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Introduction to Treatment Methods - Summary
This document contains an extensive summary of all required articles for the course "Introduction to Treatment Methods" (2020), integrated with information from the lectures.
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1Introduction to Treatment Methods (2019-2020)
Summary
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Contents
Lecture 1: Applications of CBT................................................................................................................. 6
1. Lecture 1 .......................................................................................................................................... 6
1.1. What is treatment? .................................................................................................................. 6
1.2. History of CBT ........................................................................................................................... 8
1.3. What is CBT? ............................................................................................................................. 8
1.4. CBT: Clinical Case Formulation ................................................................................................. 9
1.5. Anxiety disorders ...................................................................................................................... 9
1.6. Social anxiety disorder............................................................................................................ 10
1.7. Panic disorder ......................................................................................................................... 11
1.8. Agoraphobia ........................................................................................................................... 13
1.9. Specific phobias ...................................................................................................................... 14
1.10. Mood disorders: Major depressive disorder ........................................................................ 14
2. Cognitive Behavioral Therapy: An Information Guide .................................................................. 16
2.1. The basics of cognitive-behavioral therapy............................................................................ 16
2.2. CBT approaches to cognitive change...................................................................................... 17
2.3. CBT approaches to behavioral change ................................................................................... 18
3. Cognitive-Behavioral Therapy for Anxiety Disorders: An Update on the Empirical Evidence ...... 18
3.1. Exposure therapy.................................................................................................................... 19
3.2. Cognitive therapy ................................................................................................................... 20
4. Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators, and Mediators .......... 21
4.1. The efficacy of CBT in the acute phase of depression ............................................................ 21
4.2. CBT to prevent relapse and recurrence.................................................................................. 22
4.3. CBT to prevent relapse in bipolar disorder ............................................................................ 22
4.4. Predictors of CBT efficacy ....................................................................................................... 22
4.5. Mediators of CBT efficacy....................................................................................................... 22
4.6. Conclusion .............................................................................................................................. 23
Lecture 2: Common Factors in Psychotherapy...................................................................................... 23
1. Lecture 2 ........................................................................................................................................ 23
1.1. What makes a common factor common? .............................................................................. 23
1.2. Why are they important? ....................................................................................................... 23
1.3. Common factors ..................................................................................................................... 24
1.4. Take-home message ............................................................................................................... 28
2. How Important are the Common Factors in Psychotherapy? An Update..................................... 28
2.1. The contextual model ............................................................................................................. 28
2.2. Evidence for various common factors .................................................................................... 29
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2.3. Specific effects ........................................................................................................................ 31
3. Know Thyself ................................................................................................................................. 31
3.1. What is the field of self-knowledge? ...................................................................................... 31
3.2. Theories of self-knowledge .................................................................................................... 32
3.3. The criterion problem: What is the true self and how do we measure it? ............................ 32
3.4. Does self-knowledge matter? ................................................................................................ 33
3.5. How can we know ourselves better? ..................................................................................... 33
4. Alliance Building and Narcissistic Personality Disorder................................................................. 33
4.1. Identifying and diagnosing NPD ............................................................................................. 33
4.2. Internal experience versus external expressions of pathological narcissism ........................ 34
4.3. Grandiosity ............................................................................................................................. 34
4.4. The therapeutic alliance ......................................................................................................... 35
4.5. Clinical Practices and Summary .............................................................................................. 36
Lecture 3: CBT for older people............................................................................................................. 36
1. Lecture 3 ........................................................................................................................................ 36
1.1. What is CBT? ........................................................................................................................... 36
1.2. How was CBT developed? ...................................................................................................... 37
1.3. Basic principles of CBT ............................................................................................................ 37
1.4. Therapy sessions..................................................................................................................... 39
