Lecture 7: CBT

Question 1

Epidemiology of Mental Health

Answer 1

• 1/6 have a diagnosable mental health condition

World Health Organisation
- 2019: no. of people diagnosed with anxiety and depression has increased by 40% over the last 30 years
-2022: COVID 19 triggered a 25% increase in anxiety and depression

Question 2

Behaviour Therapy

Answer 2

1960-2023
* viewed MH conditions as learned maladaptive behaviours
* conditioning (reward being drugs and sexual high, punishment being social rejection)
* behaviour therapy uses conditioning to replace maladaptive learned responses with adaptive learned responses

Question 3

Systematic Desensitisation

Answer 3

Deep muscular relaxation is paired with a gradual hierarchy of phobic stimuli

Question 4

Behaviourism and depression

Answer 4

depression results from too little environmental reinforcement or too much environmental punishment. Treatment therefore aims to increase reinforcement and reduce punishment

Question 5

2nd wave - cognitive therapy (Beck & Ellis)

Answer 5

A persons emotional response to a situation depends on their appraisal of that situation. Our appraisals are often flawed and we may pay a heavy emotional price

Cognitive therapy helps people identify cognitive errors and distortions that lead to unnecessary distress or maladaptive behaviour (problem-solving approach - helping people become more rational, realistic, reasonable etc.)

Question 6

Becks Cognitive Hierarchy Model

Answer 6

Core Beliefs (Schema)

Intermediate beliefs (assumptions)

Automatic thoughts (inc. NATs)
- Negative Automatic Thoughts “I am hopeless”

Question 7

The aim of CBT

Answer 7

• To help clients understand the relationships between their thoughts, feelings and behaviour
• To help clients develop cognitive and behavioural skills to identify and to correct their cognitive biases, errors and distortions

Question 8

Three elements of delivering CBT:

Answer 8

1. Psychoeducation
2. Exploration (collaborative empiricism)
3. Strategic change (intervention)

Question 9

What is Collaborative Empiricism

Answer 9

Therapist and client work together to explore the cognitive basis of the clients emotional issues, to set therapeutic goals and to identify effective therapeutic strategies

• Data collection through clinical interviews, diaries and thought records, behavioural experiments

Question 10

Going from exploration -> intervention

Answer 10

• looking for NATs to identify schema
• looking for cognitive distortions to expose and correct biases
• looking for false beliefs by challenging beliefs and getting Ps to provide evidence
• conduct behavioural experiments and evaluate that outcome

Question 11

3rd wave CBT

Answer 11

• rather than focusing on the content of the thought, 3rd wave approaches place more emphasis on exploring a persons belief about their thoughts (“metacognition”)
• 3rd wave approaches focus on changing the persons relationship to their thoughts, feelings and behaviour

Question 12

What is ACT

Answer 12

Acceptance and Commitment therapy (Steven Hayes)
- ACT is a directive and experiential therapy
- doesn’t aim to repair, change or ‘fix’ problems but helps people to respond to distressing experiences in a different (“mindful”) way - which frees them to live a rich and meaningful life

Question 13

What does ACT do for the recipient?

Answer 13

• teaches mindfulness skills to reduce impact of distressing thoughts
• encourages people to respond mindfully rather than impulsively
• aims to reduce pointless struggling about things that can’t be changed (acceptance), and to help people live rich and meaningful lives

Question 14

ACT and Psychological flexibility

Answer 14

ACT develops skills to
- be present in the here and now
- to open up to experience
- to act in line with their values

Question 15

Key messages from ACT

Answer 15

• You are separate from your mind - the mind is often cautious, critical and controlling - its actions often lead us to become distressed and hold us back
• We naturally try to ‘fix’ or avoid things but such efforts make things worse and decrease our distress. Its better for us to ACCEPT what cannot be changed and to carry on THE SERENITY REQUEST
• We often react to situations without giving them any conscious consideration BUT it is often better for us to RESPOND thoughtfully, mindfully and wisely
• Its good to be aware of your values and act in accordance with these

Question 16

A major problem of CBT

Answer 16

Resource limitations makes it hard to provide 1-2-1 counselling or psychological therapy

Many people vary in the severity - most cases are mild or moderate. So many can benefit from the provision of standard, low intensity treatment
- zoom therapy
- group therapy
- bibliotherapy
-computer therapy etc.

