CBT – Literature
Summary
, WEEK 1
CHAPTER 1 – INTRODUCTION TO CBT
What is CBT?
- Beck: ‘cognitive therapy’
- Based on a cognitive formulation:
o maladaptive beliefs
o behavioral strategies
o maintaining factors that characterize a specific disorder
o Also on your conceptualization or understanding of individual clients and their
specific underlying beliefs and patterns of behavior
- Existence of other CBT forms, Beck’s shares many characteristics as well as those of
other forms of evidence-based therapies within a cognitive framework
- Based on belief that people’s thinking influences their emotions and behaviour
The CBT Theoretical Model
- Cognitive model proposes that dysfunctional thinking is common to all psychological
disturbances. When people learn to evaluate their thinking in a more realistic and
adaptive way, they experience a decrease in negative emotion and maladaptive
behavior
- Cognitions – 3 levels
o AUTOMATIC THOUGHTS: superficial, e.g., I am too tired to do anything
o INTERMEDIATE BELIEFS: underlying assumptions, e.g., If I try to ask sb. Out, I
will be rejected
o CORE BELIEFS: self, others, world, e.g., The world is dangerous
o Modifying automatic and intermediate -> long lasting change
Recovery Oriented Cognitive Therapy (CT-R) *R = recovery-oriented
- The Recovery Movement: alternative approach to the medical model for individuals
with serious mental health conditions
- CT-R: adaptation of CBT, maintains the theoretical foundation of the cognitive model
in conceptualizing individuals and planning and delivering treatment. But it adds an
additional emphasis on the cognitive formulation of clients’ adaptive beliefs and
behavioural strategies, and factors that maintain a positive mood
-> emphasizes client’s strengths, personal qualities, skills, resources
- CBT focuses on past issues, while CT-R focuses on client’s aspirations for the future
their values, steps towards goals -> Both use CBT techniques to overcome obstacles
1 – INTRODUCTION TO CBT
CHAPTER 2 – OVERVIEW OF TREATMENT
Principles of treatment
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization.
- Current cognitions (e.g., ‘I am a failure’)
- Behavioural Obstacles (e.g., isolation)
1
, - Precipitating factors (e.g., events that lead to cognitions, e.g., failing an exam and believing one
is generally incompetent)
- Developmental events and enduring patterns of interpreting (events that predispose sb. to a
mental problem, e.g., high expectations of parents and one’s own inability to live up = one must
be a failure)
2. CBT requires a sound therapeutic relationship.
3. CBT continually monitors client progress.
- Client outcomes are enhanced when both clients and therapists receive feedback on how
clients are progressing
- recovery orientation, clients’ general functioning, progress toward their goals, and sense of
satisfaction, connection, and well-being
4. CBT is culturally adapted and tailors treatment to the individual.
5. CBT emphasizes the positive.
6. CBT stresses collaboration and active participation.
7. CBT is aspirational, values based, and goal oriented.
8. CBT initially emphasizes the present.
- You shift the focus to the past in three circumstances:
• 1. When the client expresses a strong desire to do so,
• 2. When work directed toward current problems and future aspirations produces
insufficient change, or
• 3. When you judge that it’s important for you and clients to understand how and when
their key dysfunctional ideas and behavioural coping strategies originated and became
maintained.
9. CBT is educative.
10. CBT is time sensitive.
- We try to make treatment as short term as possible while still fulfilling our objectives (thus
can also become long term or with regular follow up sessions): to help clients recover from
their disorder(s); work toward fulfilling their aspirations, values, and goals; resolve their most
pressing issues; promote satisfaction and enjoyment in life; and learn skills to promote
resilience and avoid relapse.
11. CBT sessions are structured.
12. CBT uses guided discovery and teaches clients to respond to their dysfunctional
cognitions.
13. CBT includes Action Plans (therapy homework).
- identifying and evaluating automatic thoughts that are obstacles to clients’ goals,
- implementing solutions to problems and obstacles that could arise in the coming week, and/or
- practicing behavioural skills learned in session.
- Anything we want the client to remember I recorded.
14. CBT uses a variety of techniques to change thinking, mood, and behaviour.
CHAPTER 4 – THE THERAPEUTIC RELATIONSHIP
- Positive alliances correlate with positive treatment outcomes.
- Therapeutic alliances get strengthened through clients perceived improvement.
- Alliance more important with clients with particularly strong, dysfunctional
personality traits or serious mental health conditions
- Conclusions about therapeutic relationships
• Collaboration, goal consensus, empathy, positive regard and affirmation, and collecting
and delivering client feedback are effective
2
, • Congruence/genuineness, emotional expression, cultivating positive expectations,
promoting treatment credibility, managing countertransference, and repairing ruptures
are probably effective.
