Cognitive Therapy Flashcards
Starting point CT
“Psychopathology stems from the way in which information is selected and processed. Cognitive therapy focuses on awareness and influencing of these processes through critical reflection and testing against empirical reality ”
Cognitive restructuring
Beck: Cognitive therapy (CT)
Theory: Dysfunctional schedules (schemas?) ensure the development and maintenance of complaints.
Treatment: Detect dysfunctional cognitions and maladaptive schema’s change them into functional cognitions and functional schema’s to influence emotions and behavior
Characteristics of schema’s
`• Rigid thinking patterns about the relation with others, the world, the future and about oneself.
- Patient is convinced of the truth of these thinking patterns
- Stressful for the patient
Basic assumptions
Fundamental views on oneself, others, the world and the future.
Characteristics: general, rigid and overgeneralized
Example:
- Being helpless
- Not being loved
Depression: Cognitive Triade
“The central tenet of Beck’s (1987) highly influential cognitive theory of depression holds that depressed relative to nondepressed persons think more negatively about themselves, their world, and their future. This constellation of negative beliefs (e.g., “I am worthless, everyone hates me, and nothing will ever go well for me”) is called the cognitive triad of depression.
(Beck, 1970,1987; Beck, Rush, Shaw, & Emery, 1979, pp. 11-12). “- (McIntosh, C. N., & Fischer, D. G. (2000). )
Causes of depression
- Genetic factors
- Social and environmental factors
- Chemical disruption
- Hormonal disruption
• Negative life events/negative thoughts
Depression and cognitive processes
- Focus on negative material
- Attention continues to “stick to negative material“
- Recall mood matching material
- Difficult with specific memories
- Ruminate
Cognitieve model: Depression
Goal of cognitive restructuring in patients with depression.
- Helping to clarify which opinions/cognitions are responsible for the onset and course of psychopathology
- CT is a method to learn the patient to doubt the truthfullness of ones cognitions and opinions and replace dysfunctional cognitions by functional cognitions.
Cognitive restructuring in practice
“Identify and modify our default ways of thinking about things to be more flexible and realistic.”
Theory of depression(Beck)
The function of schema’s
- Perception of information
- Interpretation of information
- Transformation of information
- Memory, recall of information
- Decision making based on information
Automatic thoughts
“Specific words or sentences about oneself that arise in a stressful situation leading directly to dysfunctional negative feelings.”
Examples of themes and automatic thoughts
Responisbility/guilt:
I am a bad person
Safety
I am vulnerable
Selfworth
I have to be perfect
Freedom of choice
I cannot succeed
Thinking error cycle
Unhelpful thinking styles
- all or nothing thinkig
- mental filter
- jumping to conclusions
- emotional reasoning
- labelling
- overgeneralising
- disqualifying the positive
- magnification (catastrophising) & minimisations
- soulds and musts
10 “personalisation (this is my fault)
Cognitive restructuring
Part 1: Registration
- Problematic situation
- Emotion
- Automatic thought
* 4. Behavior (not in low intensity)*
Part 2:
- Prove of automatic thought (not in low intensity)*
- Prove against automatic thought (not in low intensity)*
- Alternative response
- Outcome: %
- Prove against automatic thought (not in low intensity)*
Thought record
Verbal techniques
Socratic dialogue
Exploring basic assumptions on a fundamental level.
Aim: change the viewpoint of the patient
Therapeutic attitude: open, transparent, untaught
Examples questions:
- What prove do you have that this is true/false
- What what you tell a friend in the same situation?
- What is the worst thing that can happen?
- What is the most realistic outcome?
- What is the effect of thinking in this way?
- How functional is this assumption for you?
- Is there another way of looking at this?
