Wk 6 - CBT Flashcards
What are the basic assumptions of CBT? (x4)
Based on learning theories but + cognitions (thoughts, memories, images, attitudes, expectations, etc)
Not only environment that influence behaviour but the way we perceive/make meaning
o It’s the processing that counts
Cognitive change leads to behavioural and emotional change
What does ABC refer to in behavioural therapy?
o A = antecedents
o B = target BEHAVIOUR
o C = consequences
What does ABC refer to in cognitive therapy?
o A = antecedents
o B = BELIEFS about the antecedents
o C = consequences (Behaviour / Emotions)
What are 7 principles of CBT?
Learning (behavioural) principles
Cognitive theories (evolving)
Sound therapeutic alliance
Collaboration and active participation
Goal oriented and problem focused
Time limited
Structured sessions
o Agenda, review, set homeworkWhat is the aim of CBT? (x1)
Teaches client to identify, evaluate and challenge dysfunctional thinking
What was the precursor (and developer) to CBT? (x1)
Rational Emotive Behaviour Therapy (REBT: Ellis)
Why did Beck develop cognitive therapy (x7)
Beck is a Psychiatrist, trained in Psychoanalysis in U.S.
Disagreed with Psychoanalytic theory that depression is aggressive drive turned inward
What 5 elements are common to all CBT approaches?
o Structured, content driven therapy (often manualised)
o Role of homework
o Client’s responsibility to take an active role
o Range of cognitive and behaviour strategies
o Educational in style
What are some common cognitive distortion in depression, anxiety, and some other problems? (x12)
All or nothing thinking
Catastrophising
Disqualifying the positive
Emotional reasoning
Labelling – a global rating of self, maybe others
• Problematic because of self-fulfilling prophecy – what if you have a success?
Magnification / minimisation
Mental filter
Mind reading– usually interpreting others' in a negative way
Overgeneralisation
Personalisation
Should statements
Tunnel visionHow does CBT link events to core beliefs? (x5)
Antecedents/situation
Belief (automatic thought) has
Consequences (emotions/behaviours), but also…
The automatic thought feeds into intermediate belief - assumptions/rules that influence
Core belief
Give egs of the three levels of cognition, as per CBT
Automatic thought: ‘I give up, this assignment is too hard’; leads to…
Intermediate belief: ‘If I don’t get my assignment done, I’ll fail the course’; leads to…
Core belief: ‘I’m a failure’
Where did attribution theory stem from (x1)
Arguing that depression occurs if… (x3)
Learned helplessness
Individual is aware of uncontrollable factors in their environment
Individual views the situation as unchangeable
Blame self for their helplessness
What are the three dichotomous characteristics of attribution?
Personal (internal vs external)
Pervasive (generalised/global vs specific)
Permanent (stable vs unstable)
What did Seligman develop his learned helplessness theory into? (x2)
Learned optimism
Positive psychology
What are Ellis’s REBT (rational emotive behavioural therapy) irrational thinking patterns?
Dire necessity for adult humans to be loved or approved by virtually everyone
Must be competent, adequate and achieving in all important respects or is inadequate person.
People must act considerately and fairly and they are damnable villains if they do not.
Awful when things are not the way one would like them to be.
Emotional disturbance is externally caused and people have no ability to change their dysfunctional feelings/behaviours.
If something is fearsome, should be constantly concerned and keep dwelling on the possibility
Cannot/must not face life’s responsibilities and difficulties -easier to avoid them.
Must be dependent on others and need them.
Past history is an all-important determiner of one’s present behaviour
Other people’s disturbances are horrible and one must feel upset about them.