• Self-disclosure and immediacy are promising but have not yet been sufficiently
researched.
• Therapist humor, self-doubt/humility, and deliberate practice also lack sufficient
research.
- Rogerian Counseling skills: empathy, genuineness, and positive regard
- Important counselling skills
• Empathy (“It must be so difficult for you when your ex-wife is angry”). •
• Acceptance of client (“It makes sense to me, given how upset you were, that you
[engaged in a dysfunctional coping strategy] this week”).
• Validation (“It can be really hard to start difficult conversations with people”).
• Accurate understanding (“Did I get this right? She said, ; you felt ; you then [did ]”).
• Inspiring hope (“The reason I’m so hopeful for you is ”).
• Genuine warmth (“I’m glad you were able to get out of your apartment so many times
this week!”).
• Interest (“Tell me more about your grandsons”).
• Positive regard (“Offering to help your neighbor was such a kind thing to do! I’m not
sure everyone would be willing to put themselves out the way you did”).
• Caring (“It’s really important to me that I make this therapy right for you”).
• Encouragement (“You know, the fact that you felt a little better when you spent some
time with your friends is such a good sign”).
• Positive reinforcement (“How great that you finally got your taxes done!”).
• Offering a positive view of the client (“It sounds like it was so complicated to figure out
what was wrong with your cousin’s car. You’re so good at things like that”).
• Compassion (“I’m sorry you had such an upsetting conversation with your ex-wife”).
• Humor (“You should have seen me when I…”).
- Monitor client’s affect and elicit feedback: also includes reacting well to negative
feedback
- Clients’ cultures and other characteristics (such as age, gender, ethnicity,
socioeconomic status, disability, gender, and sexual orientation) can influence the
therapeutic relationship
CHAPTER 5 – THE EVALUATION SESSION
- before first treatment session
- Objectives:
• collect information (both positive and negative) to make an accurate diagnosis and
create an initial cognitive conceptualization and treatment plan,
• determine whether you will be an appropriate therapist and can provide the
appropriate “dose” of therapy (level of care, frequency of sessions, and duration of
treatment),
• figure out whether adjunctive services or treatment (such as medication) may be
indicated,
• initiate a therapeutic alliance with the client (and with family members, if relevant),
• educate the client about CBT, and
• set up an easy Action Plan.
- Structure
3
Summary
, WEEK 1
CHAPTER 1 – INTRODUCTION TO CBT
What is CBT?
- Beck: ‘cognitive therapy’
- Based on a cognitive formulation:
o maladaptive beliefs
o behavioral strategies
o maintaining factors that characterize a specific disorder
o Also on your conceptualization or understanding of individual clients and their
specific underlying beliefs and patterns of behavior
- Existence of other CBT forms, Beck’s shares many characteristics as well as those of
other forms of evidence-based therapies within a cognitive framework
- Based on belief that people’s thinking influences their emotions and behaviour
The CBT Theoretical Model
- Cognitive model proposes that dysfunctional thinking is common to all psychological
disturbances. When people learn to evaluate their thinking in a more realistic and
adaptive way, they experience a decrease in negative emotion and maladaptive
behavior
- Cognitions – 3 levels
o AUTOMATIC THOUGHTS: superficial, e.g., I am too tired to do anything
o INTERMEDIATE BELIEFS: underlying assumptions, e.g., If I try to ask sb. Out, I
will be rejected
o CORE BELIEFS: self, others, world, e.g., The world is dangerous
o Modifying automatic and intermediate -> long lasting change
Recovery Oriented Cognitive Therapy (CT-R) *R = recovery-oriented
- The Recovery Movement: alternative approach to the medical model for individuals
with serious mental health conditions
- CT-R: adaptation of CBT, maintains the theoretical foundation of the cognitive model
in conceptualizing individuals and planning and delivering treatment. But it adds an
additional emphasis on the cognitive formulation of clients’ adaptive beliefs and
behavioural strategies, and factors that maintain a positive mood
-> emphasizes client’s strengths, personal qualities, skills, resources
- CBT focuses on past issues, while CT-R focuses on client’s aspirations for the future
their values, steps towards goals -> Both use CBT techniques to overcome obstacles
1 – INTRODUCTION TO CBT
CHAPTER 2 – OVERVIEW OF TREATMENT
Principles of treatment
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization.
