SUMMARY COGNITIVE
BEHAVIOUR INTERVENTIONS
• Chapter 1 of Learning Cognitive-Behavior Therapy: An Illustrated Guide.
• Chapter 1, 2, 4, 6, 8, 9, 13 & 14 of Cognitive Behavioral Therapy: Core
Principles for Practice
• Article: The cognitive behavioural model of medically unexplained symptoms:
A theoretical and empirical review
• Article: Helping an individual to develop self-control
• The lecture slides posted on BB
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,Chapter 1 of Learning Cognitive-Behavior Therapy: An Illustrated Guide
Basis principles of cognitive-behavior therapy
CBT is a bases on two central tenets:
1. Our cognitions have a controlling influence on our emotions and behavior
2. How we act or behave can strongly affect our thought patterns and emotions
Beck was the first person to fully develop theories and methods for using cognitive and behavioral
interventions for emotional disorders. He described a cognitive conceptualization of depression in which
symptoms were related to a negative thinking style in three domains: self, world and future. His theories
have been extended to a wide array of other conditions like, anxiety and eating disorders. The behavioral
components of the CBT model had their beginnings when researches began to apply ideas of Pavlov and
Skinner for example. Potential behavior interventions such as desensitization and relaxation were uses.
First were the cognitive and behavioral aspect not much combined into one therapy. Extensive research
has demonstrated the efficacy of a combined approach.
The cognitive-behavioral model
cognitive appraisal (cognitive evaluation) has a central role in
the model. People are constantly evaluating the significance of
events in the environment and the cognitions that come with
this emotion. When a situation is avoided this will
reinforcement the negative cognitions and will lead to
avoidance of the event in the future. This will become a vicious
circle of thoughts, emotions and behavior that maintains. CBT
influences in all three areas: thoughts (recognize and change
thoughts), feelings (relaxation) and behavior (step-by-step
exposure).
Levels of cognitive processing
Beck identified three primary levels of cognitive processing. The highest level is cognition is
consciousness. In CBT, therapists encourage the development of adaptive conscious thought processes
Consciousness allows us to: 1. Monitor and assess interactions with the environment
2. Link past memories with present experiences
3. Control and plan future actions.
Automatic thoughts: are cognitions that stream rapidly through our minds when we are in the midst of
situations. We might be aware of them but these cognitions are not subjected to careful rational analysis.
These cognitions can be recognized and understood if our attention is drawn to them.
Schemas: are core beliefs that act as templates or underlying rules for information processing. They serve
a critical function in allowing humans to screen, filter, code and assign meaning tot information from the
environment.
Automatic thoughts
Cognitive errors: Characteristic errors in logic in the automatic thoughts and other cognitions of persons
with emotional disorders.
The six main categories of cognitive errors:
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,- Selective abstraction (A conclusion is drawn after looking at only a small portion of the available
information. Salient data are screened out or ignored in order to confirm the person’s biased view of the
situation).
- Arbitrary inference (A conclusion is reached in the face of contradictory evidence or in the absence of
evidence).
- Overgeneralization (A conclusion is made about one or more isolated incidents and then is extended
illogically to cover broad areas of functioning).
- Magnification and minimization (The significance of an attribute, event, or sensation is exaggerated of
minimized).
- Personalization (External events are related to oneself when there is little or no basis for doing so.
Excessive responsibility or blame is taken for negative events).
- Absolustic all-or-nothing thinking (Judgements about oneself, personal experiences, or others are placed
into one of two categories, all bad or all good for example).
Schemas
Schemas take shape in early childhood and may be influenced by genetics and a multitude of life
experiences, including parental teaching and modeling, formal and informal education activities, peer
experiences, traumas and successes.
There are three main groups of schemas:
- Simple Schemas (Rules about the physical nature of the environment, practical management of everyday
activities, or laws of nature that may have little of no effect on psychopathology.)
- Intermediary beliefs and assmptions (Conditional rules such as if-then statements that influence self-
esteem, emotional regulation, and behavior.)
