Exam summary for the course Cognitive Behavioural Interventions, 2020
Cato Boeschoten
This summary contains:
• Chapter 1 of the book by Wright, Basco, & Thase: “Learning Cognitive Behavour Therapy”
(2006/2017)
• Chapter 1, 2, 4, 6, 8, 9, 13 & 14 of the book by O’Donohue & Fisher: “Cognitive Behaviour Therapy”
(2012)
• Weblectures 1, 2, 3 and 4
• Additional literature posted with the lectures on Brightspace:
o The article by Deary, Chalder & Sharpe (2007) The cognitive behavioural model of medically
unexplained symptoms
o The chapter (#26) by Martin & Pearu (2011) on Self Control
,Cato Boeschoten, Summary CBI 2020-2021 EXAM LITERATURE
CHAPER 1: (Wright et al., 2017) BASIC PRINCIPLES OF CBT
CBT is based on well-developed theories that are used to formulate treatment plans and guide the actions of
the therapist. This chapter focuses on explaining the core concepts of CBT and illustrating how the basic
cognitive model has influenced the development of special techniques.
Origins of CBT
CBT is based on two central beliefs:
• Our cognitions have controlling influence on our emotions and behaviour. (1)
• How we act or behave can strongly affect our thought patterns and emotions. (2)
The idea that conscious cognitive processes (1) play a fundamental role in human existence has been
widely advocated by many important historical figures (e.g. Kant, Heidegger, but also more ancient figures
such as Benjamin Franklin and the Greek Stoic Epictetus).
Aaron T. Beck (1960s) was the first person to fully develop theories and methods for using cognitive and
behavioural interventions for emotional disorders. Although Beck based his ideas on psychoanalytic
concepts, he noted that his cognitive theories were influenced by the work of several post-Freudian analysts.
These analysts (e.g. Adler, Horney and Sullivan) focused on distorted self-images, which formed the
foundation for other CBT concepts, such as:
o More systematized cognitive-behavioural formulations of psychiatric disorders and personality
structures
o Theory of personal constructs (core beliefs of self-schemas)
o Ellis’ rational-emotive therapy
à In turn, these concepts contributed to the development of cognitive-behavioural theories and methods.
Beck’s negative cognitive triad was a way to describe cognitive conceptualization of depression, in which
symptoms were related to a negative thinking style in three domains: self, world and future. Later on, this
model was applied to many other conditions (e.g. depression, anxiety disorder, schizophrenia).
The behavioural components (2) of the CBT model originate from the 1950s and the 1960s, when clinical
researchers began to apply the ideas of Pavlov, Skinner and other experimental behaviourists. The focus
was not so much on cognitive processes involved in psychiatric disorders yet. Instead, it was more on shaping
measurable behaviour with reinforcers and extinguishing fearful responses with exposure protocols. Later
on, researchers such as Meichenbaum and Lewinsohn began to incorporate cognitive theories and strategies
into their treatment programs. They believed that the cognitive perspective added context, depth and
understanding to behavioural interventions.
The researchers Barlow and Clark showed the efficacy of a combined approach that uses cognitive
techniques (e.g. to modify fearful cognitions) along with behavioural methods (e.g. breathing training,
relaxation, exposure therapy).
The Cognitive-Behavioural Model
Provided below are the principal elements of the cognitive-behavioural model (filled out for a person with
social phobia). Cognitive processing is given a central role in this model, because people continually appraise
the significance of events in the environment around and with them (e.g. stressful events), and cognitions
are often associated with emotional reactions.
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,Cato Boeschoten, Summary CBI 2020-2021 EXAM LITERATURE
The important interacting parts of the
cognitive model:
1) Cognitions
2) Emotions
3) Behaviours
In treating problems such as the one
portrayed here, the therapist can
choose which element to focus on. E.g.
using relaxation to reduce anxious
emotions.
Findings from other studies (e.g.
decreased regional cerebral blood flow
in brain areas associated with
response to threat) suggest that
biological and cognitive interventions
may interact in the treatment of
psychiatric disorders.
