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Summary Cognitive Behavior Therapy (Articles, Book)
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2020 Examen CBT Clinical Psychology
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Samenvatting verplichte artikelen Cognitive Behavioural Therapy Clinical Psychology Master UU
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Cognitive Behavior Therapy Basic and Beyond Summary Chapter 4
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Summary Week 1Lecture 1
Cognitive behavioral therapy:
• Systematic, action-oriented psychological treatment to improve mental health
• Focuses on challenging and changing unhelpful cognitions (thoughts, beliefs and attitudes),
behaviors and emotions
• Broad umbrella term, involves many types
• Evidence-based treatment for many disorders (depression, anxiety, PTSD, OCD tics,
substance abuse, psychotic disorders)
What does the patient think, feel and do?
• Check body language (posture, gestures,…)
Case formulation approach:
Demographic data: Sex, age cultural background
Setting impacts the type of treatment
1. Problem described by the patient
2. Information gathering + individual analysis
3. Treatment plan
4. Therapeutical plan
5. Therapeutical emthid/techniques
6. Evaluation
Chapter 1: Introduction to Cognitive behavioral therapy (CBT)
What is cognitive behavior therapy?
➢ Aaron Beck devised a structured, short-term, present-oriented psychotherapy for depression,
directed toward solving current problems and modifying dysfunctional (inaccurate and/or
unhelpful) thinking and behavior
➢ have successfully adapted this therapy to a diverse set of populations with a wide range of
disorders and problems, patients with diverse levels of education and income as well as a variety
of cultures and ages, from young children to older adults
➢ can be used for group, couple, and family therapy
➢ The therapist seeks in a variety of ways to produce cognitive change—modification in the
patient’s thinking and belief system—to bring about enduring emotional and behavioral change.
➢ One of CBTs goals: unlearning dysfunctional beliefs, teaching more functional ones
What Is the Theory Underlying Cognitive Behavior Therapy?
Cognitive model = proposes that dysfunctional thinking (which influences the patient’s mood and
behavior) is common to all psychological disturbances
➢ When people learn to evaluate their thinking in a more realistic and adaptive way, they
experience improvement in their emotional state and in their behavior
➢ For example: if you were quite depressed and bounced some checks → automatic thought: “I
can’t do anything right.” → particular reaction: you might feel sad (emotion) and retreat to bed
(behavior) → if you examined the validity of this idea, you might conclude that you had
overgeneralized and that, in fact, you actually do many things well → new perspective would
probably make you feel better and lead to more functional behavior
➢ For lasting improvement in patients’ mood and behavior, cognitive therapists work at a deeper
level of cognition: patients’ basic beliefs about themselves, their world, and other people (“I’m
not good at this [specific task].
How was CBT developed?
,➢ As Dr. Beck listened to his patients he realized two streams of thinking: 1. Free association
stream 2. Quick, evaluative thoughts about themselves
➢ Dr. Beck recognized that all of them experienced “automatic” negative thoughts (2. Stream) such
as these, and that this second stream of thoughts was closely tied to their emotions. He began to
help his patients identify, evaluate, and respond to their unrealistic and maladaptive thinking.
When he did so, they rapidly improved.
➢ Seemed to be successful, Rush and Beck researched a randomized controlled study with
depressed patients, published in 1977, established that cognitive therapy was as effective as
imipramine, a common antidepressant
➢ Important components of cognitive behavior therapy for depression include:
➢ a focus on helping patients solve problems
➢ become behaviorally activated
➢ identify, evaluate, and respond to their depressed thinking, especially to negative thoughts about
themselves, their worlds, and their future
➢ Important components of cognitive behavior therapy for anxiety include:
➢ better assess the risk of situations they feared
➢ to consider their internal and external resources
➢ improve upon their resources
➢ decrease their avoidance and confront situations they feared so they could test their negative
predictions behaviorally
What Are the Basic Principles of Treatment?
Principle No. 1. Cognitive behavior therapy is based on an ever-evolving formulation of patients’
problems and an individual conceptualization of each patient in cognitive terms:
Example:
➢ I identify her current thinking that contributes to her feelings of sadness (“I’m a failure, I can’t do
anything right, I’ll never be happy”), and her problematic behaviors (isolating herself, spending a
great deal of unproductive time in her room, avoiding asking for help)
➢ I identify precipitating factors that influenced Sally’s perceptions at the onset of her depression
(e.g., being away from home for the first time and struggling in her studies contributed to her
belief that she was incompetent).
