• 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;
• Additional literature posted with the lectures on Brightspace.
Lecture 2: Cognitive and Behavioural Interventions in Medically Unexplained Symptoms and Syndromes....16
Article - The Cognitive Behavioural Model of Medically Unexplained Symptoms: A Theoretical and Empirical
Review................................................................................................................................................................16
Lecture 3: Behavioural and Experiential Treatment Principles in Depression.................................................20
Chapter 9 – Behavioral Activation.....................................................................................................................20
Chapter 13 – Principles of positive psychology..................................................................................................23
Chapter 14 – Acceptance and cognitive behavior therapy................................................................................26
Lecture 4: Self-Regulation and Self-Control................................................................................................... 29
Chapter 8 – Self-Regulation...............................................................................................................................29
Chapter 26 – Helping an Individual to Develop Self-Control..............................................................................31
Chapter 1 – Basic Principles of Cognitive-Behavior Therapy
Wright, Basco & Thase (2006)
Origins of CBT
CBT is a commonsense approach that is based 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.
Aaron T. Beck was the first person to fully develop theories and methods for using cognitive
and behavioral interventions for emotional disorders. His early formulations were centered
on the role of maladaptive information processing in depression and anxiety disorders. His
first therapy that focused on cognitions was targeted at reversing dysfunctional cognitions
and related behaviors.
The behavioral components in CBT are based on the theories of Pavlov, Skinner and others,
focusing mainly on behavioral interventions such as desensitization and relaxation training.
As research on behavior therapy expanded, cognitive theories and strategies were merged in
to add context, depth, and understanding to behavioral interventions.
,Laura Braam - 2022 Universiteit Leiden
The cognitive-behavioral model
Cognitive processing is given a central role in the
cognitive-behavioral model, because people
continually appraise the significance of events in the
environment around and within them (e.g., stressful
events, memories, bodily sensations), and cognitions
are often associated with emotional reactions. In
treating problems like social anxiety, therapists can
use methods that target all three areas of
pathological functioning identified in the basic CBT
model: cognitions, emotions, and behaviors.
For instance, therapy could involve
teaching a client how to recognize and
change anxiety-ridden thoughts, to use
relaxation or imagery to reduce anxious
emotions, or to implement a step-by-step
hierarchy to break the pattern of avoidance
and build social skills.
The basic BT model is purposefully
simplified to direct the attention of the
clinician to the relationships among
thoughts, emotions, and behaviors to guide
treatment interventions.
Basic concepts
Three primary levels of cognitive processing:
1. Consciousness: the highest level of cognition, a state of awareness in which decisions
can be made on a rational basis. 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.
2. Automatic thoughts: cognitions that stream quickly through our minds when we are
in the midst of situations or recalling events. We may be subconsciously aware of
these thoughts, but they are not analyzed.
3. Schemas: 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 to information from the environment.
CBT is designed to help clients detect and modify (dysfunctional) inner thoughts, and to
bring autonomous cognitions into conscious awareness and control.
Automatic thoughts
We are often not aware of our automatic thoughts, but we are able to recognize and
understand them if we draw our attention to them. Persons with disorders such as
depression and anxiety often experience floods of automatic thoughts that are maladaptive
or distorted, which can generate painful emotional reactions and dysfunctional behavior.
Automatic thoughts do not occur exclusively in people with emotional disorders.
,Laura Braam - 2022 Universiteit Leiden
By recognizing their personal automatic thoughts and employing other cognitive-behavioral
processes, clinicians can improve their understanding of basic concepts, increase their
empathy with patients, and deepen awareness of their cognitive and behavioral patterns
that could influence the therapeutic relationship.
Cognitive errors
Beck theorized (what has later been confirmed by research) that there are characteristic
errors in logic in the automatic thoughts and other cognitions of persons with emotional
disorders.
Six main categories of cognitive errors:
1. Selective abstraction/ignoring the evidence: 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.
2. Arbitrary inference: A conclusion is reached in the face of contradictory evidence or
in the absence of evidence.
3. Overgeneralization: A conclusion is made about one or more isolated incidents and
then is extended illogically to cover broad areas of functioning.
4. Magnification and minimization: The significance of an attribute, event, or sensations
is exaggerated or minimized.
5. 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.
6. Absolutistic/all-or-nothing thinking: Judgments about oneself, personal experiences,
or others are placed into one of two categories (e.g., all bad or all good, total failure
or total success, completely flawed or completely perfect).
Schemas
Schemas are defined as basic templates or rules for information processing that underlie the
more superficial layer of automatic thoughts. They take shape in early childhood and are
influenced by a multitude of life experiences, including parental teaching and modeling,
formal and informal educational activities, peer experiences, traumas and success.
Schemas are needed to manage the large amounts of information that people encounter
each day, to make timely and appropriate decisions.
Three main groups of schemas:
1. Simple schemas: 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 ( ‘A good education pays off’).
2. Intermediary beliefs: Conditional rules such as if-then statements that influence self-
esteem and emotional regulation ( ‘I must be perfect to be accepted’).
3. Core beliefs about the self: Global and absolute rules for interpreting environmental
information related to self-esteem ( ‘I’m a failure’).
Most people have a mix of adaptive (healthy) schemas and maladaptive core beliefs. The
goal in CBT is to identify and build up the adaptive schemas while attempting to reduce or
modify the influence of maladaptive schemas.
, Laura Braam - 2022 Universiteit Leiden
Stress-diathesis hypothesis – the relationship between schemas and automatic thoughts in
depression and other conditions: maladaptive schemas may remain dormant until a stressful
life event 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.
Information processing in depression and anxiety disorders
Pathological information processing in depression and anxiety disorders
Predominant in depression Predominant in anxiety Common to both
disorders depression and anxiety
Hopelessness Fears of harm or danger Heightened automatic
information processing
Low self-esteem Increased attention to Maladaptive schemas
information about potential
threats
Negative view of Overestimates of risk in Increased frequency of
environment situations cognitive errors
Automatic thoughts with Automatic thoughts Reduced cognitive capacity
negative themes associated with danger, risk, for problem solving
uncontrollability, incapacity
Misattributions Underestimates of ability to Increased attention to self,
cope with feared situations especially perceived deficits
or problems
Overestimates of negative Misinterpretations of bodily
feedback stimuli
Impaired performance on
cognitive tasks requiring
effort or abstract thinking
The link between hopelessness and suicide – a number of studies demonstrate that
depressed persons are likely to have high levels of hopelessness and that lack of hope
raises the risk of suicide
Attributional style in depression – depressed persons assign meanings to life events
that are negatively distorted in three domains:
1. Internal versus external: Depression is associated with a tendency to make attribution
to life events that are biased in an internal direction, for instance taking excessive
blame for negative events.
2. Global versus specific: Instead of viewing negative events as having only limited
significance, depressed individuals may conclude that these occurrences have far-
reaching implications.
3. Fixed versus changeable: In depression, negative or troubling situations are viewed as
being unchangeable and unlikely to improve in the future.
Distortions in response to feedback: Research revealed differences between
depressed and nondepressed persons, in which depressed subjects underestimated
the amount of positive feedback that is given, and to expend less effort on tasks after
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