Overview of CBT Flashcards
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What is the main focus of CBT?
Looking at problems in the present - instilling a sense of hope and control over your own life
Changing unhelpful ways of thinking and behaving so they can have an enduring positive impact on their mood and functioning themselves
Developing some coping mechanisms can be applied and improved upon in multiple circumstances, even after therapy is over (the Sleeper Effect)
Doesn’t ignore developmental origins (as understanding some of these will inform the understanding of the automatic thoughts etc.) but isn’t of primary importance
What are some advantages of CBT?
Skills learned extend their use beyond the therapeutic scenario, for the rest of the persons life if they need
Well researched and shown to be effective across multiple different disorders (e.g. anxiety, depression, eating disorders etc.) + physical disorders with prominent psychological components (e.g. migraine headaches, terminal cancer, functional disorders)
Can be manualised e.g. a protocol can be written, tailored to a specific patient group, and taught to and delivered by therapists with more general training
What are some disadvantages of CBT?
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What is the difference between thoughts and emotions?
Thoughts = ideas, usually expressed in several/many words
Emotions = feelings, that can be expressed in one word
Sometimes thoughts can masquerade as emotions e.g. “I feel like it’s so unfair” - if you want someone to explore how they are actually feeling, you might follow it with “so how did that thought make you make you feel emotionally?”
What does the ‘Cognitive Model’ involve?
Situation -> automatic thoughts -> reactions (emotional/physiological/behavioural)
This informs the delivery of CBT - change the automatic thoughts, change the ways of feeling and being in the world
What are automatic thoughts?
Thoughts that arise in our minds spontaneously, without conscious effort
Most of the time we’re not aware of our automatic thoughts - instead we are more likely to notice a change in our reactions e.g. engaging in an unhelpful behaviour, feeling more tense etc.
Multiple different automatic thoughts can lead to the same reaction, or to different actions
Automatic thoughts can lead to reactions which lead to more automatic thoughts about the reaction (and so on)
Can be in reference to a situation happening right now, or imminently
Can be ruminant over the past or involve making negative predictions
Can be about a situation, their thoughts, feelings or behaviours
Some of these automatic thoughts are actually images
“People’s reactions always make sense once you understand what they were thinking”
What do you focus on when assessing the automatic thoughts in depression?
Looks at cognitions about:
The self
The world
The future
What do you focus on when assessing the automatic thoughts in panic disorder?
Thoughts of:
Catastrophe that the client is afraid will happen if a symptom gets worse
e.g. “my chest feels tight, im having trouble breathing - it measn iI’m having a heart attack”
What do you focus on when assessing the automatic thoughts in obsessive compulsive disorder?
We tend not to focus on the automatic thoughts themselves, instead focusing on the beliefs about their obsessive thinking and their compulsive behaviours
What are core beliefs?
People’s most basic understandings about:
- Themselves
- Their worlds
- Other people
They are filters/lenses with will affect how you perceive the world at the deepest level
They might be unconscious (if not reflected on in therapy) and difficult to shake/change
What happens to core beliefs in mental illness?
They are highly dysfunctional
- Negative
- Rigid
- Overgeneralised
Tend to fall into 3 categories: - Helplessness - Unlovability - Worthlessness The inverse of these three is true in mental wellness
People with ‘personality disorders’ may have long lasting dysfunctional core beliefs, but for people who are typically mentally well then experience an episode of mental unwellness - there is a change from positive/adaptive core beliefs to dysfunctional
What are some examples of ‘unlovability’ core beliefs?
"I dont fit in" "I'm unloveable" "I'm worthless" "I have nothing to offer other people" "I'll be rejected" "I'll be abandoned"
What are some examples of ‘helplessness’ core beliefs?
