Cognitive behavioural therapy
Table of Contents
LECTURE 1.........................................................................................................................................2
1.1. INTRO TO CBT COURSE..................................................................................................................2
1.2. THE WHY AND WHAT OF CBT........................................................................................................2
1.3. THE CASE FORMULATION APPROACH TO CBT......................................................................................2
1.4. FUNCTIONAL ANALYSIS...................................................................................................................3
1.5. TOPOGRAPHICAL ANALYSIS.............................................................................................................5
LECTURE 2.........................................................................................................................................7
2.1. IDENTIFYING COGNITIONS...............................................................................................................7
2.2. MODIFYING COGNITIONS: BASIC TECHNIQUES...................................................................................11
LECTURE 3.......................................................................................................................................13
3.1. WORKING HYPOTHESIS & THEORETICAL MODEL.................................................................................13
3.2. PSYCHOEDUCATION ABOUT (INDIVIDUAL) MODELS.............................................................................15
3.3. FROM MODELS TO TREATMENT......................................................................................................16
3.4. PSYCHOEDUCATION ABOUT TREATMENT...........................................................................................18
LECTURE 4: CBT FOR PSYCHOSIS.....................................................................................................19
4.1. WHAT IS PSYCHOSIS?..................................................................................................................19
4.2. CBT FOR PSYCHOSIS (CBTP).........................................................................................................20
4.3. CASE FORMULATION AND THOUGHT RECORDS...................................................................................22
4.4. COGNITIVE TECHNIQUES...............................................................................................................23
LECTURE 5: BEHAVIORAL TECHNIQUES...........................................................................................27
5.1. BEHAVIOURAL ACTIVATION (BA)....................................................................................................27
5.2. THEORETICAL BACKGROUND OF EXPOSURE........................................................................................29
5.3. BEHAVIOURAL EXPERIMENTS.........................................................................................................31
LECTURE 6 (WEEK 7): SELF-THERAPY...............................................................................................34
6.1. WHY EVERYONE SHOULD BECOME THEIR OWN THERAPIST....................................................................34
6.2. HOW DO YOU DO THAT?..............................................................................................................34
6.2.1. PATIENT: HOMEWORK & SELF-THERAPY........................................................................................34
6.2.2. THERAPIST: SELF-REFLECTION & SUPERVISION.................................................................................35
,Lecture 1
1.1. Intro to CBT course
Fully cycle of CBT
1.2. The Why and What of CBT
Systematic, action-oriented psychological treatment to improve mental health
Challenging and changing unhelpful cognitions (e.g. thoughts, beliefs, attitudes),
behaviours and emotions
Different types of treatments (EMDR, ACT etc.)
Evidence-based treatment for many disorders (depression, anxiety,
PTSD, OCD)
Cognitions, behaviours, and emotions/physiology are interconnected
1.3. The case formulation approach to CBT
Case formulation is needed to treat patient (individual symptom
maintenance requires individual therapy)
No direct link between problem patient presented and the treatment
(treatment plan)
Focus on understanding why (detective work)
o E.g.: why continue drinking despite the many negative
consequences (divorce, unemployment, health issues); why so
much fighting, while the couple also loves each other dearly
Develop hypotheses
o Based on individual analyses
o Information gathering
o Link to theoretical models
Examples
o “2 ppl could have the same problem, but the analyses could direct to totally
different treatments”
During treatment and evaluation phase: testing of hypos
o Effective intervention?
, o Reduction symptoms?
