Week 5: Cognitive Therapy in Theory and in Practice Flashcards
Maladaptive Contents
- NATs (Negative Automatic Thoughts)
- Cognitive Distortions
- Behavioural Responses (Avoidance and Safety)
- Schemas
Goals of Cognitive Therapy
- Positive therapeutic outcome measured in terms of symptom reduction
- Address maladaptive contents
- Improve real-life function
- Provide new insights and skills
- Reduce risks of future episodes
Fundamentals of Cognitive Therapy
- Make the cognitive model explicit from the beginning (explain what, how, why)
- Socialize client to the cognitive model (i.e., guide them in filling out hot cross bun)
- Develop an individualized model (formulation/conceptualization)
- Outline the schedule of therapy sessions
- Have a structured session/agenda
- Current state and problem (Here and now)
- Problem-focused
- Skills-based approach
- Scientific approach
Collaborative Alliance (Therapist and Client)
Building a so-called collaborative alliance is an important predictor of therapy outcomes.
Being able to recognize when we are making thinking errors allows us to correct them.
Individualized Model (Conceptualization / Formulation)
This draws together the client’s specific circumstances, concerns, and ways of dealing with them that may serve
to maintain their distress.
Structured Session/Agenda in each Therapy Session
- Clear agenda set out in advance with a clear agenda
- Summary towards the end of the session
- Outline for the next session.
Scientific Approach to Cognitive Therapy
- Best guess (Hypothesis) and can be adjusted
- Find evidence to support accuracy of the model
- Test accuracy of perceptions and expectations
How to Test Client Accuracy of Perceptions/Expectations
- Socratic Dialogue
- Measurement & Recording: keep records and diaries and provide numerical ratings of their thoughts,
feelings, and behaviors - Homework: self-monitoring and record keeping, exercises around distorted thinking, or changing aspects of their behavior. Without it or without the client actively engaging with it, outcomes tend to be less good.
Scientific Approach to Cognitive Therapy
It is based on teaching the client to appraise the evidence for and against their distorted thinking and the conclusions that they draw from them.
The typical starting point for this is the negative automatic thought, captured by the client’s thought diary and expressed during the session.
Socratic Method/Dialogue
This is a method of instruction attributed to the
philosopher Socrates, who did not teach by telling his students the solutions or what to do, but posed
questions to guide them in finding solutions for themselves.
Techniques & Tools of Cognitive Therapy & CBT
- Understanding and recognizing cognitive Distortions
- Recognizing and identifying NATs
- Challenging and replacing NATs
- Behavioural experiments
- Identifying core beliefs (schemas)
- Challenging core beliefs
Homework
Used to help clients think about their thinking.
Our thoughts are often like a background narrative, and we tend to spend more time focusing on
how we feel than on the thoughts themselves. T
Thought Record
Separating out the negative thoughts and connecting them to how we feel is the first skill to be learned.
Situation > Feeling/Emotion > Automatic Thoughts
Triggers
Events that precede negative emotions
Hot Thoughts
Several recurring themes emerging from thoughts that the client has across different situations.
Are generalized and most directly related to the experience of negative emotion.
If recognized early, we are better able to deal with them quickly and prevent the vicious cycle from developing.
Hot Thought Columns in Thought Records
- Evidence that supports the hot thought (easy)
- Evidence that does NOT support the hot thought (difficult)
Hot Thoughts in Thought Records
Completed by the client ASAP after the upsetting event and reviewed in therapy.
Encourage understanding that our thoughts are not always accurate (they reflect our immediate response to something that we find upsetting).
Encourages us to be suspicious of our own
thoughts and start the process of questioning them.
Alternative Thinking
A more balanced way of thinking to replace hot thoughts.
A thought that is better informed by all of the evidence, positive and negative.
NOTE: Being able to express such thoughts is not the same as believing them
Thought Record Therapy
- Record details of the situation where the negative emotion was experienced
- Describe emotion and rate its intensity
- Describe NATs
- Identify ‘Hot Thought/s’
- Suggest evidence that supports the hot thought
- Suggest evidence that does not support the hot thought
- Find alternative or balancing thought
- Rate belief in alternative thought
- Re-rate mood or emotion
Gather New Evidence
This allows clients to test how accurate or useful
certain thoughts and beliefs are, without having to wait for a situation to arise in the normal course of
their day.
This proactive approach is also useful when the client is avoiding the various situations that might
provide the evidence, because they are afraid of what may happen or because they are predicting
a negative and distressing outcome
Survey
- A technique for the client to get the opinions/feedback from other people relevant to one of their concerns
- Simple and straightforward
- Results as evidence are harder to ignore
- Use with caution
- Not be used when the client’s negative beliefs are likely to be supported, even if in part.
Behavioral Experiment
- More complex but also more powerful than surveys
- More direct way to gather evidence
- Something different from normal to see what outcome results for the client
- Test validity of negative thoughts or beliefs through real-world experiences
- Requires careful planning
Systematic Desensitization and Exposure Therapy
This involves doing things that are typically avoided or doing something without relying on safety behaviour. The mechanism of change is one of gradual learning,
consistent with the idea of deconditioning.
Physical Sensations
Much more prominent in cognitive therapy for anxiety disorders, where the physical symptoms play a major role in driving the vicious cycles
Core Beliefs
The set of beliefs developed and held by the individual that underpinned their various views about themself, the future, and the world.
Characterised by the cognitive distortions
Surface Thoughts
Thoughts that are accessible to consciousness
Techniques in Identifying Core Beliefs
- Downward Arrow Technique
Downward Arrow Technique
starting with a particular negative automatic thought and posing questions encouraging reflection
on its meaning and significance to the client
Process of Modifying Assumptions & Core Beliefs
- Identifying and recognizing assumptions and beliefs
- Understanding their links to feelings and behaviour
- Identifying evidence for and against assumptions and beliefs
- Identifying and strengthening alternative assumptions and beliefs
- Gathering evidence
*As therapy progresses, less time is spent on the
surface thoughts and more time on the client’s assumptions and core beliefs.
Assumption / Intermediate Beliefs
A stage that is more accessible than the core belief but more general than the automatic thought.