1.5. Adjustments for elderly people .............................................................................................. 39
1.6. 6 conceptual modifications .................................................................................................... 39
1.7. CBT for late life depression .................................................................................................... 41
1.8. CBT for late life anxiety .......................................................................................................... 41
1.9. Augmented age appropriate CBT: Wisdom enhancement .................................................... 41
1.10. Becoming a CBT therapist .................................................................................................... 41
2. Introduction to Cognitive Behavior Therapy ................................................................................. 42
2.1. What is cognitive behavior therapy?...................................................................................... 42
2.2. What is the theory underlying cognitive behavior therapy? ................................................. 42
2.3. What does the research say? ................................................................................................. 42
2.4. What are the basic principles of treatment? ......................................................................... 43
2.5. What is a therapy session like? .............................................................................................. 44
2.6. Developing as a cognitive behavior therapist ........................................................................ 44
3. Cognitive-behavior therapy: How is it different with older people? ............................................ 44
3.1. Is CBT with older people sufficiently different that modifications are necessary?................ 44
3.2. How is CBT with older people different?................................................................................ 44
Lecture 4: Schema-focused therapy for PDs ......................................................................................... 47
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1. Lecture 4 ........................................................................................................................................ 47
1.1. Schema therapy ...................................................................................................................... 47
1.2. Early maladaptive schemas .................................................................................................... 47
1.3. Schema operations: perpetuation.......................................................................................... 48
1.4. Coping styles and responses .................................................................................................. 48
1.5. Schema operations: healing ................................................................................................... 48
1.6. Modes ..................................................................................................................................... 48
1.7. Schema assessment................................................................................................................ 49
1.8. Schema change ....................................................................................................................... 49
2. Schema therapy: Conceptual model ............................................................................................. 49
2.1. The evolution from cognitive to schema therapy .................................................................. 49
2.2. The development of schema therapy .................................................................................... 50
2.3. Early maladaptive schemas .................................................................................................... 51
2.4. Characteristics of early maladaptive schemas ....................................................................... 51
2.5. The origins of schemas ........................................................................................................... 52
2.6. Schema domains and early maladaptive schemas ................................................................. 53
2.7. The biology of EMS ................................................................................................................. 58
2.8. Schema operations ................................................................................................................. 60
2.9. Maladaptive coping styles and responses .............................................................................. 60
2.10. Schema modes ..................................................................................................................... 64
2.11. Schema assessment and change .......................................................................................... 66
2.12. Comparison between schema therapy and other models ................................................... 67
Lecture 5: EMDR .................................................................................................................................... 69
1. Lecture 5 ........................................................................................................................................ 69
1.1. Posttraumatic Stress Disorder ................................................................................................ 69
1.2. What is EMDR? ....................................................................................................................... 69
1.3. EMDR protocol ....................................................................................................................... 72
2. How does EMDR work? ................................................................................................................. 75
2.1. History and effects of EMDR .................................................................................................. 75
2.2. A model of EMDR ................................................................................................................... 75
2.3. The effect of beeps ................................................................................................................. 77
2.4. Mindfulness and mindful breathing ....................................................................................... 78
Lecture 6: Acceptance and commitment therapy ................................................................................. 78
1. Lecture 6 ........................................................................................................................................ 78
1.1. Acceptance and commitment therapy ................................................................................... 79
1.2. ACT Hexaflex ........................................................................................................................... 80
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2. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral
and cognitive therapies ..................................................................................................................... 81
2.1. The waves of behavior therapy .............................................................................................. 81
2.2. The theoretical and philosophical basis of ACT...................................................................... 82
2.3. Acceptance and commitment therapy ................................................................................... 85
