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Summary of exam relevant material (books and additional literature)
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- Universiteit Leiden (UL)
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CBI LITERATURE 1CORE CURRICULUM: COGNITIVE BEHAVIORAL
INTERVENTIONS (LITERATURE)
Exam material
- Chapter 1 of the Wright, Basco, & Thase (2006/2017) book;
- Chapter 1, 2, 4, 6, 8, 9, 13 & 14 of the O’Donohue & Fisher (2012) book;
- The weblectures posted on Brightspace + the pdfs of the lectures posted on Brightspace;
- Additional literature posted with the lectures on Brightspace.
Week 1: Exposure and Cognitive Restructuring
Wright, Basco, & Thase (2017) Chapter 1: Basic Principles
of Cognitive-Behavior Therapy
1.1 THE ORIGINS OF CBT
- CBT has two central tenets
> (1) our cognitions have a controlling influence on our emotions and behavior
> (2) how we behave can strongly affect our thought patterns and emotions
- Kelly: influenced CBT with his theory of personal constructs (core beliefs and self-schema’s)
- Ellis: also influenced CBT through rational-emotive therapy
- Beck: first to develop theories and methods for
CBT → first focussed on aberrant information
processing in depression and anxiety disorders
- Behavioral components of CBT came with the
application of behaviorist ideas
> Wolpe, Eysenck: pioneered in desensitization
and relaxation training
1.2 THE COGNITIVE BEHAVIORAL MODEL
- Cognitive processing has a central role in cognitive
behavioral model
> Because humans continually appraise the
significance of events and cognitive appraisal is
associated with emotions
,CBI LITERATURE 2
> Behavior (e.g. avoidance) then reinforces negative thinking
1.3 BASIC CONCEPTS
- Three primary levels of cognitive processing:
> Consciousness (highest level) = state of awareness where decisions can be made on a
rational basis
> Automatic thoughts (intermediate level) = cognitions that stream rapidly through our minds,
may be subliminally aware but these thoughts are usually not subjected to rational analysis
> Schemas (lowest level) = core beliefs that act as templates for information processing →
allow us to screen, code, assign meaning
- CBT teaches clients to think about their thinking → brings automatic cognitions into conscious
control
- Automatic thoughts are private and unspoken, rapid-fire manner → generate painful emotional
reactions and dysfunctional behavior
> In depression, automatic thoughts center around themes of hopelessness, low self-esteem,
and failure
> In anxiety disorders automatic thoughts include predictions of danger, harm, uncontrollability,
or inability to cope
> Thought record = identifying automatic thoughts (event, automatic thought, emotions)
> Automatic thoughts can be logically sound and an accurate reflection of reality → in these
situations CBT does not aim to gloss over actual problems but to help cope
> Cognitive errors = there are characteristic errors in logic in the automatic thoughts
• Selective abstraction = conclusion drawn after looking at only a small portion of the
available information (also „ignoring the evidence“ or „mental filter“)
• Arbitrary inference = conclusion reached in the face of contradictory evidence
• Overgeneralization = conclusion made about isolates incident(s) and extended to cover
broad areas of functioning
• Magnification/minimization = significance of an attribute, event, sensation is
exaggerated or minimized
• Dichotomous/absolutistic thinking = judgements about oneself, personal experiences,
or others are placed into one of two categories (all bad or all good)
> There is overlap between cognitive errors → goal is not to identify each and every error in
logic that is occurring, but more that one is engaging in cognitive errors at all
- Schema’s are enduring, shape in early childhood and are influenced by lifetime experiences
> We need to develop schemas to efficiently manage the large amounts of information we
encounter → allows for timely decisions
> Three main groups of schema’s
• Simple schemas = rules about the physical nature of the environment, „take shelter
during a thunderstorm“ (have little effect on psychopathology)
,CBI LITERATURE 3
• Intermediary beliefs = conditional if-then statements that influence self esteem and
emotional regulation „I must be perfect to be accepted“
• Core beliefs = global and absolute rules for interpreting the environment related to self-