There is invariably a right, precise and perfect solution to human problems and it is awful if not found
What do we mean by cognitive content specificity? (x1 plus 2 e.g. disorders/patterns)
Different cognitive themes are found in the different disorders
Eg depression: negative cognitions about self, others, future
Body image distortions - not objective, telling them doesn’t work
What are some common cognitive themes in OCD? (x5)
Overestimated threat Thought-action fusion Inflated responsibility Intolerance of uncertainty Perfectionism
What are some common cognitive themes in addictive behaviours? (substance x2, gambling x3)
Cravings - could be a taste or smell sensation, not just thoughts of eg I’d love a beer
Expectancies – can be more or less accurate, and differ across substances
Illusion of control – I’m playing on my lucky machine, wearing my lucky undies => I’ll win
Gamblers fallacy – 6 heads in a row, next one is bound to be a tail
Chasing losses – increase my bet to win back the money
What are some common cognitive themes in social phobia? (x2)
Feel like they’re going out without their skin on, that everyone is watching and judging them negatively
Images of self looking anxious or performing poorly
What are the therapeutic goals in CBT? (x3)
Behavioural strategies (eg behavioural activation in depression; exposure therapy in anxiety disorders; etc)
Identify and challenge cognitive distortions
Learning ways to deal with future difficulties - become own therapist
What is the therapist’s role in CBT? (x3)
Active role – set agenda, structure sessions
Educational - teach clients cognitive model and how to identify and challenge distorted thinking; prepare materials, provide information
Guidance and support
What is the client’s role in CBT? (x3)
Learner
Actively participate in session
Homework assignments
How does CBT see the therapeutic relationship? (x2)
Which is still debated because… (x2)
Collaborative relationship
Rapport and therapist warmth is important but not sufficient
Ellis took a very directive approach
While Beck suggested 90% socratic questioning; 10% didactic educating
What is the general treatment plan in CBT? (x6)
Assessment of symptoms, maybe a functional analysis
Psychoeducation & orientation to treatment
Goal setting
Behavioural activation & other behavioural interventions
Cognitive interventions – addressing the thoughts attached to the above
Relapse prevention – how to transfer to daily life
What are 6 common CBT techniques?
Coping statements
Activity scheduling
ID, evaluate, challenge cognitive distortions
ID, evaluate, challenge distorted core beliefs
Behavioural experiments
Problem solving
What is involved in the CBT technique of ‘coping statements’? (x5)
Positive realistic statements to replace negative automatic thoughts Need to be: • Believable • Stated positively • First person
What is involved in the CBT technique of ‘activity scheduling’? (x4)
As with behavioural therapy, but
Check in/troubleshoot if client non-compliant
Set small manageable activities
Encourage client to continue even if tough/not initially reinforcing
What is involved in the CBT technique of ‘ID, evaluate, challenge cognitive distortions’? (x5)
ID from intake, monitoring homework
Differentiating thoughts from feelings
Looking for patterns (common cognitive distortions) and educating your client to “catch” them
Rational replacement can be very hard at beginning – patterns are well ingrained
Questioning automatic thoughts - helpful? Evidence for/against? Perspective - what would a friend say?
What is involved in the CBT technique of ‘ID, evaluate, challenge distorted core beliefs’? (x4)
Downward (Vertical) Arrow technique
• Automatic thought, down to…
• ‘Assuming this is true, what does it mean? Why is it so bad? (questioning the process before it gets down to…)
• Core belief
What is involved in the CBT technique of ‘behavioural experiments’? (x6)
Testing the validity of a thought
Eg for prediction: “When I go to the supermarket alone and don’t take my usual precautions, I will faint and it will cause a lot of drama and embarrassment”
Set up a specific test of the prediction
Gather the evidence
Revise the thought in accordance with evidence:
• “I can go to the supermarket without fainting.
What is involved in the CBT technique of ‘problem solving’? (x7)
(same as for IPT) o Identify problem o Generate solutions o Evaluate solutions o Choose solution(s) o Plan and implement solution(s) o Evaluate
Give an example of how CBT might operate in marital distress situation(x5)
Behavioural strategies
Cognitive strategies:
o Identification and challenging of automatic thoughts & beliefs: “I expected that a husband would make all the major decisions about our home and finances”
o Identification and challenging of attributions: “She didn’t respond to my distress because she doesn’t care”
What evidence is there for CBT and depression? (x5)
Significantly better than • Wait list • Anti-depressants • Miscellaneous therapies Equal to behaviour therapy May prevent relapses in the long-term (cf antidepressants)
What evidence is there for CBT in general clinical practice? (x2)
Effective treatment (effect sizes not as high as in research trials) Approx. half of the sample reliably improved over a course of therapy, including about a third who recovered to normal range.
