Cognitive behavioural therapy – Flashcards
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Cognitive behavioural therapy
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-type of psycotherapy, that changes unhealthy thinking habits feelings and behaviours its a short term approach aimed at psycological behaviours to help learn/relearn behaviours -orignates from the behavioural approach and cognitive psychology - CBT is a well established treatment for depression panic disorder anixety phobias PTSD, OCD eating disorders.
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Behavioural therapy
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-focuses on observable ptoblems, -the idea that humans behave in a certain way due to reacting to stimuli from the environment -encourages humans to change behaviour rathr than focus on cognitions through learning fails to incoporate biological and mental processes.
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Cogitive therapy/psychology
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Cognitive resolution maintained behavioural principles but interpreted mental and biological processes into therapy largely influenced by beck 1963 ellis 1955 and meichenhatim 1977 -beck created cbt emphasised that it is a collabrtation between the client and the therapist.
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Cognitive principles
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-peoples emotions reactions and behaviours are strongly influenced by cognitions -cognitions are thoughts beliefs interpretations perceptions and thoughts on self that have meaning attach to them -humans have a capacity to respond to different circumstances we have an ability to bring cognitions to concious this happens automatically threat responses occur creating different reactions as a responds to evolution we behave in certain way to survive. -different cognitions give rise to different emotions -by helping people change cognitions you can help them change the way they feel. -cbt argues that people are disturbed not by things but by the views which they take on them, it is not the event but our attitudes and beliefs that causes an emotional reaction.
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Behavioural principles
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-behaviour can maintain or change thoughts and emotions -mental health problems can happen to anyone - they are influenced by environmental stressors and pschological problems. -here and now principle- both CBT and BT are foucsed in the present, what are the present symptoms 'what is happening now what is maintaining the problem rather than what lead to its development.
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Interacting system
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Problems are conceptualised they are made up of an interacting system of thoughts physiology emotions and behaviours which influence each other.
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Feature of CBT
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-based on a cognitive formulation -focuses on clients difficulties -focused on clients different cognitions - which differ in content/process.
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Collaborative
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-CBT is a collaboratie approach -client therapist work together- they share expertise curiosity within the relationship, questions,. Clients are the expert of their own cognitions CBT therapist share perception with clients they describe the formulation with clients CBT is structured time liited and brief it involves active engagement.
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Empirical in its approach
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CBT is up to date with research evidece develops an exploratory attitude in the client uses hypothesis collects data questions the clients cognitions and evaluates their beliefs problem oriented guided discory approach.
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ABC Theory
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-is made up of four emotional reaction that effects peoples cognitions after an event, these are irrational thoughts upsetting emotional concequences disputing of irrational ideas new emotion concequence or effect.
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Progressive approach
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-cbt is a progressive approach always selective to change through expanding applications attention to emotion changing theraputic relationships, -broad movement= incoporates many approaces such as behavioural theray, emotive behavioural therapy, cognitive therapy, schema focused therapy, mindfulness based cognitive therapy acceptance and commitment therapy. CBT requires an active direct highly cognitive approach it dosnt encourage positive thinking but rational thinking
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Albert Ellis
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- first cognitive therapist -emerged in the 1950's -trained in psychoanalysis -believed thinking was effect by behaviours and feelings, believed that their was an association between thoughtsfeelings behaviours and cognitions if you change your philosophy of life you can change your life and behavioural problems.
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Basic Assumption REBT
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-people contribute to their own problems as well as to specific symptoms by the way they interpret events and situation 'People dont just get upset they contribute to the upsetness' Albert Ellis. -REBT focuses on the idea that we have rational and irrational thoughts. - irrationl and rational thoughts are influenced by culture family experience- this can change our thoughts which effect the way we respond to environmental stimuli and stressors. -we learn and invent disturbing beliefs and keep ourself disturbed by self talk. If you accept self talk it can change our cognitions emotive behavioural processes suggesting people have the capacity to change thoughts and behaviurs through being taught strateies to deal with thoughts and behaviour.
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Rational thoughts
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Self constructed thinking
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Irrational thoughts
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Self defeating thinking.
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Humans and Thoughts
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The main reasons we over or underreact to adversities is that we have some dogmatic, irrational, unexamined beliefs for example being rejected by a lve, you become an emotional mess, created by your own beliefs or phulosophys such as i will never be loved by someone again im worthless because they rejected me. -humans have a general tendency to turn desire and prefernces into demands for example we dont need to be accepted or loved in reality but we feel like we do.