➢ I hypothesize about key developmental events and her enduring patterns of interpreting these
events that may have predisposed her to depression (e.g., Sally has had a lifelong tendency to
attribute personal strengths and achievement to luck, but views her weaknesses as a reflection
of her “true” self)
→ In every session the conceptualization of Sally’s depression is reevaluated and refined by obtaining
more data
→ share the conceptualization with patient to ensure that it “rings true”
→ throughout therapy I help Sally view her experience through the cognitive model
Principle No. 2. Cognitive behavior therapy requires a sound therapeutic alliance:
➢ ingredients necessary in a counseling situation: warmth, empathy, caring, genuine regard, and
competence: making empathic statements, listening closely and carefully, and accurately
summarizing her thoughts and feelings
➢ pointing out her small and larger successes and maintain a realistically optimistic and upbeat
outlook
➢ asking for feedback at the end of the session
Principle No. 3. Cognitive behavior therapy emphasizes collaboration and active participation:
➢ view therapy as teamwork
➢ in the beginning therapist takes lead in deciding which problems to talk about, identifying the
distortions in her thinking, summarizing important points, and devising homework assignments
which is then taken over more and more by the patient
,Principle No. 4. Cognitive behavior therapy is goal oriented and problem focused:
➢ first session to enumerate her problems and set specific goals so both she and I have a shared
understanding of what she is working toward
Principle No. 5. Cognitive behavior therapy initially emphasizes the present:
➢ The treatment of most patients involves a strong focus on current problems and on specific
situations that are distressing to them. Therapy starts with an examination of here-and-now
problems, regardless of diagnosis
➢ Attention shifts to the past in two circumstances
1. when patients express a strong preference to do so, and a failure to do so could endanger the
therapeutic alliance
2. when patients get “stuck” in their dysfunctional thinking, and an understanding of the childhood
roots of their beliefs can potentially help them modify their rigid ideas
➢ if someone suffers from a personality disorder one can spent more time on discussing history
and childhood
Principle No. 6. Cognitive behavior therapy is educative, aims to teach the patient to be her own
therapist, and emphasizes relapse prevention:
➢ First session: educate patient about the nature and course of the disorder, about the process of
cognitive behavior therapy, and about the cognitive model (i.e., how her thoughts influence her
emotions and behavior)
➢ Each session: Teach how to set goals, identify and evaluate thoughts and beliefs, and plan
behavioral change (+ how to do so); ensure patient takes notes with key points → she can
benefit from her new understanding in the ensuing weeks and after treatment ends
Principle No. 7. Cognitive behavior therapy aims to be time limited:
➢ straightforward patients with depression and anxiety disorders are treated for 6 to 14 sessions
➢ Therapists’ goals:
▪ provide symptom relief
▪ facilitate a remission of the disorder
▪ help patients resolve their most pressing problems
▪ teach them skills to avoid relapse
Principle No. 8. Cognitive behavior therapy sessions are structured
➢ introductory part: doing a mood check, briefly reviewing the week, collaboratively setting an
agenda for the session
➢ middle part: reviewing homework, discussing problems on the agenda, setting new homework,
summarizing
➢ final part: eliciting feedback
➢ following this format increases likelihood that patient is able to do self-therapy after termination
Principle No. 9. Cognitive behavior therapy teaches patients to identify, evaluate, and respond to
their dysfunctional thoughts and beliefs
➢ Therapists help patients identify key cognitions and adopt more realistic, adaptive perspectives,
which leads patients to feel better emotionally, behave more functionally, and/or decrease their
physiological arousal
➢ They do so through the process of guided discovery, using questioning to evaluate their thinking
➢ Therapists also create experiences, called behavioral experiments, for patients to directly test
their thinking → therapists engage in collaborative empiricism because they don’t generally
know in advance to what degree a patient’s automatic thought is valid or invalid, but together
they test the patient’s thinking to develop more helpful and accurate responses
, Principle No. 10. Cognitive behavior therapy uses a variety of techniques to change thinking, mood,
and behavior
➢ Socratic questioning and guided discovery are central to cognitive behavior therapy, behavioral
and problem-solving techniques are essential, as are techniques from other orientations that are
implemented within a cognitive framework
➢ types of techniques you select will be influenced by your conceptualization of the patient, the
problem you are discussing, and your objectives for the session
What is a therapy session like?
1. Check on patient’s mood, symptoms, experiences from the past week
2. Collect data about problem, patient’s difficulties
3. Collaboratively plana a strategy
➢ Repeat this process with another encountered problem
Developing as a cognitive behavioral therapist:
➢ Experienced cognitive behavior therapists, however, accomplish many tasks at once:
conceptualizing the case, building rapport, socializing and educating the patient, identifying
problems, collecting data, testing hypotheses, and summarizing
➢ beginners need to learn the skill of developing the therapeutic relationship, the skill of
conceptualization, and the techniques of cognitive behavior therapy, all of which is best done in
a step-by-step manner
➢ basic counseling skills: listening, empathy, concern, positive regard, and genuineness, as well as
accurate understanding, reflection, and summarizing.
Stage 1:
➢ you learn basic skills of conceptualizing a case in cognitive terms based on an intake evaluation
and data collected in session. You also learn to structure the session, use your conceptualization
of a patient and good common sense to plan treatment, and help patients solve problems and
view their dysfunctional thoughts in a different way. You also learn to use basic cognitive and
behavioral techniques
Stage 2
➢ you become more proficient at integrating your conceptualization with your knowledge of
techniques. You strengthen your ability to understand the flow of therapy. You become more
easily able to identify critical goals of treatment and more skillful at conceptualizing patients,
refining your conceptualization during the therapy session itself, and using the conceptualization
to make decisions about interventions. You expand your repertoire of techniques and become
more proficient in selecting, timing, and implementing appropriate techniques.
Stage 3
➢ you more automatically integrate new data into the conceptualization. You refine your ability to
make hypotheses to confirm or revise your view of the patient. You vary the structure and
techniques of basic cognitive behavior therapy as appropriate
➢ in general: When patients are hesitant, you can suggest the institution of a change (such as
setting an agenda) as an “experiment,” rather than a commitment, to motivate them to try it.
Chapter 3: Cognitive Conceptualization
Cognitive Conceptualization
➢ provides the framework for understanding a patient. To initiate the process of formulating a
case, you will ask yourself the following questions:
▪ What is the patients diagnosis(es)?
▪ What are his current problems? How did these develop? How are they maintained?
▪ What dysfunctional thoughts and beliefs are associated with the problems? What reactions
(emotional, physiological, behavioral) are associated with the thinking?
➢ Then you will hypothesize how the patient developed this particular psychological disorder
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