Cognitive Behavioural Therapy

Question 1

Who developed CBT?

Answer 1

Aaron Beck (1979)

Question 2

What observations is CBT based on?

Answer 2

Common thinking styles and themes in depression sufferers, and common behaviours

Question 3

Key ideas of CBT summarised

Answer 3

What you think and do affects the way you feel

Question 4

Skinner (1953)

Answer 4

Reinforcement 
Positive reinforcement 
Negative reinforcement 
Punishment 
Frustration

Question 5

Skinner reinforcement

Answer 5

The notion that the way in which we behave can be reinforced by positive or negative reinforcement

Question 6

Skinner positive reinforcement

Answer 6

Rewarding good behaviour

Question 7

Skinner negative reinforcement

Answer 7

Behaviour leads to the removal of a negative stimulus or feelings
E.g. crying when hungry and getting fed reinforces crying behaviour

Question 8

Skinner punishment

Answer 8

Adverse consequences for bad behaviour, attempts to stop behaviour

Question 9

Skinner frustration

Answer 9

If you expect a reward for a behaviour and that reward does not come, you may become unmotivated to perform that behaviour

Question 10

Ferster (1973)

Answer 10

The depressed person’s activities function as avoidance and escape from aversive thoughts, feelings or external situations
Reduced access to pleasure and satisfaction are consequences of avoidance

Question 11

Lewinsohn (1974-76)

Answer 11

Social reinforcement theory
Lack of social reinforcement of adaptive behaviour
Depressive behaviours can also become reinforced (sympathy, help)

Question 12

Who developed the first behavioural treatment for depression?

Answer 12

Lewinsohn

Question 13

Ellis (1957)

Answer 13

Emotions influenced by appraisals 
Irrational beliefs cause suffering's 
A - antecedent 
B - beliefs 
C - consequences

Question 14

Beck (1979)

Answer 14

Focus on modifying cognitive biases and maladaptive behaviours that maintain emotional disorders

Question 15

Beck (1979) cognitive triad beliefs (depression)

Answer 15

Core beliefs about the self (I am useless)
Core beliefs about others (Others are better than me)
Core beliefs about the future (No matter how hard I try I will never amount to anything)

Question 16

How does the cognitive triad work in depression?

Answer 16

Core beliefs about self, others and future feed into conditional beliefs which are rules that help us navigate interpersonal relationships and interactions (If I get close to others, they will eventually reject me)

This then feeds into automatic thoughts (I will make a fool of myself, people will think I’m the odd one out, nobody will talk to me, I’ll feel awful)

Can be triggered by social situations (being invited to the office party)

Question 17

Beck (1979) cognitive triad beliefs (generalised anxiety)

Answer 17

Core beliefs about self (I am unable to cope and protect myself)
Core beliefs about others (others are threatening, the world is dangerous)
Core beliefs about the future (terrible things can happen at any moment)

Question 18

How does the cognitive triad work in generalised anxiety?

Answer 18

Core beliefs about self, others and future feed into conditional beliefs which are rules that help us navigate interpersonal relationships and interactions (If I leave the house something bad will happen)

This then feeds into automatic thoughts (What if I get lost? What if I get robbed?)

Can be triggered by everyday events (needing to go shopping)

Question 19

All or nothing thinking

Answer 19

If I am not perfect, I have failed

Question 20

Mental filter

Answer 20

Only paying attention to certain types of evidence, noticing failures but not seeing successes

Question 21

Jumping to conclusions

Answer 21

Mind reading - imagining what others are thinking

Fortune telling - predicting the future

Question 22

Over generalising

Answer 22

Seeing a pattern based upon a single event, or being overly broad in the conclusions we draw

Question 23

Disqualifying the positive

Answer 23

Discounting the good things that have happened or that you have done for some reason or another

