Samenvatting CBT – Literatuur
Week 1:
H1 Beck – Introduction to Cognitive Behaviour Therapy:
CBT: Psychotherapy. Treatment is based on maladaptive beliefs and behavior. You will try to
understand these for your specific client.
CBT theoretical model:
- Cognitive model: dysfunctional thinking (in the form of negative automatic thoughts) is
common with all mental disorders. specific behavior
- validate these thoughts and use critical thinking with the client functional behavior.
- Cognitions: 1) automatic thoughts 2) intermediate beliefs 3) core beliefs. You will work at all3
levels.
- Recovery approach focuses on positive thoughts you can have in the future instead of the
more negative thoughts that occur first.
CBT research:
>2000 studies found CBT to be effective. CBT also helps to prevent relapse.
Development of Beck’s CBT:
Beck was a psychoanalyst and tried to test psychoanalytic concepts in research but couldn’t find
evidence. Then, he discovered that a lot of his patients had automatic thoughts during their sessions.
So he began to help clients identify and evaluate their thoughts and they quickly got better. He did an
RCT and this proved CBT to be effective.
Recovery oriented cognitive therapy: CT-R. it adds an emphasis on the cognitive formulation of the
clients adaptive beliefs and behavioural strategies. Like strengths and personal qualities. Help clients
draw positive conclusions about experiences.
H2 Beck – Overview of treatment:
Principals of CBT:
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization (key
cognitions, behavioural strategies, precipitating factors and developmental events and
enduring patterns of interpretation)
2. CBT requires a sound therapeutic relationship (through collaboration and using the therapeutic
relationship as an example for positives beliefs about the clients)
3. CBT continually monitors client progress
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 on the past in three circumstances: 1)
when the client expresses a strong desire to do so 2) when work directed to the present is
working insufficiently 3) when you think it’s important for you and clients to understand
where the maladaptive cognitions and strategies come from.
9. CBT is educative: you learn the client to recognize their own negative thoughts, treatment
techniques and you encourage them to write down what they learned.
10. CBT is time sensitive. It is different for every disorder/individual how long treatment is
necessary.
, 11. CBT sessions are structured: 1) reestablish the relationship, review the action plan and collect
data to collaboratively set the agenda 2) discuss issues on the agenda 3) summarize the
session, make an action plan and elicit clients feedback.
12. CBT uses guided discovery and teaches the client to respond to their dysfunctional cognitions
13. CBT includes action plans (therapy homework = identifying obstacles, finding solutions,
practicing behavioural skills from session) You write everything important down.
14. CBT uses a variety of techniques to change thinking, mood and behaviour.\
H4 Beck – The therapeutic relationship:
The rogarian counselling skills of empathy, genuineness and positive regard are especially important.
You make the client feel seen, feel likeable, feel optimistic and feel more competent. You will be
constantly alert for emotional responses within the client and immediately address them. After that you
positively reinforce the client. Always ask for feedback at the end of the session. This can strengthen
your bond. You have to tailor your input of counselling skills to the individual.
Some amount of self-disclosure is good, because you want to be seen as an authentic and warm person
who wants to help the client.
Clients with negative beliefs about relationships with others, bring these beliefs into the therapeutic
relationship. You can also just make a mistake. Sometimes it’s enough to address these and find a
solution, but sometimes it’s a bit more difficult. You can also address if clients generalize these beliefs
to different relationships.
It is also important to have an accurate cognitive conceptualization of yourself so it doesn’t get in the
way of therapy.
H5 Beck – The evaluation session:
During CBT you constantly evaluate your conceptualisation and your clients progress. You want as
much information as possible before the evaluation session. During the evaluation session you want to
collect information, create rapport, increase clients hope determine whether you are an appropriate
therapist and assess if other treatment is necessary (like medication). You will also write down an
initial diagnosis. Also you educate your client about CBT and set up an easy action plan. Sometimes it
can be helpful for a client to bring a trusted accompany to the session. You start the session alone and
then decide collaboratively if an accompany is coming.
You start the session by setting the agenda. When you start your assessment, note that there are various
areas that you will need to get information about. It is extra important to ask if someone is homicidal
or suicidal. It is important to ask clients how they spent their time. It gives you insight in their lives an
helps setting goals. Throughout the evaluation you look for indications that the client is unsure about
therapy. Positively reinforce their thoughts (“it’s good you told me that”).
Toward the end of the evaluation it’s useful to ask if there is anything else that’s important to know
and is there anything you’re reluctant to tell me.
If a trusted person comes in you can ask what they think is most important to know and tell them your
insights.
At the end of the session you will give clients your initial impression of their diagnosis. Then you will
tell them your general treatment plan and elicit feedback from the client. You also create a first action
plan for the client to work on in between sessions.
