Introduction To Cognitive Behavioral Therapies (PSB3EKP07)
Institution
Rijksuniversiteit Groningen (RuG)
Lecture notes of all the lectures (14 in total) given during the third year course Introduction to Cognitive Behavioral Therapies (PSB3E-KP07) at the University of Groningen. The parts that discussed personal information are not included due to privacy reasons.
Introduction To Cognitive Behavioral Therapies (PSB3EKP07)
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Notes lectures Introduction to Cognitive Behavioral
Therapies
Lecture 1: Introduction to CBT
What is CBT; empirically based form of treatment, departing from theoretical models on learning and
information processing.
History of CBT:
- Late 1950s-1960s first generation
Behavior therapy (observable behaviors, classical and operant conditioning)
- Early 1970s-1980s; second generation
Cognitive therapy (information processing, negative automatic thoughts, Socratic
dialogue, cognitive restructuring)
- Integrated during the 80’3 into cognitive-behavioral therapy
- 2000s; third generation
Mindfulness Based Cognitive Therapy, Acceptance and Commitment Therapy, Dialectical
Behavior Therapy
Characteristics of CBT;
- Focus on present
- Question is; why does the problem persist
- Focus on thoughts, behaviors, emotions
- Time-limited
- Goal oriented
- Problem solving approach
- Building on theoretical and clinical research
CBT assessment;
- Aim; to investigate the exact nature of this patients thoughts and behaviors
- Initial approach; formal assessment using interview, self-monitoring
- Maintenance; assess the nature and impact of cognitions and behaviors continuously during
treatment phase and also in interaction with the patient (assessment never stops)
Behavior is a logical response to a meaningful situation. Behavior is the result of a complex
information system with antecedent and consequent factors (ABC).
Learning= acquiring knowledge about the connection between events (=expectations) can result in a
behavioral change.
Levels of knowledge;
- Learning model; abnormal behavior is achieved by the same learning processes as normal
behavior (the ways of developing, maintaining and changing behavior are the same)
- Normal or abnormal; deficits/excess (frequency, intensity, duration, inappropriate situation).
Norm; general norm, impairment, health-related risk, illegal
Behavioral therapy (BT); basic principles; interaction of person with his/her environment.
, 1. Antecedents; conditions/stimuli that set the occasion for behavior to occur
2. Behavior; anything a person does (or does not)
3. Consequences; effect that behavior produces (immediate and delayed)
Behavior is maintained by its consequences.
Assessment;
- Intake evaluation; assessing problem behavior (behavioral excesses/deficits), coping
behavior
- Registration of problem behavior and antecedents/consequences (typically in BT) or thought
records (typically in CT)
Functional analysis – antecedents
- Discriminative stimuli (Sd); events/situations
that elicit the behavior and predict
reinforcement/punishment.
- Establishing operations (EO);
Factors changing the
reinforcing/punishing properties of other
environmental events (hunger, thirst,
craving, negative mood, thoughts rules)
Motivational factors
- S-delta; situations/circumstances in which
the behavior does not take place.
Cognitive therapy (CT); basic principles of CT
- Thoughts (cognitions) give meaning to neutral stimulus and determine feelings and behavior
- Beliefs/schema’s are developed through (childhood) experiences and form a filter
- Identify thoughts
- Distinguish between automatic thoughts, (intermediate) beliefs, and core beliefs
- Challenge and change thoughts
Analyses in CBT on different levels;
- Most specific (movie-like)
Topographical analyses (chain of behaviors)
- On the level of problem behavior
Functional analysis in BT (describing antecedents (Sd/EO) – behavior – positive and
negative consequences
Cognitive conceptualization in CT (core beliefs, beliefs, situation, automatic thoughts,
reactions (emotional, physiological, behavioral))
- On the level of an overview of problem areas and their interactions/causal relations
Case formulation/holistic theory
New developments in CBT;
- Mindfulness
Mindfulness-based cognitive therapy (MBCT); non-judgmental observation of present
experiences
Thoughts can be observed
, Meditation
- Acceptance and commitment therapy (ACT)
Acceptance= willingness to stay in contact with aversive experiences
Commitment to life values and goals
Cognitive diffusion
Lecture 2: Exposure in practice
How do you apply exposure:
- Analysis of meaning: how do we think the classical of fear response is conditioned
- Conditioned stimulus (CS) unconditioned stimulus (UCS) conditioned response (CR)
Exposure to what? What is being avoided/prevented to happen;
- Little Albert; rabbit (CS) unexpected loud noise (UCS) fear (CS)
- Pavlov and the dog food; sound (CS) food (UCS) drooling (CS)
Fear responses in the brain:
- Quick route: eyes thalamus amygdala brainstem
Super quick fight, flight
In anxiety disorders is the amygdala very active sweating, difficulty thinking, rapid
breathing, stomachache, increasing heartrate, shaking
- Long route: eyes thalamus visual cortex amygdala brainstem
Takes longer, interpretation is involved
Exposure to the conditioned stimulus (CS) in exposure therapy.
Panic disorder:
- Dizziness (CS) faint (UCS) fear (CR)
- Higher heart rate (CS) having heart attack and dying (UCS) fear (CR)
Interoceptive exposure= exposure to bodily sensations.
Interceptive exposure in action;
- Hyperventilation provocation; dizziness (CS) fainting, going crazy, losing control, heart
attack (UCS) fear (CR)
- Breathing though a straw
- Walking the stairs
- Shaking your head
- Spinning around
- Holding your breath
- Looking at stripes
, Exposure: variants
- Exposure in vivo/in real life (agoraphobia)
- Exposure invitro/imagery exposure (PTSD)
- Interceptive exposure (panic disorders, hypochondriasis)
- Cue exposure (bulimia, addictive behaviors)
- Exposure with response prevention (OCD)
- Social mishap exposure (social phobia)
- Therapist-assistant/self-directed exposure
- Virtual reality exposure therapy (VRET)
Social anxiety disorder (SAD); social mishap (CS) rejection (UCS) fear (CR)
Mowrer’s two-factor theory;
- Classical conditioning to develop fear
- Operant conditioning to maintain fear through safety behaviors
Safety behavior=
- Behaviors that predict safety (absence of UCS) and that there are related to the prevention
of the feared outcome
- Safety behavior = R (operant)
Safety signal=
- Predictors of the absence of UCS
- Safety signal = CS
Avoidance behavior;
- Passive avoidance; avoiding situations/objects to prevent the expected feared outcome to
occur.
- Active avoidance; escaping from (leaving) the anxiety provoking situation (and therefore the
feared outcome).
Obsessive compulsive disorder (OCD);
- Obsessions that give rise to anxiety
My hands are dirty
Harming self/others
Did I leave the gas on
Did I just hit someone
I am gay
God is bad
- Compulsions that function as a mean to
diminish this anxiety (can be overt and
covert)
Washing (hands)
Cleaning
Checking
Praying
Counting
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