Lecture 7 Flashcards
What is very important in CBT that is often not acknowledged?
Emotions
When did behavior therapy emerge?
What was it trying to do?
Late 1950’s
Systematic approach to assessment and treatment based on principles and procedures of classical and operant conditioning i.e. learning theory
What is classical conditioning and who discovered it?
Ivan Pavlov
- UCS (food) > UCR (bell)
-Bell paired with food
- CS (bell) > CR (dog drools)
- used as Systematic desensitization
What is operant conditioning and who is responsible?
B F Skinner
- the assumption that behaviour is learned by its consequences
- reinforcement increases
punishment decreases
- star chart, time out
What is social learning theory and who is responsible?
Albert Bandura
Behavior is learned by social modelling (observing others)
Eg fear of dogs
What is REBT and who made it?
Rational emotive behavior therapy
- Albert Ellis
- the first DBT approach
- Self-defeating beliefs lead to emotional pain
- ABC model
What and who made cognitive therapy?
Aaron T Beck (1921-2021)
- Similarities with REBT/Ellis about changing cognitions to alter behaviour, but a gentler approach drawing from Person- centered approach too
What are 5 common characteristics of CBT today?
1) commitment to a scientific approach
2) Most types of unhelpful behavior are regarded as “problems of living”
3) Assumed to be acquired and maintained the same way as helpful behaviour
4) Assessment focuses on current rather than historical determinants of behavior
5) Treatment involves analysis of the problem into sub-parts, with strategies targeted to specific parts
What method is CBT committed to?
The scientific method
- Mental health profession emphasizes evidence-based therapy: what works for whom and with what problems?
- Because CBT encourages the development of concrete, specific goals and has specific and testable techniques, it is easily researched
What are 3 areas CBT has found to be effective?
1- mental health problems (depression, anxiety, PTSD/trauma, eating disorders, substance abuse/dependence
2 - Medical condition eg chronic pain
3 - Social and interpersonal problems ie anger, couple distress
What is the focus of CBT?
Cognitive restructuring
Core belief/schema > intermediate belief (rules, attitudes and assumptions) > Situation (AUTOMATIC THOUGHT) > reaction (which can be emotional, behavioral or physiological)
What is the 5-part model diagram?
Padesky and Greenberger, 1995
Draw it - Environment > situation = thoughts, emotions, behavior and physical reactions interlinked
What are the essential elements of CBT? (7)
1 - CBT conceptualization/ever evolving formulation
2- Phenomenological emphasis
3 - collaborative therapeutic approach
4- use of Socratic q’s (open-ended) and guiding discovery (empathetic listening, summarizing, synthesizing and analytical questions)
5- consistent therapy structure
6 - emphasis on empiricism (hypothesis testing)
7 - Teach client to become own therapist
What is the cognitive model for anxiety?
1) Threat appraisals are made for:
-view of self as vulnerable
- view of environment/world as threatening
- view of future as unpredictable
2) Overestimation of danger and underestimation of ability to cope
What are the 2 CBT interventions for anxiety?
1) behavioral interventions - psycho-education, mood monitoring, diaphragmatic breathing, graded exposure
2) cognitive interventions - thought records and through challenges, behavioral experiments, core-belief work
What is the cognitive model for depression?
Negative cognitive triad (Beck)
- negative view of self (I’m worthless)
- Negative view of the world/environment (no one values me)
- Negative view of future (things can only get worse)
What are cbt interventions for depression?
1) behavioral interventions - psycho-education, activation, mastery and pleasure (what I can do, what I enjoy)
2) cognitive interventions - thought records, behavioral experiments, core belief work
What are some aspects for using CBT with younger people? (9)
1) strong therapeutic rel’n (flexible, empathic, non-judgmental)
2) age appropriate language
3) be creative! adapt techniques
4) make CBT relevant to daily lives
5) collaborate and engage them in decision making
6) explore issues related to pairs
7) family involvement where possible/appropriate
8) integrate digital tools
9) peer support group
What are considerations for CBT with older people? (10)
1) respect for wisdom and life experience
2) consider health concerns
3) make CBH relevant to age-specific concerns
4) address grief and loss
5) adjust pace of therapy and identify cog challenges
6) provide memory aids
7) involve family if appropriate
8) emphasise strengths/resilience
9) focus on social connections
10) focus on finding helpful meaning in older age
How does CBT fit in NZ?
Bicultural - so think beyond individual framework
- Te Tiriti o Waitangi = partnership, participation, protection
- powhiri - welcome others into our whanau
- Tikanga - customs matter, we think about respectful ways of doing things
- Te whare tapa wha (Durie, 1994) -
In CBT the focus is on what wall of whare model?
Te taha hinengaro. But important to consider other 3
What are some cultural adaptations to use with Maori clients?
Invite clients to open sessions with
karakia or whakatauki
■ Greater self-disclosure by clinicians
to establish family
background/heritage and connection
with the client
■ Greater emphasis on whakapapa
through use of genograms
■ Use of Māori terms and phrases
where appropriate
Integration of Māori model of health
such as Te Whare Tapa Wha
■ Use of visual representations /
diagrams of CBT concepts
■ Greater emphasis on the role of
spirituality and whanau involvement
■ Use of metaphors such as the
skateboard model by Tania Cargo
What are some of the pros of CBT?
evidence based
- structured and goal orientated
- emphasizes the present
- can be individualized
- contextual
- collaborative
- focuses on clients developing skills
Cons of CBT?
Requires active participation
- limited focus on past issues
- may not be suitable for everyone
- origins in western psych so need to consider cultural factors and nuances
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