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Types of irrational beliefs
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-interference= persons interpretations of events people will think this about me,... -demands= must/should thoughts other people should approve of me -evauluations= awfulizing the situations í cant stand this-- -irrational beliefs lead to unhealthy emotions.
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Negative emotions
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-unhealthy anger -anxiety -depression -guilt -shame -unhealthy jealousy -negative emotions have irrational thinking attached to it
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Healthy emotions
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-concern -sadness -remorse -disappointment -healthy anger -healthy jealous
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Secondary emotions
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Involve being distressed about being distressed- REBT therapist think it is more useful to focus on secondary emotions than primary emotional responses.
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ABC
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A- activated event B- belief- is activated by event C. Concequences of that belief creates an emotional response.
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REBT therapy
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-long term process -involves 7 steps which are 1. Fully acknowledging we are responsible to emotion Accepting- that they are only emotions Recognising- emotions stem from irrational beliefs Clearly percieving beliefs values Accepting change ????
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Theraputic Process of REBT
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-creating goals- Ellis thoughtgoals should focus on seperating the problem from the person rather than improving self esteem goals should be unconditional acepted and unconditional acceptance of others. - focus on achieving levels of acceptanc constructs healthy emotions. -therapust function and goals= highly diactic structured direct concerned with both feeling and thinking empathy and rapport are important but you cant be too warm or it makes the theraputic process unconstructive. You need to show clients irrational beliefs show and change heir beliefs through teaching and challenging them to take on a rational beliefs. Techniques used homework, psycoeducation hujour rational emotive immager challenges behavioural component, role, playing shame attacking exercises reclaxition techniques, modelling -application- broad based oderatly server mental disorders works well with anger and agression and sexual difficultiies.
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Limitations of REBT
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-need to have a certain level o understanding to use this approach -not suitale for all clients -can be time consuming.
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Becks cognitive therapy
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-was developed by aaron beck (1921-1960) -highly influenced by psychoanalysis and the ABC Theory -Focuses on levels of cofnitions, these are automatic thoughts, dsyfunctions, assumptions and core beliefs
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Negative Automatic Thoughts
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-are thoughts which are available to the concious mind -automatic, tends to be influenctial bt humans dont notce their impact -taken as factual/true although thoughts are just opinions and not facts Are the early focus of cognitve therapy Has the accrimin NAT.
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Core beleifs
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- also known as schemas -fundamental beliefs about self, others, the world and reality -deepest level of cofnitions, not accessiabl to conciousness learnt through childhood experience can be latenet global and absolute typically not the direct focus of therapy.
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BecassDsyfunctional assumptions
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-rules for living Conditional statements í must' i should developed to protect against negative core beliefs can be culturally reinforced ridgid focsed on in therapy to prevent relapse.
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Automatic thoughts
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Thoughts that come to concious mind automatically can be both positive and negative beliefs.
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Beck's view of emotional disturbances
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-Becks cognitive therapy is to correct faulty information processing and to help modify assumptons that maintain maladaptive behaviour and emotions rather than irrational thinking. This is the goal of becks cognitive emotional therapy.
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Cognitive distortions
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-extreme thinking= dichotomous thinking, unrealistic expectations, high standards catastrophisation -selective attention- over generalised mental filter disqualifying the positive magnification and minimisation -relying on intution- jumping to conclusions, emotional reasoning. -self reproach- taking thinks personally self blam self criticism name calling. -certain cognitive distortions tend to be charactised swith specific disorders for example depression is associated with negative view of self and the world Anxiety has a sense of physical or psychological danger to it
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Theraputic relationship of Becks cognitive therapy
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-offers a safe private confidential setting Treats concerns seirously prioritises interest of clients practical information is givven personal choces involved flexible in time feedback is given. One of the main ways becks differes from ellis was his emphasis on the importance of the theraputic relationship.
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Factors for positive outcome of becks cognitive therapy
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-theraputic relationship, expectancy, hope, placebo, theraputic factors theraputic techniques.
