Cognitive-Behavioural Approaches 3 Quiz

Cognitive-Behavioural Approaches 3

• Lecture 10, covering Cognitive-Behavioural Approaches 3, is part of a larger course, PSGY1009: Psychological Approaches to Therapy.
• A quiz on Block 4 is available on Moodle.
• Learning objectives include describing Beck's cognitive therapy (CT) principles, goals, and process; outlining important cognitive and behavioral techniques used in therapy; and evaluating CBT as an approach.

Cognitive Therapy (CT): Theory

• Aaron Beck (1921-2021) was born in Rhode Island and completed a psychiatry rotation against his wishes.
• He began research into depression in the 1950s, rejecting psychoanalytic accounts based on data.
• Beck is a professor emeritus of the Beck Institute for Cognitive Therapy and Research.
• He authored/co-authored over 600 articles and 25 books.
• He developed important psychological tests, including the Beck Depression Inventory (BDI).

Basic Principles of CT

• Information processing is critical for survival.
• Feelings and behaviour are based on how we perceive and structure experiences (cognition).
• Fundamental beliefs and assumptions about self, others, and goals develop early in life through experiences and form schemas.
• Schemas affect how we select and perceive information.

Psychological Distress

• Evolutionary, biological, environmental, and developmental factors contribute to psychological distress.
• Schemas create unique cognitive vulnerabilities, predisposing individuals to distress.
• Psychological disorders result from systematic biases in information processing.
• These include rigid and absolutist thinking (cognitive distortions).

Cognitive Distortions

• Magnification/Minimization: Events are perceived as more significant or less significant than they are.
• Selective Abstraction: Drawing conclusions based on isolated pieces of evidence rather than the whole picture.
• Arbitrary Inference: Drawing conclusions without evidence.
• Dichotomous Thinking: Evaluating experiences as extremes (e.g., all or nothing).
• Personalization: Events are seen as related solely to the self.
• Over-generalization: Drawing broad conclusions from one single event.

Automatic Thoughts

• Automatic thoughts are involuntary, recurring words or images that occur rapidly at the edge of awareness.
• They are similar to Freud's preconscious and Ellis' self-talk.
• They reflect schema content.
• In psychological disorders, negative automatic thoughts (NATs) are common.
• NATs are generally plausible but unrealistic and can become frequent and severe.

Cognitive Model: Depression

• A systematic bias towards negative information exists in three areas (the cognitive triad): self, future, and world.
• As depression worsens, depressive schemas become more activated and worsen cognitive distortions.

Beck's Cognitive Therapy

• The goal of therapy is to correct faulty information processing.
• This involves symptom relief, and by adjusting beliefs and automatic thoughts as testable hypotheses
• Patients learn to become their own therapist.
• There are similarities with Ellis' REBT (rational emotive behavioral therapy)

Therapy Process

• An initial in-depth session analyzes functional and cognitive patterns, and problem lists are drawn up.
• Treatment involves weekly sessions (5-16).
• Homework assignments are given; the therapeutic style is Rogerian but differs from Ellis'
• The approach is collaborative (co-investigator); techniques include collaborative empiricism and guided discovery (e.g., disputing automatic thoughts).

Cognitive and Behavioral Interventions

• Replacing distorted NATs and beliefs with more realistic information processing.
• Techniques include eliciting and identifying NATs, reality-testing and correcting NATS, identifying and altering beliefs.
• Cognitive interventions utilize socrates dialogues, decatastrophizing, and decentring; behavioral interventions include rating mastery/pleasure, rehearsing behaviour, hypothesis testing, and assigning graded tasks.

3rd Wave Approaches

• 3rd wave approaches complement and extend CBT, promoting wellbeing by being more holistic, rather than focused on symptoms.
• 3rd wave CBT shifts focus from thoughts to a broader context
• Many 3rd wave concepts, such as values, mindfulness, and acceptance, are increasingly integrated into CBT.

Dialectical Behavior Therapy (DBT)

• DBT emphasizes that two opposing things can be true, such as accepting oneself while changing.
• Primarily used for borderline personality disorder, but also for depression, preventing self-harm, and eating disorders.
• DBT is based on CBT but adapted for those with intensely strong emotions.
• The focus is on self-acceptance, emotion regulation, and strengthening interpersonal relationships.
• Systematic reviews show effectiveness for disorders like eating disorders and BPD, but DBT is less effective in reducing suicide attempts and has mixed results against depression.

Mindfulness Based Cognitive Therapy (MBCT)

• Combines mindfulness techniques with CBT.
• Techniques like meditation, breathing exercises, and stretching help observe and recognize thoughts without reacting.
• Improves identification of thoughts, allows challenging and changing thoughts, helping to prevent relapse in recurrent depression.
• NICE recommends MBCT for preventing relapse in recurrent depression, supported by evidence like from Fjorback et al (2011).

Acceptance and Commitment Therapy (ACT)

• ACT focuses on accepting thoughts and feelings as parts of experience, rather than fighting or changing them.
• It is less about directly changing thoughts and more about aligning actions with values.
• ACT helps by finding values and aligning them with client goals
• Used for conditions like chronic pain, and has shown effectiveness in improving chronic pain, depression, and anxiety.

Effectiveness and Evaluation of CBT

• CBT is supported by substantial evidence and widely considered an effective evidence-based treatment (EBT) for diverse psychological disorders.
• Some research suggests little difference in effectiveness across various types of psychological treatment.
• CBT's effectiveness is challenged based on the generalizability of research findings to practice, where therapist drift and departures from manuals might affect effectiveness.

Culturally Adapted CBT

• Culturally adapted CBT methods address cultural considerations by incorporating relevant cultural contexts, such as integrating aspects of indigenous cultures.
• Such approaches may work better than standardized CBT approaches in patients from different cultures.
• Some successful examples include adapting CBT for use in Pakistan by Naeem et al (2015).

Summary

• Beck posits that psychological disorders stem from faulty information processing, demonstrating a bias towards certain types of information (e.g., negative).
• CBT's main goal is to correct faulty information processing by using cognitive and behavioral techniques to identify, test, and modify negative automatic thoughts and beliefs.
• CBT is widely supported by empirical evidence and is consistently effective.