Coun222 lecture 3: Beck’s cognitive therapy – Flashcards

Aaron Beck. 1921 to 1960s: -university of Pennsylvania- been there for decades. -psychoanalysis. -negative bias. Self report inventories: BDI (Beck depression inventory) and BAI (Beck anxiety inventory). -used very widely. -degree of symptoms. -orientation towards measurement of things for use of information for data. Judith Beck. -daughter. -now major in the field of CBT. -produced a couple of books- really instructive. -structured. -how to conduct CBT. About the same time as Albert Ellis. Didn't have a lot to do with each other. Studied psychoanalysis. Very empirical. Ideas of psychoanalysis to the test. Picked on the idea of depression being anger turned inward- Freud. -put that to the test. -what extent is anger part of depression? -didn't really seen to be well represented. -wasn't a good representation. You didn't have to dig very far to find something that was representative of people who were suffering from depression. Profound and pronounced negative bias. Tendency toward bias- everything coloured with the same grey and dark hue. -even if everything around them didn't support that as a system of interpretation. -relevant for depression. Works well with depression.

Cognitions are the seed for any problem. Linear relationship. Hot cross bun model: all influence one another. Representation of the nature of cognitions. Levels of cognition: -negative automatic thoughts (NATs). -dysfunctional assumptions (rules for living). -core beliefs (schemas).

Flow is from the belief to the consequence. Make it clear that the different elements of our responses were interaction.

Automatic thoughts: -almost like a heart. It is beating all the time but we are not noticing that it is. -our mind is creating thoughts all the time and sometimes we don't notice them or ask the mind to. Negative automatic thoughts: -available to conscious mind. -automatic- happen without any conscious direction. Not trying to think these thoughts. What the mind is producing. -tend to not realize their influence- happen very quickly. We don't direct our attention to them. -taken as true; 'thoughts are opinions, not facts."-especially if they are strong. -the early focus of therapy. -different levels of cognition- upper most level- these thoughts are available to the conscious mind although we don't necessarily notice them all the time. Being anxious can bring up negative automatic thoughts. Put something into a statement- depends on how anxious you are feeling. Close relationship with the emotion, what you are feeling.

Core beliefs (schemas): -fundamental beliefs about self, others and world. -deepest level. -not usually accessible to consciousness- take quite a bit of work before they are uncovered. -global and absolute- deep seeded. -usually learnt through childhood- consequence of experience but also to a major stressful event or trauma. -can be latent- not so apparent in feelings and behaviours. When the person comes under pressure, the beliefs are given life. -typically not the focus of therapy.

Dysfunctional assumptions (rules for living): -more difficult than automatic thoughts and core beliefs to uncover. -typically in place to try to cover up the core beliefs. -NATs are quite specific. -not as easy to identity as NATs. -conditional statements or phrases- self demands. -develop as a way of protecting against negative core beliefs. -can be culturally reinforced- ways to live and behave. -rigid- almost like religious commandments. -focus later in therapy to prevent relapse.

Goal of therapy: -to correct faulty information processing and to help modify assumptions that maintain maladaptive behaviours and emotions- negative cognitive bias- help the person alleviate themselves from the bias tendency that help maintain NATs. -what keeps the problem alive? -interpretation of what happened and how does that affect how a person understands themselves. Rather than irrational thinking. -CBT therapists won't use this term now. -person will feel as though they have mucked up. -give the impression that it is wrong. -person might feel a little bit ashamed. -might think they are childlike. -lead to a secondary emotion. Cognitive distortions/biases: -range of common cognitive distortions. -how our cognitions can be helpful or unhelpful.

Extreme thinking: -dichotomous thinking- things are this or they are that. -unrealistic expectations/high standards- exaggerated performance criteria. Anything less than the best doesn't count. -catatrophisation- to what extent am I catatrophising? - one thought leads to another and then another. Selective attention: -over-generalization. -mental filter- I got a poor mark for that assignment so that means I will do badly in the whole unit and then my course will be ruining. -disqualifying the positive- not being able to accept a compliment. -magnification and minimization. Relying on intuition: -jumping to conclusions. -emotional reasoning. Self reproach: -taking things personally. -self blame or self criticism. -name calling. Related to emotional disturbance. Coaching ourselves to feel worse about ourselves. No evidence. All biased. Range of common cognitive distortions. Certain biases tend to characterize specific disorders. Depression: negative view of self, world and future. Anxiety: sense of physical or psychological danger.

If you needed help, what would you look for in a therapist: -empathy. -male/female preference. -honest challenging. -realization that you are going to have to work. -experience. -age?

A physically safe, private, confidential setting. Be flexible. Some practical information. Not technical competencies. Degree might be related to experience. Nobody thought that qualifications were very important. Could have had a relationship but they were personal characteristics. Who is the therapist?

Give emphasis to the personal qualities. One of the main ways Beck differed from Ellis was his emphasis on the importance of the therapeutic relationship. -needs to have the empathy.

Therapeutic technique (15%). Expectancy, hope, placebo (15%). Extra therapeutic factors (40%). Therapeutic relationship (30%). Interrelationship between the different elements.

Genuine interest in others. Empathic ability. Personal warmth (UPR). Active listening. Rogers: necessary and sufficient for the therapeutic process. Beck: necessary but not sufficient.

1. peoples' internal communication is accessible to introspection. -fundamental to behaviours, feelings, physiological responses. 2. client's beliefs have highly personal meanings. -always going to be individual variation. 3. these meanings can be discovered by the client rather than being taught or interpreted by the therapist.

Team approach/ a joint effort/ working alliance/ collaborative empiricism: -viewed clients as practical scientists- has certain benefits. -emphasizes the client's role- supply the raw material, identify distortions, summarise important parts and devise homework tasks. Therapist provide structure and expertise on how to solve problems. This involvement makes lasting change more likely.

Time speaking might be able equal. In an initial session, the therapist will explain and discuss the approach with the client. Identify goals together. Collaborate on setting a weekly agenda. The therapist shares their thoughts about the client's thoughts and asks for feedback. Both client and therapist ask questions and work together to find answers. The clients thoughts, feelings and behaviours are reflected, not interpreted. Sharing of information and skills enables the client to become their own therapist.

Socratic method. Socrates, ancient Greece. A lot of discovery happening on both parts. Particular style of instructing students- ask questions in such a way that discoveries would be made. Better way for people to come to an understanding. What kinds of questions are there? -open questions: encourage clients to talk and provide maximum information- how, what, could, how, why? -closed questions: used to gather specific information- is, are, do? What aspects make a question not very helpful? -questions you don't understand. -double barreled questions. What aspects make a question useful? 1. your client can work out an answer. 2. the answer reveals new perspectives.

Information gathering: -what did it mean to you when you thought/did that? Education: -three people waiting for the bus at the bus stop. As they are waiting, they see the bus come but the bus just drives past and doesn't stop. The first person is absolutely furious that the bus didn't stop. The second person is really anxious. The third person doesn't really care, feeling quite neutral. What thoughts would be going through each of these peoples' minds. Emotional blends. Anxiety might precipitate anger. Not every thought has the same weight. Connection between thoughts and feelings. To explicate the cognitive model: -highlight the links between thoughts, feelings and behaviours. -what goes through your mind when you feel like that? To help recognize unhelpful cognitions: -is there anything that doesn't seem to fit with that thought? To help recognize the consequences of unhelpful cognitions: -how helpful (or unhelpful) is it to hold this belief? To develop alternative cognitions: -how likely is it that the worst will happen? Problem solving. For developing action plans.