Lecture 7 - Cognitive Therapy and CBT Overview

Question 1

What are the core features of CBT?

Answer 1

➢Structured… clear beginning, middle and end
➢Short-term (e.g., 6-20 sessions)
20 sessions = length for eating disorders, more complex, depends on symptoms
➢Present-oriented
-not focused on the past
➢Empirical
▫Both from a nomothetic and idiographic perspective
➢Directed toward modifying dysfunctional thinking (main goal)
➢Treatment based on cognitive case conceptualization/formulation for individual client
-Cognitive conceptualization done in collaboration with client
➢Techniques designed to produce cognitive change
▫At level of daily automatic thoughts AND more basic beliefs
-Try to modify the thought part of the cognitive model

Question 2

Describe the cognitive model

Answer 2

Situation: something happens
Ex: You walk by two people and they start laughing.
-
Thought: the situation is interpreted
Ex: ?? (this part is what we can work on)
-
Emotion: a feeling occurs as a result of the thought
Ex: embarassed
-
Behaviour: an action in response to the emotion
Ex: walk faster

In the thought part, core beliefs feed into intermediate beliefs (rules, attitudes, assumptions) which feed into thoughts.
See interactive systems

What we try to modify in CBT are the thoughts!

Question 3

What are the 14 principles of CBT?

Answer 3

1.Based on ever-evolving cognitive conceptualization
*Developed based on evaluation; refined based on ongoing sessions
-done in collaboration with client

2.Requires sound therapeutic alliance

3.Continually monitors client progress
*Using symptom-and function-based outcome measures

4. Culturally adapted and tailors treatment to the individual
   *May need to adapt approach for individuals from different cultures
5. Emphasizes the positive
   *To counteract the negative of most depressed clients
6. Emphasizes collaboration and active participation
   *View therapy as “team work”; collaborative empiricism

7.Aspirational, values-based (more ongoing, long-term), goal-oriented (more short-term)

8.Initially emphasizes the present
*“Here-and-now” focus
*Explore past to understand patterns of beliefs
-Etiology (cause) of someone’s mental problems is not necessarily the same as the maintenance processes
-Exploring the past comes later (and sometimes not even necessary)

9. Aims to be educative
   *Educate client on cognitive model and techniques
   *Teach client HOW to evaluate dysfunctional thoughts
   -Educate client on why and how
   -Client must understand to be able to generalize outside of therapy
   -Trying to teach client to be their own therapist sort of
10. Aims to be time limited
    *Straight-forward clients: 6-16 sessions
    *Some clients require a year or more in treatment
11. Consists of structured sessions
    *Maximize efficiency and effectiveness
    *Check-in (=mood), agenda (what are we gonna talk about today (client brings and therapist brings), “business of week” (cover the agenda, wrap-up ), feedback (how do you think this session went)
12. Teaches patients to identify, evaluate, and respond to dysfunctional beliefs
    *“Guided discovery”… lead client to the answer
    *Behavioural experiments… testing out
13. Includes “Action Plans” (therapy homework)
    *“Anything we want clients to remember is recorded”
14. Uses a variety of techniques to change thinking, mood, and behavior
    *Not just cognitive strategies are used
    *Can pull techniques from other treatment approaches

Question 4

Cognitive model example with Lucy, a student with depression

Answer 4

What the therapist was doing in the video:
Focused on a particular situation
Asked about thoughts, feelings (emotions, and distinguishing from thoughts), physiological symptoms and the behaviour
Asked about how feel afterwards… to show that what doing doesn’t make them feel better
Taking notes… to show later