Introduction to Cognitive Behavioral Therapy
Lecture 1 Introduction to CBT
After this course you can:
- Name the historical background of behaviour therapy, cognitive therapy, and the new
developments in CBT (such as mindfulness)
- List the treatment components of CBT interventions
- Recognize components of CBT interventions
- Map and explain problem behavior by means of a functional analysis
- Describe which behavioural interventions are indicated given a specific case example
- Describe which cognitive interventions are indicated given a specific case example
- Make an outline of the supposed underlying working mechanisms of CBT interventions
- Recognize the effectiveness of CBT techniques and CBT interventions.
Exam: open questions 1 hour, not open book, graded.
Slimstampen gaat over hetzelfde onderwerpen, maar erg andere manier van vragen.
Slimstampen erg snel, en exam heb je de tijd.
What is CBT?
It’s empirically based form of treatment, departing from theoretical models on learning and
information processing: so, there is a theory behind it
History of CBT:
- 1950-1960 – onward: 1st generation: Behaviour therapy
- 1970-1980-onward: 2 st generation: Cognitive therapy (information processing, negative
automatic thoughts, the Socratic dialogue (to understand what’s going on), cognitive
restructuring)
- Integrated in the 90’s: cognitive-behavioural therapy
- 2000’s onward: 3rd generation: MBCT, ACT, DBT
Practice of CBT: characteristics
- Focus on present
- Question is: why does the problem persist? Not why did it become a problem (in intake
but not focus), because there may be a different reason it persists then onset. Because
you need to stop persistence
- Focus on thoughts, behaviours, emotions
- Time- limited usually 12 sessions
- Goal oriented
- Problem solving approach
- Building on theoretical and clinical research
,Introduction to Cognitive Behavioral Therapy
These are all interconnected, that’s the basis of CBT
Structure of CBT:
1. Validation of patient’s complaints
2. Building therapeutic relationship/engagement: Therapeutic relationships build during
the sessions; it the client notices it works the relationship builds
3. Explaining general treatment rationale: you tell them what you do and why
4. 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
Maintenance: Assess the nature and impact of cognitions and behaviours
continuously during treatment phase and also in interaction with the patient
(assessment never stops)
5. Formulating realistic goals
6. Designing treatment plan
7. Carrying out treatment plan
8. Broadening to other areas of dysfunction
9. Relapse prevention
Definitions:
Behavioural therapy: Applying experimentally verified learning principles (classical)
conditioning and operant conditions
Behavior is a logical response to a meaningful situation. And behavior is the result of a
complex information system with antecedent and consequent factors (ABC).
Learning: acquitting knowledge about the connection between events (=expectations) can
result in a behavioural change
Learning model: Abnormal behavior is achieved by the same learning processes as normal
behaviour: the ways of developing, maintaining and changing behavior are the same.
Normal or abnormal: Deficit or excess
Norm: general norm, impairment, health-related risk, illegal)
EMDR: Eye Movement Desensitization and Reprocessing
Possible connected to REM sleep, but we don’t know why it works.
Shows there is a need for good communication between research and clinical practice. As
effective as other trauma therapies (CBT).
Shows how something that was developed in the clinical practice and was researched and
adapted and not the other way around.
,Introduction to Cognitive Behavioral Therapy
It’s not CBT
Why it is effective? Which factors are contributing?
- Accuracy of memory does not change, but the
people with eye movements shows that the vividness
did go down quicker and same for emotionality
So, the conclusion is that eye-movements help.
Original theory: activation two hemispheres. So, you
should only see horizontal and not vertical (then not
two hemispheres). →? tested and not true
Theory now: Working memory resources. The eye
movements take up space on the working memory, and less space for emotionality and
vividness. And then its saved as less emotionality or vivid.
So that should mean, there are other tasks that also work (maths, Tetris) that take up
working memory. Beeps work less well, because it takes up less space in the working
memory.
Conclusions for CBT interventions:
Importance of:
- Clear procedure
- Established effectiveness
- Empirical evidence of supposed mechanism of change (CBT: embedded in learning
theory or in information processing)
Status of CBT:
- Treatment of choice for many disorders (www.ggzrichtlijnen.nl)
- It’s an important treatment option
- Attractive, because it’s short-term, complaint-driven and has measurable effects.
Cbt is not perfect: according to the disorder, about 50-60% who start the treatment reach
recovery. The possible is 60%, so how do we reach that?
It has to do with therapists’ beliefs and attitudes
- We rarely use manuals and we dislike them: even though using them results in better
outcomes for patients
- We believe the therapeutic alliance will do lots of the work for us
But therapist’s belief about 32%, but it’s only 4-5%. So, we overestimate the
importance of therapeutic relations. Does the relationships drive therapy outcome?
Not in CBT and it’s important to focus on early behavioural change
But when we drift (don’t use techniques that are effective), we underperform on what it could
deliver to our patients. Don’t need more new therapies. Not more
effective but should focus on delivering the current technique
goods.
, Introduction to Cognitive Behavioral Therapy
What is the best indicator of therapist drift: Is years of not school, so to correct that you need
to do more school. Many people stick to what they know, but if something else is more
effective you should change.