Question 17

What’s mindfulness?

Answer 17

thinking things through and deciding what you are going to do

Question 18

How the mind works

Answer 18

Firstly YOU are not your MIND
- the mind does its own thing (jumps to conclusions, constantly makes comparisons, hard to control)
- the mind reacts automatically
- the mind triggers emotional reactions

Question 19

When the mind triggers emotional reactions, what is it important to recognise?

Answer 19

Feelings are not actions, feelings just happen to us, whether we like it or not.

And because feelings just happen, we shouldn’t feel guilty about feelings that happen to us (anger, resentment, jealousy)

Question 20

Mind comparisons

Answer 20

You can’t stop your mind comparing you with other people. But you can learn to not be bothered by this. If you accept yourself as you are right now, you will be a lot better off - if your mind makes a negative comparison, recognise this but “shrug it off”

Question 21

Our critical minds

Answer 21

• Minds can be very negative
• But, when the mind is being critical (you look in the mirror and think “I look disgusting”,) this is only negative if you take them seriously.
• If you notice your minds criticism and let them be, this will take away the power to cause negative affect

Question 22

What is the Serenity request

Answer 22

some things you just can’t change

“may I have the strength to change the things things that i can change; the courage to accept the things i cannot; and the wisdom to know the difference”

Question 23

Problems with unwanted thoughts

Answer 23

• We all get them. But we try very hard to reduce these thoughts.

Reducing these negative thoughts is exactly the wrong thing to do because this with strengthen the power of the unwelcome thoughts

• When you have unwanted thoughts, notice them, accept them, let them be. But don’t deliberatley focus on them and don’t try to suppress them

Question 24

A key distinction between pain and suffering

Answer 24

It is possible to reduce the level of suffering even when the level of pain itself cannot be reduced

Question 25

The ACT approach to dealing with persistent pain

Answer 25

Acceptance of the pain
Mindfullness
Commitment to carry on doing the things you enjoy and the things that matter to you.

Question 26

Avoidance and ACT

Answer 26

Avoidance leads to short term reward but long term punishment (e.g. avoiding the park in fear of seeing a dog, that will bring up feelings of my recent dog passing, BUT you love the park, so in the long run this is a negative thing)

You need to expose yourself to the thing you fear, confront the object or the situation you dread and accept that when you do this, you will experience anxiety and fear.

Question 27

Experiential avoidance

Answer 27

This is when we avoid internal situations - distressing emotions.

Question 28

What is “Fusion”

Answer 28

when we confuse thoughts, images or words as REALITY

Question 29

DE-FUSION techniques

Answer 29

They help put your thoughts in place

“I’m am a loser” Vs “I am having the thought that I am a loser”

simply reminding ourselves that something is a thought or image or belief can lead to a powerful delusion effect - just in our head, not the real world

Delusion techniques help people to respond to thoughts appropriately - and to avoid confusing them with reality

Question 30

What does ACT encourage you to live by?

Answer 30

Your values!!

recognising what you value can help you make the right decision - carefully, and mindfully- about the best direction to take.

Question 31

ACT view towards Mental Health

Answer 31

MH problems are contextually informed - the things we go through in our life change what happens in our mind. Rather than placing psychological problems with someone (biological level) they look at the context for answers.

The world we live in effects our mental health and these environmental contextual influences informs mental health problems.

MH problems aren’t abnormal, they are a normal consequence in the terms of the context.

Question 32

What is psychological flexibility?

Answer 32

doing things that are important to you, bringing your values to life, whilst taking those thoughts and feelings that aren’t nice with you

Question 33

How do ACT therapists develop psychological flexibility? (the 6 processes of ACT)

Answer 33

1. acceptance/willingness - having the client practice the discomfort and controlling behaviour at the same time
2. self as context - overtime we build stories about who we are and sometimes those stories imprison us. Tries to have us contact the deeper sense of self at a stable base to make decisions
3. Mindfulness - contacting the present moment. most time we act automatically. become more aware of what’s going on inside them.
4. diffusion - stepping back and watching our thoughts, evaluating them in terms of how useful they are in moving us to what’s important . Is that thought helping us move towards what we want to do?
5. / 6. Committed action/values- help people file out what they want and who they want to be on earth. How do you bring those values to life?