esteem, „I am unlovable“
> We all have a mixture of adaptive and maladaptive beliefs
> Stress-diasthesis hypothesis = maladaptive schema’s may remain dormant until a
stressful life event occurs that activates a core belief
• The activated schema then drives a more superficial information processing of negative
automatic thoughts
- Information processing in depression and anxiety disorders
> Hopelessness is the most important predictor of suicide → CBT that includes writing a
specific anti suicide plan reduces the risk of suicide
> Attributional style in depression
• Interval (vs. external) = taking excessive blame for negative events
• Global (vs. specific) = occurrences have far reaching implications
• Fixed (vs. changeable) = troubling situations are viewed as unlikely to improve
> Distortions in response to feedback
• Depressed = underestimate amount of positive feedback received, spend less effort on
tasks after they have been told to have performed poorly
• Nondepressed = positive self-serving bias, hear more positive feedback than is given and
downplay significance of negative feedback
> Thinking style in anxiety disorders
• Heightened level of attention to potential threats
• Fear that panic attacks themselves may have catastrophic consequences (heart attack)
> Learning, memory, cognitive capacity → impaired in both depression and anxiety
- Overview of therapy methods
> Therapy length and focus = typically 5-20 sessions, longer with more comorbidity/chronicity
• 25-50 minutes per session
• Patients with recurrent illnesses → front-loaded therapy (weekly visits in the beginning,
then booster sessions later)
> CBT primarily focussed on here and now but longitudinal perspective is critical to fully
understand the patient and treatment planning
> CBT is problem focussed → also beneficial to reduce dependence and regression in
therapeutic relationship
- Case conceptualization = carefully thought out strategy, guides each question, each
intervention, all adjustments we make to enhance communication
, CBI LITERATURE 4
- Therapeutic relationship = shares many aspects with other therapies but is unique in that it
oriented towards a high degree of collaboration and is more active than other therapies
> Collaborative empiricism = therapist and client work together as investigative team
> Patients also assumed to take responsibility in treatment relationship
- Socratic questioning = asking questions to stimulate curiosity and inquisitiveness, e.g. guided
discovery = series of deductive questions used to reveal dysfunctional thought patterns
- Structuring and psychoeducation
> CBT uses agenda setting and feedback to maximize efficiency of sessions → helps to not
divert from topic that was chosen focus of therapy
> Psychoeducation in the form of: self-help books, handouts, rating scales, computer programs
- Cognitive restructuring = help patients recognize and change maladaptive thoughts
> Can be done via thought records, examining the evidence, reattribution (modifying
attributional style), cognitive rehearsal (practicing a new way of thinking in role play)
- Behavioral methods = aimed at helping people break patterns of avoidance or helplessness,
gradually face feared situations, build on coping skills, reduce painful emotions or autonomic
arousal
> Can be done via behavioral activation, hierarchical exposure (systematic desensitization),
graded task assignments, activity scheduling, breathing training, relaxation training
- Building CBT skills to help prevent relapse = rehearsal techniques, discussion of possible
challenges and coaching on how to respond
O’Donohue & Fisher (2012) Chapter 1: The Core
Principles of Cognitive Behavior Therapy
- CBT has repeatedly been shown to be efficacious for a wide array of psychological problems
- Other CBT advantages are that is quicker and more scalable than other therapies
- CBT is manualized
> Deals with one disorder at a time and not with comorbidity
> Clinicians must thoroughly understand core principles in order to adjust them to comorbidity
or treatment preferences of clients
> In the packages, we don’t know what the active ingredients are → more process research is
needed to understand mechanisms of change
1.1 THERAPY IS NOT AN ART
- CBT views therapy not as art but at least in large part a technical enterprise that involves the
active ingredients of change (lol thought they didn’t know what these were)
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