Then you set expectations for treatment: like the treatment duration and the frequency of the sessions.
At the end you’ll summarize the session and ask if there is anything unclear or if there’s anything else
the client wants to tell. After the session you contact relevant other healthcare professionals.
Page & Stritzke (2014):
, Page 61-77 (not page 78-84)
A case formulation is a hypothesis about causes, precipitants and maintaining influences of a persons
psychological, interpersonal and behavioural problems. It helps structure information and enhances the
therapeutic relationship.
Behavioural case formulation:
A functional analysis involves the identification of important, controllable, causal functional
relationships applicable to a specified set of target behaviours for an individual client. The aim is not
to explain behaviour but to identify the variables that can be manipulated to change behaviour. There
are three sets of variables:
A: Antecedents = prior factos
- Distal to behaviour and proximal in time
- Moderator = has a direct effect on
behaviour
- Mediator = influences a relationship
between two variables
B: Behaviour = actions, physiological responses
and cognitions
- Topography = how typical it is
C: Consequences
Automatic reinforcement is when there is no clear
external reinforcement.
To identify the function of behaviour you can use
- Indirect assessment: questioning an
observer about the (non)occurrence of
some behaviours.
- Analog assessment: experimental
conditions to test hypothetical reinforcer
- Naturalistic assessment: behaviour is
observed in a natural setting and frequency and topography are different contingencies.
After this, a working hypothesis is tested to identify which contingency is related to the problem
behaviour and a treatment will be developed which will aim to modify the contingencies controlling
the problem behaviour. A functional assessment is often used whit developmental disabilities.
Limitation: Cognitions that may occur between antecedent and consequence are not regarded.
Cognitive Behavioural Case formulation:
A cognitive behavioural case formulation begins with a problem list of the client (this is comparable
with the “behaviour, B”). Then, a diagnosis is given that accounts for the most of the problems on the
list. Nomothetic (describes the study of a group) formulation = explanation of the type typically
found in the literature that serves to provide an account for all people who have a diagnosis. Like an
social anxiety explanation model. After, you will individualize the nomothetic formulation. Then, the
psychologist makes hypothesises about how the dysfunctional behaviour is learned, why functional
behaviour wasn’t learned, how underlying schema’s were developed, how emotion regulation deficits
were acquired and the origins of any biological vulnerabilities. Then precipitants (antecedents) are
identified.
Strengths: diagnostic assessment has a key role and nomothetic formulations are linked with
idiographic accounts.
Week 1:
H1 Beck – Introduction to Cognitive Behaviour Therapy:
CBT: Psychotherapy. Treatment is based on maladaptive beliefs and behavior. You will try to
understand these for your specific client.
CBT theoretical model:
- Cognitive model: dysfunctional thinking (in the form of negative automatic thoughts) is
common with all mental disorders. specific behavior
- validate these thoughts and use critical thinking with the client functional behavior.
- Cognitions: 1) automatic thoughts 2) intermediate beliefs 3) core beliefs. You will work at all3
levels.
- Recovery approach focuses on positive thoughts you can have in the future instead of the
more negative thoughts that occur first.
CBT research:
>2000 studies found CBT to be effective. CBT also helps to prevent relapse.
Development of Beck’s CBT:
Beck was a psychoanalyst and tried to test psychoanalytic concepts in research but couldn’t find
evidence. Then, he discovered that a lot of his patients had automatic thoughts during their sessions.
So he began to help clients identify and evaluate their thoughts and they quickly got better. He did an
RCT and this proved CBT to be effective.
Recovery oriented cognitive therapy: CT-R. it adds an emphasis on the cognitive formulation of the
clients adaptive beliefs and behavioural strategies. Like strengths and personal qualities. Help clients
draw positive conclusions about experiences.
H2 Beck – Overview of treatment:
Principals of CBT:
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization (key
cognitions, behavioural strategies, precipitating factors and developmental events and
enduring patterns of interpretation)
2. CBT requires a sound therapeutic relationship (through collaboration and using the therapeutic
relationship as an example for positives beliefs about the clients)
3. CBT continually monitors client progress
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 on the past in three circumstances: 1)
when the client expresses a strong desire to do so 2) when work directed to the present is
working insufficiently 3) when you think it’s important for you and clients to understand
where the maladaptive cognitions and strategies come from.
9. CBT is educative: you learn the client to recognize their own negative thoughts, treatment
techniques and you encourage them to write down what they learned.
10. CBT is time sensitive. It is different for every disorder/individual how long treatment is
necessary.
, 11. CBT sessions are structured: 1) reestablish the relationship, review the action plan and collect
data to collaboratively set the agenda 2) discuss issues on the agenda 3) summarize the
session, make an action plan and elicit clients feedback.
