Introduction to CBT Flashcards
How does Beck define CBT?
An active, directive, time limited structured approach… base on an underlying rationale that and individuals affect and behaviour are largely determined by the way in which he structures the world.
1) What are the main ways CBT works?
2)What should we ask ourselves within CBT?
1)-Distance and disidentification
-Elicits alternative perspectives
-Metacognitive awareness
2)Ask yourself
“If I constructed that framework, would I see the world as they do?”
“Would I feel as they do”
1) What is the Epictetus quote that best represents the CBT model?
2) Summarise the quote given?
1)“Men are disturbed not by things but by the views which they take of them… when, therefore, we are hindered, or disturbed, or grieved, let us never blame anyone but ourselves: that is our own judgments”
2) It is not events in themselves that matter, but rather the meaning of these events to the individual
How does the 2 arrow Buddhist parable fit with the CBT model?
What are some of the main tenents behind CBT?
-Thoughts and feelings are linked
-Beliefs and assumptions (cognition) may underlie and help explain emotions/affect
-Collaborative method
-Uses experimental and behavioural assignments to facilitate change/modification of thoughts and feelings
What are some of the key elements of collaborative practice within CBT?
-Developing compatible goals
-Minimises client ‘resistance’ (ie therapy is not ‘done to’ the client, but instead the work is ‘done with’ them)
-Rapport – function as a team, develop a style of therapy suitable to needs of individual clients
- Deciding when to talk/listen, confront/back off, offer suggestions/make own suggestions
Focus on most important problem
Explaining rationale – demystifies therapy improves adherence to homework tasks etc.
What are the levels of cognition identified in CBT?
-Automatic Thoughts
“I am being boring / I can’t think of anything worthwhile to say / they don’t like me / this will never work”
-Dysfunctional Assumptions
“If people get to know me they will find out how useless I am & reject me”
“If I try to be perfect 100% of the time, my uselessness will remain hidden”
-Core Beliefs / Schema
“I am unlovable / I am defective”
What are the assumptions behind the CBT model/cycles?
Therefore, how do we go about solving these problems via the CBT model?
Problems are the result of interactions between ‘mind’, ‘body’ and environment (physical, social, economic, cultural…)
To understand problems, we need to model these interactions – ‘diagnosis’ is not enough, because across different people the same diagnosis may conceal idiosyncratic maintenance processes
What does a good socratic question do?
1…the client has the knowledge to answer
2…draw the client’s attention to information which is relevant to the issue being discussed, but which may be outside the client’s current focus
3…generally move from the concrete to the more abstract so that…
4…the client can apply the new information to either re-evaluate a previous conclusion or construct a new idea
Give an example of a trail of socratic questioning?
Situation: My heart races really fast when I get on the bus
What do you think is happening when your heart is racing?
If you were to pass out, what do you think is the worst thing that could happen from that?
What are some of the common problems you might run into with socratic questioning?
1Patient avoids distressing cognitions
2“Yes, but…” responses
3Aimless, meandering questions
4Exploration but no synthesis – ‘therapist drift’ Waller (2008)
How could we set-up/sell the need for an agenda?
Short-term problem-solving therapy
Limited time – used efficiently
Imposes structure
What are the main criticisms of CBT?
-CBT is often criticised for only addressing the current problem, or focussing on only specific issues rather than any underlying difficulties such as an unhappy childhood -NHS Choices (2010)
Commonly referred to as ‘technique-y’ or just about the here-and-now, although as the longitudinal formulation and treatment recommendations demonstrate, this criticism isn’t completely accurate…
-Another limitation of CBT is that the model focuses on the individual’s capacity to change themselves (thoughts, feelings, behaviours) and doesn’t address wider problems in families and other systems and environmental factors that might maintain distress
-Reinforces the dominant cultural value (individualist versus collectivist)
What’s a critique of the CBT evidence base?
The effect of CBT seems to be reducing over time
Increase popularity = increase in inexperienced therapists?
Placebo effect? (it was, after all, the ‘miracle cure’) – Has this now worn off due to reduced expectations of the outcome of therapy??
e.g. Johnsen & Friborg (2015).
-CBT is not as effective as some would want us to believe
-Reviews indicate that two-thirds of CBT clients go on to relapse and/or seek further treatment within two years Weston et al. (2004)
-Review of meta-analyses has shown that the effects of CBT are extremely low, largely as a consequence of methodological flaws in the evaluations Wampold et al. (2007)
What are some of the critiques of CBT in terms of social difference?
CBT theory is Eurocentric, which doesn’t account for other communities/cultures in terms of how distress is conceptualised
e.g. CBT’s emphasis on rational thinking can devalue Asian-Muslim spirituality and tendencies towards emotional expressiveness
-Very few evaluations of the effectiveness of psychotherapy include adequate numbers of racially minoritised groups Alvidrex et al. (1996