o Responsibility of T to go back to the individual analyses/hypos
o With complex problems: individual analyses = better treatment effects
Different types of case formulations
o Behavioural case formulation
o Cognitive conceptualization / case formulation
o Cognitive behavioural case formulation
In summary
o Synthesises client experience, CBT theory and research
o It guides treatment
o Makes numerous, complex problems more manageable in the case of
multiple disorders
o Guides the selection, focus, and sequence of interventions
o Indentifies client strenghts and suggests ways to build client resilience
o Helps understand non-response in therapy and suggests alternative routes
for change
o Promotes client engagement
1.4. Functional analysis
Individual analysis
Conditioning models helps understanding (adaptive and maladaptive) behaviour
Classical conditioning learning by associations
Reinforcement increases behaviour, punishment decreases behaviour
o Positive = addition of stimulus
o Negative = removal of stimulus
Functional analyses: focus on the function of the problem/behaviour
consequences of it
Links to operant conditioning: a learning process through which the strength of a
behavior (voluntary behavior) is modified by reinforcement or punishment
Focus on when does it happen. Always? Or in certain situations? What defines the
context where the maladaptive behaviour is present vs absent? → Antecedents =
Activating event = Discriminating Stimulus (Sd)
o 3 elements in functional analysis: Activating event – Behaviour –
Consequences (ABC)
Example:
, o Jonathan, age 14, problems at school
Teachers at school say it is a difficult boy. He teases and also hits other
children (Behaviour) because he likes
o that and gets attention (positive reinforcing consequence, +S+).
Psychologist is observing the boy for a few days (gathering information) and
notices that the problematic behaviour is mainly occurring in the theory
classes (Activating event). The hypothesis is that Jonathan has difficulty with
theory and that he teases other children to reduce his boredom (negative
reinforcing consequence: -S-).→schooltest confirms mismatch Jonathan and
current school choice
Different types of consequences: Can you provide examples???
o Reinforcing consequences, that increase the likelihood of the behaviour
o Punishment consequences, that decrease the likelihood of the behaviour
Different types within the Reinforcing and Punishment consequences: positive and
negative
o Reinforcement: “get something positive” or “remove something negative”
o Punishment: “get something negative” or “remove something positive”
How to get input for a functional analysis
o Ask the client, for example using topographical analysis (indirect assessment,
Page & Stritzke, p. 65)
o Registration assignment for client
o Use your clinical knowledge and scientific knowledge of common
antecedents and consequences of certain behaviours
Summary
o The functional analysis is concerned with the (perceived) association
between preceding stimuli, the behaviour (R), and the consequences. It is
based on operant conditioning
Table of Contents
LECTURE 1.........................................................................................................................................2
1.1. INTRO TO CBT COURSE..................................................................................................................2
1.2. THE WHY AND WHAT OF CBT........................................................................................................2
1.3. THE CASE FORMULATION APPROACH TO CBT......................................................................................2
1.4. FUNCTIONAL ANALYSIS...................................................................................................................3
1.5. TOPOGRAPHICAL ANALYSIS.............................................................................................................5
LECTURE 2.........................................................................................................................................7
2.1. IDENTIFYING COGNITIONS...............................................................................................................7
2.2. MODIFYING COGNITIONS: BASIC TECHNIQUES...................................................................................11
LECTURE 3.......................................................................................................................................13
3.1. WORKING HYPOTHESIS & THEORETICAL MODEL.................................................................................13
3.2. PSYCHOEDUCATION ABOUT (INDIVIDUAL) MODELS.............................................................................15
3.3. FROM MODELS TO TREATMENT......................................................................................................16
3.4. PSYCHOEDUCATION ABOUT TREATMENT...........................................................................................18
LECTURE 4: CBT FOR PSYCHOSIS.....................................................................................................19
4.1. WHAT IS PSYCHOSIS?..................................................................................................................19
4.2. CBT FOR PSYCHOSIS (CBTP).........................................................................................................20
4.3. CASE FORMULATION AND THOUGHT RECORDS...................................................................................22
4.4. COGNITIVE TECHNIQUES...............................................................................................................23
LECTURE 5: BEHAVIORAL TECHNIQUES...........................................................................................27
5.1. BEHAVIOURAL ACTIVATION (BA)....................................................................................................27
5.2. THEORETICAL BACKGROUND OF EXPOSURE........................................................................................29
5.3. BEHAVIOURAL EXPERIMENTS.........................................................................................................31
LECTURE 6 (WEEK 7): SELF-THERAPY...............................................................................................34
6.1. WHY EVERYONE SHOULD BECOME THEIR OWN THERAPIST....................................................................34
6.2. HOW DO YOU DO THAT?..............................................................................................................34
6.2.1. PATIENT: HOMEWORK & SELF-THERAPY........................................................................................34
6.2.2. THERAPIST: SELF-REFLECTION & SUPERVISION.................................................................................35
,Lecture 1
1.1. Intro to CBT course
Fully cycle of CBT
1.2. The Why and What of CBT
Systematic, action-oriented psychological treatment to improve mental health
Challenging and changing unhelpful cognitions (e.g. thoughts, beliefs, attitudes),
behaviours and emotions
Different types of treatments (EMDR, ACT etc.)