Basic principles of Behavioural therapy: Interaction 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 en delayed)
➔ Behaviour is maintained by its consequences
Assessment:
Intake evaluation: assessing problem behaviour and coping behavior
Registration of problem behaviour and antecedents/ consequences (BT) or though records
(typically in CT)
Registration of pr
Combine information in functional analysis:
Lecture 1 Introduction to CBT
After this course you can:
- Name the historical background of behaviour therapy, cognitive therapy, and the new
developments in CBT (such as mindfulness)
- List the treatment components of CBT interventions
- Recognize components of CBT interventions
- Map and explain problem behavior by means of a functional analysis
- Describe which behavioural interventions are indicated given a specific case example
- Describe which cognitive interventions are indicated given a specific case example
- Make an outline of the supposed underlying working mechanisms of CBT interventions
- Recognize the effectiveness of CBT techniques and CBT interventions.
Exam: open questions 1 hour, not open book, graded.
Slimstampen gaat over hetzelfde onderwerpen, maar erg andere manier van vragen.
Slimstampen erg snel, en exam heb je de tijd.
What is CBT?
It’s empirically based form of treatment, departing from theoretical models on learning and
information processing: so, there is a theory behind it
History of CBT:
- 1950-1960 – onward: 1st generation: Behaviour therapy
- 1970-1980-onward: 2 st generation: Cognitive therapy (information processing, negative
automatic thoughts, the Socratic dialogue (to understand what’s going on), cognitive
restructuring)
- Integrated in the 90’s: cognitive-behavioural therapy
- 2000’s onward: 3rd generation: MBCT, ACT, DBT
Practice of CBT: characteristics
- Focus on present
- Question is: why does the problem persist? Not why did it become a problem (in intake
but not focus), because there may be a different reason it persists then onset. Because
you need to stop persistence
- Focus on thoughts, behaviours, emotions
- Time- limited usually 12 sessions
- Goal oriented
- Problem solving approach
- Building on theoretical and clinical research
,Introduction to Cognitive Behavioral Therapy
These are all interconnected, that’s the basis of CBT
Structure of CBT:
1. Validation of patient’s complaints
2. Building therapeutic relationship/engagement: Therapeutic relationships build during
the sessions; it the client notices it works the relationship builds
3. Explaining general treatment rationale: you tell them what you do and why
4. 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
Maintenance: Assess the nature and impact of cognitions and behaviours
continuously during treatment phase and also in interaction with the patient
(assessment never stops)
5. Formulating realistic goals
6. Designing treatment plan
7. Carrying out treatment plan
8. Broadening to other areas of dysfunction
9. Relapse prevention
Definitions:
Behavioural therapy: Applying experimentally verified learning principles (classical)
conditioning and operant conditions
Behavior is a logical response to a meaningful situation. And behavior is the result of a
complex information system with antecedent and consequent factors (ABC).
Learning: acquitting knowledge about the connection between events (=expectations) can
result in a behavioural change
Learning model: Abnormal behavior is achieved by the same learning processes as normal
behaviour: the ways of developing, maintaining and changing behavior are the same.
Normal or abnormal: Deficit or excess
Norm: general norm, impairment, health-related risk, illegal)
EMDR: Eye Movement Desensitization and Reprocessing
Possible connected to REM sleep, but we don’t know why it works.
Shows there is a need for good communication between research and clinical practice. As
effective as other trauma therapies (CBT).
Shows how something that was developed in the clinical practice and was researched and
adapted and not the other way around.
,Introduction to Cognitive Behavioral Therapy
It’s not CBT
Why it is effective? Which factors are contributing?
- Accuracy of memory does not change, but the
people with eye movements shows that the vividness
did go down quicker and same for emotionality
So, the conclusion is that eye-movements help.
Original theory: activation two hemispheres. So, you
should only see horizontal and not vertical (then not
two hemispheres). →? tested and not true
Theory now: Working memory resources. The eye
movements take up space on the working memory, and less space for emotionality and
vividness. And then its saved as less emotionality or vivid.
So that should mean, there are other tasks that also work (maths, Tetris) that take up
working memory. Beeps work less well, because it takes up less space in the working
memory.
Conclusions for CBT interventions:
Importance of:
- Clear procedure
- Established effectiveness
- Empirical evidence of supposed mechanism of change (CBT: embedded in learning
theory or in information processing)
Status of CBT:
- Treatment of choice for many disorders (www.ggzrichtlijnen.nl)
- It’s an important treatment option
- Attractive, because it’s short-term, complaint-driven and has measurable effects.
Cbt is not perfect: according to the disorder, about 50-60% who start the treatment reach
recovery. The possible is 60%, so how do we reach that?
It has to do with therapists’ beliefs and attitudes
- We rarely use manuals and we dislike them: even though using them results in better
outcomes for patients
- We believe the therapeutic alliance will do lots of the work for us
But therapist’s belief about 32%, but it’s only 4-5%. So, we overestimate the
importance of therapeutic relations. Does the relationships drive therapy outcome?
Not in CBT and it’s important to focus on early behavioural change
But when we drift (don’t use techniques that are effective), we underperform on what it could
deliver to our patients. Don’t need more new therapies. Not more
effective but should focus on delivering the current technique
goods.
, Introduction to Cognitive Behavioral Therapy
What is the best indicator of therapist drift: Is years of not school, so to correct that you need
to do more school. Many people stick to what they know, but if something else is more
effective you should change.
Basic principles of Behavioural therapy: Interaction 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 en delayed)
➔ Behaviour is maintained by its consequences
Assessment:
Intake evaluation: assessing problem behaviour and coping behavior
Registration of problem behaviour and antecedents/ consequences (BT) or though records
(typically in CT)
Registration of pr
Combine information in functional analysis:
