Clinical Psychology - Lecture 2

Front 1

The Cognitive Model

Back 1

- It's not an event itself that causes emotions and behaviour, but instead the interpretation/thought of the event

Front 2

ABC Framework

Back 2

- Activating event: Bird poos on you
- Beliefs: "I'm so unlucky!" OR "This is a sign of good luck"
- Consequences: Depressed, give up go home OR Excited, buy lottery ticket

Front 3

Cognitive Behaviour Therapy

Back 3

- Ellis & Beck: cognitive responses to events, not events themselves determines mood
- Emotional disorders/mental health problems a consequence of faulty/irrational thinking
- Uses cognitive and behavioural techniques to deal with unhelpful thoughts
- Teaches people to control psychological process

Front 4

CBT Session

Back 4

1. Working collaboratively with therapist, equal power sharing
2. Talk about current problems, set own goals
3. Asked questions about problem (i.e. thoughts, feelings, experiences, behaviours, mental imagery, memories)
4. Work with therapist to develop 'formulation'
5. Test out new ways of thinking and behaving
6. Learn to manage more independently or fully recover after therapy
7. Consider 'booster' sessions in future

Front 5

Basic CBT Interventions

Back 5

- Psychoeducation
- Behavioural Activation
- Behavioural Experiments
- Cognitive Restructuring

Front 6

Psychoeducation

Back 6

- Explaining effects of thinking on mood and physiology (adrenaline, sleep disturbance etc.)
- Explaining role of cognitive biases (over-generalisation, selective attention)
- Provide information about how person is thinking

Front 7

Behavioural Activation

Back 7

- Basic CBT intervention
- Involves client scheduling activities
- Complete diary measure of activity
- Increase activities that promote mastery and enjoyment
- Manage mood by managing behaviours

Front 8

Cognitive Restructuring

Back 8

- Aims to directly change appraisals made about situations
- Clients 'think about thinking'
- Therapist encourages rational thought, questioning of accuracy, is it normal?
- Thought diary: unhelpful belief, emotions, evidence for and against, develop reasonable alternative

Front 9

Behavioural Experiments

Back 9

1. Identify problematic belief
2. Devise situation to test belief
3. Identify prediction
4. Do experiment and identify outcome
5. What has been learned? Compare outcome with original prediction

Front 10

Butler et al. (2006)

Back 10

- Review of 16 meta-analysis of CBT, 332 studies, nearly 10k participants
- Highly effective across a range of disorders
- Large effect sizes

Front 11

Tolin (2010)

Back 11

- Meta-analysis of CBT vs. other therapies
- 26 studies, N = 1981
- CBT larger effects than psychodynamic therapy, but not interpersonal or supportive therapy
- CBT superiority specific to anxiety and depression

Front 12

Hollon & Ponniah (2010)

Back 12

- CBT has higher long-term enduring effects than medication

Front 13

Potential Mechanisms of CBT

Back 13

- Changing dysfunctional beliefs
- Differentially accessing new information
- 'Decentering'
- Attentional control
- Emotional processing
- Therapeutic relationship

Front 14

The Accommodation Model

Back 14

- CBT works by modifying structures in memory that give rise to negative beliefs
- Client directly alters content of underlying schemas
- Beck et al. (1979)

Front 15

The Activation-Deactivation Model

Back 15

- CBT does not change content of structures in memory (schema)
- New information brought to clients attention in therapy is stored in new positive schemas
- Therapy helps client learn to deactivate negative memories/thoughts and activate positive schemas
- Barber & DeRubeis (1989)

Front 16

Retrieval Competition Account

Back 16

- Draws on activation-deactivation model
- CBT increases accessibility of positive memories/schema
- Brewin (2006)

Front 17

Decentering

Back 17

- Observing ones thoughts and feelings as temporary features of mind
- Documented within CBT as mechanism of change (Beck, 1979)
- Mindfulness based CBT

Front 18

Fresco et al. (2007)

Back 18

- CBT responders showed greater increases in decentering ability than medication responders
- Ability predicted low relapse at 18 months

Front 19

Attentional Control

Back 19

- Having voluntary control over where you place attention and how you divide it
- Key part of interventions for anxiety disorders
- Attentional training leads to improvements in depression and anxiety symptoms (Papageorgiou & Wells, 2000)

Front 20

Emotional Processing

Back 20

- Applies across therapies
- Encourages exposure to difficult emotional states
- Promotes flexible use of emotions and integration of emotional memories into autobiographical memory (Conway, 2001)

Front 21

Enhancing Control

Back 21

- Proposed as mediator of change in therapy since 1940's
- Study of panic patients inhaling CO2 enriched air, potential control over air reduced panic attacks (Sanderson et al., 1985)

Front 22

2nd Wave CBT

Back 22

- Traditional CBT focusses upon changing the content of negative thoughts and beliefs

Front 23

3rd Wave CBT

Back 23

- Newer forms of CBT focus on changing the process people use to relate to negative thoughts
- Overcome the avoidance of negative thoughts
- Acceptance of the experience of these mental events, natural products of the mind, noticing thoughts rather than treating them as true or false

Front 24

Arch & Craske (2008)

Back 24

- 2nd and 3rd Wave CBT have overlapping techniques
- Exposure to emotional material
- Reappraising involves accepting thought/feeling as normal
- Decentering always part of CBT
- Both involve enhancing control