Week 1
First Assessment Session
1. Why the referral?
a. Who brought you here and why did they decide to do so?
2. What are the problems?
a. Go into specifics about: emotions, thoughts, support group, barriers,
recent/worse situations
3. Goals and expectations of the patient
a. What do they want to achieve and what do they expect from the therapist
Week 2
Identification of negative beliefs- Downward arrow technique
● Therapist asks ‘confrontational’ questions to understand
underlying thoughts to then be able to understand deeper level
beliefs/cognitions that are making the patient’s problem worse
or maintains the problem
○ Be empathetic, use concretization, summarizing,
reflecting, open questions, small encouragements
○ Encourage collaboration and therapeutic alliance
● Client feels unimportant→ known belief
○ Deeper levels→I am not worthwhile, I am small and insignificant
■ Therapist asks: Imagine that you are insignificant…
● What would you be doing and not doing if you are insignificant?
● How would this affect your relationships?
● What would your life be looking like?
Therapeutische technieken en vaardigheden- Neerwaartse pijltechniek
The downward arrow technique is an interview technique to identify underlying/sequential
or referential beliefs surrounding a problem
● Standard questions:
○ Imagine that what you think is actually true
■ What would happen and what does that mean for you?
■ What does that say about you as a person?
● Identifies hot cognitions- beliefs that activate emotional and behavioral schemas
○ An activated hot cognition is recognized by the emotional response it evokes in a
person
, CBT for social anxiety disorder: Using downward arrow and thought challenging
techniques
Downward arrow technique→ understand underlying thoughts and beliefs
● Repeatedly ask: “What would be so bad about…’
○ Goes from automatic thoughts→ to intermediate beliefs→ to core beliefs
● ‘What does … mean to you?’
● ‘What makes you think it is true?
● Is there anything that makes you feel like it is not true?’
Thought challenging techniques→ negative thoughts get weight based on evidence for and
against that thought
● Therapist concludes on the results of brainstorming
○ Client then reflects on the list and would probably realize that the negative
thought is not backed up
Week 3
Explaining cognitive model
Events are interpreted by us→ reactions depend on the interpretation
● All kinds of neutral events might be given negative interpretations
○ The way you think of an event is what determines your reaction
■ Some are more inclined to give a negative or fearful meaning to events
● Anxiety and other symptoms are the result
○ Looking closely and testing your thoughts can give you a
more realistic view
■ CBT helps with this
Developing the model
One of the first steps in treatment (for cognitive
therapy) is to develop an individualized version of
the cognitive model
● The model is used to guide treatment
○ It helps patients understand the
WHY to their current problems and
the PERSISTENCE of these
1. Ask client to think about a recent situation
when they felt [insert symptom]
First Assessment Session
1. Why the referral?
a. Who brought you here and why did they decide to do so?
2. What are the problems?
a. Go into specifics about: emotions, thoughts, support group, barriers,
recent/worse situations
3. Goals and expectations of the patient
a. What do they want to achieve and what do they expect from the therapist
Week 2
Identification of negative beliefs- Downward arrow technique
● Therapist asks ‘confrontational’ questions to understand
underlying thoughts to then be able to understand deeper level
beliefs/cognitions that are making the patient’s problem worse
or maintains the problem
○ Be empathetic, use concretization, summarizing,
reflecting, open questions, small encouragements
○ Encourage collaboration and therapeutic alliance
● Client feels unimportant→ known belief
○ Deeper levels→I am not worthwhile, I am small and insignificant
■ Therapist asks: Imagine that you are insignificant…
● What would you be doing and not doing if you are insignificant?
● How would this affect your relationships?
● What would your life be looking like?
Therapeutische technieken en vaardigheden- Neerwaartse pijltechniek
The downward arrow technique is an interview technique to identify underlying/sequential
or referential beliefs surrounding a problem
● Standard questions:
○ Imagine that what you think is actually true
■ What would happen and what does that mean for you?
■ What does that say about you as a person?
● Identifies hot cognitions- beliefs that activate emotional and behavioral schemas
○ An activated hot cognition is recognized by the emotional response it evokes in a
person
, CBT for social anxiety disorder: Using downward arrow and thought challenging
techniques
Downward arrow technique→ understand underlying thoughts and beliefs
● Repeatedly ask: “What would be so bad about…’
○ Goes from automatic thoughts→ to intermediate beliefs→ to core beliefs
● ‘What does … mean to you?’
● ‘What makes you think it is true?
● Is there anything that makes you feel like it is not true?’
Thought challenging techniques→ negative thoughts get weight based on evidence for and
against that thought
● Therapist concludes on the results of brainstorming
○ Client then reflects on the list and would probably realize that the negative
thought is not backed up
Week 3
Explaining cognitive model
Events are interpreted by us→ reactions depend on the interpretation
● All kinds of neutral events might be given negative interpretations
○ The way you think of an event is what determines your reaction
■ Some are more inclined to give a negative or fearful meaning to events
● Anxiety and other symptoms are the result
○ Looking closely and testing your thoughts can give you a
more realistic view
■ CBT helps with this
Developing the model
One of the first steps in treatment (for cognitive
therapy) is to develop an individualized version of
the cognitive model
● The model is used to guide treatment
○ It helps patients understand the
WHY to their current problems and
the PERSISTENCE of these
1. Ask client to think about a recent situation
when they felt [insert symptom]