To provide overall direction for
treatment, an integrated, fully detailed
formulation that includes cognitive-
behavioural, biological, social and
interpersonal considerations is
strongly recommended.
Basic Concepts of CBT
Levels of cognitive processing
Beck and his colleagues identified three levels of cognitive processing:
1. Consciousness
This is the highest level of cognition. It’s a state of awareness in which decisions can be made on a rational
basis. Conscious attention allows us to 1) monitor and assess interactions with the environment, 2) link past
memories with present experiences and 3) control and plan future actions. Examples are rational thinking
and problem solving.
2. Automatic (or preconscious) thoughts
These are cognitions that stream rapidly through people’s minds when they are in the midst of situations, or
when they are recalling events. People may subliminally aware of the presence of automatic thoughts, but
they are not subjected to careful rational analysis.
Automatic thoughts might be occurring in the presence of strong emotions. E.g. thinking about a big project
that is due at work à thinking it is ‘too much’ and won’t be finished in time (negative biased cognitions) à
anxiety, sadness. In general, persons with depression, anxiety disorders and other psychiatric conditions
often show increased distorted automatic thinking.
Beck also argued that persons with emotional disorders often have cognitive errors in the automatic
thoughts and other cognitions. Examples of cognitive errors are all-or-nothing thinking (when judgement is
placed into one of two categories, usually good or bad) or personalization (when external events are related
to oneself when there is little or no reason for doing so). In order to reduce cognitive errors, CBT therapists
usually focus on simply recognizing these errors.
3. Schemas
These are core beliefs that act as basic templates or underlying rules for information processing. They serve
as a critical function in allowing humans to screen, filter, code and assign meaning to information from the
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, Cato Boeschoten, Summary CBI 2020-2021 EXAM LITERATURE
environment. Schemas are shaped in early childhood and influenced by life experiences such as parental
teaching and modelling, trauma or education. Humans need schemas to manage large amounts of
information they encounter and to make timely and appropriate decisions.
There are three main groups of schemas:
1. Simple schemas
These are rules about the physical nature of the environment, practical management of everyday
activities, or laws of nature that may have little or no effect on psychopathology. E.g. “take shelter
during a thunderstorm”.
2. Intermediary beliefs and assumptions
Conditional rules such as if-then statements that influence self-esteem and emotional regulation. E.g.
“If I work hard, I can succeed”.
3. Core beliefs about the self
Global and absolute rules for interpreting environmental information related to self-esteem. E.g. “I’m
a failure”.
There’s a difference between adaptive (healthy) and maladaptive (unhealthy) core beliefs. The goal in CBT
is to identify and increase adaptive schemas while modifying and reducing the influence of maladaptive
schemas.
The stress-diathesis hypothesis states that in psychiatric conditions, maladaptive schemas may remain
dominant until a stressful life event occurs that activates the core belief. The maladaptive schema is then
strengthened to the point that it stimulates and drives the more superficial stream of negative automatic
thoughts. For example, an underlying core belief could be “I am never good enough’ – which can come out
once someone is fired and has to look for a new job. This is when the maladaptive schema really interferes
with someone’s functioning.
Side note: CBT differs from
psychodynamically oriented therapy
because it does not believe that specific
structures or defences block thoughts
from awareness (remember Freud and
his interesting ideas about everyone
secretly supressing strange desires etc.).
Instead, CBT emphasizes techniques
designed to help patients detect and
modify their inner thoughts – especially
those associated with emotional
symptoms such as depression or anxiety.
CBT teaches patients to think about
their thinking.
Information processing in depression and
anxiety disorders à:
These are some research findings on
depression and anxiety disorders that
also provide theoretical background for
specific CBT treatment methods.
E.g. hopelessness can predict suicide, and hence, a cognitive-behavioural intervention that includes specific
anti-suicide action reduces suicide risk.
Overview of therapy methods
Before choosing and applying CBT techniques, a therapist will need to develop an individualized
conceptualization that directly ties cognitive-behavioural theories with the patient’s unique psychological
makeup and constellation of problems. Other features of CBT include:
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