- Core beliefs about the self (Global and absolute rules for interpreting environmental information related
to self-esteem.)
The relationship between automatic thoughts and schemas is shown in the stress diathesis hypothesis.
Maladaptive schedules can remain in the background until they be triggered by a life event. The schedule
is then strengthened to a point that stimulates and drives negative automatic thoughts.
Information processing In depression and anxiety disorders
With depression there is an association between hopelessness and suicidality. Cognitive therapy can
reduce the risk of suicide. The therapy includes specific suicide prevention strategies. Depressed people
give distorted meaning to life events in three domains:
- Internal VS external: depression is associated with a tendency to make attributions to life events that are
biased in an internal direction.
- Global VS specific: Instead of viewing negative events as having only isolated significance, people with
depression may conclude that these occurrences have far-reaching, global, or all-encompassing
implications.
- Fixed VS changeable: In depression, negative or troubling situations may be viewed as being
unchangeable and unlikely to improve in the future.
Important of CBT
Don’t only focus on the interventions. Key methods: problem-oriented focus, individualized case
conceptualization, collaborative empirical therapeutic relationship, socratic questioning, use of
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, structuring, psychoeducation, and rehearsal to enhance learning, eliciting and modifying automatic
thoughts, uncovering and changing schemas, behavioral methods to reverse patterns of helplessness, self-
defeating behavior, and avoidance and building CBT skills to help prevent relapse.
Chapter 1 of Cognitive Behavioral Therapy: Core Principles for Practice
The Core Principles of Cognitive Behavior Therapy
CBT is not a one problem therapy. Also, it is cost effective and time limited. Furthermore, cognitive
therapy is often conducive to manualization and it can thus be scaled. A significant problem arises,
however, with the notion of manualized therapy. It should be understood that the problem attempted to
be solved with a treatment manual is fidelity, which is related to generalizability. One sees that one
treatment manual for each category of problem as delineated by these kinds of parameters clearly
produces an unmanageable number of manuals. Moreover, one still needs to understand the core of the
treatment manual. A treatment manual for PTSD may contain many particular requirements and
subgoals, but some of these are much more critical than others. All requirements in a manual are not of
equivalent importance. In addition, manuals cannot anticipate the idiosyncratic nature of many actual
clinical cases. An understanding of the core principles embodied in the manual can be helpful to
successfully adapting a manual to an idiosyncratic situation.
Thus, one advantage of thinking in terms of principles is that it allows a more parsimonious but at the
same time a deeper understanding of the mechanisms of change underlying treatment. This can also
mean that more process research is needed to better understand the actual mechanisms of change in
therapies that have been identified as effective.
The 13 core principles from O’Donohue en Fisher: 1. Functional analysis and contingency management;
2. Skills training; 3. Exposure; 4. Relaxation; 5. Cognitive restructuring; 6. Problem solving;
7. Self-regulation; 8. Behavioral activation; 9. Social skills; 10. Emotional regulation; 11. Communication;
12. Positive psychology and 13. Acceptance.
Chapter 2 of Cognitive Behavioral Therapy: Core Principles for Practice
Clinical Functional Analysis: Understanding the Contingencies of Reinforcement
Clinical functional analysis (CFA) is a powerful method of empirically identifying the variables that
maintain a problem behavior. Defined as ‘‘the identification of important, controllable, causal functional
relationships applicable to a specified set of target behaviors for an individual client’’. CFA takes a step
closer to answering Gordon Paul’s (1967) classic treatment question: ‘‘What treatment, by whom, is most
effective for this individual with that specific problem, and under which set of circumstances?’’. Often
described as at odds with topographically focused diagnostic strategies, functional analyses can
complement the current diagnostic system through application when a client doesn’t closely fit diagnostic
criteria, a powerful empirically supported treatment package does not exist, or when a treatment has
failed to create effective change.
Topography
CFA focuses on the function or purpose of the behavior rather than the behavior’s topography. For
example, self-harm behavior, significant weight loss, and self-isolation all describe the topography of
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