12. CBT uses guided discovery and teaches the client to respond to their dysfunctional cognitions
13. CBT includes action plans (therapy homework = identifying obstacles, finding solutions,
practicing behavioural skills from session) You write everything important down.
14. CBT uses a variety of techniques to change thinking, mood and behaviour.\
H4 Beck – The therapeutic relationship:
The rogarian counselling skills of empathy, genuineness and positive regard are especially important.
You make the client feel seen, feel likeable, feel optimistic and feel more competent. You will be
constantly alert for emotional responses within the client and immediately address them. After that you
positively reinforce the client. Always ask for feedback at the end of the session. This can strengthen
your bond. You have to tailor your input of counselling skills to the individual.
Some amount of self-disclosure is good, because you want to be seen as an authentic and warm person
who wants to help the client.
Clients with negative beliefs about relationships with others, bring these beliefs into the therapeutic
relationship. You can also just make a mistake. Sometimes it’s enough to address these and find a
solution, but sometimes it’s a bit more difficult. You can also address if clients generalize these beliefs
to different relationships.
It is also important to have an accurate cognitive conceptualization of yourself so it doesn’t get in the
way of therapy.
H5 Beck – The evaluation session:
During CBT you constantly evaluate your conceptualisation and your clients progress. You want as
much information as possible before the evaluation session. During the evaluation session you want to
collect information, create rapport, increase clients hope determine whether you are an appropriate
therapist and assess if other treatment is necessary (like medication). You will also write down an
initial diagnosis. Also you educate your client about CBT and set up an easy action plan. Sometimes it
can be helpful for a client to bring a trusted accompany to the session. You start the session alone and
then decide collaboratively if an accompany is coming.
You start the session by setting the agenda. When you start your assessment, note that there are various
areas that you will need to get information about. It is extra important to ask if someone is homicidal
or suicidal. It is important to ask clients how they spent their time. It gives you insight in their lives an
helps setting goals. Throughout the evaluation you look for indications that the client is unsure about
therapy. Positively reinforce their thoughts (“it’s good you told me that”).
Toward the end of the evaluation it’s useful to ask if there is anything else that’s important to know
and is there anything you’re reluctant to tell me.
If a trusted person comes in you can ask what they think is most important to know and tell them your
insights.
At the end of the session you will give clients your initial impression of their diagnosis. Then you will
tell them your general treatment plan and elicit feedback from the client. You also create a first action
plan for the client to work on in between sessions.
Then you set expectations for treatment: like the treatment duration and the frequency of the sessions.
At the end you’ll summarize the session and ask if there is anything unclear or if there’s anything else
the client wants to tell. After the session you contact relevant other healthcare professionals.
Page & Stritzke (2014):
, Page 61-77 (not page 78-84)
A case formulation is a hypothesis about causes, precipitants and maintaining influences of a persons
psychological, interpersonal and behavioural problems. It helps structure information and enhances the
therapeutic relationship.
Behavioural case formulation:
A functional analysis involves the identification of important, controllable, causal functional
relationships applicable to a specified set of target behaviours for an individual client. The aim is not
to explain behaviour but to identify the variables that can be manipulated to change behaviour. There
are three sets of variables:
A: Antecedents = prior factos
- Distal to behaviour and proximal in time
- Moderator = has a direct effect on
behaviour
- Mediator = influences a relationship
between two variables
B: Behaviour = actions, physiological responses
and cognitions
- Topography = how typical it is
C: Consequences
Automatic reinforcement is when there is no clear
external reinforcement.
To identify the function of behaviour you can use
- Indirect assessment: questioning an
observer about the (non)occurrence of
some behaviours.
- Analog assessment: experimental
conditions to test hypothetical reinforcer
- Naturalistic assessment: behaviour is
observed in a natural setting and frequency and topography are different contingencies.
After this, a working hypothesis is tested to identify which contingency is related to the problem
behaviour and a treatment will be developed which will aim to modify the contingencies controlling
the problem behaviour. A functional assessment is often used whit developmental disabilities.
Limitation: Cognitions that may occur between antecedent and consequence are not regarded.
Cognitive Behavioural Case formulation:
A cognitive behavioural case formulation begins with a problem list of the client (this is comparable
with the “behaviour, B”). Then, a diagnosis is given that accounts for the most of the problems on the
list. Nomothetic (describes the study of a group) formulation = explanation of the type typically
found in the literature that serves to provide an account for all people who have a diagnosis. Like an
social anxiety explanation model. After, you will individualize the nomothetic formulation. Then, the
psychologist makes hypothesises about how the dysfunctional behaviour is learned, why functional
behaviour wasn’t learned, how underlying schema’s were developed, how emotion regulation deficits
were acquired and the origins of any biological vulnerabilities. Then precipitants (antecedents) are
identified.
Strengths: diagnostic assessment has a key role and nomothetic formulations are linked with
idiographic accounts.
