Complete summary: Cognitive and Behavioral therapy
(201600815)
Master Clinical Psychology
Utrecht University
2022-2023
Table of contents
Summary lectures
Lecture 1: Case formulation approach
Lecture 2: Cognitive behavioral therapy
Lecture 3: Hypothesis and individual models
Lecture 4: CBT for psychosis
Lecture 5: Behavioral interventions
Lecture 6: Self-therapy
Summary expert meetings
Week 1: Topographical and functional analyses
Week 2: Psycho-education CBT
Week 3: Best practice: theoretical models
Week 4: Q&A lecture
Week 5: Exposure: behavioral techniques
Week 6: Therapist drift
Summary course book
Chapter 1: Introduction to cognitive behavioral therapy
Chapter 2: Overview of treatment
Chapter 3: Cognitive conceptualization
Chapter 4: The therapeutic relationship
Chapter 5: The evaluation session
Chapter 6: The first therapy session
Chapter 7: Activity scheduling
Chapter 8: Action plans
Chapter 9: Treatment planning
Chapter 10: Structuring sessions
Chapter 11: Problems in structuring sessions
Chapter 12: Identifying automatic thoughts
Chapter 13: Emotions
Chapter 14: Evaluating automatic thoughts
Chapter 15: Responding to automatic thoughts
Chapter 16: Integrating mindfulness into CBT
Chapter 17: Introduction to beliefs
Chapter 18: Modifying beliefs
Chapter 19: Additional techniques
Chapter 20: Imagery
Chapter 21: Termination and relapse prevention
Chapter 22: Problems in therapy
Summary compulsory articles
Page & Stritzke (2014): Chapter 5: Linking assessment to treatment
Page & Stritzke (2014): Chapter 10: Case management
Craske et al. (2022): Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
Speers et al. (2022): Correlates of therapist drift in psychological practice
,Summary lectures
Lecture 1: Case formulation approach
The Why and What of CBT
Basic principles
↳ Cognitive behavioral therapy is a systematic, action oriented psychological treatment to improve
mental health
↳ CBT focuses on challenging and changing unhelpful cognitions (e.g. thoughts, beliefs, attitudes),
behaviors and emotions
↳ It can be seen as a very broad umbrella term → encompasses several types of treatments
↳ more cognitive focused variant by Beck
↳ exposure focused
↳ behavioral activation (BA)
↳ relatedness to EMDR
↳ mindfulness
↳ ACT
↳ EFT
↳ etc.
↳ CBT is evidence-based treatment for many disorders → depression, anxiety, PTSD, OCD, tics,
substance abuse, psychotic disorders
Fundamental aspect of CBT = cognitions, behaviors & emotions/ physiology are interconnected!
→ If you change one thing, it is likely that the other things will change as well
Meaning: you have many different ways of tackling the same problems using different techniques on
different levels
The case formulation approach
↳ Diagnosis ≠ enough
↳ Explore how different factors are related + how symptoms are maintained
↳ = formulation for your patients specifically → = used for treatment plan
, ↳ Combine existing evidence-based knowledge with patient
formulation
↳ No direct link problem patient presented and the
treatment (treatment plan)
↳ Focus on understanding why (detective work)
E. why continued drinking despite many negative
consequences (divorce, unemployment, health issues)
E. why so much fighting, while the couple also loves
each other dearly
↳ Develop hypotheses (see also book Beck)
↳ based on individual analysis
↳ information gathering
↳ link to theoretical models (used for the bigger picture)
Example case formulation
James: trauma-focused treatment → possibly include EMDR or exposure therapy
Pete: treatment focused on training social skills → reducing social anxiety and negative
interpretations
= Implications for treatment !
* two people could have the same problem but the analyses could direct to totally different treatments
Therapist: During treatment
↳ Always monitor your treatment + testing your hypotheses
↳ Effective intervention?
↳ Reduction symptoms?
↳ Responsibility of the therapist to go back to the individual analyses/hypotheses; might they be
incorrect?
↳ And should different therapeutic methods be used?
→ always evaluating how your patient is doing and if they are benefiting (or not) and why that is
In summary
↳ Synthesis client experience, CBT theory and research
↳ It guides treatment
↳ Makes numerous, complex problems more manageable in the case of multiple disorders
↳ Guides the selection, focus and sequence of interventions
, ↳ Identifies client strengths and suggests ways to build client resilience
↳ Helps understand non-response in therapy and suggests alternative routes for change
↳ Promotes client engagement
Individual analysis: link to conditioning models
↳ Conditioning models help us understand behavior (both adaptive and maladaptive)
↳ Classical conditioning: learning associations (pairing neutral stimulus with positive stimulus for
wanted behavior)
↳ Operant conditioning: increasing/decreasing behavior by reinforcement (both positive and negative
reinforcement)
↳ Positive = addition of stimulus
↳ Negative = removal of stimulus
Individual analysis: Functional analysis
↳ Functional analyses: focus on the function of the problem/behavior → consequences of it
↳ Links to operant conditioning: a learning process through which the strength of a behavior
(voluntary) is modified by reinforcement or punishment
↳ Focus on when it happens → Always? / Certain situations?
↳ What defines the context where the maladaptive behavior is present vs absent?