Is cognitive change exclusive to CBT? (x3)
No, occurs in CBT, Drug therapy, Other psychological therapy and WLC
Degree of change in cognitive style is related depression as measured by BDI, but not Hamilton Rating Scale for Depression (HRS-D)
Relationship between cognitive change and depression change is not unique to CBT
What are the theoretical contributions/benefits of CBT? (x6)
Focus on impact of cognitions Translating skills into action Self-regulatory approach Comprehensive conceptualisation of case Structured approach to therapy Empirical emphasis
What are the limitations of CBT? (x4)
De-emphasis on influence of past experiences
REBT: minimisation of importance of therapeutic relationship
Uncommon to evoke and address strong emotions during session (ie “cold” processing rather than “hot”)
Signif minority of clients don’t respond to cognitive therapy
Young’s Schema Focussed Theory was developed by Jeffrey Young for… (x2)
Integrating … approaches (x3)
Personality disorders or long-standing emotional difficulties
• Presumed to have significant origins in childhood & adolescent development
CBT,
Psychodynamic (object relations, attachment), and
Experiential (Gestalt) approaches
What is the rationale for Schema Focussed Therapy? (x4)
Cognitions & behaviours are more rigid with Personality Disorder
Gap between cognitive & emotive change is much greater with PD than eg depression, anxiety
Intimate relationships are more central to problems of clients with PD
Many PD clients will not follow traditional CBT techniques
What are schemas? (x7)
Broad, pervasive theme or pattern
Comprised of memories, bodily sensations, emotions, cognitions
About self & relationships.
Like core beliefs, but much broader operating system -
Organising structure through which we filter life events – consistent gets retained, inconsistent gets discounted
Developed during childhood or adolescence, and elaborated through lifetime
Functional or dysfunctional (Early Maladaptive Schemas)
Schema focussed therapy looks at… (x2, plus 7 factors)
Schemas, and the Unmet childhood needs • Safety • Predictability • Love, nurturing & attention • Acceptance & praise • Empathy • Guidance & protection • Validation of feelings & needs That inform them
How do Early Maladaptive Schemas form? (x5)
Interaction between child’s needs and social environment:
• Core childhood needs are not met
• Child is victim of abuse or mistreatment
Selective internalization or identification with significant others - selectively internalises parent’s thoughts, feelings, experiences, and behaviours
Give two egs of schemas formed by different survivors of child abuse
Ruth, succumbed to the victim role - sid not fight back, became passive and submissive. Experienced feeling of being a victim, but did not internalize feeling of being an abuser.
Kevin fought back against his abusive father - identified with him, internalized his aggressive thoughts, feelings, and behavior, and eventually became abusive himself.
What are 5 schemas related to attachment?
- Abandonment
- Mistrust & Abuse
- Emotional Deprivation
- Defectiveness
- Social isolation
What are 4 schema related to Self and competencies?
- Dependence / incomp
- Vulnerability
- Enmeshment
- Failure
What are two schemas related to narcissistic personality?
- Entitlement
* Insufficient Self-Control
What are 3 schemas related to obsessiveness?
- Subjugation
- Self-Sacrifice
- Approval seeking
What are 4 schemas related to depression?
- Negativity / pessimism
- Emotional inhibition
- Unrelenting Standards
- Punitiveness
How do schemas persist? (x6)
Cognitive distortions Self-defeating life patterns Schema maintenance processes “coping styles”: • Surrender • Avoidance • Overcompensation
What are the goals of schema focussed therapy? (x3)
Help clients to adaptively get their core needs met -
To feel bonded, attached, empathised with, understood
Change maladaptive schemas, coping responses
What are the two stages of the therapy process in schema focussed?
Assessment and education
Change
What is involved in the Assessment and education stage of schema focussed therapy? (x5)
Identify and educate about central life schemas
Link schemas to presenting problems & life history (origins of schemas)
Bring client in touch with emotions surrounding schemas
Identify dysfunctional coping styles
Schema diary
What might be detailed in a schema diary (schema focussed therapy)? (x7)
Trigger: Feelings: Thoughts: Which schema and what are its origins? What was valid about your response? What may have been an over-exaggeration? If you are in this situation again, how could you respond differently?
What is involved in the Change stage of Schema focussed therapy? (x5)
Cognitive – as per CBT + schema level
Experiential - (eg imagery) evoke relevant emotions, change schema (hot processing)
Limited ‘reparenting’ - modelling provision of core needs
Heal coping styles triggered in sessions
Pattern-Breaking: Assign/rehearse behavioural/interpersonal changes
What do some selected schema scores correlate with? (x5)
Depression Eating disorders Substance abuse Anxiety Sexual dysfunction in males and females
Giesen-Bloo et al conducted a study into schema therapy and borderline PD, involving… (x3)
Which found…(x3)
N = 88 people with BPD
Randomly assigned to Transference Focused Psychotherapy or Schema Focused Therapy
Three years; 2 sessions per week
Both groups showed improvement
Sig more people showed clinically reliable symptom and Quality of Life improvement in SFT
SFT also more cost effective than TFP
What was Beck’s ‘negative cognitive triad’? (x3 plus explain x1)
Noticed that depressed patients experience overly negative/persistent thinking about:
• The Self
• The World (others and events) and
• The Future