- Current cognitions (e.g., ‘I am a failure’)
- Behavioural Obstacles (e.g., isolation)
1
, - Precipitating factors (e.g., events that lead to cognitions, e.g., failing an exam and believing one
is generally incompetent)
- Developmental events and enduring patterns of interpreting (events that predispose sb. to a
mental problem, e.g., high expectations of parents and one’s own inability to live up = one must
be a failure)
2. CBT requires a sound therapeutic relationship.
3. CBT continually monitors client progress.
- Client outcomes are enhanced when both clients and therapists receive feedback on how
clients are progressing
- recovery orientation, clients’ general functioning, progress toward their goals, and sense of
satisfaction, connection, and well-being
4. CBT is culturally adapted and tailors treatment to the individual.
5. CBT emphasizes the positive.
6. CBT stresses collaboration and active participation.
7. CBT is aspirational, values based, and goal oriented.
8. CBT initially emphasizes the present.
- You shift the focus to the past in three circumstances:
• 1. When the client expresses a strong desire to do so,
• 2. When work directed toward current problems and future aspirations produces
insufficient change, or
• 3. When you judge that it’s important for you and clients to understand how and when
their key dysfunctional ideas and behavioural coping strategies originated and became
maintained.
9. CBT is educative.
10. CBT is time sensitive.
- We try to make treatment as short term as possible while still fulfilling our objectives (thus
can also become long term or with regular follow up sessions): to help clients recover from
their disorder(s); work toward fulfilling their aspirations, values, and goals; resolve their most
pressing issues; promote satisfaction and enjoyment in life; and learn skills to promote
resilience and avoid relapse.
11. CBT sessions are structured.
12. CBT uses guided discovery and teaches clients to respond to their dysfunctional
cognitions.
13. CBT includes Action Plans (therapy homework).
- identifying and evaluating automatic thoughts that are obstacles to clients’ goals,
- implementing solutions to problems and obstacles that could arise in the coming week, and/or
- practicing behavioural skills learned in session.
- Anything we want the client to remember I recorded.
14. CBT uses a variety of techniques to change thinking, mood, and behaviour.
CHAPTER 4 – THE THERAPEUTIC RELATIONSHIP
- Positive alliances correlate with positive treatment outcomes.
- Therapeutic alliances get strengthened through clients perceived improvement.
- Alliance more important with clients with particularly strong, dysfunctional
personality traits or serious mental health conditions
- Conclusions about therapeutic relationships
• Collaboration, goal consensus, empathy, positive regard and affirmation, and collecting
and delivering client feedback are effective
2
, • Congruence/genuineness, emotional expression, cultivating positive expectations,
promoting treatment credibility, managing countertransference, and repairing ruptures
are probably effective.
• Self-disclosure and immediacy are promising but have not yet been sufficiently
researched.
• Therapist humor, self-doubt/humility, and deliberate practice also lack sufficient
research.
- Rogerian Counseling skills: empathy, genuineness, and positive regard
- Important counselling skills
• Empathy (“It must be so difficult for you when your ex-wife is angry”). •
• Acceptance of client (“It makes sense to me, given how upset you were, that you
[engaged in a dysfunctional coping strategy] this week”).
• Validation (“It can be really hard to start difficult conversations with people”).
• Accurate understanding (“Did I get this right? She said, ; you felt ; you then [did ]”).
• Inspiring hope (“The reason I’m so hopeful for you is ”).
• Genuine warmth (“I’m glad you were able to get out of your apartment so many times
this week!”).
• Interest (“Tell me more about your grandsons”).
• Positive regard (“Offering to help your neighbor was such a kind thing to do! I’m not
sure everyone would be willing to put themselves out the way you did”).
• Caring (“It’s really important to me that I make this therapy right for you”).
• Encouragement (“You know, the fact that you felt a little better when you spent some
time with your friends is such a good sign”).
• Positive reinforcement (“How great that you finally got your taxes done!”).
• Offering a positive view of the client (“It sounds like it was so complicated to figure out
what was wrong with your cousin’s car. You’re so good at things like that”).
• Compassion (“I’m sorry you had such an upsetting conversation with your ex-wife”).
• Humor (“You should have seen me when I…”).
- Monitor client’s affect and elicit feedback: also includes reacting well to negative
feedback
- Clients’ cultures and other characteristics (such as age, gender, ethnicity,
socioeconomic status, disability, gender, and sexual orientation) can influence the
therapeutic relationship
CHAPTER 5 – THE EVALUATION SESSION
- before first treatment session
- Objectives:
• collect information (both positive and negative) to make an accurate diagnosis and
create an initial cognitive conceptualization and treatment plan,
• determine whether you will be an appropriate therapist and can provide the
appropriate “dose” of therapy (level of care, frequency of sessions, and duration of
treatment),
• figure out whether adjunctive services or treatment (such as medication) may be
indicated,
• initiate a therapeutic alliance with the client (and with family members, if relevant),
• educate the client about CBT, and
• set up an easy Action Plan.
- Structure
3
