What if I get lost? What if I get robbed?)
Can be triggered by everyday events (needing to go shopping)
All or nothing thinking
If I am not perfect, I have failed
Mental filter
Only paying attention to certain types of evidence, noticing failures but not seeing successes
Jumping to conclusions
Mind reading - imagining what others are thinking
Fortune telling - predicting the future
Over generalising
Seeing a pattern based upon a single event, or being overly broad in the conclusions we draw
Disqualifying the positive
Discounting the good things that have happened or that you have done for some reason or another
Magnification (catastrophising) and minimisation
Blowing things out of proportion
Inappropriately shrinking something to make it seem less important
Role of case formulation in CBT
Explanatory models for an individual’s differences
Usually includes predisposing, precipitating and maintaining factors
Emphasis is put on current cycle of distress
Guides the selection of relevant treatment strategies
Idiographic formulation
A specific formulation for an individual given that the individual’s life history
Disorder specific formulation for panic disorder
Clark (1986) Trigger Threat perceived Anxiety Body symptom or mental symptom Catastrophic misinterpretation (I am dying) (final three in a cycle)
Disorder specific formulation for social phobia (Wells and Clark, 1997)
Social situation
Activates assumptions
Perceived social danger -> somatic and cognitive symptoms and safety behaviours
Processing of self as a social object (from and feeds into perceived social danger)
Epictetus quote
Human beings don’t suffer because of the things that happen to them; human beings suffer because of what they think about the things that happen to them
Common strategies in CBT
Goal setting Behavioural activation Graded exposure Cognitive restructuring Behavioural experiments Problem solving Attention training Automatic thought record
Goal setting
Long-term - reconnect with meaningful others
Short-term - get out of bed for a few hours a day
Behavioural activation
Gradual activity scheduling in a way that the easiest is scheduled first, gradually moving on to the more difficult ones
Graded exposure
Gradual exposure to the anxiety inducing stimuli
Cognitive restructuring
Central technique
Recognising the ways in which your thinking may be problematic and changing this
Behavioural experiments
Experiments set up to check whether core beliefs are true
When your belief doesn’t come true, it changes your belief
Problem solving
Enables people to work through problems in a systematic way
Weigh up the pros and cons of different decisions
Gain a sense of control over problems
Attention training
Used when paying attention to specific components of the environment or in the body are the problem
Retrain to pay attention to other things
Automatic thought record
When you notice your mood getting worse, ask yourself ‘what is going through my mind right now?’
Fill in table with columns of: Situation Automatic thoughts Emotions Adaptive response Outcome
Key principles of CBT treatment in practice
Structured and time-limited Goal oriented Emphasis on the present Change oriented Active Evidence-based Collaborative empiricism Educational
Structured and time-limited
Sessions have an agenda
There is a set number of sessions
Goal oriented
Focused on the defined problems and targets
Emphasis on the present
We consider relevant history to make sense of the problem but mainly focus on finding ways to improve wellbeing today
Change oriented
Promoted changes in how we think and/or behave
Active
CBT involved talking, but is primarily a doing therapy, patients are encouraged to practice skills in between sessions
Evidence-based
Guided by case formulation, grounded in research data, use of validated outcome measures to assess progress
Collaborative empiricism
We work as a team to learn about what maintains problems, take an objective view about our internal and external worlds
Educational
We use psycho-education and guided discovery to learn about ourselves
Traditional high intensity CBT
Individual psychotherapy (typically 16-20 sessions, 1hr/week) Group-based
Contemporary low intensity CBT
Self-help (biblio-therapy)
Individual guided self-help (<8 sessions, 30mins/week, in person and/or via phone)
Computerised CBT (online modules, forums, apps)
Large group psycho-educational CBT (e.g. stress control classes)
Less costly and quite effective for common psychological problems
