Introduction to Cognitive
Behavioural Therapies
1. (15-11)
Goals: Name the historical background of behaviour therapy, cognitive therapy,
and the new developments in CBT. List the treatment components of CBT
interventions. Recognize components of CBT interventions from case
descriptions. Map and explain problem behaviour by means of a functional
analysis. Describe which behavioural or 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.
All lecturers have clinical experience.
Two books will be used in this course:
Behavioural Interventions in Cognitive Behaviour Therapy
Cognitive Behaviour Therapy, Basics and Beyond
+ several background papers, available via Brightspace.
Rugged learning – mandatory!
o You need to get two credits per lesson
o You can earn 1 credit a day per lesson, so keep in mind!
o All 14 credits need to be gained BEFORE the day of the exam (January
18th)!
Exam
o 40 MC questions & 3 open questions
Exam Wednesday, January 18th 18.15 – 20.15 Exam hall
4, Blauwborgje 4
Resit exam Tuesday, April 4th 18.15 – 20.15 Exam hall 4,
Trigger warnings will not be used, due to empirical evidence, which shows
unfavourable effects. Moreover, it is better to get confronted with you own
difficulties while in training, rather than when you are in front of a patient.
Disclosure: Miriam “loves” CBT, so not the most objective perspective.
Psychology is always evolving and changing so in a few years’ time, the whole
perceptive towards CBT might change. However, this is what we now at the time.
Theory behind CBT:
Empirically based form of treatment, departing from theoretical models on
learning and information processing.
History of CBT:
,1st generation: Behaviour therapy (observable behaviour, classical and operant
conditioning, behavioural interventions like exposure) = late 1950’s till 1960’s
2nd generation: Cognitive therapy (information processing, negative automatic
thoughts, the Socratic dialogue, cognitive restructuring) = early 1970’s – 1980’s.
Integrated during the 80’s into: Cognitive-behavioural therapy
3rd generation: Mindfulness Based Cognitive Therapy (MBCT), Acceptance and
Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT)
Characteristics of CBT:
Focus on present
Why does the problem persist? Focussing on maintaining factors.
Focus on thoughts, behaviours, emotions
Time-limited. Usually about 12 to 16 sessions.
Goal oriented.
Problem solving approach
Building on theoretical and empirical evidence.
Structure of CBT:
1. Validation of patients complaints
2. Building therapeutic relationship/engagement (happens over time)
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
You are kind of doing science, you have to continuously evaluate how well the
treatment plan is working and whether you should change you hypothesis.
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 the treatment phase and also in the interaction with the
patient.
Definitions:
Behavioural therapy: Applying experimentally verified learning principles.
Behaviour: A logical response to a meaningful situation, 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.
,Learning model: Abnormal behaviour is achieved by the same learning processes
as normal behaviour: the ways of developing, maintaining and changing
behaviour are the same.
Normal or abnormal?
Deficit or excess (frequency, intensity, duration, inappropriate situation) from the
norm.
How to assess suicidality? Explanatory models?
Follow module 1 & module 2. Some patients might be ashamed or scared of
suicidal thoughts themselves. So it is not very likely that they start talking about
it themselves. Therefore, it is important to know what kind of questions you
should be asking and how you could perform a risk assessment.
Conclusions for CBT interventions
Importance of:
o Clear procedure
o Established effectiveness (functional relationship)
o Empirical evidence of supposed mechanism of change
Status of CBT:
Treatment of choice for many disorders (www.ggzrichtlijnen.nl)
Important treatment option for many disorders (anxiety, depression, psychosis,
somatoform, etc.)
Attractive, because it is short-term, is complaint-driven and measurable effect.
Therapist drift
CBT is not perfect!
About 50-60% who start treatment reach recovery
Efficacy (in the research lab) and effectiveness (in the real world).
Therapists’ beliefs
We rarely use manuals and we dislike them (as psychologists), even
though they result in better outcomes for patients.
