CBT Basic Principles of Cognitive-Behavior Therapy

Pathological information processing in depression and anxiety disorders. PREDOMINANT IN ANXIETY DISORDERS

--Fears of harm or danger --Increased attention to information about potential threats --Overestimates of risk in situations --Automatic thoughts associated with danger, risk, uncontrollability, incapacity --Underestimates of ability to cope with feared situations --Misinterpretations of bodily stimuli

Pathological information processing in depression and anxiety disorders. COMMON TO BOTH DEPRESSION AND ANXIETY DISORDERS

--Heightened automatic information processing --Maladaptive schemas --Increased frequency of cognitive errors --Reduced cognitive capacity for problem solving. --Increased attention to self, especially perceived deficits or problems.

Pathological information processing in depression and anxiety disorders. PREDOMINANT IN DEPRESSION

--Hopelessness --Low self-esteem --Negative view of environment --Automatic thoughts with negative themes --Misattributions --Overestimates of negative feedback --Impaired performance on cognitive tasks requiring effort or abstract thinking.

Maladaptive Schemas

--If I choose to do something, I must succeed. I 'm stupid --I'm a fake --I can never be comfortable around others. --Without a man (woman), I'm nothing. --I must be perfect to be accepted. --No matter what I do, I won't succeed. --The world is too frightening for me.

Research has confirmed that persons with depression, anxiety disorders, and other psychiatric conditions have a high frequency of distorted automatic thoughts

--In depression, automatic thoughts often center on themes of hopelessness, low self-esteem, and failure. --In anxiety persons usually have automatic thoughts that include predictions of danger, harm, uncontrollability, or inability to manage threats.

COGNITIVE-BEHAVIOR THERAPY (CBT)

--Is based on a set of well-developed principles that are used to formulate treatment plans and guide the actions of the therapist.

Adaptive Schemas

--No matter what happens, I can manage somehow. --If I work at something, I can master it --I'm a survivor --Others can trust me --I'm loveable --People respect me If I prepare in advance, I usually do better --There's not much that can scare me.

Thinking Style In Anxiety Disorders

--a heightened level of attention to information in the environment about potential threats. --view triggers for their fears and would pay attention to these stimuli --view the triggers for their fear as being unrealistically dangerous or likely to cause harm. --Many have fears that the panic attacks, or the situations that induce them, may cause catastrophic damage, perhaps even heart attacks, strokes, and death. --have a diminished estimate of their abioity to manage or cope with fear-laden situations; a sense of uncontrollability, and a high frequency of negative self-statements, misinterpretations of bodily stimuli and overestimates of the risk for future calaminites. Awareness of these different types of biased information processing can ehlp clinicians plan and implement treatment for anxiety disorders.

Conscious attention allow one to

--monitor and assess interactions with the environment --link past memories with present experiences --control and plan future actions

Attributional Style in Depression--persons assign meanings (attributions) to life events that are negatively distorted in three domains.

1. Internal versus external 2. Global versus specific 3. Fixed versus changeable Many depressed patients can readily grasp the concept that their thinking style is skewed in the direction of internal, global, and fixed attributions.

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.

Selective Abstraction-sometimes called Ignoring the Evidence or the Mental Filter

A conclusion is drawn after looking at only a small protion of the available information. Salient data are screened out or ignored in order to confirm the person's biased view of the situation.

Overgeneralization

A conclusion is made about one or more isolated incidents and then is extended illogically to cover broad areas of functioning.

Arbitrary Inference

A conclusion is reached in the face of contradictory evidence or in the absence of evidence.

PERSONS WHO EXPERIENCE ANXIETY DISORDERS HAVE BEEN SHOWN TO HAVE SEVERAL CHARACTERISTICS. ONE OF THESE CHARACTERISTICS IS A HEIGHTENED LEVEL OF_____________TO INFORMATION IN THE ENVIRONMENT ABOUT POTENTIAL THREATS.

ATTENTION

ARE TYPICALLY PROVATE OR UNSPOKEN AND OCCUR IN A RAPID-FIRE MANNER AS WE EVALUATE THE SIGNIFICANCE OF EVENTS IN OUR LIVES

AUTOMATIC THOUGHTS

AUTOMATIC THOUGHTS

Are cognitions that stream rapidly through our minds when we are in the midst of situations (or recalling events). Although we may be subliminally aware of the presence of automatic thoughts, typically these cognitions are not subjected to careful rational analysis. They are typically private or unspoken and occur in a rapid-fire manner as we evaluate the significance of events in our lives.

SCHEMAS

Are core beliefs that act as templates or underlying rules for information processing. They severe a critical function in allowing humans to screen, filter, code, and assign meaning to information from the environment. --They are defined as basic templates or rules for information processing that underlie the more superficial layer of automatic thoughts. --They are unduring principles of thinking that start to take shape in early childhood and may be influenced by genetics and multitude of life experiences, including parental teaching and modeling, formal and informal educational activities, peer experiences, traumas and successes.

Cognitive Errors

Beck theorized that there are characteristic errors in logic in the automatic thoughts and other cognitions of persons with emotional disorders. --Subsequent research has confirmed the importance of cognitive errors in pathological styles of information processing.

THE OVERALL STRATEGY OF________________ IS TO IDENTIFY AUTOMATIC THOUGHTS AND SCHEMAS IN THERAPY SESSIONS, TEACH PATIENTS SKILLS FOR CHANGING CONGNITIONS, AND THEN HAVE PATEIENTS PERFORM A SERIES OF HOMEWORK EXERCISES DESIGNED TO EXGTEND THERAPY LESSONS TO REAL-WORLD SITUATIONS

COGNITIVE RESTRUCTURING

IS A STATE OF AWARENESS IN WHICH DECISIONS CAN BE MADE ON A RATIONAL BASIS

CONSCIOUSNESS

The cognitive-behavioral model

Cognitive processing is given a central role because humans appraise the significance of events in the environment around and within them and cognitions are often associated with emotional reactions. event----congtitive appraisal-----emotion----behavior

Intermediary beliefs and assumptions

Conditional rules such as if-then statements that influence self-esteem, emotional regulation, and behavior. Examples: I must be perfect to be accepted If I don;t please others all the time, they will reject me. If I work hard, I can succeed.

Three levels of cognition

Consciousness is the highest level of cognition and is a state of awareness in which decisions can be made on a rational basis. Preconsciousness--automatic thoughts that occur in a rapid-fire manner and are typically personal or unspoken. They can be understood if our attention is drawn to them.

Internal versus external

Depression is associated with a tendency to make attributions to life events that are biased in an internal direction. --depressed individuals commonly take excessive blame for negative events. --Non depressed persons are more likely to view noxious happenings as being due to external forces such as bad luck, fate, or the actions of others.

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.

A SERIES OF QUESTIONS A CBT THERAPIST MAY ASK TO REVEAL DYSFUNCTIONAL THOUGH PATTERNS OR BEHAVIOR IS CALLED

GUIDED DISCOVERY

Core Beliefs about the self

Global and absolute rules for interpreting environmental information related to self-esteem. Examples: I'm unlovable; I'm stupid; I'm a failure; I am a good friend; I can trust others.

CBT FOCUSES ON A ______________AND_____________APPROACH BECAUSE ATTENTION TO CURRENT ISSUES HELPS STIUMLATE THE DEVELOPMENT OF ACTION PLANS TOCOUNTER SYMPTOMS SUCH AS HOPELESS, HELPLESSNESS, AVOIDANCE, AND PROCRASTINATION.

HERE NOW

A NUMBER OF STUDIES HAVE DEMONSTRATED THAT DEPRESSED PERSONS ARE LIKELY TO HAVE HIGH LEVELS OF_____________-AND THAT LACK OF _____________RAISES THE RISK OF SUICIDE

HOPELESSNESS HOPE

Fixed versus changeable

In depression, negative or troubling situations may be viewed as being unchangeable and unlikely to improve in the future. --A healthier style of thinking is observed in nondepressed person, who more often believe that negatve conditions or circumstances will reced with time (this too shall pass).

