Hoorcollege 1: Introduction to cognitive behavioural therapies
Cognitive behavioural therapy= an empirically based form of treatment, departing from
theoretical models on learning and information processing.
à bv. Empty chair technic, talking to an empty chair as if you are talking to a person or
your depression/psychosis. It is not about the empty chair but how it is conceptualized.
People think that this is from 1950, Carl Rogers, so it isn’t CBT because it is stolen, but
that’s true. (gebaseerd op de verandering van gedrag, door de emotionele component te
vergroten)
à Kortom CBT is meer de theoretische achtergrond dan de verschillende technieken die
het weerspiegeld.
à belangrijkste taak therapeut is het vertalen van hoe CBT werkt aan de patient in
makkelijke taal. (zie eerste filmpje)
à CBT is short term, treatment 12-14 weeks. It is goal directing.
à It is about practicing your behaviour. Patients think the therapist is trying to cure
them, but it is hard work because you have to change your thoughts and behaviour so
you have to do it yourself. That’s why there is a lot of homework.
à 1950 and earlier, the idea that you are inside your thoughts and behaviour is
changing itself, but that’s not true you have to work for it.
It is not true that you thoughts have influence on your feeling and your behaviour. It is
not that simplistic.
A scientific perspective on CBT
- CBT can be regarded as an n=1 experiment
- Hypothesis testing
- Independent variable= specific intervention/therapy
- Dependent variable= symptoms
à Your hypothesis is that if you are changing the independent variable the dependent
variable will change.
à Theories are flexible over time. Bv. Exposure in vivo, if you are afraid to something
you have to face it by staying in the place you are afraid of. It is popular for several
decades, recently it is reconceptualised as a cognitive change. Recently it is about
prediction/explorative (falling dead or stay alive) instead of anxiety (name your anxiety
from scale from 1 to 10)
A very brief history of CBT
- Late 1950’s – 1960’s – onward: 1st generation
Behaviour therapy (observable behaviours; classical and operant conditioning,
behavioural interventions like exposure)
, - Early 1970’s – 1980’s – onward: 2nd generation
Cognitive therapy (information processing: negative automatic thoughts, the
Socratic dialogue, cognitive restructuring)
à In 1980, computer science is coming up, it is all about processing information.
- BT and CT integrated during 80’s into
Cognitive- behavioural therapy
à Not about what is happening in the brain
- 2000’s onward: 3rd generation
Mindfulness Based Cognitive Therapy (MBCT)
Acceptance and Commitment Therapy (ACT)
Dialectical behaviour therapy (DBT)
- Nowadays often referred to as
Cognitive- behavioural therapy
à Starts with behaviour, then to thoughts, then how do you interpretation your
thoughts.
Characteristics of CBT
- Focus on the present (this is where we can influence our behaviour, bullying is
the same but how you relate to it is in the present. Some people are not
influenced by bullying and others are, it is dominating there life’s)
- Question is: Why does the problem persist?
- Focus on thoughts, behaviours, emotions (emotions is the most important part of
CBT, they can’t be influenced directly they are influenced through thoughts and
behaviour)
- Relatively structured (some people think it is very structured by actions)
- Time-limited
- Goal oriented
- Problem solving approach
Structure of CBT
1. Validation of patients complaints
2. Building therapeutic relationship/engagement
3. Explaining general treatment rationale
4. Cognitive and behavioural assessment
5. Formulating realistic goals
6. Designing treatment plan
7. Carrying out treatment plan
8. Broadening to other areas of dysfunctioning
9. Relapse prevention
Cognitive and Behavioural Assessment
Aim: to investigate the exact nature of this patient’s thoughts and behaviours
Initial approach: Formal assessment using interview, self-monitoring etc.
Maintenance: Assess the nature and impact of cognitions and behaviours continuously
during treatment phase and also in interaction with the patient (Assessment never
stops)
à als je opschrijft ik ben in het winkelcentrum en ik krijg een paniekaanval, gaat je level
van angst omlaag omdat je jezelf distancieerd van je gedachten.
,à filmpje toilet aanraken, het is de beste theorie om over OCD te komen. Exposure in
vivo met reponse …
Behaviour= a logical response to a meaningful situation, it 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 behavioural change.
Levels of knowledge
1. Learning model à abnormal behaviour is achieved by the same learning
processes as normal behaviour: the ways of developing, maintaining and
changing behaviour are the same.
2. Normal of Abnormal à Deficit of excess (frequency, intensity, duration,
inappropriate situation) Norm: general norm, impairment, health-related risk,
and illegal.
Eye movement desensitization and reprocessing (EMDR)
- Shapiro in the park
- Theory: cathalyses a rebalancing in the neurosystem, by shifting information that
is locked up in the central nervous system to the two hemispheres.