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Assumptions of becks cognitive therapy
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-peoples internal commnication is accessible to intropection cleints beliefs have highly personal meaning these meanings can be discovered by clients rather than taught or interpreted by the therapist -collaborative approach- team, joint eggoy, working allance, the client supplys the information does homework task and the therapist provides structure and expertise on how to solve problems. -its not the therapist function to reform the client rather his role is working with the client against it the client problem. Placing emphasis on solving problems rather than his presumed deficits or bad habbits help the client to examine his diffculties with more detachment and make him less rone to experience shame a sense of inferiority and defenssiveness. The therapist role is to time speaking explain and discuss approahc, goal setting together collaboration on seeting weekly adgenda, feedback from therapist to client, versue questions working together sharing information and skills. Becks cogntive therapy uses socratic methods, ancient greece methods, it uses open questions to encourage the clients to talk, ad provide maximum information and it uses clsed questions used to gather specific information.
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Questions
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-are not useful if they are not understood, doubl barreled questions, grilling questions as statments questions that see specific answers. -a useful question is one where the client works out the answer the answer reveals a new perspective. -porpose of socratic questioning is it gathers infomration educates cleitns explicate the cognitive model to help recognise unhelpful cofntions to recognise the concequences of unhelpful cognitions to develop alternative cognitions.
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Donald meichenbaums
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Born in 1940 Creator of STI stress inoculation training Used in the 70's and 80's
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Stress inoculation training
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-is used for people with post traumatic stress disorder and anger problems. -aime to educate people on cognitions and triggers it involves teaching cleints skills and control so they can control their emotions, cognitions and behaviour. -provides expereince with minor stressors that foster psychological prepardness and resilence, its a preventatve approach but can be used as a treatment.
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Innoculation
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-concept -refers to variations method to immunize an individual against small pox ww2 childbirth and the work of worrying.
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View of stress and coping
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-people face stimuli from the environment they respond to this stimuli by physical and psychological reactions -transaction occurs whn they percieve demands exceeds the percieved resources which give ephasis to cognitive effective approasials process -coping activities need to be taught
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Constructivist narrative perspective
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-focuses on the stories people tell about themselves and other regading signitficant events in their lives -their are multiple realities STI therapy helps cleints appreciate how they are the author of their own stories and to reauthor more adaptive stories.
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Behaviours and cognitions: which lead to stress responses
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-self focused cognitions- victim themse seeing themselves as vunerable mentally defeated dwelling on things negative implications preoccuipid with other bviews of themself imaging/rumminating on what might have happened. -beleifs- perment views, world as unsave unpredictable untrustworthy future will be negative loss of meaning -blame blames others angry at others blame of self guilt and shame and humiliated -comparisons- oneself with others before with now now/what might have been -action taken- being abvoidant having contractfactual thinking delyang changing behaviour fails to share stories putting self at risk for more victiization -action not taken- beliving positives in trauma events having positive self identity skeeking social supports protecting self from stressors having faith to cope.
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Features of stress inoculation training
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-not a speficic treatment formular. Sets general and clinical guidlines Can be individual or group processs Can be brief 8-15 sessions with a follow up.
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FollowNature of STI
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- has three phases conceptual educational skill acquistion & consolidation, application and follow through -focuses on acute time limited stressors sequences of stressful events chronic intermittent stressors chronic continual stressors it measures a persons level of controlability and predictability. -the goal is to bost individuals coping skills to restore confidence and be able to apply coping skills when faced wih stressors
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Phase 1: Conceptual/educational Phase
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-creates working relationship with client, Enchants clients awareness understanding of stress and how it impacts them Identifys determines individual stress through interviews imagery, assessments, behavioural observations Clients can teel their story, evaluate maladaptive and adaptiecoping skills distinguished between changeavle and unchangable aspects of stressful situtations establish LT and ST foals identify clients distress.
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Phase 2: skills acquistions and consdidation
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-ensures cleint develops the capacity to apply coping skills to stress Uses skill training cognitive reconstructing assertions problem solving skills humour, relaxation techniques acceptance reframing social upport development skill rehrsal modelling planning to addres barriars and self instructional training (identifys havbitual statements how do these statement exacerbate the stress reaction how can i prepare how can i confront and deal with it how can i cope with feeling overwerwhelmed how can i reinfource self statments)
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Phase 3: application and follow up
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-provides opportunity for clients to apply coping skills on a graduated basis across increasing demanding levels of stressors -encourages applicatin of coping skills Relapse prevention Bolster self efficacy Treatment adherence Gradually fades out treatment sessons developing coping strategies,
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Applications of STI
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- therapist examiner client is the student working relationships, Uses techniques such as breathing exercises, teaches person to become aware of sensory experience. Sti is effective in medical patients chronic pain breast cancer hypertension used to prepare for medical dental procedures used for psychiatric pations, anxiety anger control panic attacks agrssive behaviour proplr who may have hig stressed job coping with exams STI has stong empiical support that is effective.
