Introduction in cognitive behavior therapy (PSB3EKP07)
Institution
Rijksuniversiteit Groningen (RuG)
Volledige literatuur van het vak Introduction to Cognitive Behavioral Therapies is samengevat, jaar 2022/2023.
Complete literature of the course Introduction to Cognitive Behavioral Therapies is summarized, year 2022/2023.
Introduction in cognitive behavior therapy (PSB3EKP07)
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Introduction to Cognitive Behavioural Therapies
Lecture 1: Introduction to cognitive behavioral therapies: An overview, the process and
applications…………………………………………………………………………………………………………………………..……3
Chapter 1: Overview
Chapter 2: Principles, Goals and Structure of Initial Assessment Sessions
Chapter 3: Behavioral case formulation and treatment planning
Suïcide preventie Module 2 – Het gesprek aangaan
Suïcide preventie Module 3 – Eerste verklarende modellen
Lecture 2: Exposure in Practice……………………………………………………………………………………………..……25
Chapter 9: Exposure-Based Interventions
Article: The more you do it, the easier it gets: Exposure and response prevention for OCD
Lecture 3: Classical Conditioning and Exposure…………………………………………………………………………..33
Chapter 9: Exposure-Based Interventions
Article: Maximizing exposure therapy: An inhibitory learning approach
Lecture 4: Parent training: Analyzing and observing behavior/antecedent and consequent
interventions……………………………………………………………………………………………………………………………..36
Chapter 3: Behavioral case formulation and treatment planning
Chapter 4: Changing behavior by changing the environment
Lecture 5: ………………………………………………………………………………………………………………………………….42
Article: How does EMDR work?
Lecture 6 - Psychosis…………………………………………………………………………………………………..……………..44
Article: Cognitive restructuring and graded behavioural exposure for delusional appraisals of
auditory hallucinations and comorbid anxiety in paranoid schizophrenia
Article: Cognitive behavioral therapy for psychosis in clinical practice
Lecture 8 – Behavioral interventions in eating disorders…………………………………………………………….62
Article: from lab to clinic: Extinction of cued craving to reduce overeating
Lecture 10: Behavioral activation/activity scheduling and cognitive training in the prevention of
relapse in depression…………………………………………………………………………………………………………………70
Chapter 8: Behavioral Activation
Chapter 7: Activity scheduling
,2
Lecture 11: Schema focused therapies…………………………………………………………………………………………75
Article: Eighteen schemas
Article: Results of a multicenter randomized controlled trial of the clinical effectiveness of schema
therapy for personality disorders
Article: schema therapy for personality disorders: a qualitative study of patients and therapist
perspectives
Article: principles and clinical application of schema therapy for patients with borderline personality
disorder
Lecture 12: Relational framing, MBCT………………………………………………………………………………………….81
Article: Mindfulness decouples the relation between automatic alcohol motivation and heavy drinking
Article: Mindfulness meditation in clinical practice
Lecture 13: ACT……………………………………………………………………………………………………………………………87
Article: acceptance and commitment therapy for anxiety disorders: three case studies exemplifying a
unified treatment protocol
Lecture 14: Critical look at Cognitive Behavioral Therapy
No literature
Lecture 1: Introduction to cognitive behavioral therapies: An overview, the process and
applications
Chapter 1: Overview
Cognitive Behavior Therapy (CBT) is a widely used treatment approach for psychological conditions
such as depression, anxiety disorders, personality disorders, substance abuse disorders, eating
disorders and couple’s distress. CBT is a broad concept, which represents a variety of therapeutic
approaches that highlight cognitive, behavioral, emotional, physiological and environmental factors
in relation to psychological disorders.
There are at least 10 different schools. The cognitive perspectives differ in the degree to which they
view the environment as a determinant of action, thinking and emotion. The influential cognitive
approach assumes that mood and behavior are influenced by distorted and dysfunctional thinking
and that inaccurate and biased forms of thinking are common to all psychological disorders. For each
disorder there is a unique set of thought distortions and underlying beliefs (schemas). Therapeutic
activities should promote realistic, accurate and balanced thinking. The modification of thinking will
produce changes in mood and behavior and establish lasting therapeutic change. Schemas are
cognitive structures that can predispose persons to emotional and behavioral disorders and influence
evaluation and interpretation of experiences.
In contrast, behavior theory and therapy avoid to ascribe mental concepts a causal role in behavior,
instead they place emphasis on the physical environment. Thinking and emotional responding are
examples of behavior, according to the behavioral perspective.
