The Second Wave - The role of cognition and the emergence of cognitive therapy Flashcards
What did Epictetus propose that is associated to modern CBT?
> The choice of wether something is good or not good
= conscious thought
> There is no absolute
What are the 3 approaches in CBT?
- Adaptive (coping) skills
- provide more effective (adaptive) coping responses
- identify person’s maladaptive coping responses and replace them with a set of more adaptive ones - Problem solving
- new ways of understanding problems
- alternative solutions - Cognitive restructuring
- identify and change maladaptive thinking patterns
Who are the pioneers of cognitive therapy and what are their respective approaches?
> Aaron Beck: cognitive therapy
> Albert Ellis: rational emotive therapy
What did the pioneers of cognitive therapy reject?
Rejected the psychoanalytical approach
What influenced the pioneers of cognitive therapy?
Emerging evidence from cognitive psychology
What was the goal and statement of cognitive therapy?
Reduction of emotional distress
What was the statement of cognitive therapy?
The emotional state is not a direct consequence of a situation, but mediated
What was Aaron Beck influenced by in his development of a new treatment?
His work in psychiatry, treating people with depression
What were the three principles of Aaron Beck in developing a new treatment
He stated the need for:
- Construct Theory
- to identify targets that inform a treatment - Testable theory
- Test the treatment
- if it does not change the target - symptoms - it has no clinical value
- > empirical tests
=> “To construct a comprehensive theory of psychopathology that articulates well the psychotherapeutic approach”
What was Aaron Beck’s continuous cycle of psychotherapy?
Construct/refine theory -> Test theory -> Test treatment
Why did Beck develop the Beck Depression Inventory (BDI) (2005)?
> Need of a questionnaire for reliable assessment of symptoms
> To assess the patient’s actual experience:
- mood
- thinking
- behaviour
- physical state
What characterises the Beck Depression Inventory (BDI)?
> 21 questions with 4 possible answers
> Assess frequency, intensity, and impact of symptoms
> Not diagnostic
- requires application of clinical criteria, detailed interview with trained clinician or researcher
> Total level of depression-related symptoms
- “cut-off” scores to group people
- > minimal, mild, moderate, or severe depression
> ‘Self-report instrument’
- ‘Patient-reported Outcome Measure (PROM’
- subjective
What makes a cut-off score arbitrary in the Beck Depression Inventory (BDI)?
The scores will be continuously distributed in the population
- very different groups following age, physical health, etc.
What is the opposite assessment of a subjective ‘patient-reported outcome measure (PROM)?
Assessment based on expert judgment
- typically through interview with trained clinician or researcher
What is Aaron Beck’s Cognitive Triad of depression (1963)?
> Outward expressions of stereotyped pattern of thinking
> Underlying schema based on a set of negative beliefs over 3 areas:
- the Self
- the World
- the Future
= “biased thinking” in depression
What are Aaron Beck’s negative automatic thoughts (NATs)?
Negative thinking as first response to trigger event
- emerging without effort
- because they’re our thoughts, we tend to think they are true
- Depressive NATs
- Angry NATs
- Anxious NATs
- Guilty NATs
How does a normal reaction to an upsetting event differ from NATs?
- No self-blame
- Search for explanations
What are the key characteristics of NATs?
> NATs tend to be:
- negative
- feel bad
- uninvited
- unhelpful
- believable
> Two-way process between our thinking and our mood:
-> negative thoughts may induce a low mood that may be maintained for a long time by recurring negative thoughts
What makes Aaron Beck’s model of depression a cognitive model?
- Negative thinking maintains depression
- schemas bias perceptions and memory
- depressive schema increases negative thinking - It is biased or illogical
= Cognitive distorsion
- “Unhelpful thinking styles” (as described to patients) - It ignores evidence
What are the 7 cognitive biases found in people with depression?
- ‘All or Nothing’ thinking
- Mental Filtering (selective abstraction)
- Magnification and Minimization
- Catastrophizing
- Personalizing
- Overgeneralization
- Emotional Reasoning (Labelling)
What is the ‘All or Nothing’ thinking bias?
Splitting, dichotomous reasoning, black and white thinking
- sets up for disappointment and failure
- success isn’t typically celebrated
What is the mental filtering (selective abstraction) bias?
Confirmatory cognitive bias
- pay more attention to events that support our views
- depressive bias to confirm negative thoughts
- > notice failures, ignore successes
- happens in the moment or when events are recalled later
What is the magnification or minimisation bias?
Magnify the significance of the negative
- disqualifying the positive
What is the catastrophizing bias?
Significance of negative event is blown out of proportion
- extreme of magnification
- illogical leap from one event to a disastrous future seemingly inevitable outcome
- semi-logical steps between thoughts
What is the personalising bias?
A person assumes responsibility for events when they cannot fully or partially control them
- often involves other people
- failure translates into guilt and low self-worth
What is the overgeneralisation bias?
Hasty conclusion from partial information
- e.g. “never”, “always” in thought process
What is the emotional reasoning (labelling) bias?
We equate what we feel with what is real
- our feelings and emotions, and language we use to define them influence what we believe
Emotion -> (illogical link) -> Fact
- e.g. “I feel like a failure” -> “I am a failure”
How can the emotional reasoning (labelling) bias be reinforced?
It can be hard to separate feelings from reality
- especially when combined with other biases such as filtering, personalisation, overgeneralisation, etc.
What characterises the language of cognitive distorsions in depression?
> The thinking is often marked by polarisation, referring to ourselves or others
> The words used describe unbendable expectations about person’s behaviour or outcomes
> These words can be combined and become more extreme
- e.g. “must always succeed”, “should never fail”)
What characterises the “hot cross bun model” - cognitive model?
> Triggering event: external or internal
- influences the thoughts
> Bidirectional links between Thoughts, Feelings, Physical sensations, and Behaviour
- influencing each other
> No specific direction of flow
> Dynamic systems with potential of vicious cycle
- unhelpful thoughts, behaviours, feelings
- which built up on each other, driving maladaptive processes further
What is the role of the schema in Aaron Beck’s model?
> Schema acts as filter and transforms an event which then becomes a trigger event
> Schema is not static
- it updates with new information from our thoughts, feelings and behaviour
- if these are shaped by a negative schema, the updating reinforces it
=> It is not the event, but the way information is processed and appraised
What does Aaron Beck’s model describe?
A basic system that, in certain conditions, can become maladaptive and increase the risk of depression and maintain the symptoms over time
What is the development of the negative schema in depression according to Aaron Beck?
Negative schema is dominant
- our schema has become biassed by our mood to negatively appraise and filter information negatively
- > state-based association
What does Aaron Beck suggest is the origin of the negative schema in depression?
Predisposition
- negative schema develops over lifetime
- increases vulnerability to depression in context of subsequent stressors
-> Depressogenic trait
What do Beck and Bredemeier suggest is the origine of the cognitive triad of depression (2016)?
Combined and interacting influence of 4 factors:
1. Genetic risk
- Early experience (e.g. trauma)
- Information processing biases
- Biological stress reactivity
Following the Beck’s cognitive triad of depression, what happens when beliefs are activated by stressful events in a person’s life?
The beliefs can feedback and further strengthen information processing biases and stress reactivity