→ Antecedents = activating event also called Discriminating Stimulus (Sd)
↳ 3 elements in functional analysis: Activating event - Behavior - Consequences (ABC)
Example:
Example Jonathan (age 14 / problems at school)
Different types of consequences
↳ Reinforcing: increases the likelihood of behavior
↳ Positive: get something positive
↳ Negative: remove something negative
↳ Punishing: decreases the likelihood of behavior
↳ Positive: get something negative
(201600815)
Master Clinical Psychology
Utrecht University
2022-2023
Table of contents
Summary lectures
Lecture 1: Case formulation approach
Lecture 2: Cognitive behavioral therapy
Lecture 3: Hypothesis and individual models
Lecture 4: CBT for psychosis
Lecture 5: Behavioral interventions
Lecture 6: Self-therapy
Summary expert meetings
Week 1: Topographical and functional analyses
Week 2: Psycho-education CBT
Week 3: Best practice: theoretical models
Week 4: Q&A lecture
Week 5: Exposure: behavioral techniques
Week 6: Therapist drift
Summary course book
Chapter 1: Introduction to cognitive behavioral therapy
Chapter 2: Overview of treatment
Chapter 3: Cognitive conceptualization
Chapter 4: The therapeutic relationship
Chapter 5: The evaluation session
Chapter 6: The first therapy session
Chapter 7: Activity scheduling
Chapter 8: Action plans
Chapter 9: Treatment planning
Chapter 10: Structuring sessions
Chapter 11: Problems in structuring sessions
Chapter 12: Identifying automatic thoughts
Chapter 13: Emotions
Chapter 14: Evaluating automatic thoughts
Chapter 15: Responding to automatic thoughts
Chapter 16: Integrating mindfulness into CBT
Chapter 17: Introduction to beliefs
Chapter 18: Modifying beliefs
Chapter 19: Additional techniques
Chapter 20: Imagery
Chapter 21: Termination and relapse prevention
Chapter 22: Problems in therapy
Summary compulsory articles
Page & Stritzke (2014): Chapter 5: Linking assessment to treatment
Page & Stritzke (2014): Chapter 10: Case management
Craske et al. (2022): Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
Speers et al. (2022): Correlates of therapist drift in psychological practice
,Summary lectures
Lecture 1: Case formulation approach
The Why and What of CBT
Basic principles
↳ Cognitive behavioral therapy is a systematic, action oriented psychological treatment to improve
mental health
↳ CBT focuses on challenging and changing unhelpful cognitions (e.g. thoughts, beliefs, attitudes),
behaviors and emotions
↳ It can be seen as a very broad umbrella term → encompasses several types of treatments
↳ more cognitive focused variant by Beck
↳ exposure focused
↳ behavioral activation (BA)
↳ relatedness to EMDR
↳ mindfulness
↳ ACT
↳ EFT
↳ etc.
↳ CBT is evidence-based treatment for many disorders → depression, anxiety, PTSD, OCD, tics,
substance abuse, psychotic disorders
Fundamental aspect of CBT = cognitions, behaviors & emotions/ physiology are interconnected!
→ If you change one thing, it is likely that the other things will change as well
Meaning: you have many different ways of tackling the same problems using different techniques on
different levels
The case formulation approach
↳ Diagnosis ≠ enough
↳ Explore how different factors are related + how symptoms are maintained
↳ = formulation for your patients specifically → = used for treatment plan
, ↳ Combine existing evidence-based knowledge with patient
formulation
↳ No direct link problem patient presented and the
treatment (treatment plan)
↳ Focus on understanding why (detective work)
E. why continued drinking despite many negative
consequences (divorce, unemployment, health issues)
E. why so much fighting, while the couple also loves
each other dearly
↳ Develop hypotheses (see also book Beck)
↳ based on individual analysis
↳ information gathering
↳ link to theoretical models (used for the bigger picture)
Example case formulation
James: trauma-focused treatment → possibly include EMDR or exposure therapy
Pete: treatment focused on training social skills → reducing social anxiety and negative
interpretations
= Implications for treatment !
* two people could have the same problem but the analyses could direct to totally different treatments
Therapist: During treatment
↳ Always monitor your treatment + testing your hypotheses
↳ Effective intervention?
↳ Reduction symptoms?
↳ Responsibility of the therapist to go back to the individual analyses/hypotheses; might they be
incorrect?
↳ And should different therapeutic methods be used?
→ always evaluating how your patient is doing and if they are benefiting (or not) and why that is
In summary
↳ Synthesis client experience, CBT theory and research
↳ It guides treatment
↳ Makes numerous, complex problems more manageable in the case of multiple disorders
↳ Guides the selection, focus and sequence of interventions
, ↳ Identifies client strengths and suggests ways to build client resilience
↳ Helps understand non-response in therapy and suggests alternative routes for change
↳ Promotes client engagement
Individual analysis: link to conditioning models
↳ Conditioning models help us understand behavior (both adaptive and maladaptive)
↳ Classical conditioning: learning associations (pairing neutral stimulus with positive stimulus for
wanted behavior)
↳ Operant conditioning: increasing/decreasing behavior by reinforcement (both positive and negative
reinforcement)
↳ Positive = addition of stimulus
↳ Negative = removal of stimulus
Individual analysis: Functional analysis
↳ Functional analyses: focus on the function of the problem/behavior → consequences of it
↳ Links to operant conditioning: a learning process through which the strength of a behavior
(voluntary) is modified by reinforcement or punishment
↳ Focus on when it happens → Always? / Certain situations?
↳ What defines the context where the maladaptive behavior is present vs absent?
→ Antecedents = activating event also called Discriminating Stimulus (Sd)
↳ 3 elements in functional analysis: Activating event - Behavior - Consequences (ABC)
Example:
Example Jonathan (age 14 / problems at school)
Different types of consequences
↳ Reinforcing: increases the likelihood of behavior
↳ Positive: get something positive
↳ Negative: remove something negative
↳ Punishing: decreases the likelihood of behavior
↳ Positive: get something negative