- Procedure is very clear
- EMDR is effective in reducing PTSD symptoms (functional relationship clear)
Three levels of knowledge (BELANGRIJK!)
1. Procedure (How?) = intervention aimed at an effect
2. Principle (what?) = result of the procedure
3. Theory (why?) = explanation of the results of the procedure
Conclusions for CBT interventions
Importance of
- Clear procedure
- Established effectiveness (functional relationship)
- Empirical evidence of supposed mechanism of change (CBT: embedded in
learning theory or in information processing etc.)
Behavioural therapy (BT)
Interaction of person with his/her environment
- Antecedents of behaviour – conditions or stimuli that set the occasion for
behaviour to occur
- Behaviour – anything a person does (or not does)
- Consequences – effect that behaviour produces (immediate & delayed)
à Behaviour is maintained by its consequences
Assessment
- Intake evaluation: assessing problem behaviour (behavioural excess/deficits),
coping behaviour
- Registration of problem behaviour and antecedents/consequence (typically in
BT) or thought records (typically in CT)
, Analyses in CBT on different levels
Most specific (movie-like)
- Topographical analyses (chain of behaviours)
On the level of problem behaviour
- Functional analysis in BT (describing antecedents (Sd/EO) – behaviour – pros
and negative consequences)
- Cognitive conceptualisation in CT (core belief, beliefs, situation, automatic
thoughts, reactions (emotional, physiological, behavioural)
On the level of interaction between problem areas
- Case formulation/ Holistic theory
Functional analysis – antecedents
Ø Discriminative stimuli (Sd)
- Events or situations that elicit the behaviour and predict reinforcement or
punishment
Ø Establishing operations (EO)
- Factors changing the reinforcing or punishing properties of other environmental
events
- E.g.: hunger, thirst, craving, negative mood, thoughts, rules (e.g. if-then
statements)
- Motivational factors
Ø S-delta are situations or circumstances in which the behaviour does NOT take
place
Example functional analysis – problematic drinking
Basic principles of Cognitive therapy (CT)
- Thoughts (or cognitions) give meaning to a neutral stimulus and determine
feelings and behaviours
- Beliefs or schema’s are developed through (childhood) experiences and form a
filter
- Identify thoughts
- Distinguish between automatic thoughts, (intermediate) beliefs, and core beliefs.
Cognitive behavioural therapy= an empirically based form of treatment, departing from
theoretical models on learning and information processing.
à bv. Empty chair technic, talking to an empty chair as if you are talking to a person or
your depression/psychosis. It is not about the empty chair but how it is conceptualized.
People think that this is from 1950, Carl Rogers, so it isn’t CBT because it is stolen, but
that’s true. (gebaseerd op de verandering van gedrag, door de emotionele component te
vergroten)
à Kortom CBT is meer de theoretische achtergrond dan de verschillende technieken die
het weerspiegeld.
à belangrijkste taak therapeut is het vertalen van hoe CBT werkt aan de patient in
makkelijke taal. (zie eerste filmpje)
à CBT is short term, treatment 12-14 weeks. It is goal directing.
à It is about practicing your behaviour. Patients think the therapist is trying to cure
them, but it is hard work because you have to change your thoughts and behaviour so
you have to do it yourself. That’s why there is a lot of homework.
à 1950 and earlier, the idea that you are inside your thoughts and behaviour is
changing itself, but that’s not true you have to work for it.
It is not true that you thoughts have influence on your feeling and your behaviour. It is
not that simplistic.
A scientific perspective on CBT
- CBT can be regarded as an n=1 experiment
- Hypothesis testing
- Independent variable= specific intervention/therapy
- Dependent variable= symptoms
à Your hypothesis is that if you are changing the independent variable the dependent
variable will change.
à Theories are flexible over time. Bv. Exposure in vivo, if you are afraid to something
you have to face it by staying in the place you are afraid of. It is popular for several
decades, recently it is reconceptualised as a cognitive change. Recently it is about
prediction/explorative (falling dead or stay alive) instead of anxiety (name your anxiety
from scale from 1 to 10)
A very brief history of CBT
- Late 1950’s – 1960’s – onward: 1st generation
Behaviour therapy (observable behaviours; classical and operant conditioning,
behavioural interventions like exposure)
, - Early 1970’s – 1980’s – onward: 2nd generation
Cognitive therapy (information processing: negative automatic thoughts, the
Socratic dialogue, cognitive restructuring)
à In 1980, computer science is coming up, it is all about processing information.
