College aantekeningen
Summary of Lectures CBT
- Instelling
- Universiteit Utrecht (UU)
This is a summary of all the lectures of CBT (6 lectures).
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Summary LecturesCBT
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Lecture 1
CBT
The first contact person is Noury van der End (n.n.vanderend@uu.nl).
- In this course, we will use a full cycle of CBT.
- It starts with understanding (the cognitions and emotions of) your patient.
- Often, you’ll see there’s not only one problem, but multiple problems (e.g. financial
problems, anxiety, drinking problems, work).
- All these problems and factors have an influence on each other – and the first step is to find
out what factor has an influence on what.
- Using theoretical and empirical knowledge and literature (e.g., we know that drinking often
is used as a coping mechanism for anxiety), we can understand how the problems evolve over
time and which factor is driving which factor.
- Week 1, 2, 3: Assessment & Case Formulation.
- Week 3, 5: Treatment Planning & Measurement.
- Week 4, 5: Treatment Implementation & Monitoring.
- Week 7: Evaluation & Accountability.
Literature:
Course Book Beck
Separate articles
Videos
Lectures
- In total there will be 6 lectures.
- They are available earlier (Wednesdays).
- Q&A’s are Mondays from 10.30 to 11.00 in MS Teams.
- The Q&A’s are recorded.
,Working groups
- In total there will be 6 working groups.
- You’re allowed to miss one session, when wanting to miss one – inform Noury and your
working group teacher.
- Prepare for each working group; see manual what you have to do for preparation.
Unsupervised practise sessions
- Group of 3 students.
- During each session, there will be 3 roles: Therapist, patient, observer.
- Then you swap; so, you’ll have 3 conversations.
- Patients present their own problem/issue (not too big or personal).
Course assignment
- Every week you work on your course assignment.
- There is also a manual on the course assignment on BB.
Part 1: Case conceptualization & analysis.
- Analyse your client and create hypothesis about how problems are related.
- How does the theoretical model fit the problems of the client?
- The problems are small, so they’re not directly related to the DSM-5 – but try to look
at how some of the symptoms could be related to a diagnosis.
Part 2: Treatment plan.
- What treatment are you planning to offer to your client?
- What techniques and why are you proposing your elements?
- In here, you focus on a DSM-5 diagnosis – you make the actual symptoms of your
client larger.
Part 3: Self-reflection.
- There is instruction on how to reflect on your own doings.
- The course assignment is 50% of your final grade.
Exam
- 50% of your final grade is your exam.
- This will contain open questions containing different cases.
- It will be held on Monday November 1st.
,Why and what of CBT – Basic principles
- CBT is a systematic, action-oriented psychological treatment to improve mental health.
- CBT focusses on challenging and changing unhelpful cognitions (e.g. thoughts, beliefs,
attitudes), behaviours, and emotions.
- It can be seen as a very broad umbrella term which includes several types of treatments,
such as; the cognitive focused viriant by Beck, exposure therapy, behavioural activation (BA).
- CGT is related to EMDR, mindfulness, ACT, EFT, etc.
- CBT is an evidence based-treatment for many disorders (e.g. depression, PTSD, tics).
- Patients tend to be desperate with their symptoms.
- The basic principle of CBT is that cognitions, behaviours, and emotions/physiology are
interconnected.
- These are mutual connections that reinforce or drive each other.
- The behavioural aspect is not only what you do, but also what you don’t do (e.g. fail to go to
the supermarket because of your social anxiety).
- If you conceptualize negative thoughts as a crucial factor that drives other symptoms, there
are different possibilities to change these cognitions.
- There are more options to change cognitions – it’s not like if you have problems with
cognition, you have to apply cognitive techniques (e.g. you can use behavioural techniques to
change cognitions).
- You can start to change at any factor– emotional, cognitive, or behavioural.
The case formulation approach
- There are different disorders in the DSM, these are clusters of symptoms.
- But we also know that 2 persons with the same disorder might look and act very differently.
- These differences might be related to personality, age, sex, culture, but also to maintaining
factors and comorbidity.
- If you want to treat a patient, knowing the symptoms is not enough – you need to know how
different factors are related and maintained.
- This is why you need a case formulation.
- Based on the case formulation you form a treatment for your patient.
Problem described by patient
- After asking “what brings you here?”.
- This might not always be the main focus in the treatment.
- It can also be that there is no direct link between the problem that the patient presents and
the treatment (treatment plan).
, Information gathering
- You want to understand how processes are maintained.
- You ask the patient why, how, what happened before, what happened after, etc. (e.g. why
continue drinking despite the negative consequences?).
- Sometimes a patient doesn’t have insight in how processes are related, then you might
benefit from asking the patient to do a registration assignment (to let them register
what/when things happen).
- Focus on the why (the detective work).
Treatment and evaluation phase
- Testing your hypothesis.
- Is the intervention effective and does it reduce symptoms?
- If not, why not?
- It is the responsibility of the therapist to go back to the individual analyses/hypotheses –
might they be incorrect?
Complex problems
- With complex problems, it has been shown that it’s more effective to do individual analysis.
- With simple problems, sometimes you can just start with your evidence-based treatment
and it’ll be enough.
- More complicated patients demand more time and investment in getting to know their
problems.
- There are different types of case formulations (e.g. cognitive conceptualization/case
formulation).
- The book of Beck has a strong focus on the cognitive part, so in the lecture we will focus on
the behavioural part.
Individual analyses
- Examining certain behaviours from a behavioural learning perspective, that includes
someone’s early life learning and conditioning experiences, makes these behaviours logical
and understandable.
- E.g.: Why does a couple who have a too early born child in the hospital feel very anxious
when smelling sanitisers? Classical conditioning.
- E.g.: Why is a woman always sitting on a chair at the end of a row in the cinema, and not in
the middle? Operant conditioning.
- Conditioning models helps understanding behaviour – both adaptive as well as maladaptive
behaviour.
Learning
- Learning: a long-term change in behaviour that is based on experience.
- There are two types: classical conditioning and operant conditioning.
Classical conditioning
- When pairing an unconditioned stimulus (e.g. food) with a neutral stimulus (e.g. a bell),
that neutral stimulus becomes the conditioned stimulus (e.g. a bell).
- Classical conditioning is about learning associations.
Operant conditioning
- Consequences of behaviour lead to changes in voluntary behaviour.
- There are two main components in operant conditioning: reinforcement and punishment.
- Reinforcement: makes it more likely that you’ll do something again.
- Punishment: makes it less likely that you’ll do something again.
- Reinforcement and punishment are therefore (2) different types of consequences of
behaviour.
- Reinforcement and punishment can be positive of negative; but this doesn’t mean good or
bad.
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