3x subcategories:
Ineffective in getting things done-
“I’m incapable”
“I’m helpless”
“I can’t do anything right”
Ineffective in being able to protect themselves (emotionally or physically) - "I'm vulnerable" "I'm powerless" "I'm weak" "I'm out of control"
Ineffective as compared to other people -
“I don’t measure up”
“I’m a failure”
“I’m not as good as other people in terms of achievement”
What are some examples of ‘worthlessness’ core beliefs?
Not like they are worthless in comparison to others, but instead they are morally bad - there is something inside them that is fundamentally awful
“I’m bad”
“I’m worthless”
“I’m evil/toxic”
“I’m a danger to other people”
What are some examples of negative core beliefs about other people?
That they are:
- Out to get you
- Fundamentally untrustworthy
- Going to hurt you
- Going to manipulate you
- Superior to you
- Demeaning to you
- Critical of you
etc.
What are some examples of negative core beliefs about the world?
The world is fundamentally:
- Hostile
- Dangerous
- Doomed
What are assumptions/rules for living?
The products of core beliefs:
The core beliefs will guide your worldview, how you expect to see the world e.g. assumptions/expectations
The assumptions are represented in mind in an “if X then Y” format i.e. if in a romantic relationship then you should receive all the attention of your partner
What are coping strategies?
The products of assumptions/rules for living:
Behaviourally how these assumptions are manifested in the world
The characteristic ways that clients behave in order to protect themselves from the activation of their core beliefs
What is a cognitive conceptualisation diagram (CCD)?
SEARCH FOR A PICTURE EXAMPLE
They are completed from the bottom up
Try to think of multiple different situations as examples as it will make it easier to identify the coping strategies
The meaning of the automatic thoughts boxes i.e. “if the AT was true what would this say about me?” relate directly to the core beliefs box - if there is consistency in meaning of AT across multiple situations then you can be relatively sure that this makes up a core belief
How do you use a CCD to plan treatment?
In the early sessions with your clients, you will be sticking to the bottom of the diagram, identifying situations and the automatic thoughts, subsequent emotions and behaviours
You will be helping clients problem solve real time for given situations, teaching different behaviours and emotional regulation skills
Once multiple situations have been discussed and patterns start to emerge, you will be able to construct the top of the diagram
At this point, the client will have more trust in you as a therapist as well as a greater understanding of what they think and how it affects their actions and emotions, and it doesn’t mean that it is necessarily true, and be better prepared to work on things that have a significant impact on how they experience their life
What are cognitive distortions?
Cognitive biases that skew the meaning of how data (including what the therapist says) is interpreted
If not identified and brought to consciousness, therapy may be unsuccessful as patient might be misinterpreting therapist input
More present in the thinking of those with ongoing mental disorder
What is selective abstraction?
Cognitive distortion
You pay attention only to the negative aspects of situations instead of considering the entire experience. “I made so many mistakes”.
What is overgeneralisation?
Cognitive distortion
You draw a general conclusion on the basis of a small amount of evidence. “I do everything wrong.”
What is “all-or-nothing” thinking?
Cognitive distortion
You see things only in two categories. Things are black or white, with no shades of grey. “I have to do a great job on everything.”
What is fortune telling?
Cognitive distortion
You make negative predictions about what will happen when other outcomes are more likely. “I’ll always have trouble figuring out my thoughts.”
What is labelling?
Cognitive distortion
You put a globally negative label on yourself. “I’m a failure for making a mistake.”
What is emotional reasoning?
Cognitive distortion
You believe something must be true because it “feels” true. “I must be incompetent.”
What is mind reading?
Cognitive distortion
You are sure you know what others are thinking. “They probably think I’m foolish.”
What is personalisation?
Cognitive distortion
You take others’ actions personally when they actually have other intentions. “They did that to me on purpose.”
What are imperatives?
Cognitive distortion
You have an unreasonably rigid idea about how you or others should/must/ought to behave. “I should always do my absolute best.”
What is magnification and minimisation?
Cognitive distortion
You magnify the negatives or minimise the positives. “I’m no good at figuring out what to do.” “It doesn’t matter that I have good common sense.”
