Cognitive Behavioural Therapy

Question 1

Cognitive behavioural therapy

Answer 1

• short-term, goal oriented form of treatment
• addresses thought and behavioural processes to help solve individual’s problems (behaviour or cognitive based)
• effective in helping problems of anxiety, depression, ocd, addictions
• CBT uses techniques/concepts from behavioural therapy, social learning theory, cognitive therapy, social skills training, mindfulness and task-centered models

behaviour aspect: focus on defining/addressing people’s problem behaviour
cognitive aspect: focus on addressing problem in how thoughts affect behaviour

Question 2

3 Principles of CBT (Payne)*

Answer 2

1) Access hypothesis: all thinking is knowable to us, nothing remains in the unconscious
2) Mediation hypothesis: Our rational minds manage our emotional responses; we do not have solely emotional responses to experiences – implies that emotional responses incorporate “decision-making”
3) Change hypothesis: We are able to modify our reactions to what happens to us. Understanding reactions and using cognitive strategies to manage them make coping easier.

Question 3

CBT is rooted in a number of theories (5)

Answer 3

• cognitive theories
• behaviour theories
• social learning
• social skills training
• mindfulness

Question 4

CBT ideas

Answer 4

• focus on how thinking processes generate behaviour patterns – person’s thoughts (reactions to experiences) cause feelings
• Process of teaching, coaching and reinforcing useful behaviours
o Assertiveness training enables people to practice behaviours so that they can gain confidence in their behaviours and thus improve their overall social confidence
o Modeling is a form of social learning in which people understand and copy useful behaviours from a valued role model
o Mindfulness techniques focus on paying attention to important issues in our lives
• Motivational interviewing may be used to engage challenged clients (clients who are not necessarily on board with treatment)

Question 5

5 forms of cognition distortion

Answer 5

1) selective perceptions (noticing selective aspects of child’s behaviour - only bad behaviour, not realizing when child is cooperating)
2) distorted attributions (you only did that favour in order to control me)
3) inaccurate expectations (or predictions of what will happen - if i tell him how i feel, he’ll break up with me)
4) inappropriate/inaccurate assumptions (general beliefs about people and their relationships - “men don’t have a need for emotional attachment)
5) unrealistic standards (I must maintain a 4.5 gpa throughout my entire undergrad degree)

Question 6

Operant conditioning

Answer 6

• behaviours are strengthened or weakened by altering the consequences that follow them. Focus on changing contingencies that were affecting behaviour, leading to new consequences

Question 7

extinction - important basis for treatment

Answer 7

condition response fades or loses connection to antecedent event

Question 8

counterconditioning

Answer 8

systemic desensitization

e.g.: relaxation and support techniques are taught, unwanted stimulus is slowly reintroduced -> school phobia

Question 9

reinforcement

Answer 9

strengthens behaviour

Question 10

punishment

Answer 10

reduces behaviour

Question 11

positive vs negative punishment

Answer 11

positive: doing something
negative: taking something away

Question 12

social learning theory

Answer 12

• origins in behaviourism
• ability to learn new responses through observing and imitating others
• theory that problematic interactions are learned (30% of children)

Question 13

modeling

Answer 13

• form of social learning where people understand and copy useful behaviours from a valued role model

Question 14

Motivational interviewing

Answer 14

• used to engage difficult (perhaps involuntary) clients
• “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (miller and rollnick)
• use of empathy, points out discrepancy between client’s values and behaviours, deals with resistance and supports self-efficacy
• designed to address ambivalence in clients

Question 15

5 basic questions of motivational interviewing

Answer 15

1) why would you want to make this change?
2) how might you go about it in order to succeed?
3) what are the three best reasons for you to do it
4) how important is it for you to make this change
5) so what do you think you’ll do?

Question 16

mindfulness

Answer 16

paying attention in a particular way: on purpose, in the present moment, and non-judgementally
- used to focus on paying attention to important issues in our lives

Question 17

assertiveness training

Answer 17

people to practice behaviours to feel comfortable and gain social confidence

Question 18

rational emotive behaviour therapy

Answer 18

• based on cognitive theory
• client is encouraged to make distinctions between objective fact in environment, and inaccurate, negative and self-limiting interpretations of one’s behaviour/life

Question 19

cognitive restructuring

Answer 19

reveal faulty logic in client’s pattern of thinking, replace with rational and logical thinking
- major endeavor of rational-emotive therapy

Question 20

attributions

Answer 20

explanations for relationship events/behaviours that have already occurred
- we make attributions about both positive and negative characteristics in each other

Question 21

expectancies

Answer 21

predictions about other’s future ehaviour

Question 22

relationship between attributions and expectancies

Answer 22

intent that one partner attributed to the other’s actions contributes to dysfunctional cycle.
-> aaron wants to sleep because he doesn’t want to hang with me

Question 23

schemas

Answer 23

cognitive structures that organize thoughts and perceptions - core beliefs about the world
- people are not always aware of their schemas, can learn to identify and report them

Question 24

goals in CBT

Answer 24

1) what are the schemas, what do they mean to you?
2) how did schemas become entrenched?
3) looking at benefits of changing now
4) helping people manage their schemas
5) moving on

Question 25

Strengths of CBT

Answer 25

• strong research evidence (successful intervention for anxiety, depression, ocd)
• brief and structured, gets to core of what client wants to solve

Question 26

Limitations of CBT

Answer 26

• does not allign with SW values of self-determination, agency, collaboration
• lies at centre of EBP debate (used with involuntary or unwilling clients - elderly, incarcerated)
• imposing social expectations on clients reflects authoritarian position
• technical nature - jargon and formal procedures may result in dehumanizing treatment
• opposite of standpoint theory - one’s personal experience/perception of the world is not validated
• Western model - emphasis on change at the level of the individual -> not at structural level (does not account for social problems - depression - caused by racism, sexism, ableism, etc)