We believe the therapeutic alliance will do lots of the work for us
1. How much of the clinical outcome is associated with the alliance?
Clinician beliefs = 32%
The evidence = 4-5%
2. Does the alliance drive therapy outcome?
Not in CBT, it is important to focus on early behavioural change (in
the first few sessions)
Therapists have a tendency to drift, to underperform on what we could
deliver to our patients (which means that people suffer)
Maybe we should not develop new theories but execute the therapy we
give now the best way possible, because not executing is properly leads to
more suffering and fewer people recovering.
, Therapists are the best, just after they graduated. After a bit of practicing
therapists start doing their own thing, and then you see the drift. Because
therapists want to be liked by their patient, but that is not your job!
Therapy is not supposed to be fun, it causes distress. Therapists need to
be comfortable, while patients are in distress, even though this is hard
So, you should stay on top of literature and keep learning!
Basis principles of BT
o Antecedents of behaviour – conditions or stimuli that set the occasion for
behaviour to occur.
o Behaviour – anything a person does (or not does)
o Consequences – effect that behaviour produces (immediate or delayed)
Assessment:
Intake evaluation: assessing problem behaviour (excesses / deficits), coping
behaviour.
Registration of problem behaviour and antecedents / consequences (BT), or
thought records (CT)
Functional analysis
Discriminative stimuli (Sd):
Events or situations that elicit the behaviour and predict reinforcement or
punishment
Establishing operations (E0):
Factors changing the reinforcing or punishing properties of other
environmental events, these are motivational factors (hunger, thirst, etc.)
S delta:
Situations or circumstances in which the behaviour does NOT take place.
Basic principles of CT
o Thoughts (cognitions) give meaning to a neutral stimulus and determine
feelings and behaviours
o Beliefs or schema’s are developed trough (childhood) experiences and
form a filter
o It is important to identify thoughts (maladaptive ones)
o Distinguish between automatic thoughts (intermediate) beliefs and core
beliefs
o Challenge and change thoughts
CBT can be used on different levels:
Most specific (movie like)
Topographical analyses (chain of behaviors)
On the level of problem behaviour
Functional analysis in BT (describing antecedents (Sd / EO) – behaviour –
pos and neg consequences). Cognitive conceptualisation in CT (core belief,
beliefs, situation, automatic thoughts, reactions (emotional, physiological,
behavioural)
Behavioural Therapies
1. (15-11)
Goals: Name the historical background of behaviour therapy, cognitive therapy,
and the new developments in CBT. List the treatment components of CBT
interventions. Recognize components of CBT interventions from case
descriptions. Map and explain problem behaviour by means of a functional
analysis. Describe which behavioural or 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.
All lecturers have clinical experience.
Two books will be used in this course:
Behavioural Interventions in Cognitive Behaviour Therapy
Cognitive Behaviour Therapy, Basics and Beyond
+ several background papers, available via Brightspace.
Rugged learning – mandatory!
o You need to get two credits per lesson
o You can earn 1 credit a day per lesson, so keep in mind!
o All 14 credits need to be gained BEFORE the day of the exam (January
18th)!
Exam
o 40 MC questions & 3 open questions
Exam Wednesday, January 18th 18.15 – 20.15 Exam hall
4, Blauwborgje 4
Resit exam Tuesday, April 4th 18.15 – 20.15 Exam hall 4,
Trigger warnings will not be used, due to empirical evidence, which shows
unfavourable effects. Moreover, it is better to get confronted with you own
difficulties while in training, rather than when you are in front of a patient.
Disclosure: Miriam “loves” CBT, so not the most objective perspective.
Psychology is always evolving and changing so in a few years’ time, the whole
perceptive towards CBT might change. However, this is what we now at the time.
Theory behind CBT:
Empirically based form of treatment, departing from theoretical models on
learning and information processing.
History of CBT:
,1st generation: Behaviour therapy (observable behaviour, classical and operant
conditioning, behavioural interventions like exposure) = late 1950’s till 1960’s
2nd generation: Cognitive therapy (information processing, negative automatic
thoughts, the Socratic dialogue, cognitive restructuring) = early 1970’s – 1980’s.
Integrated during the 80’s into: Cognitive-behavioural therapy
3rd generation: Mindfulness Based Cognitive Therapy (MBCT), Acceptance and
Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT)
Characteristics of CBT:
Focus on present
Why does the problem persist? Focussing on maintaining factors.
