Week 5: The Role of Cognition and the Emergence of Cognitive Therapy

Question 1

Hamlet’s Cognitive Model

Answer 1

“There is nothing either good or bad, but thinking makes it so.” (Shakespeare, Hamlet)

Situation -> Thought -> Emotions/Action

Question 2

Cognition

Answer 2

Mental processes involving thinking, perceiving, remembering, learning, and reasoning.

Question 3

Epictetus

Answer 3

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.

Question 4

Intervening Variable / Mediating Variable

Answer 4

Transforms the relationship between input (situation) and output (emotions/actions)

Question 5

Cognitive Behavioural Therapy (CBT)

Answer 5

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.

Question 6

3 Strands of CBT

Answer 6

• Adaptive Skills: More effective coping responses
• Problem-Solving: New ways of understanding problems / alternative solutions
• Cognitive Restructuring: Identify & change maladaptive thinking patterns

Question 7

Aaron T Beck (1921 - 2021)

Answer 7

American psychiatrist. Father of CBT

Question 8

Albert Ellis (1913 - 2007)

Answer 8

Clinical psychologist who introduced rational therapy (1957), now called, Rational Emotive Behavioural Therapy.

Question 9

Beck and Ellis

Answer 9

Pioneers of Cognitive Therapy with the primary aim to reduce emotional distress, whether depression, anxiety, anger, or other negative emotional state

Question 10

Core Premises of CBT

Answer 10

1. Emotional state is not a direct consequence of a situation but mediated by thoughts
2. Those thoughts are often illogical or irrational

Question 11

History of CBT

Answer 11

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.

Question 12

Key Approach to Therapy Development and Evaluation

Answer 12

1. Construct/Refine Theory -> Identify Targets - > Informs Treatment
2. Test Theory
3. Test Treatment

Question 13

Beck Depression Inventory (BDI)

Answer 13

In 1961, Beck developed and published a questionnaire that allows for the reliable assessment of the range of depression symptoms within a theoretical framework.

Question 14

BDI-II (1996)

Answer 14

The most recent version of Beck’s Depression Inventory

Question 15

BDI/BDI-II

Answer 15

• 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

Question 16

Limitations of BDI

Answer 16

• 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)

Question 17

Beck’s Cognitive Triad (Schema of Negative Beliefs)

Answer 17

1. The Self - worthlessness, inadequacy, and failure
2. The World - unfair and hostile (friends, employers, etc.)
3. The Future - hopelessness and despair

Question 18

Schema

Answer 18

Mental structures or frameworks that help us organize and interpret information.

Mental shortcuts that allow us to process information quickly.

Question 19

Negative Thinking

Answer 19

Not only common in people with depression, but is often the first thought to emerge in response to a particular situation or trigger

Question 20

Negative Automatic Thoughts (NAT/ ANT)

Answer 20

Negative thoughts emerging without effort

Question 21

Depressive NATs (sadness)

Answer 21

I will always be alone
Why am I so stupid
Everything is hopeless

Question 22

Anxious NATs (threats)

Answer 22

I’m going to faint
They will be injured

Question 23

Angry NATs

Answer 23

He is rude
She is selfish

*Often about behaviour of other people and how they break rules that you hold to be important

Question 24

Guilty NATs

Answer 24

I should never have done that
I let her down

*Thoughts of breaking your own rules

Question 25

Different patterns of thoughts to an unwelcome event

Answer 25

NATs: Depressive thoughts (Because they are our thoughts, we tend to think they are true)
Normal reaction: No self blame, search for explanations

Question 26

NATs Characteristics

Answer 26

1. Negative in valence.
2. When we experience them, we feel bad.
3. They are uninvited.
4. They tend to be unhelpful and unconstructive
5. Believable.

Question 27

The Cognitive Model of Negative Thinking

Answer 27

1. Negative thinking maintains depression
2. Negative thinking is biased or illogical
3. Inconsistent with or ignore evidence

Question 28

Cognitive Distortion

Answer 28

Unhelpful thinking styles.

Systematic errors in thinking that can contribute to emotional distress, including depression.

Question 29

Schema Characteristics

Answer 29

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

Question 30

All-or-Nothing Thinking

Answer 30

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.

Question 31

Mental Filtering (Selective Abstraction)

Answer 31

A cognitive distortion where individuals focus excessively on negative details while ignoring positive aspects of a situation.

Question 32

Confirmation Bias

Answer 32

Paying more attention to events and outcomes that support our existing views and ideas, while ignoring or downplaying those that contradict them

Question 33

Magnification & Minimization Biases

Answer 33

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

Question 34

Disqualifying the Positive

Answer 34

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)

Question 35

Catastrophizing

Answer 35

An extreme form of maximizing where the significance of a perceived negative event is blown out of proportion

Question 36

Personalization

Answer 36

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.

Question 37

Overgeneralization

Answer 37

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.

Question 38

Emotional Reasoning

Answer 38

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

Question 39

Simplified Model of Depression

Answer 39

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)

Question 40

Hot Cross Bun Model (Christine Padesky and Dennis Greenberger, 1995)

Answer 40

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.

Question 41

The Role of Schema in Beck’s Model of Depression

Answer 41

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.

Question 42

State-based association

Answer 42

Our schema has become biassed by our low mood
to negatively appraise and filter information negatively

Question 43

Depressogenic Schema

Answer 43

A pattern of negative thinking that makes someone more vulnerable to depression.

Question 44

Factors Contributing to Depressogenic Schemas

Answer 44

• Genetic Predisposition
• Early Life Experiences
• Personality Traits
• Cognitive Biases
• Neurobiological Factors

Question 45

“Yes, but…”

Answer 45

A cognitive distortion that dismisses alternative explanations that do not match our beliefs and
assumptions.

Negates positive feedback