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Summary Cognitive behavior therapy
Summary of 29 pages for the course Introduction in cognitive behavior therapy at RuG
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Cognitive behavior therapyChapter 1
Introduction to cognitive behavior therapy
1.1 What is cognitive behavior therapy?
Cognitive (behavior) therapy: treatment is based on a cognitive formulation, the beliefs and
behavioral strategies that characterize a specific disorder. Treatment is also based on a
conceptualization, or understanding, of individual patients (their specific beliefs and patterns of
behavior).
1.2 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. It’s about patients’ basic beliefs about themselves, their world, and other people.
Automatic thought: an idea that just seemed to pop up in your mind, bv. I can’t do anything right
1.3 What does research say?
Cognitive behavior therapy is effective for a wide range of psychiatric disorders, psychological
problems, and medical problems with psychological components
1.4 How was Beck’s cognitive behavior therapy developed?
In the late 1950s and early 1960s, Dr. Beck decided to test the psychoanalytic concept that
depression is the result of hostility turned inward toward the self.
To his surprise, he ultimately found that the dreams of depressed patients contained fewer themes
of hostility and far greater themes of defectiveness, deprivation, and loss. He recognized that these
themes paralleled his patients’ thinking when they were awake.
They occasionally reported two streams of thinking: a free-association stream and quick, evaluative
thoughts about themselves. All of them experienced “automatic” negative thoughts 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.
Components of cognitive behavior therapy:
Focus on helping patients solve problems
Become behaviorally activated
Identify, evaluate and respond to their negative thoughts about themselves, their worlds
and their future
1.5 What are the basic principles of treatment?
The basic principles of treatment:
1. Cognitive behavior therapy is based on an ever-evolving formulation of patients’
problems and an individual conceptualization of each patient in cognitive terms:
Identify current thinking and problematic behaviors
Identify precipitating factors
Hypothesize about key developmental events and enduring patterns of interpreting
these events
2. Cognitive behavior therapy requires a sound therapeutic alliance: warmth,
empathy, caring, genuine regard, and competence
, 3. Cognitive behavior therapy emphasizes collaboration and active participation:
together decide what to work on each session, how often to meet and what someone can
do between sessions for therapy homework
4. Cognitive behavior therapy is goal oriented and problem focused: in the first
session, I ask the patient to enumerate his problems and set specific goals so both he and I
have a shared understanding of what he is working toward
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.
6. Cognitive behavior therapy is educative, aims to teach the patient to be her own
therapist, and emphasizes relapse prevention: educate the patient about the nature
and course of her dis- order, about the process of cognitive behavior therapy, and about the
cognitive model
7. Cognitive behavior therapy aims to be time limited: Many straightforward patients
with depression and anxiety disorders are treated for six to 14 sessions. Therapists’ goals
are to provide symptom relief, facilitate a remission of the disorder, help patients resolve
their most pressing problems, and teach them skills to avoid relapse.
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
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 (socratic questioning) to evaluate their
thinking
Behavioral experiments: to directly test their thinking
10. Cognitive behavior therapy uses a variety of techniques to change thinking,
mood, and behavior
These basic principles apply to all patients, but therapy does vary considerably according
characteristics of patients
1.6 What is a therapy session like?
The structure of therapy sessions is quite similar for the various disorders, but interventions can
vary considerably from patient to patient.
At the beginning of sessions, you will reestablish the therapeutic alliance, check on patients’ mood,
symptoms, and experiences in the past week, and ask them to name the problems they most want
help in solving. You will also review the self-help activities (“homework” or “action plan”) patients
engaged in since the previous session.
Then, in the context of discussing a specific problem patients have put on the agenda, you will
collect data about the problem, cognitively conceptualize patients’ difficulties (asking for their
specific thoughts, emotions, and behaviors associated with the problem), and collaboratively plan a
strategy. The strategy most often includes straightforward problem solving, evaluating patients’
negative thinking associated with the problem, and/or behavior change.
1.7 Developing as a cognitive behavior therapist
Cognitive model: the proposition that one’s thoughts influence one’s emotions and behavior, is
quite straight-forward.
Although the ultimate goal is to interweave these elements and conduct therapy as effectively and
efficiently as possible, beginners must first 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. Developing expertise as a cognitive behavior therapist can
be viewed in three stages:
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.
2. You expand your repertoire of techniques and become more proficient in selecting, timing,
and implementing appropriate techniques.
3. You more automatically integrate new data into the conceptualization. You refine your
ability to make hypotheses to con- firm or revise your view of the patient. You vary the
structure and techniques of basic cognitive behavior therapy as appropriate, particularly for
patients with personality disorders and other difficult disorders and problems.
Chapter 2
Overview of treatment
Several essential streams that run through each therapy session:
Developing the therapeutic relationship
Planning treatment and structuring sessions
Identifying and responding to dysfunctional cognitions
Emphasizing the positive
Facilitating cognitive and behavioral change between sessions (homework)
2.1 Developing the therapeutic relationship
It is essential to start building trust and rapport with patients from your first contact with them.
Research demonstrates that positive alliances are correlated with positive treatment outcomes. To
accomplish this goal, you will:
Demonstrate good counselling skills and accurate understanding: you demonstrate
empathy and accurate comprehension of their problems and ideas through your thoughtful
questions, reflections, and statements, which leads to their feeling valued and understood.
You will try to impart the following implicit (and sometimes explicit) messages, bv. I care
about you and value you and I’ve helped other patients much like you
Share your conceptualization and treatment plan: you will continuously share your
conceptualization with patients and ask them whether it “rings true”. You conceptualize a
problem in summary form
Collaboratively make decisions: while you guide patients during sessions, you will also
actively enlist their participation, bv. you will help them prioritize the problems they want
help in solving during a session.
Seek feedback: it is important to positively reinforce patients for providing feedback, then
conceptualize the problem and plan a strategy to solve it.
Vary your style: most patients will respond positively to you when you are warm,
empathic, and caring. However, an occasional patient might have a negative reaction. For
example, a patient may perceive you as being overly caring
Help patients solve their problems and alleviate their distress: the therapeutic
alliance becomes strengthened when patients’ symptomatology is reduced
2.2 Planning treatment and structuring sessions
Most patients feel more comfortable when they know what to expect from therapy . You will
maximize the patient’s understanding by explaining the general structure of sessions and then
adhering (flexibly at times) to that structure.
You will have a general idea of how you intend to structure the session: you will begin to plan
treatment for a session before patients enter your office. You will quickly review their chart,
especially their goals for treatment and the therapy notes and homework assignments from the
previous session(s)
First part of the session: your goal in the first part of a therapy session is to reestablish the
therapeutic alliance and collect data so you and the patient can collaboratively set and prioritize
the agenda.
Second part of the session: you and the patient will discuss the problems on the agenda. These
kinds of discussions and interventions naturally lead to homework assignments, which usually
involve having patients remind themselves of their new, more realistic way of thinking about the
problem and implementing solutions during the week.
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