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Formulation
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Case connceptualisation an individual picture that helps us understand and explain clients problems- provides knowlege to therapist, provides a rational guide for therapy, anticipates course of treatment Focuses on on art and science of therapy, helps identify what is mainting processes of the problem, what perpetuates the problem.
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Assessments
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Gathering information to develop psychological formulations and treatment plan its more concerned about unerstanding a persons own characteristics and meaning aims to reach agreement on issues to be workd on and how this might proceed
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Clinical interview
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Primary means of assessmnt allows direct gathering of information about clients experiiences observed clietns appears to be non verbal behaviour uses self monitoring self report questionaires interviews with significant others.
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Importance of the theraputic relationship
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-team approach joint effort working relationship Shares formulatuions Process of guided discovery a 2 way process therapist assists client client decides if itsright for them.
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Problem descriptions
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-identifys what problem is , onset and course of problem main issues and symptoms identifys clients cognitions and thought paterns emotional feelings behaviours clients response to cognitions physical responses.
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Triggers
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-factors that ake problems or less likely to occur.
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Modifiers
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How servre the problem is when it occurs
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Types of triggers and modifications
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Situational variales, social/interpersonal variables, cognitive variables, behavioural variables, physiological variables, effective variables.
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Concequences
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Refer to impact of triggers and modifers the involvement of significant others coping efforts,
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Predisposing factors
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-why me -includes historical information -personal/individual factors- genetics developmental problems, disability personality, coping skills, coping stylesm social skills, self esteem social contextual factors parenting attachment styles family school early trauma societal cultural issues.
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Precipitating factors
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-associated with onset of problem, critical incidnts can be personal illness developmental phases contextual-life changes stresors fininacial presures relationship problems loss of social support
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Perpetuating factors
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-what mainted the problem often takes a form of a vicious cycle.
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Case study
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Looks at clients presenting problems predisposing factors precepitating factors perpectuating factors protective factors and treatment.
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Structure
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Length of therapy depends on severity of problems 620 session usually duration is 45 mintues frequency of sessions weekly or fortnightly follow up Adgenda setting benefits prioritised promotes structure maintain focus colaboration. Content of therapy- review of the week, review of sessions , assessment of feelings, review of homework, main topics, assign homework and feedback.
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Goal setting
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Set realistic goals specific measurable, achievable reaalistic time frame the dead mans solution miracle questions review.
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Behavioural activities
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- are experimintation or observations aimed to test the validity of patients exsisting beliefs construct and or test new more adaptive beliefs contributes to the development of ognitive formulations -are designed like experiments to gather evidence to test and understand unhelpful cognitions. Aims to get cleints use to stimuli, learn how to respond to fear. They need to be tailored to meet clients needs and cognitions its a trail error processes Experiments involve assigned homeork encourage clients to be fully engaged, minitor thoughts/emotions- identify changes be flexibel respond to unexpected evidence. -after experiment is conduct their is a debrief stage- how did the client feel what was expected reflect how can the client make sense of what happend how does it influnce future situations. Always try t find success after an experiement even if they go wrong, make sure their are clear boundaries when using an experiment.
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Physical techniques used in behavioural interventions
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-relaxation reduces physical arousal changes body flow only one componenet of treatment can be anything that makes you feel good such as exercising getting nails done, reading puzzles, traditional relaxation techniques, matching relaxation methods to symptoms has shown some ffectiveness your goal is to find the technique that suits your clients best interest/needs. -controlled breathing- misinterpretation of physical symptoms can lead to hyperventilation mimics panic attack breathing at high rate/volumes percievd as catastrophic indicating death ask clients to overbreath, ask them to compare both breathing patterns ask if panic is related to breathing showinf them control over breathing and reduction of breathing. -physical exercises reduces depressive symptoms releases ensorphines in the body decreases feelings of fatigue increases energy uses up access adrealine helps people with low mood and low sel esteem relases tension good for anxiety, anger management and sleep disorders.