Evidence-based treatment for many disorders (depression, anxiety,
PTSD, OCD)
Cognitions, behaviours, and emotions/physiology are interconnected
1.3. The case formulation approach to CBT
Case formulation is needed to treat patient (individual symptom
maintenance requires individual therapy)
No direct link between problem patient presented and the treatment
(treatment plan)
Focus on understanding why (detective work)
o E.g.: why continue drinking despite the many negative
consequences (divorce, unemployment, health issues); why so
much fighting, while the couple also loves each other dearly
Develop hypotheses
o Based on individual analyses
o Information gathering
o Link to theoretical models
Examples
o “2 ppl could have the same problem, but the analyses could direct to totally
different treatments”
During treatment and evaluation phase: testing of hypos
o Effective intervention?
, o Reduction symptoms?
o Responsibility of T to go back to the individual analyses/hypos
o With complex problems: individual analyses = better treatment effects
Different types of case formulations
o Behavioural case formulation
o Cognitive conceptualization / case formulation
o Cognitive behavioural case formulation
In summary
o Synthesises client experience, CBT theory and research
o It guides treatment
o Makes numerous, complex problems more manageable in the case of
multiple disorders
o Guides the selection, focus, and sequence of interventions
o Indentifies client strenghts and suggests ways to build client resilience
o Helps understand non-response in therapy and suggests alternative routes
for change
o Promotes client engagement
1.4. Functional analysis
Individual analysis
Conditioning models helps understanding (adaptive and maladaptive) behaviour
Classical conditioning learning by associations
Reinforcement increases behaviour, punishment decreases behaviour
o Positive = addition of stimulus
o Negative = removal of stimulus
Functional analyses: focus on the function of the problem/behaviour
consequences of it
Links to operant conditioning: a learning process through which the strength of a
behavior (voluntary behavior) is modified by reinforcement or punishment
Focus on when does it happen. Always? Or in certain situations? What defines the
context where the maladaptive behaviour is present vs absent? → Antecedents =
Activating event = Discriminating Stimulus (Sd)
o 3 elements in functional analysis: Activating event – Behaviour –
Consequences (ABC)
Example:
, o Jonathan, age 14, problems at school
Teachers at school say it is a difficult boy. He teases and also hits other
children (Behaviour) because he likes
o that and gets attention (positive reinforcing consequence, +S+).
Psychologist is observing the boy for a few days (gathering information) and
notices that the problematic behaviour is mainly occurring in the theory
classes (Activating event). The hypothesis is that Jonathan has difficulty with
theory and that he teases other children to reduce his boredom (negative
reinforcing consequence: -S-).→schooltest confirms mismatch Jonathan and
current school choice
Different types of consequences: Can you provide examples???
o Reinforcing consequences, that increase the likelihood of the behaviour
o Punishment consequences, that decrease the likelihood of the behaviour
Different types within the Reinforcing and Punishment consequences: positive and
negative
o Reinforcement: “get something positive” or “remove something negative”
o Punishment: “get something negative” or “remove something positive”
How to get input for a functional analysis
o Ask the client, for example using topographical analysis (indirect assessment,
Page & Stritzke, p. 65)
o Registration assignment for client
o Use your clinical knowledge and scientific knowledge of common
antecedents and consequences of certain behaviours
Summary
o The functional analysis is concerned with the (perceived) association
between preceding stimuli, the behaviour (R), and the consequences. It is
based on operant conditioning