Focus on thoughts, behaviours, emotions
Time-limited. Usually about 12 to 16 sessions.
Goal oriented.
Problem solving approach
Building on theoretical and empirical evidence.
Structure of CBT:
1. Validation of patients complaints
2. Building therapeutic relationship/engagement (happens over time)
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
You are kind of doing science, you have to continuously evaluate how well the
treatment plan is working and whether you should change you hypothesis.
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 the treatment phase and also in the interaction with the
patient.
Definitions:
Behavioural therapy: Applying experimentally verified learning principles.
Behaviour: A logical response to a meaningful situation, 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.
,Learning model: Abnormal behaviour is achieved by the same learning processes
as normal behaviour: the ways of developing, maintaining and changing
behaviour are the same.
Normal or abnormal?
Deficit or excess (frequency, intensity, duration, inappropriate situation) from the
norm.
How to assess suicidality? Explanatory models?
Follow module 1 & module 2. Some patients might be ashamed or scared of
suicidal thoughts themselves. So it is not very likely that they start talking about
it themselves. Therefore, it is important to know what kind of questions you
should be asking and how you could perform a risk assessment.
Conclusions for CBT interventions
Importance of:
o Clear procedure
o Established effectiveness (functional relationship)
o Empirical evidence of supposed mechanism of change
Status of CBT:
Treatment of choice for many disorders (www.ggzrichtlijnen.nl)
Important treatment option for many disorders (anxiety, depression, psychosis,
somatoform, etc.)
Attractive, because it is short-term, is complaint-driven and measurable effect.
Therapist drift
CBT is not perfect!
About 50-60% who start treatment reach recovery
Efficacy (in the research lab) and effectiveness (in the real world).
Therapists’ beliefs
We rarely use manuals and we dislike them (as psychologists), even
though they result in better outcomes for patients.
We believe the therapeutic alliance will do lots of the work for us
1. How much of the clinical outcome is associated with the alliance?
Clinician beliefs = 32%
The evidence = 4-5%
2. Does the alliance drive therapy outcome?
Not in CBT, it is important to focus on early behavioural change (in
the first few sessions)
Therapists have a tendency to drift, to underperform on what we could
deliver to our patients (which means that people suffer)
Maybe we should not develop new theories but execute the therapy we
give now the best way possible, because not executing is properly leads to
more suffering and fewer people recovering.
, Therapists are the best, just after they graduated. After a bit of practicing
therapists start doing their own thing, and then you see the drift. Because
therapists want to be liked by their patient, but that is not your job!
Therapy is not supposed to be fun, it causes distress. Therapists need to
be comfortable, while patients are in distress, even though this is hard
So, you should stay on top of literature and keep learning!
Basis principles of BT
o Antecedents of behaviour – conditions or stimuli that set the occasion for
behaviour to occur.
o Behaviour – anything a person does (or not does)
o Consequences – effect that behaviour produces (immediate or delayed)
Assessment:
Intake evaluation: assessing problem behaviour (excesses / deficits), coping
behaviour.
Registration of problem behaviour and antecedents / consequences (BT), or
thought records (CT)
Functional analysis
Discriminative stimuli (Sd):
Events or situations that elicit the behaviour and predict reinforcement or
punishment
Establishing operations (E0):
Factors changing the reinforcing or punishing properties of other
environmental events, these are motivational factors (hunger, thirst, etc.)
S delta:
Situations or circumstances in which the behaviour does NOT take place.
Basic principles of CT
o Thoughts (cognitions) give meaning to a neutral stimulus and determine
feelings and behaviours
o Beliefs or schema’s are developed trough (childhood) experiences and
form a filter
o It is important to identify thoughts (maladaptive ones)
o Distinguish between automatic thoughts (intermediate) beliefs and core
beliefs
o Challenge and change thoughts
CBT can be used on different levels:
Most specific (movie like)
Topographical analyses (chain of behaviors)
On the level of problem behaviour
Functional analysis in BT (describing antecedents (Sd / EO) – behaviour –
pos and neg consequences). Cognitive conceptualisation in CT (core belief,
beliefs, situation, automatic thoughts, reactions (emotional, physiological,
behavioural)