- BT and CT integrated during 80’s into
Cognitive- behavioural therapy
à Not about what is happening in the brain
- 2000’s onward: 3rd generation
Mindfulness Based Cognitive Therapy (MBCT)
Acceptance and Commitment Therapy (ACT)
Dialectical behaviour therapy (DBT)
- Nowadays often referred to as
Cognitive- behavioural therapy
à Starts with behaviour, then to thoughts, then how do you interpretation your
thoughts.
Characteristics of CBT
- Focus on the present (this is where we can influence our behaviour, bullying is
the same but how you relate to it is in the present. Some people are not
influenced by bullying and others are, it is dominating there life’s)
- Question is: Why does the problem persist?
- Focus on thoughts, behaviours, emotions (emotions is the most important part of
CBT, they can’t be influenced directly they are influenced through thoughts and
behaviour)
- Relatively structured (some people think it is very structured by actions)
- Time-limited
- Goal oriented
- Problem solving approach
Structure of CBT
1. Validation of patients complaints
2. Building therapeutic relationship/engagement
3. Explaining general treatment rationale
4. Cognitive and behavioural assessment
5. Formulating realistic goals
6. Designing treatment plan
7. Carrying out treatment plan
8. Broadening to other areas of dysfunctioning
9. Relapse prevention
Cognitive and Behavioural Assessment
Aim: to investigate the exact nature of this patient’s thoughts and behaviours
Initial approach: Formal assessment using interview, self-monitoring etc.
Maintenance: Assess the nature and impact of cognitions and behaviours continuously
during treatment phase and also in interaction with the patient (Assessment never
stops)
à als je opschrijft ik ben in het winkelcentrum en ik krijg een paniekaanval, gaat je level
van angst omlaag omdat je jezelf distancieerd van je gedachten.
,à filmpje toilet aanraken, het is de beste theorie om over OCD te komen. Exposure in
vivo met reponse …
Behaviour= a logical response to a meaningful situation, it 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 behavioural change.
Levels of knowledge
1. Learning model à abnormal behaviour is achieved by the same learning
processes as normal behaviour: the ways of developing, maintaining and
changing behaviour are the same.
2. Normal of Abnormal à Deficit of excess (frequency, intensity, duration,
inappropriate situation) Norm: general norm, impairment, health-related risk,
and illegal.
Eye movement desensitization and reprocessing (EMDR)
- Shapiro in the park
- Theory: cathalyses a rebalancing in the neurosystem, by shifting information that
is locked up in the central nervous system to the two hemispheres.
- Procedure is very clear
- EMDR is effective in reducing PTSD symptoms (functional relationship clear)
Three levels of knowledge (BELANGRIJK!)
1. Procedure (How?) = intervention aimed at an effect
2. Principle (what?) = result of the procedure
3. Theory (why?) = explanation of the results of the procedure
Conclusions for CBT interventions
Importance of
- Clear procedure
- Established effectiveness (functional relationship)
- Empirical evidence of supposed mechanism of change (CBT: embedded in
learning theory or in information processing etc.)
Behavioural therapy (BT)
Interaction of person with his/her environment
- Antecedents of behaviour – conditions or stimuli that set the occasion for
behaviour to occur
- Behaviour – anything a person does (or not does)
- Consequences – effect that behaviour produces (immediate & delayed)
à Behaviour is maintained by its consequences
Assessment
- Intake evaluation: assessing problem behaviour (behavioural excess/deficits),
coping behaviour
- Registration of problem behaviour and antecedents/consequence (typically in
BT) or thought records (typically in CT)
, Analyses in CBT on different levels
Most specific (movie-like)
- Topographical analyses (chain of behaviours)
On the level of problem behaviour
- Functional analysis in BT (describing antecedents (Sd/EO) – behaviour – pros
and negative consequences)
- Cognitive conceptualisation in CT (core belief, beliefs, situation, automatic
thoughts, reactions (emotional, physiological, behavioural)
On the level of interaction between problem areas
- Case formulation/ Holistic theory
Functional analysis – antecedents
Ø Discriminative stimuli (Sd)
- Events or situations that elicit the behaviour and predict reinforcement or
punishment
Ø Establishing operations (EO)
- Factors changing the reinforcing or punishing properties of other environmental
events
- E.g.: hunger, thirst, craving, negative mood, thoughts, rules (e.g. if-then
statements)
- Motivational factors
Ø S-delta are situations or circumstances in which the behaviour does NOT take
place
Example functional analysis – problematic drinking
Basic principles of Cognitive therapy (CT)
- Thoughts (or cognitions) give meaning to a neutral stimulus and determine
feelings and behaviours
- Beliefs or schema’s are developed through (childhood) experiences and form a
filter
- Identify thoughts
- Distinguish between automatic thoughts, (intermediate) beliefs, and core beliefs.
