Week 1 Flashcards
How was CBT developed?
- In early 1960’s Beck tested various psychoanalytic concepts to do with depression and found them to be invalidated
- He investigated depression in different ways and found that depressed clients experienced “automatic thoughts” closely tied to their emotion
- Helping the clients identify, evaluate and respond to these unrealistic and maladaptive thinking = rapid improvement (both for him and his psych residents)
- 1977 - CT outcome tested and found to be as effective than an antidepressant at the time
- Follow up test found CT to be MORE effective than the antidepressant at relapse prevention
- 1979 the first CT treatment manual was published
What does CT-R stand for?
Recovery-oriented cognitive therapy
Explain CT-R
Maintains conceptual model in conceptualising individuals and planning and delivering treatment with extra emphasis on the cognitive formulation of clients’ adaptive beliefs and behavioural strategies, and factors that maintain a positive mood.
Focusses less on psychopathology and more on client’s aspirations for the future, values, strengths, personal qualities and steps they can take each week toward their goals.
Integrates cognitive-behavioural strategies to foster self-awareness and adaptive thinking in overcoming challenges or obstacles clients will face when taking steps towards goals.
What is the theory behind CBT?
Cognitive model: dysfunctional thinking (which influences the client’s mood and behaviour) is at the heart of all psychological disturbances
Cognitions (adaptive and maladaptive) occur at 3 different levels:
1. Automatic thought: At most superficial level
2. Intermediate beliefs: Underlying assumptions (“if I try to initiate relationships, I’ll get rejected”
3. Core beliefs: Deepest level
Modifying both automatic thoughts and dysfunctional underlying beliefs produces enduring change
What does research tell us about the effectiveness of CBT?
- It is effective for a wide range of psychological disturbances
- Helps reduce the severity of future episodes
- A study showed long-term effects up to 20 years after treatment ended compared to those who utilised medical intervention
What is a Recovery-oriented approach?
Evaluates automatic thoughts but focus less on past cognitions and more on cognitions likely to occur in coming week that could interfere with achieving specific goals
What is the cognitive model?
The proposition that one’s thoughts influences one’s emotions and behaviour (and sometimes physiology)
Dysfunctional thinking (which influences the client’s mood and behaviour) is at the heart of all psychological disturbances
What are some of the tasks simultaneously juggled by a CBT therapist during a session?
- Building rapport
- Socialising and educating
- Collecting data
- Conseptualising the case
- Working towards clients’ goals and overcoming obstacles
- Teaching skills
- Summarising
- Eliciting feedback
What is CBT?
“A relatively short term focused approach to the treatment of psychological problems that is collaborative and individualised to help people identify unhelpful thoughts and behaviours and learn healthier skills and habits”
Identify 4 characteristics of CBT treatment
- Session content is not predetermined but flexible to meet client needs/goals.
- Treatment length can be 6-20 sessions.
- 50 - 60 minutes.
- No two clients receive the same treatment.
What are 5 central assumptions of CBT?
- Thoughts/cognitions influence emotions, physiology and behaviour (causal and bi-directional)
- Behaviours are developed and maintained via learning principles
- Unhelpful thinking creates and/or magnifies difficult emotions and leads to unskilful behaviours
- Cognitive activity may be monitored and altered
- Weakening unhelpful cognitions (and behaviour) will result in less distress (more positive emotion and behaviours).
Origins of Psychotherapy
Explain Psychoanalysis
- Psychoanalysis: 1890’s onwards (Freud, Jung, Adler?)
- Freud = father of psychoanalysis
- Focus on the unconscious, goal of insight
- Defence mechanisms / tracking affect
- Patient / analyst relationship
- Id, ego, superego
- Primitive drives and conflicts
- Later psychoanalytic theories moved away from Freud’s drive theory to Object Relations and Self Psychology
- Not very flexible, quite rigid and not a lot of collaboration between analysts
Origins of Psychotherapy
Explain Person Centred Therapy
Person Centred Therapy: 1900’s (Rogers)
- Facilitate person’s self-actualising tendencies
- Non-directive; Unconditional Positive regard
Origins of Psychotherapy
Explain Behaviour Therapy
Behaviour Therapy: 1950’s & 60’s (Skinner, Watson)
- Move away from the unconscious
- Scientific approach, but incomplete explanation
- Human action dependent upon previous action
- Reinforcement important, cognition far less so
- Consequences good = repeat, consequences bad = avoid
Simply, what is:
- Operant Conditioning
- Classical Conditioning
- Social Learning Theory
- Inconsistent schedule of positive and negative reinforcement / punishment
- Think Pavlov - Learning through association
- Bandura - Modelling
Discuss the C in CBT
Focus on information processing
Biases in:
Attention
Interpretation
Memory (recall, recognition)
Biases in these areas correlate with emotional difficulties
E.g.
Anxiety: Bias towards threat and danger
Depression: Bias towards hopelessness and weakness
Anger: Bias towards unfairness, firmly help rules, “shoulds”
Principles of Treatment in CBT
(14)
- Treatment plans are based on an ever-evolving cognitive case conceptualisation (FORMULATION)
- Requires a sound therapeutic RELATIONSHIP
- Continuous MONITORING of client PROGRESS
- Culturally adapted and treatment is tailored to the INDIVIDUAL
- CBT emphasises the person’s STRENGTH
- Emphasises collaboration and ACTIVE PARTICIPATION
- CBT is aspirational, values based, and GOAL ORIENTED
- CBT initially emphasises the PRESENT
- CBT is EDUCATIVE
- CBT is TIME SENSITIVE
- CBT sessions are STRUCTURED
- CBT uses GUIDED DISCOVERY and teaches clients to respond to their DYSFUNCTIONAL COGNITIONS
- CBT includes ACTION PLANS = therapy HOMEWORK
- CBT uses a VARIETY of TECHNIQUES to change thinking, mood, and behaviour
What are the 3 circumstances where it is advisable to shift focus to the past?
- Client expresses strong desire to do so
- When working towards current problems or future aspirations produces INSUFFICIENT CHANGE
- When you judge that it’s important for you and your client to understand the ORIGINS of their unhelpful ideas / beliefs / coping strategies - how they arose and why they were maintained
What is Evidence-Based Practice?
- Integration from quality, current scientific evidence
- Clinical expertise of practitioner
- Consideration of client characteristics / values
Historical Development of Evidence-Based Practice in Psych
APA (1940s) psychologists trained as scientists
Mirrors the past 30+ years in medicine
Associated with the development of task forces and treatment guidelines
Now - tied to government funding / insurance
Regulators and funders are often looking for demonstration of effectiveness
Includes move towards more outcome measurements in therapy
Why Evidence-based practice?
Benefits:
- Standardisation of treatment and “best practice”
- Improved client outcomes
- Accountability (time, money in public service ect)
- Safeguards against the harm of pseudoscience
- Reflects “scientist-Practitioner” model
- Expectation that practitioners remain up to date with current practice
Limitations of Evidence-Based practice
- Often for single disorders - comorbidity is often not included
- Diagnoses can change and can be influenced by culture
- Just because we don’t have scientific evidence, doesn’t mean the therapy doesn’t work
- Doesn’t account for therapeutic relationship but evidence points towards this being an important factor in therapy effectiveness
What makes a good therapist?
(5)
- Someone who LISTENS well
- Practices with HUMILITY
- Good at ACCURATE EMPATHY
- Has POSITIVE REGARD for their client
- GENUINE in the interaction (authenticity)