Because of the different origins and frequently conflicting theories regarding the determinants of
behavior of cognitive and behavior therapies, cognitive behavior therapy incorporates several points
of view that can be contradictory or even incompatible.
Behavioral interventions in CBT: Underlying assumptions and common features
Behavioral Views on abnormality
Individuals who have psychological disorders or who display problematic behaviors are often
considered as deviant or abnormal because of the dominant role of ‘deviant’ or ‘defect’ models of
abnormality. Psychological disorders are often regarded as having maladaptive schemas and
underlying diseases or biological processes are presumed to underlie psychological syndromes. The
internal defect that the person has must be changed, removed or altered in some way to no longer
be disordered.
Behavior theorists and therapists do not search for internal causes of behavior. Although it is
acknowledged that genetics might predispose individuals to react in certain ways, they are primarily
concerned about what a person does and the context where the behavior occurs. Culture provides
the context for referencing which behaviors are (ab)normal. Cultural norms and values can change
over time (homosexuality was seen as a mental disorder until the 70s).
From a behavioral perspective normal and abnormal behavior is shaped by the same determinants. It
is assumed that there is nothing inherently defective or deviant about people who report emotional
or behavioral problems.
Behavioral interventions within CBT: Description and Application
Some people have negative thoughts about terms as behavioral therapy. These reactions are the
result of misunderstanding, such as the belief that behavioral therapy is an attempt to control
someone’s actions.
Psychological disorders from a behavioral perspective are defined by behavior, occurring both within
the individual (covert behavior such as thoughts) and as actions that can be observed by others
(overt behavior). The environment establishes the context of such behavior.
The three-term contingency represents the basic units of analysis. When applied to behavior therapy,
the three-term contingency concept refers to the interaction of the person with his or her
environment and includes 3 elements:
, 4
1. Antecedents of behavior: Stimuli and conditions that set the occasion for behavior to occur
(specific places, persons, objects or events, and a person’s learning history (if behavior has
been performed before and gave positive outcomes, the behavior is more likely to be
performed again).
2. Behavior: Anything a person does (overt; speak or perform a physical movement and covert;
thoughts, emotions and physical sensations).
3. Consequences that follow behavior refers to the effects that behavior produces.
This framework is often used to develop hypotheses about behavior. Engaging in certain behavior
depends on the learning history of behavior under similar conditions and reinforcement. When
behavior was successful in the past, it is more likely to occur in similar current and future
environments.
Functionalism is a term based on the evolutionary theory of Darwin. The physical structure of a
species is determined by its associated function. Natural selection is selecting the most adaptive
physical structures with functional properties that are associated with the enhancement of gene
fitness. People are more likely to select functional behavior that produces reinforcing consequences.
Behavior varies and some units of behavior are selected because they are more successful than other
units. Environmental determinism is the process of selection of variations in an individual’s behavior
during his or her lifetime. Cultural norms are also selected. Norms that proved to be most beneficial
or enhance fitness tend to be retained over time.
Contextual approaches in behavioral theories focus on how events and behavior are organized and
linked together in meaningful ways. Contextualism is about the context within behavior takes place,
also called the contextual flow in which behavior occurs.
Therapies differ in underlying theories and presumed mechanisms of behavior change. Cognitive
therapies, for example, focus on automatic thoughts, underlying assumptions and schemas. Every
therapy targets on the most central determinant or cause of problematic behavior as understood by
the associated theory. Consequently the types of interventions vary between the different therapies.
In the assessment of clients, behavior therapies focus on the behavioral repertoire to see if it is
necessary to learn new alternatives and the context within which the problematic behavior occurs.
They are looking for internal and external factors that maintain problematic behavior. The motivation
to change is also important. Behavior therapists see motivation as a condition resulting from
environmental events and is changeable by manipulations of the environment.
The following features are assessed an evaluated in the behavioral assessment:
Antecedents of problematic behavior: internal or environmental cues, verbal rules.
Consequences of problematic behavior: short-term, long-term, positive or negative
reinforcing.
The client's learning history as it relates to current problematic behaviors.
Current behavioral repertoire: This would cover 4 response domains:
o Overt behaviors (skill deficits, coping and social and problem-solving skills). Is de
client flexible in situations?
o Thoughts; Does the client have negative evaluations of self, world and future?
o Emotions (appropriate responses, only negative responses, overly reactive).
o Physiological sensations or responses (associations with catastrophic outcomes, like
sweating and heart pounding, associated with anxiety and feelings of dying).
Motivation for change: Does the client show a willingness to change behavior? Is behavior
consistent with values and goals.
Even though some people have similar problems, the factors that influence behavior vary across
individuals.
General characteristics of behavioral interventions are:
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