Week 5: The Role of Cognition and the Emergence of Cognitive Therapy Flashcards
Hamlet’s Cognitive Model
“There is nothing either good or bad, but thinking makes it so.” (Shakespeare, Hamlet)
Situation -> Thought -> Emotions/Action
Cognition
Mental processes involving thinking, perceiving, remembering, learning, and reasoning.
Epictetus
Greek philosopher who proposed that determining between what is good and what is not good is made by the capacity for choice, in other words, our conscious thoughts, and is not absolute.
Intervening Variable / Mediating Variable
Transforms the relationship between input (situation) and output (emotions/actions)
Cognitive Behavioural Therapy (CBT)
Describes a broad range of different therapeutic
approaches each developed and applied within its own particular framework that emphasise different aspects of the mediational process and specific therapeutic techniques.
3 Strands of CBT
- Adaptive Skills: More effective coping responses
- Problem-Solving: New ways of understanding problems / alternative solutions
- Cognitive Restructuring: Identify & change maladaptive thinking patterns
Aaron T Beck (1921 - 2021)
American psychiatrist. Father of CBT
Albert Ellis (1913 - 2007)
Clinical psychologist who introduced rational therapy (1957), now called, Rational Emotive Behavioural Therapy.
Beck and Ellis
Pioneers of Cognitive Therapy with the primary aim to reduce emotional distress, whether depression, anxiety, anger, or other negative emotional state
Core Premises of CBT
- Emotional state is not a direct consequence of a situation but mediated by thoughts
- Those thoughts are often illogical or irrational
History of CBT
Beck’s ideas were strongly influenced by his work as a practicing psychiatrist, treating patients with a wide range of mental health problems. However, it was his experience treating people with depression that formed the foundation of his model.
Key Approach to Therapy Development and Evaluation
- Construct/Refine Theory -> Identify Targets - > Informs Treatment
- Test Theory
- Test Treatment
Beck Depression Inventory (BDI)
In 1961, Beck developed and published a questionnaire that allows for the reliable assessment of the range of depression symptoms within a theoretical framework.
BDI-II (1996)
The most recent version of Beck’s Depression Inventory
BDI/BDI-II
- assessed what the patient was actually experiencing (mood, motivation, thinking, behavior, and physical state)
- covers a specific timeframe (the preceding week), acknowledging that depression is a persistent problem, not a fleeting change in response to an immediate event
- comprise 21 questions, each presented with four
different options, indicating the presence and increasing severity of a depression-related problem or
symptom
Limitations of BDI
- Not a diagnostic tool (must be accompanied by an interview with a clinician)
- Cut-off scores are arbitrary (somewhat randomly assigned to minimal, mild, moderate, and severe)
- Cut-off scores vary between groups (i.e., age, physical health, etc.)
- Subjectivity due to self-report nature or Patient Reported Outcome Measure (PROM)
Beck’s Cognitive Triad (Schema of Negative Beliefs)
- The Self - worthlessness, inadequacy, and failure
- The World - unfair and hostile (friends, employers, etc.)
- The Future - hopelessness and despair
Schema
Mental structures or frameworks that help us organize and interpret information.
Mental shortcuts that allow us to process information quickly.
Negative Thinking
Not only common in people with depression, but is often the first thought to emerge in response to a particular situation or trigger
Negative Automatic Thoughts (NAT/ ANT)
Negative thoughts emerging without effort
Depressive NATs (sadness)
I will always be alone
Why am I so stupid
Everything is hopeless
Anxious NATs (threats)
I’m going to faint
They will be injured
Angry NATs
He is rude
She is selfish
*Often about behaviour of other people and how they break rules that you hold to be important
Guilty NATs
I should never have done that
I let her down
*Thoughts of breaking your own rules
Different patterns of thoughts to an unwelcome event
NATs: Depressive thoughts (Because they are our thoughts, we tend to think they are true)
Normal reaction: No self blame, search for explanations
NATs Characteristics
- Negative in valence.
- When we experience them, we feel bad.
- They are uninvited.
- They tend to be unhelpful and unconstructive
- Believable.
The Cognitive Model of Negative Thinking
- Negative thinking maintains depression
- Negative thinking is biased or illogical
- Inconsistent with or ignore evidence
Cognitive Distortion
Unhelpful thinking styles.
Systematic errors in thinking that can contribute to emotional distress, including depression.
Schema Characteristics
Can create biases in our perceptions, memory,
and appraisal
Can shape our attitude
Can explain why two different people have different thoughts about the same event and react differently
Can increase the chance of negative thoughts and appraisals
All-or-Nothing Thinking
A cognitive distortion that categorises outcomes and interpretations as either good or bad, positive or negative, with no shades of grey in between.
AKA splitting, or dichotomous reasoning, polarised, or black-and-white thinking
Can be motivating but can also lead to feelings of inadequacy and disappointment.
Mental Filtering (Selective Abstraction)
A cognitive distortion where individuals focus excessively on negative details while ignoring positive aspects of a situation.
Confirmation Bias
Paying more attention to events and outcomes that support our existing views and ideas, while ignoring or downplaying those that contradict them
Magnification & Minimization Biases
These refer to the fact that we not only attend to negative evidence more than positive, but that we magnify the significance of the negative giving it greater weight and importance and, at the same time, minimizing the positive
Disqualifying the Positive
A specific form of minimizing bias where positive experiences are dismissed (i.e., I was lucky, she was just being polite, he didn’t even try so I won)
Catastrophizing
An extreme form of maximizing where the significance of a perceived negative event is blown out of proportion
Personalization
A form of bias where the individual assumes personal responsibility for events or outcomes over which they have no control or only partial control.
Often these involve other people and a perceived failure or a negative outcome translates into feelings of guilt and low self-worth.
Overgeneralization
Describes where a person draws a hasty conclusion from partial information.
In depression, those conclusions tend to be negative
and sometimes catastrophic.
Overgeneralised thoughts often contain the words always or never.
Emotional Reasoning
We equate what we feel with what is real (i.e., Because I feel it, it must be true)
Feelings as Facts
Rigid Labels: Creating fixed self-descriptions based on temporary emotional states (I feel stupid therefore I am stupid)
Ignoring Evidence: Overlooking contradictory information
Simplified Model of Depression
Our thoughts play a central role in determining our emotional responses and behaviors.
An event triggers the cycle but thoughts and behaviour can also be triggers.
Thoughts > Feelings > Behaviour (cyclical)
Hot Cross Bun Model (Christine Padesky and Dennis Greenberger, 1995)
Thoughts > Feelings > Body / Physical Sensations > Behaviour
All components influence each other in a reciprocal manner.
Huge potential for so-called vicious cycles of unhelpful thoughts, behaviours, emotions, and feelings to build up, feeding on each other, and driving the maladaptive processes further.
The Role of Schema in Beck’s Model of Depression
Schema as a filter: Our underlying beliefs and assumptions shape how we interpret events.
Event as a trigger: Events themselves are neutral, but their impact depends on how we process them.
Dynamic nature of the schema: Schemas can change over time, but negative schemas can be self-reinforcing.
State-based association
Our schema has become biassed by our low mood
to negatively appraise and filter information negatively
Depressogenic Schema
A pattern of negative thinking that makes someone more vulnerable to depression.
Factors Contributing to Depressogenic Schemas
- Genetic Predisposition
- Early Life Experiences
- Personality Traits
- Cognitive Biases
- Neurobiological Factors
“Yes, but…”
A cognitive distortion that dismisses alternative explanations that do not match our beliefs and
assumptions.
Negates positive feedback
