Lecture - CBT Flashcards
What are the modalities of psychotherapies?
The ‘other’ group have a good evidence base but are rarely used in the NHS.
How did behaviour therapy develop? What is the main theory backing it?
Started with behavioural therapy
1950s/60s – Wolpe/Eysenck/Skinner
Arose as reaction against dominant Freudian psychodynamic psychotherapy – ‘not empirical’
Learning Theory: how individuals learn associations between STIMULI and RESPONSES. BASED ON THE IDEA THAT MALADAPTIVE BEHAVIOUR IS LEARNED, THEREFORE ADAPTIVE BEHAVIOUR CAN ALSO BE LEARNED
What is the difference between operant and classical conditioning?
Operant Conditioning - rewards “behaviour modified by consequence” eg social skills training (learning difficulties) e.g star for good behaviour
Classical Conditioning – stimulus/response “behaviour modified by antecedent” e.g. Pavlov’s dog, ringing bell caused salivation before dogs even saw the food
What is reciprocal inhibition conditioning?
Train the patient to use relaxation so that they become really good at it
“anxiety inhibited by a feeling or response not compatible with the feeling of anxiety” i.e. using relaxation techniques
Led to:
- Systematic Desensitisation (Wolpe)
- overcoming fear gradually (hierarchy)
- & pairing with relaxation (phobias)
What does this show?
With each exposure the anxiety gets lower. Basis of CBT
What does escape/avoidance cause?
It causes a rapid decrease in the fear but the person will never learn to reduce anxiety in the long term so it is quite damaging
What kinds of exposure therapies are used in CBT?
- Hierarchies
- Gradual exposure
- Habituation
- Extinction
- Safety behaviours -Salkovskis (‘91) - this is what you are trying to avoid the person from doing
What is behaviour therapy useful and not useful for?
Underlying principle - what we do has a powerful influence on our thoughts and emotions
BUT although successful with simple phobias and OCD, pure behaviour therapy had very limited success with other anxiety disorders and depression
How did cognitive therapy develop?
Aaron Beck – 1960s:
Cognitive Therapy Psychoanalyst researching depressed patients - discovered stream of parallel thinking spontaneous, fleeting negative ‘automatic thoughts’
(NAT’s) - negative cognitive triad (!)
What is the Beck’s negative cognitive triad?
Negative views of
- World
- Self
- Future
What was the precursor of CBT? What acronym was used?
ABC of CBT
- A - activating event
- B - thoughts, attitudes, asumptions
- C - behaviour or emotion, cosequences
NB: ABC meaning (antecedent)(behaviour)(consequence) is different
What is the basis of this kind of response?
Negative automatic thought
Transference affects this
How is formulation done (cognitive model)?
Explore:
- Origin
- Current status
- Maintenace
Done in collaboration
Different types of formulation e.g. cross-sectional, longitudinal
Describe this longitudinal formulation.
Failure can lead to the bottom cycle which can lead to depression.
Give an example of the cross-sectional formulation.
This may be useful if you are trying to figure out if CBT would be useful for the patient.
What would the formulation be for this patient? (next card)
What initial behavioural component can be used in CBT? Why might this be difficult?
Difficult already to do things for a person with depression.
Can be made easier if you tell the person to fill in what they do when they have their breaks.
Can be useful as helps them see patterns which are useful and which you can increase.
A - achievement; P - pleasure
- Stopped doing enjoyable activities
- Avoiding family and friends
- Isolating self in bedroom
- Using more alcohol to cope
Goal:
- Restart pleasurable activities eg reading, gardening
- Decrease avoidance of family and friends eg stay up with family until 10.00 p.m.
- Gradually reduce symptomatic use of alcohol
What is used to target negative automatic thoughts (NATs) in CBT?
A thought record is used which is a table as shown below.
- Identify situations that lead you to feel worse
- Where you were, what was happening.
- Describe the emotion and rate from 0-10.
- What was going through your mind at the time (words / images)
What do we do with the thought record?
- Identify the cognitive distortions
- Challenge
- ‘Chain down’to deeper levels
You look at their thoughts and ask them if it fits with any of the cognitive distorsions below.
Cognitive distorsions
Cognitive distortions allow events to fit in with underlying assumptions and beliefs
Assumption - ‘In order to be happy I must be liked by everybody’
Cognitive error - ‘mind reading’
How do you challenge distorsions?
- Tools/techniques - behavioural experiments/ thought records
- Guided discovery - socratic questioning
What is the evidence?
What alternative views are there?
What is the effect of thinking the way I do?
It’s not about ‘positive thinking’ but more FLEXIBLE BALANCED thinking
- Developing a therapeutic relationship
- Empathic and collaborative
- Socratic questioning
- Time-limited
- Agenda-setting / goals
- Formulation
- Homework
- Relapse prevention