Cognitive processes in general
- Memory
- Interpretation
- Perception
- Attention
Procedure
- Step 1: Analyzing the problem
- Step 2: Introduction thought record
- Step 3: Register situations directly connected to the problem
- Step 4: fill in thought record
- Step 5: Evaluate and adapt
Case
Victor, male, 36 years old
Feels depressed most of the days. Works very hard but does not enjoy it. Feels exhausted, stressed and sleep problems. Takes stress out on his two young children. Shouts at them and is very impatient when they do not listen. He sais he is a bad father.
Marriage problems, wife is cheating and drinking to much. He worries a lot does not want a divorce. The thought makes him feel worthless, a failure.
Diagnose: Dysthymia
Relation: Married
Work: Dentist
What do we do?
Step 1. I found out my wife is cheating on me. Ichecked her phone and found out she is having an affair
step 2: Examples • ”I feel guilty” “I am guilty of neglecting my children and that makes me sad” • “I feel worthless” “I think that I am a worthless dad and that makes me anxious” • “I feel betrayed” “My partner is cheating and I feel angry”
step 3: …
Step 1: (Case of Victor, male 36)
Select a problematic situation
Questions:
- Describe the situation like looking through a camera and stop it at the worst moment/
- Describe the situation in 2-3 lines.
- Describe briefly what exactly happened.
Step 2: Feelings/emotions
Examples:
• ”I feel guilty”
“I am guilty of neglecting my children and that
makes me sad”
• “I feel worthless”
“I think that I am a worthless dad and that
makes me anxious”
• “I feel betrayed”
“My partner is cheating and I feel angry”
Step 2: Feelings/emotions
Register & rating feelings (scale 1-10).
- Fear
- Anger
- Sadness
- (Disgust)
Questions:
• 1. What feeling did you have in the worst moment of the problematic situation?
- Try to describe the feeling you had in the situation in one word
More then one feeling? (Step 2)
- Which feeling is the most dysfunctional?
- Intensity does not fit the situation
- Feeling the is directly responsible for the dysfunctional behavior
- • What would others see as the most dysfunctional feeling?*
- • Which feeling hinders you the most*
Automatic thought (practically)
Select the ‘hot thought’
Questions:
- At the moment that you felt sad what did you think?
- What other thoughts arose?
- Which thought was directly related to the emotion?
Examples of rephrasing:
- Thought: What have I done wrong?
Ask: What is your answer to that??
- Thought: I hope I never see him again!
Ask: Because….?
- Thought: O No…
Ask : Can you finish that sentence?
Select most important automatic thought
Hot thought’
- Most related to the most dysfunctional feeling
- Most central
- Dysfunctional
- Testable
Questions:
- If we could delete one thought, which one would that be?
- How did you want to respond and what thought prevented you form doing so?
Evaluate automatic thought
- Is the thought helpful?
- Is the thought true?
- Is the thought rational
Questions to evaluate the automatic thoughts
- Is the thought helping me to solve the problem?
- What is the evidence?
- How can I know what other people think?
- How can I predict the future?
- Don’t I forget to look at the bright side?
- How would I react if it happened to a friend?
- What would another person think in my situation?
- How big is the chance that this would really happen?
“I am worthless” (evaluation of thought)
Evidence supporting the thought:
- My partner cheats on me
- I shout at my children
Evidence against the thought:
- I am a good dentist
- I am a loving partner
- Most of the time I treat my children kind
- I am friendly
Alternative response
Characteristic:
- Is a direct result of the evaluation of the automatic thought
- Puts the automatic thought in perspective
Examples of alternative responses
I am a bad person
“I can learn from my mistakes and change”
I am vulnerable
“I can protect myself”
I have to be perfect
“I can be myself”
I am a worthless
“I am valuable”
Effect of thought evaluation
What is the credibility of the alternative response?
Test:
- Recall the problematic situation
- Replace the automatic thought by the alternative response
- What is the intensity of the feeling?
- Has the feeling decreased?
Evidence
- CBT is effective in patients suffering from depression.
- CBT with cognitive restructuring only is little less effective then CBT with various
- BA+ cognitive restructuring is as effective as BA alone.
cognitive model