2.4. ACT empirical findings ............................................................................................................ 88
2.5. The third wave of behavior therapy ....................................................................................... 88
3. Embracing your demons: an overview of acceptance and commitment therapy ........................ 90
3.1. The goal of ACT ....................................................................................................................... 90
3.2. How does ACT differ from other mindfulness-based approaches? ....................................... 90
3.3. What is unique to ACT? .......................................................................................................... 90
3.4. Healthy normality ................................................................................................................... 91
3.5. Destructive normality ............................................................................................................. 91
3.6. Experiential avoidance ........................................................................................................... 91
3.7. Therapeutic interventions ...................................................................................................... 91
3.8. Six core principles of ACT ....................................................................................................... 92
3.9. The ACT therapeutic relationship ........................................................................................... 93
Lecture 7: Psychodynamic psychotherapy ............................................................................................ 93
1. Lecture 7 ........................................................................................................................................ 93
1.1. History of psychodynamic psychotherapy ............................................................................. 93
1.2. Psychodynamic psychotherapy .............................................................................................. 94
1.3. Mentalization based treatment (MBT) ................................................................................... 94
1.4. Transference Focused Therapy (TFP) ..................................................................................... 95
1.5. Comparison of MBT and TFP .................................................................................................. 98
1.6. Example: Non-malignant narcissism ...................................................................................... 98
1.7. Conclusion .............................................................................................................................. 99
2. Transference focused psychotherapy: Overview and update ...................................................... 99
2.1. Strategies .............................................................................................................................. 100
2.2. Tactics ................................................................................................................................... 101
2.3. Techniques............................................................................................................................ 102
2.4. Empirical findings ................................................................................................................. 103
2.5. Indications and contraindications ........................................................................................ 103
2.6. The relationship between TFP and alternative psychoanalytic approaches ........................ 103
2.7. Differences with SP, DBT, and SFT........................................................................................ 104
3. Mentalization-based treatment for borderline personality disorder ......................................... 104
3.1. What is mentalization? ......................................................................................................... 104
3.2. The development of mentalizing.......................................................................................... 105
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3.3. Mentalization based treatment ........................................................................................... 105
3.4. Effectiveness of MBT ............................................................................................................ 106
Lecture 8: Experiential/ Client-centered therapy................................................................................ 106
1. Lecture 8 ...................................................................................................................................... 106
1.1. Carl Rogers and Humanism .................................................................................................. 106
1.2. Emotion Focused Therapy .................................................................................................... 110
2. Client-centered therapy .............................................................................................................. 112
2.1. Rogers’ theory of therapy..................................................................................................... 112
2.2. The actualizing tendency ...................................................................................................... 113
2.3. The core conditions .............................................................................................................. 113
2.4. The nondirective attitude ..................................................................................................... 114
2.5. Rogers’ theory of change...................................................................................................... 114
2.6. Means and ends in therapy .................................................................................................. 114
2.7. Client-initiated experiments and homework ....................................................................... 114
3. Emotion-focused therapy: The transforming power of affect .................................................... 115
3.1. Principles of emotional change ............................................................................................ 115
3.2. Markers and interventions ................................................................................................... 117
3.3. Phases of treatment ............................................................................................................. 117
3.4. The therapeutic tasks ........................................................................................................... 118
4. Humanistic-experiential psychotherapy in practice: Emotion-focused therapy......................... 119
4.1. Historical background and evolution of the approach ......................................................... 119
4.2. Principles of change and case conceptualization ................................................................. 120
4.3. Research on the efficacy and effectiveness of emotion-focused therapy ........................... 122
4.4. Treatment ............................................................................................................................. 122
4.5. Diversity ................................................................................................................................ 124
Lecture 1: Applications of CBT
1. Lecture 1
1.1. What is treatment?
1.1.1. Treatment aims:
− Symptom relief and/ or acceptance
− Targeting underlying deficits/ conflicts/ …
− Increasing happiness?