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Problem solving q
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1. What is the problem 2. How do we solve the problem 3. Determine which is best 4 pick solution 5 small steps to goal 6 step into action 7 continue to solbve.
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Cognitive interventions
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-thoughts impact the way we behave, thinking influences our environment and how we respond to it. -identify negative cognitions through listening to clinets thoughts -hot cognitions more directly linked to emotions identified by downward arrowing- system of question to elaborate identfy meaninf leads to developing understanding of thought processes -turning questions into statments- diary keeping imagery role playing in sessions mood shifts identify what going on for them in their life idntify cues and triggers. -distractions- attentinal control limited congnitive resources focusattention on something else, breaks cognitions cycle gives break from negative thoughts mental exercises grounding refocusing grounding and physical exersies.
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Cognitive distortions in cognitive interventions
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-grounding- focusing cognitive resources on something bringing them back to present moment ie name three things you can hear smell see. -identifying bias- identifying extreme thinking (black and white thinking) or selective attention (overgeneralisation single event into negative) -relying n intutions jumping to cnclusions mind reading predicting future emotional reasoning -self approach- self labellizing self blame, criticising.
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Decentering
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-thoughts are not facts seperating thoughts and reality metacognition awareness understanding the origin of cognitions.
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Reframing
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Reflecting on other side of can involve positive spin works with cognitive bias.
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Developing new perspective
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Developing balanced view experiences not completely true all the time identifying strengths and resources how do they cope what helps them how are strength used. Collecting evidence contridiction of thughts are you jumpng to onclusions that events justified by evidence. Self reflectioning on cognitions and self friendly voicewhat would you tell your friend if they had this thought what would they say to you taking on a new perspective.
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anxiety
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Relates to worrying stress nerves increased heart rate fear it has an adaptive functioning we need it to activate the flight fight response and to identify stress. Anxety becomes maladaptive if it becomes overly excessive. -is problematic en it effects functioning and life when it reinforces safety behaviours causes personal distress triggered in inappropriate sistuations servere and long lasting, methods to cope becomes a problem. - anxiety impacts imairment in psychological functioning, poorer quality of life, high suicidality, higher serverity of illness higher rates of relapse. -conceputalisation anxiety predisposing factor of other disorders emerges due to experience lost unusal experiences -treatment anxiety client care needs to be incoporated in treatment for psycotic disorders to reduce worrrying. Anxiety disorders adopt cbt frameworks can be deliered in group work aswell.
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Stress reduction
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-begins in the brain releases narcotics releases blood sugar increases pulse rates releases insulin- causes psychological response increases blood preasure breathing saliva decreases muscls tense consistent with anxiety response
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Anxious
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Overheat told us to relax, aggrssin tense uncomfortable nausea excessive cognitions shaking repetitive self dialogue physiological emotional behavioural cognitive components in anxiety.
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Prevalace
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Anxiety affects 18% of females and 11 % of males more people with anxiety than substance abuse and effective disorders more common in females.
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Types of anxiety
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Panic- peirod of intense fear and discomfort symptoms include heart pounding shaking sweating, panic attacks, worrying behavioural change. -agrophobia anxiety about situations and places, symptoms include avoidance fear of situation distress. -specific- accessive unreasonable fear of something symptoms type of fear of objects causes distess. -social phobias- fear of social situations symptoms include hallicinations humiliations caused by others -generalised anxiety disorder excessive worrying about events and problems difficult concentrating sleep disturbances irritability muscle tension restlessness fatigue. -OCD obsessin/compulisive thoughts causes anxiety and stress irrational product or thinkng -PTSD truaumatic event fear/horro relieved avoidanc behaviour irritability distress sensitivity -cmorbility of anxiety disorders- associated with substance abuse depression sub clinical anxiety.
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Cycle of anxiety
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1. Trigger 2. Percieved threat 3 fear anxiety 4 response 5 cognitions 6 increased anxiety 7 intense response
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Psychoeducation
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Teaches clients to identify responses of anxiety teaches them control.
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Safety behaviours
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-maintained anxiety, focus attention on maintained anxiety spontanueous imagery maintains anxiety emotional reasoinng maintains anxiety memory processes prepetuates symptoms of anxiety.