Question 24

Magnification (catastrophising) and minimisation

Answer 24

Blowing things out of proportion

Inappropriately shrinking something to make it seem less important

Question 25

Role of case formulation in CBT

Answer 25

Explanatory models for an individual's differences Usually includes predisposing, precipitating and maintaining factors Emphasis is put on current cycle of distress Guides the selection of relevant treatment strategies

Question 26

Idiographic formulation

Answer 26

A specific formulation for an individual given that the individual's life history

Question 27

Disorder specific formulation for panic disorder

Answer 27

``` Clark (1986) Trigger Threat perceived Anxiety Body symptom or mental symptom Catastrophic misinterpretation (I am dying) (final three in a cycle) ```

Question 28

Disorder specific formulation for social phobia (Wells and Clark, 1997)

Answer 28

Social situation Activates assumptions Perceived social danger -> somatic and cognitive symptoms and safety behaviours Processing of self as a social object (from and feeds into perceived social danger)

Question 29

Epictetus quote

Answer 29

Human beings don't suffer because of the things that happen to them; human beings suffer because of what they think about the things that happen to them

Question 30

Common strategies in CBT

Answer 30

``` Goal setting Behavioural activation Graded exposure Cognitive restructuring Behavioural experiments Problem solving Attention training Automatic thought record ```

Question 31

Goal setting

Answer 31

Long-term - reconnect with meaningful others | Short-term - get out of bed for a few hours a day

Question 32

Behavioural activation

Answer 32

Gradual activity scheduling in a way that the easiest is scheduled first, gradually moving on to the more difficult ones

Question 33

Graded exposure

Answer 33

Gradual exposure to the anxiety inducing stimuli

Question 34

Cognitive restructuring

Answer 34

Central technique | Recognising the ways in which your thinking may be problematic and changing this

Question 35

Behavioural experiments

Answer 35

Experiments set up to check whether core beliefs are true | When your belief doesn't come true, it changes your belief

Question 36

Problem solving

Answer 36

Enables people to work through problems in a systematic way Weigh up the pros and cons of different decisions Gain a sense of control over problems

Question 37

Attention training

Answer 37

Used when paying attention to specific components of the environment or in the body are the problem Retrain to pay attention to other things

Question 38

Automatic thought record

Answer 38

When you notice your mood getting worse, ask yourself 'what is going through my mind right now?' ``` Fill in table with columns of: Situation Automatic thoughts Emotions Adaptive response Outcome ```

Question 39

Key principles of CBT treatment in practice

Answer 39

``` Structured and time-limited Goal oriented Emphasis on the present Change oriented Active Evidence-based Collaborative empiricism Educational ```

Question 40

Structured and time-limited

Answer 40

Sessions have an agenda | There is a set number of sessions

Question 41

Goal oriented

Answer 41

Focused on the defined problems and targets

Question 42

Emphasis on the present

Answer 42

We consider relevant history to make sense of the problem but mainly focus on finding ways to improve wellbeing today

Question 43

Change oriented

Answer 43

Promoted changes in how we think and/or behave

Question 44

Active

Answer 44

CBT involved talking, but is primarily a doing therapy, patients are encouraged to practice skills in between sessions

Question 45

Evidence-based

Answer 45

Guided by case formulation, grounded in research data, use of validated outcome measures to assess progress

Question 46

Collaborative empiricism

Answer 46

We work as a team to learn about what maintains problems, take an objective view about our internal and external worlds

Question 47

Educational

Answer 47

We use psycho-education and guided discovery to learn about ourselves

Question 48

Traditional high intensity CBT

Answer 48

``` Individual psychotherapy (typically 16-20 sessions, 1hr/week) Group-based ```

Question 49

Contemporary low intensity CBT

Answer 49

Self-help (biblio-therapy) Individual guided self-help (<8 sessions, 30mins/week, in person and/or via phone) Computerised CBT (online modules, forums, apps) Large group psycho-educational CBT (e.g. stress control classes) Less costly and quite effective for common psychological problems