Evidence based psychological treatments = scientifically proven methods that involve talking to
a psychologist
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1.1.2. Treatment types:
− Short-term vs. long-term
− Individual vs. group
− Symptom-focused vs. person-centered
− Psychotherapy vs. other treatments (medication, deep brain stimulation, electroconvulsive
therapy, running therapy, art/music/ dance therapy)
Types of psychotherapy:
− Psychoanalysis (Freud)
▪ Psychodynamic therapies
▪ Transference-focused
▪ Mentalization-based treatment
− Behavioral (Skinner)
− Humanistic (Rogers)
▪ Client-centered
▪ Emotion Focused Therapy
▪ Gestalt (Perls)
▪ Experiential (formerly CC)
▪ Existential (Yalom)
− System (family-, couple-)
− Cognitive therapy (Beck)
▪ CBT
▪ 2nd wave
▪ 3rd wave: a.o. EMDR, ACT, MBCT
− Schema focused therapy (Young)
▪ Integrates CBT, experiential and gestalt
− Eclectic therapies
▪ Approach to psychotherapy that incorporates principles or techniques from various
systems or theories
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1.2. History of CBT
− Synthesis of cognitive therapy and behavioral therapy
− Three generations/ waves of behavior therapy
▪ 1st generation: Behavior therapy (1950-1960)
→ Objective scientific approach to understand psychological problems by
looking at behavior
→ Focus on modification of problematic behaviors
▪ 2 generation: CBT (1960s-1990)
nd
→ Emphasizing cognitive processes
→ Focus on modification of maladaptive thoughts, schemas, or information
processing styles
→ Rational emotive therapy (Ellis, 1962)
→ Cognitive therapy (Beck, 1979)
▪ 3rd generation: Acceptance based models of CBT (since 1990s)
→ Identified as "third wave" that extends and deviates from traditional CBT
approaches
→ Integrates new concepts into traditional behavioral interventions:
metacognition, acceptance, mindfulness, personal values, and spirituality
→ E.g. Acceptance and commitment therapy (ACT), compassionate mind
training (CMT), Mindfulness-based cognitive therapy (MBCT), DBT,
Metacognitive therapy (MCT), Solution-focused therapy, SFT, EMDR
1.3. What is CBT?
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CBT is a type of psychotherapy in which patients reframe negative thinking patterns into
positive thoughts. Transforming one's thoughts will ultimately result in positive actions and
behaviors in difficult moments.
Beck Institute: CBT is a time-sensitive, structured, present-oriented psychotherapy directed
toward solving current problems and teaching clients skills to modify dysfunctional thinking
and behavior.
1.4. CBT: Clinical Case Formulation
A Clinical Case formulation is an individual overview of the problems that a patient is dealing
with, pointing out the interconnectedness or causal relationships between them and the
patient's history and personality.
− Made together with the patient after or during the first intake session(s)
− Goal:
▪ Get an overview of the problems of the patients
▪ Discover causal relationships between these problems
▪ Gain insight for the patient
▪ Determine which problem to treat first
▪ Set goals for therapy
− Discuss case formulation with patient
▪ Starting point for treatment
− CBT is symptom-focused treatment
− In consent with patient set goals for treatment which are:
▪ Realistic/ doable
▪ Actual
▪ Demarcated
▪ Structured in time
1.5. Anxiety disorders
Anxiety disorders as classified by DSM-5:
− Generalized Anxiety Disorder (GAD)
− Social Anxiety Disorder
− Panic Disorder
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− Agoraphobia
− Specific Phobias
− Illness Anxiety Disorder
− OCD
− PTSD
1.5.1. Anxiety
Basic principle useful for all anxiety disorders: cycle of fear
1.6. Social anxiety disorder
Different treatment options in CBT for social anxiety:
− Psychoeducation (cognitive)
− Examining negative thoughts and core beliefs (cognitive)
− Explaining cognitive distortions (cognitive)
− Task concentration training (behavioral)
− Monitoring safety behaviors (behavioral)
− Behavioral experiment/ exposure in vivo or imaginary (behavioral)
− Other interventions (i.e. Role-playing, progressive muscle relaxation, social skills training)
1.6.1. Task concentration training
Heightened self-focused attention is assumed to play an important role in the maintenance of
social phobia. Social phobics direct too much attention to themselves during social interactions
and have little attention for their task, the other person(s) and their environment. As a result of
their internal focus, they become inconveniently aware of their fear and arousal, and of possible
flaws in their appearance and behavior.
Task-focused attention is attention towards the behavior that is required in the specific
situation, including attention for the other (relevant) persons in that situation. Environment-
focused attention involves focusing on those aspects of the environment which aren't necessary
to perform the task.
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