Global versus specific

Instead of viewing negative events as having only isolated or limited significance, people with depression may conclude that these occurrences have far-reaching, global, or all-encompressing implications. --Persons who are not depressed have a better capacity to wall off negative events andprevent them from having a pervasive effect on self-esteem and behavioral responses.

Absolutistic (all-or-nothing) thinking

Judgements about oneself, personal experiences, or others are placed into one of two categories (all bod or all good, total failure, or total success, completely flawed or completely perfect).

RATING SCALES, HANDOUTS, COMPUTER PROGRAMS AND SELF-HELP BOOKS ARE TOOLS AVAILABLE TO ASSIST CBT THERAPISTS IN PROVIDING

PSYCHOEDUCATION

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. Examples: be a defensive driver; a good education pays off; take shelter during a thunderstorm

ARE ENDURING PRINCIPLES OF THINKING THAT START TO TAKE SHAPE IN EARLY CHILDHOOD

SCHEMAS

INVOLVES ASKING THE CLIENT/PATIENT QUESTIONS THAT STIUMLATE CURIOSITY AND INQUISITIVENESS

SOCRATIC QUESTIONING

Six Main Categories of Cognitive Errors

Selective Abstraction Arbitrary inference Overgeneralization Magnification and minimization Personalization Absolutistic (all-or-nothing) thinking

Magnification and Minimization

The significance of an attribute, event, or sensation is exaggerated or minimized.

Stress-diathesis hypothesis

Theory stating that mental and physical disorders develop from genetic or biological predisposition combined with stress. Beck and others have suggested that in depression and other conditions, maladcapti8ve schemas may remain dormant, or have reduced salience until a stressful even occurs that activates the core belief. --The maladaptive schemas is then strengthened to the point that it stimulates and drives the more superficial stream of negative automatic thouts.

In depression

automatic thoughts often center on themes of hopelessness, low welf-esteem, and failure.

In CBT Schemas are defined as

basic templates or rules for information processing that underlie the more superficial layer of automatic thoughts. --They are enduring principles of thinking that start to take shape in early childhood and may be influenced by genetics and a multitude of life experiences, including parental teaching and modeling, formal and informal educational activities, peer experiences, traumas, and successes.

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 --deepen awareness of their own congnitive and behavioral patterns that could influence the therapeutic relationship.

CBT emphasizes techniques

designed to help patients detect and modify automatic thoughts and schemas, especially those that are associated with emotional symptoms such as depression, anxiety, or anger. --CBT teaches patients to think about their thinking to reach the goal of bringing autonomous cognitions into conscious awareness and control.

Goal in CBT is to

identify and build up the adaptive schemas while attempting to modify or reduce the influence of maladaptive schemas.

In anxiety

persons usually have automatic thoughts that include predictions of danger, harm, uncontrollability, or inability to manage threats.

One of the most clinically relevant findings from research on depression is

the association between hopelessness and suicide. --Depressed persons are likely to have high levels of hopelessness and that lack of hope raises the risk of suicide. --Cognitive therapy resulted in a lower rate of suicide attempts when compared to usual clinical care. --Narrative interview of recent suicidal crises to help guid treatment, developing a safety plan, identifying reasons for living, constructing a hope kit, and engaging patiens in a guided imagery task to practicing using their skills during suicidal crises.

Because a goal of CBT is to help patients develop an accurate and rational style of information processing

therapist need to recognize and address possible feedback distortions. --One of the principal methods of doing this is providing and asking for detailed feedback in therapy sessions.

Automatic Thoughts are

typically private or unspoken and occur in a rapid-fire manner. The term PRECONSCIOUS is used in describing automatic thoughts because these cognitions can be recognized and understood if our attention is drawn to them. --Persons with psychiatric disorders such as depression or anxiety often experience floods of automatic thoughts that are maladaptive or distorted. These thoughts can generate painful emotional reactions and dysfunctional behavior.

By recognizing our personal automatic thoughts and employing other cognitive behavioral processes

we can improve the understanding of basic concepts, increase the empathy with pateients and deepen awarenss of one's own cognitive and bhavioral patterns that could influence the therapeutic relationship.