lecture 3

Question 1

Cognitive theory - Beck
mini diagram

Answer 1

dysfunction = interpretation of event - influences behaviours -maintains emotional problem
situation -> negative automatic thoughts -> reaction

Question 2

negative automatic thoughts

Answer 2

distortions in processing reflect the underlying beliefs and assumptions stored in memory - schemas

involuntary, rapid, negative

Question 3

Unhelpful Thinking Styles

Answer 3

Overgeneralization - applying conclusion to range of situations based on isolated evidence “nothing good ever happens”

Magnification or minimization  enlarging/reducing important events

Mind Reading - assuming people are reacting negatively to you despite lack of evidence for this

Arbitrary Inference - drawing conclusions without sufficient evidence

Question 4

schemas

Answer 4

Schemas shape interpretation of experience and effect behavior - behaviour to them is logical, not irrational, as based on underlying schemas

Act in a way that’s consistent with core beliefs (schemas)
Can be formed through early learning experiences

Question 5

cognitive theory principles
5 points

Answer 5

Emotional disorders are maintained by a thinking disorder (negative interpretation of events)

Negative interpretations involve distortions in thinking (thinking errors)

Biased processing manifests as automatic thoughts which are content specific

Distortions and automatic thoughts reflect - schemas

Individuals behave in a way that is consistent with their schemas (prevent disconfirmation)
Problematic as prevents disconfirmation

Question 6

behaviour

Answer 6

Behavior prevents them from gaining disconformity evidence
maintains or chnages psycholoical states

Question 7

Clarks panic model

+ drawing

Answer 7

Panic results from catastrophic misinterpretation (CM) of internal sensations

trigger stimulus -> perceived threat-> apprehension -> body sensations -> interpretation of sensations as catastrophic

Question 8

psychological therapy in practive

Answer 8

Improving Access to Psychological Therapies – NHS based treatment
CBT first line of treatment
If CBT doesn’t work Multi disciplinary for complex

Question 9

steps of psychological therapy

Answer 9

step 1 - D, assessment, active monitoring
step 2: low-intensity treatment i.e. guided self-help
Step 3: high intensity treatment i.e. CBT, EMDR, IPT, behavioral activation, psychodynamic therapy, counselling
Step 3+: Multi disciplinary treatment, often complex/recurrent cases

Question 10

efficacy of CBT

Answer 10

Recommended treatment in NICE Guidelines for treating psychological disorders
Effectiveness varies: Approximately 50% recovery in GAD, and MDD
Higher recovery in panic and social phobia
66% improve, but only 50% meet full recovery criteria

Question 11

interventions during COVID

Answer 11

Capobianco analused data from remote and in person therapy to see effects of remote delivery
both treatments significanty reduced symptoms over time
Remote therapy required treatment length would have been 16 weeks

face-to-face 24weeks

Question 12

issues w CBT

Answer 12

Relapse rates a problem, especially in depression
Some anxiety disorders are harder to treat (OCD, GAD)
Springer et al (2018) meta-analysis of GAD outcomes
Remission rates

Question 13

more issues w CBT - exposure

Answer 13

CBT is no more effective than exposure (PTSD, OCD; Fisher & Wells, 2005)ERP- exposure response prevention
This suggests that ERP rather than cog therapy may be most effective treatment for OCD
Efficacy of CBT seems to be falling  results getting worse

Question 14

metacognitive therapy principles:
4 points

Answer 14

Overcome theoretical limitations of CBT
- Psychological distress is maintained by a style of thinking (the Cognitive attentional syndrome (CAS))
- CAS includes worry, dwelling (rumination), threat monitoring, unhelpful coping strategies (thought suppression)
- CAS is driven by a set of metacog beliefs

Question 15

Negative/positive Metacognitive Beliefs

Answer 15

negative: Uncontrollability or dangerousness of worry
Positive: benefits/usefulness of worry

Question 16

Sun et al meta-analysis of metacognitive

Answer 16

(2017) meta-analysis of metacognitive beliefs in various psychological disorder
Negative MC regarding uncontrollability and danger seen across psychological disorders = strongest predictor of anxiety/depression

Question 17

Capobianco - metacognitive beliefs in patients with physical illnesses

Answer 17

systematic review of metacognitive beliefs in patients with physical illnesses
NMC positively associated with increased anxiety and depression across physical illnesses
Even after controlling for age, gender, disease factors and cognition

Question 18

Metacognitive Model of GAD (general anxiety disorder)
type 1 and 2 worry

Answer 18

Characteristics of GAD = Uncontrollable worry
Type 1 worry = worry about social, self and world - not sufficient to cause GAD
GAD develops when negative metacognitive beliefs are activated
Type 2 worry (meta-worry)- Worry about worrying

Question 19

behavioursin GAD

Answer 19

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition
More thinking
Suppression of trigger thoughts
Reassurance seeking
Avoidance

Question 20

MCT for GAD

Answer 20

Generate case formulation
Share case formulation
Challenge uncontrollability metabeliefs
Challenge danger metabeliefs
Challenge positive metabeliefs

Question 21

efficacy of metacognitive therapy

Answer 21

Normann & Nexhmedin (2018) - metanalysis
25 efficacy studies of MCT, 15 were controlled trials
MCT significantly more effective than waitlist
MCT significantly more effective than CBT and follow-up
Conclusions: Results suggest that MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT