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Summary of the lectures - Introduction to CBT

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This document summarises all the lectures from Miriam Lommen, it is quite important to have the lectures notes along with the summary of the literature. Eventhough there is a lot of overlap, there are some very important aspects in the lectures not covered in the literature.

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  • January 21, 2023
  • 41
  • 2022/2023
  • Class notes
  • Miriam lommen
  • All classes
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Introduction to Cognitive Behavioural Therapies – Lectures
Lecture 1 – overview, process, and application
Theory behind CBT
 Empirically based form of treatment departing from theoretical models on learning
and information processing (several types of biases)

History of CBT
 Late 1950’s-1960’s onwards – 1st generation
o Behaviour therapy (observable behaviours; classical and operant
conditioning, behavioural interventions like exposure)
 1970’s-1980’s
o Cognitive therapy (information processing; negative automatic thoughts,
Socratic dialogue, cognitive restructuring)
 1980’s (Aaron and Julie Beck)
o Integrated into cognitive behavioural therapy
 2000’s onwards
o Mindfulness based cognitive therapy
o Acceptance and commitment therapy
o Dialectical behavioural therapy
 Nowadays referred to as CBT

Practice of CBT
Characteristics
 Focus on the present
 Why does the problem persist
 Focus on thought, behaviours, and emotions
 Time limited (depends on where, but around 12-16 sessions)
 Goal oriented (work toward a goal set with patient)
 Problem-solving approach (teaching patient to be their own therapist)
 Building on theoretical and clinical research
 Focus on THINK, FEEL and BEHAVE (all related)

Structure of CBT
1. Validation of patient complaints
2. Building therapeutic relationship/ engagement
3. Explain general treatment rationale
4. Cognitive and behavioural assessment
5. Formulating realistic goals (not “I want to be happy again”, but more specific)
6. Designing a treatment plan
7. Carrying out the treatment plan
8. Broadening to other areas of dysfunctioning
9. Relapse prevention

Aim
 To investigate the exact nature of the patients thought and behaviours
Initial approach
 formal assessment using interview, self-monitoring

,Maintenance
 Assess the nature and impact of cognitions and behaviours continuously during
treatment phase and also in interaction with the patient

Definitions
Behavioural therapy – applying experimentally verified learning principles

Behaviour – a logical response to a meaningful situation; result of a complex information
system with antecedent and consequent factors (ABC)

Learning – acquiring knowledge about the connection between evens (=expectations) can
result in a behavioural change

Levels of knowledge
Learning model – abnormal behaviour is achieved by the same learning processes as normal
behaviour: the ways of developing, maintaining, and changing behaviour are the same

Normal of Abnormal – deficit or excess (frequency, intensity, duration, inappropriate
situations)?
Norm: general norm, impairment, health-related risk, illegal

www.samenmindersuicide.nl

Conclusions of CBT
 Importance of
o Clear procedure
o Established effectiveness
o Empirical evidence of supposed mechanism of change (CBT: embedded in
learning theory or in information processing, etc)

Status of CBT
 First line of treatment for disorders: affective disorders (anxiety/ depression)
 www.ggzrichtlijnen.nl
 Attractive because it is short-term, complaint-driven and has measurable effects.
 CBT is not perfect
o According to the disorder, about 50-60% who start the treatment reach
recovery
 In well-conducted studies
 Efficacy and effectiveness
o So how might we improve our empirically supported treatments?
 Develop new therapies?
 Deliver the existing ones appropriately?

Therapists beliefs and attitudes
 We rarely use manuals, and we dislike them
o Even though using them results in better outcome for patients
o Many clinicians have no idea what a manual is

,  We believe the therapeutic alliance will do lots of work for us
o 1. How much of the clinical outcome is associated with the alliance
 Clinician beliefs = 32%
 The evidence = 4-5%
o 2. Does the alliance drive therapy outcome
 Not in CBT
 Important to focus on early behavioural change

But when we drift, we underperform on what it could deliver to our patients and that means
people suffer

Basic principles of BT – ABC
Interaction of a person with his/her environment
 Antecedent
o Conditions or stimuli that set the occasion for behaviour to occur
 Behaviour
o Anything a person does (or not does)
 Consequence
o Effect that behaviour produces (immediate & delayed)
 behaviour is maintained by its consequences

Assessment
 Intake evaluation: assessing problem behaviour (behavioural excesses/ deficits),
coping behaviour
 Registration of problem behaviour and antecedents/ consequences (typically in BT)
or thought records (typical in CT)
 Functional analysis

Functional analysis – antecedents
 Discriminative stimuli
o Events of situations that elicit the behaviour and predict reinforcement/
punishment
 Establishing operations
o Factors changing the reinforcing or punishing properties of other
environmental events
o E.g., hunger, thirst, craving, negative mood, thoughts, rules
o Motivational
factors
 S delta
o Situations or
circumstances
in which the
behaviour
does NOT take
place

Example functional analysis

, Basic principles CT
 Thoughts or cognitions give meaning to a neutral stimulus and determine feelings
and behaviours
 Beliefs or schemas are developed through (childhood) experiences and form a filter
 Identify thoughts
o Distinguish between automatic thoughts and core beliefs
o Challenge and change these thoughts

Analysis of CBT on different levels
 Most specific (movie-like)
o Topographical analysis (chain of behaviours)
 On the level of problem behaviour
o Functional analysis in BT behaviour – describing antecedents (Sd/EO) –
behaviour – positive and negative consequences
o Cognitive conceptualisations in CT (core beliefs, beliefs, situation, automatic
thoughts, reactions (emotional, physiological, behavioural)

New developments in CBT
 Mindfulness/ acceptance and commitment therapy
o Mindfulness-based cognitive therapy (MBCT)
 Non-judgemental observation of present experiences. Thoughts can
be observed. Meditation.
o Acceptance and commitment therapy (ACT)
 Acceptance: willingness to stay in contact with aversive experiences
 Commitment to life values and goals
 Cognitive diffusion: not change content of the thoughts, but the
relation with the thoughts
o Dialectic Behaviour Therapy (DBT)

Lecture 2 – Exposure in practice
Effectiveness of exposure therapy
 Mean effect sizes for exposure-based therapy of anxiety disorders
o Overview of treatments protocols that contain exposure to anxiety provoking
stimuli as a central component of treatment

What is being avoided?
 Situations (e.g., social interaction)
 Emotions (e.g., fear)
 Bodily sensations (e.g., palpitations)
 Cognitive contents (e.g., memories)
 This is a key question in treatment design

Classical conditioning
Thorndike
 1800s
 Represented the original S-R framework
 Learning is the result of associations forming between stimuli and responses

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