Notes lectures Introduction to Cognitive Behavioral Therapies (PSB3E-KP07)

Notes lectures Introduction to Cognitive Behavioral
Therapies
Lecture 1: Introduction to CBT
What is CBT; empirically based form of treatment, departing from theoretical models on learning and
information processing.

History of CBT:

- Late 1950s-1960s first generation
 Behavior therapy (observable behaviors, classical and operant conditioning)
- Early 1970s-1980s; second generation
 Cognitive therapy (information processing, negative automatic thoughts, Socratic
dialogue, cognitive restructuring)
- Integrated during the 80’3 into cognitive-behavioral therapy
- 2000s; third generation
 Mindfulness Based Cognitive Therapy, Acceptance and Commitment Therapy, Dialectical
Behavior Therapy

Characteristics of CBT;

- Focus on present
- Question is; why does the problem persist
- Focus on thoughts, behaviors, emotions
- Time-limited
- Goal oriented
- Problem solving approach
- Building on theoretical and clinical research

CBT assessment;

- Aim; to investigate the exact nature of this patients thoughts and behaviors
- Initial approach; formal assessment using interview, self-monitoring
- Maintenance; assess the nature and impact of cognitions and behaviors continuously during
treatment phase and also in interaction with the patient (assessment never stops)

Behavioral therapy= applying experimentally verified learning principles.

Behavior is a logical response to a meaningful situation. Behavior 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
behavioral change.

Levels of knowledge;

- Learning model; abnormal behavior is achieved by the same learning processes as normal
behavior (the ways of developing, maintaining and changing behavior are the same)
- Normal or abnormal; deficits/excess (frequency, intensity, duration, inappropriate situation).
Norm; general norm, impairment, health-related risk, illegal

Behavioral therapy (BT); basic principles; interaction of person with his/her environment.

, 1. Antecedents; conditions/stimuli that set the occasion for behavior to occur
2. Behavior; anything a person does (or does not)
3. Consequences; effect that behavior produces (immediate and delayed)

Behavior is maintained by its consequences.

Assessment;

- Intake evaluation; assessing problem behavior (behavioral excesses/deficits), coping
behavior
- Registration of problem behavior and antecedents/consequences (typically in BT) or thought
records (typically in CT)

Functional analysis – antecedents

- Discriminative stimuli (Sd); events/situations
that elicit the behavior and predict
reinforcement/punishment.
- Establishing operations (EO);
 Factors changing the
reinforcing/punishing properties of other
environmental events (hunger, thirst,
craving, negative mood, thoughts rules)
 Motivational factors
- S-delta; situations/circumstances in which
the behavior does not take place.

Cognitive therapy (CT); basic principles of CT

- Thoughts (cognitions) give meaning to neutral stimulus and determine feelings and behavior
- Beliefs/schema’s are developed through (childhood) experiences and form a filter
- Identify thoughts
- Distinguish between automatic thoughts, (intermediate) beliefs, and core beliefs
- Challenge and change thoughts

Analyses in CBT on different levels;

- Most specific (movie-like)
 Topographical analyses (chain of behaviors)
- On the level of problem behavior
 Functional analysis in BT (describing antecedents (Sd/EO) – behavior – positive and
negative consequences
 Cognitive conceptualization in CT (core beliefs, beliefs, situation, automatic thoughts,
reactions (emotional, physiological, behavioral))
- On the level of an overview of problem areas and their interactions/causal relations
 Case formulation/holistic theory

New developments in CBT;

- Mindfulness
 Mindfulness-based cognitive therapy (MBCT); non-judgmental observation of present
experiences
 Thoughts can be observed

,  Meditation
- Acceptance and commitment therapy (ACT)
 Acceptance= willingness to stay in contact with aversive experiences
 Commitment to life values and goals
 Cognitive diffusion



Lecture 2: Exposure in practice
How do you apply exposure:

- Analysis of meaning: how do we think the classical of fear response is conditioned
- Conditioned stimulus (CS) unconditioned stimulus (UCS) conditioned response (CR)

Exposure to what? What is being avoided/prevented to happen;

- Situations (e.g. social interaction)
- Emotions (e.g. fear)
- Bodily sensations (e.g. palpitations)
- Cognitive contents (e.g. memories)

Classical conditioning;

- Little Albert; rabbit (CS) unexpected loud noise (UCS) fear (CS)
- Pavlov and the dog food; sound (CS) food (UCS) drooling (CS)

Fear responses in the brain:

- Quick route: eyes thalamus  amygdala brainstem
 Super quick fight, flight
 In anxiety disorders is the amygdala very active sweating, difficulty thinking, rapid
breathing, stomachache, increasing heartrate, shaking
- Long route: eyes thalamus visual cortex amygdala brainstem
 Takes longer, interpretation is involved

Exposure to the conditioned stimulus (CS) in exposure therapy.

Panic disorder:

- Dizziness (CS) faint (UCS) fear (CR)
- Higher heart rate (CS)  having heart attack and dying (UCS) fear (CR)
 Interoceptive exposure= exposure to bodily sensations.

Interceptive exposure in action;

- Hyperventilation provocation; dizziness (CS) fainting, going crazy, losing control, heart
attack (UCS)  fear (CR)
- Breathing though a straw
- Walking the stairs
- Shaking your head
- Spinning around
- Holding your breath
- Looking at stripes

, Exposure: variants

- Exposure in vivo/in real life (agoraphobia)
- Exposure invitro/imagery exposure (PTSD)
- Interceptive exposure (panic disorders, hypochondriasis)
- Cue exposure (bulimia, addictive behaviors)
- Exposure with response prevention (OCD)
- Social mishap exposure (social phobia)
- Therapist-assistant/self-directed exposure
- Virtual reality exposure therapy (VRET)

Social anxiety disorder (SAD); social mishap (CS) rejection (UCS) fear (CR)

Mowrer’s two-factor theory;

- Classical conditioning to develop fear
- Operant conditioning to maintain fear through safety behaviors

Safety behavior=

- Behaviors that predict safety (absence of UCS) and that there are related to the prevention
of the feared outcome
- Safety behavior = R (operant)

Safety signal=

- Predictors of the absence of UCS
- Safety signal = CS

Avoidance behavior;

- Passive avoidance; avoiding situations/objects to prevent the expected feared outcome to
occur.
- Active avoidance; escaping from (leaving) the anxiety provoking situation (and therefore the
feared outcome).

Obsessive compulsive disorder (OCD);

- Obsessions that give rise to anxiety
 My hands are dirty
 Harming self/others
 Did I leave the gas on
 Did I just hit someone
 I am gay
 God is bad
- Compulsions that function as a mean to
diminish this anxiety (can be overt and
covert)
 Washing (hands)
 Cleaning
 Checking
 Praying
 Counting