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Anxiety and CBT
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- really effective for anxiety -shown through randomized control trials -treatment involves strong theraputic relationships and psycoeducation. Empowers them givs them control over treatment doesnt leave them in the dark. Techniques used GAD exercise cbt and relaxation methods, PANIC- exposure breathing retaining, medications effective.
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MMD
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Major depressive disorder, Presents of depressed mood marketly disminished pleasure in activities weight loss weight gain insomina hyposomia loss of energy worthlessness guilt. MMD rare only have one episode, 4-7 episodes occur recurrent.
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Anhendonia
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Lost of energy and ability to engage in pleasurable activities causes physical dsyfunction behavioural symptoms.
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Dysthymic disorder
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-like mmd, but milder, 2 years, chronic persistent less server/longer than same symptoms as MMD.
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Prevalance
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-depression main course of disability developed and developing countries 16% of people who experience MMD within their lifetime. Dsythymic disorder effect more females than males. Depression can occur in childhood, rates rise in adolescnts gender differences emerges in adolescents. Consistent across culture symptoms interprut low mood across culture.
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Beck's theory of depression
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-cognitive distortions depressive cognitive triad negative thoughts of self the world and the future. People with depression are more likely to interprete negativ wiew interpret information negatively remembers negative events rather than positive events. Impacts how you percieve the world causes dsyfunctions forilles beliefs -negative events come from stable global internal factors self vblaming 2ndary thoughts and emotions about depressive symptoms reinforces cycle of depression.
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Depressive cycle
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Symptoms followed by negative thoughts follows high expections followed by less behaviour energy thhan drops negative thoughts no self confience feel more depressed.
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Goals for cbt for depression
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-helps clients counteract negative biases and develop a more balanced viw of self world future. Restore activities levels and enjoyment/achievement Increase activ engagment and problem solving skills
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Treatment for depression
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Behavioural treatment= exercises scheduling graded tasks assignments Early cognition strategy= distractions attitude shiftsm thoughts are not facts minimise depressive symptoms main cognitive strategy identyfng NAT what is their fuction identify realistic thoughts test alternatives. Lapse-trying it again not continuous Relapse- going back before change has occured. Continuous.
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Parent infant research
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Postnantal depression different from mmd -onset needs to occur within 4 weeks of child birth postpartum, occurs for males and females peeks at 6-8 months antealtal episodes during pregnncy peirod symptoms refer to tears panic attacts anciety worrying agitation lack of energy hyper activity low moods sadness loss of pleasure activity, irritabiity appetite disturbances reduce concentration emotional lability thoughts of death and suicide. Context of PN- fa,males recuperate from cild birth they are sleep deprivation constant demand of infant emotion contagion- infant and others fear of fail as a parent, preoccupid with infancts wellfaire lack of own wellbeing couple reationship becomes difficult Risks pre term labour predalpsiagestational diabetes postnatal depression. Impacts- baby attachment mother attacment distinguished relationship Treatment relaxation psycoeducation awareness self esteem more helpful thinking style relapse presvention. Treatment focuses on impoving mood and social interaction learning self nuturing techniques enchant commnication skills increases positive thoughts and challenging unhelpful thinking patterns.
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CBT and present
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-cbt has dicersified ues schema focused therpy, mindful based cogntive therapy acceptance and commitment therapy, dialetical behavioral therapy.
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Empirical evidence and cbt
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-clinical issues adaption to meet the ever widening range of people who seek help increases emphasis on retational emotional and experimental aspects of therapy.
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Cmpassionate based therapy
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Aims to help self critical and self condeming clients to develop compassion towards them reduce feelings og shame focuses on internal relationships shifts attiudes towards self crictism experiental promotes acceptance sense of security self soothing.
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Mindfunllness
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Based cognitie therapy, relapse prevention for depression combinds classic cbt and mindfulness training promoties clients to pause identify thoughts evoluatin distance thoughts
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Acceptance and commitment therapy
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Relation fram theory goals not symptom reduction transforms relationships with uncomfortable thoughts feelings healthy normality abiquity of human suffering act- human pain is normal destructive noemality use of language double edge sword problem solving. Act principle defusion acceptance contact with present moment obsercing self value and commitment to action Acceptance openly up making room for pain senstions urges and emotions Contact with the present moment being egaging and connected. Values desirable qualities ongoing action commitment action taking effective action guided by our value. Acceptance of thoughts feelings and present Choose valued directions take action.
