This is the Chapter 4 of the book The Individual (de Bruin, E., 1st Edition). Which is content for the exam of the Theory component of Module 4 (The Individual) of the University of Twente, in the Netherlands.

Chapter 4

Cognitive-behavioural perspective

Cognitive-behavioural therapy (CBT): change-focused approach, attention cognitive processes to which people monitor/ control their behaviour

Origins/ development cognitive-behavioural approach:

• Introspection: subjects report own internal thought processes as engaged in remembering/ learning/ or any other psychological activity
• J.B.Watson: psychology = scientific study actual behaviour

• Laws of learning:  all habits/ beliefs people exhibit must be learned

• Applying behavioural concepts:

• Principles behaviourism influential CBT:

• Collaborative empiricism: client/ therapist together observe patterns of behaviour and then design new behavioural responses
• Functional analysis: analysis stimulus (where/when) --> behaviour (what he does) --> consequences (rewards/ pleasures)

• Systematic desensitisation: client relaxed --> identify hierarchy of fear-eliciting stimuli/ situations  --> by the end relaxation response rather than fear response should be elicited by stimuli included in the hierarchy

Cognitive approaches to therapy:

• Internal dialogue: stream automatic thoughts accompany/ guide actions. Make choices about appropriateness of self-statements, and if necessary, introduce new thoughts/ ideas which lead to happier/ more satisfied lifes
• Cognitive distortion: experience of threat results in loss ability process information effectively

• Over-generalisation: drawing general/ all-encompassing conclusion from very limited evidence --> memories: recall something that happened, unable to fill in the detail.
• Dichotomous thinking: tendency see situations in terms of polar opposites
• Personalisation: people tendency imagine events always attributable to their actions, even when no logical connection

• Irrational beliefs/ crooked thinking: viewing life in terms of should and musts

• Catastrophising: fuels feeling anxiety/ depression

Practice of cognitive-behavioural therapy:

• Theoretical principles CBT

1. Cognitive activity affects behaviour
2. Cognitive may be activity monitored/ altered
3. Desired behaviour change may be affected through cognitive change

• Scientist-practitioner/ Boulder model: therapist should be trained in methods of systematic research, and routinely collect qualitative data on outcomes of their work with clients.
• Areas of focus CBT:

• Therapeutic relationship: working alliance
• Assessment: identify/ quantify frequency/ intensity/ appropriateness problem behaviours/ cognitions
• Case formulation: agreed conceptualisation origins/ maintenance of current problems, setting goals for change
• Intervention: application cognitive behavioural techniques
• Monitoring: Ongoing assessment target behaviours to evaluate effectiveness intervention
• Relapse prevention: attention termination and planned follow-up reinforce

• Working alliance: work together on identifying problems/ implementing interventions
• Assessment: find out about content (what is being felt/ thought), intensity (how strong is emotion?/How disturbing is belief?) and sequencing (reoccurrence cycles of dysfunctional activity)
• Case formation: should be constuctet around the five Ps:

• Presenting issues
• Precipitating factors
• Perpetuating factors
• Predisposing factors (origins underlying vulnerability)
• Protecting factors (person’s resilience, and safety activities)

• Intervention: ‘

• Socratic dialogue: facilitate further exploration material --> underlying assumptions/ logical contradictions
• Behaviour experiments: give opportunities practise new skills/ways of coping
• Assertiveness/ social skills training: central idea: people develop psychological problem because they not very good at engaging in micro-level social interaction sequences --> need to learn rules of everyday social interaction --> by the end, client learns how to collect feedback on their social performance
• Exposure techniques: face fear directly in context which they feel supported by therapist --> either realise fear is illusory or that they possess coping skills adequate to allow them to tolerate the situation
• Imagery rescripting: when client bothered by intrusive memories of traumatic past events --> invited tell story of what happened --> after reflecting, rescript the event by imagining what would have needed to happen to make event less distressing --> event observed point of view of their “adult self”.
• Homework: practice new behaviours/ cognitive strategies in behavioural experiments and collection self-monitoring data
• Mindfulness: way of being --> learn accept flow of thoughts/ feelings without reacting to them
• Using vivid/ memorable metaphors/ analogies/ stories: range creative ways explaining approach to clients
• Self-learning materials: information sheets/ worksheets enable clients learn about how to apply CBT ideas and use CBT methods to make changes

• Monitoring:

• Subjective Units of Distress Scale (SUDS): measurement techniques to assess severity problems and to monitor change --> rate level anxiety/ panic

• Relapse prevention: encounter crisis, triggers resumption of original problem behaviour --> provide skills/ strategies client deal with relapse events

Flourishing of CBT (the 3^rd wave):

• Dialectical behaviour therapy: helping people diagnosed borderline personality disorder

• principles:

• Validation/ acceptance emotional distress/ troubled life
• Emphasis in learning new life skills in areas self-regulation/ self-control of emotion and coping with relationships
• Dialectic:  maintain dialectical tension between acceptance of suffering, versus demanding change in behaviour

• Borderline personality disorder: biological sensitivity to strong emotional responses to threat, exacerbated childhood experiences

• Characteristics:

• Difficulty forming lasting relationships
• Troubled by strong/ fluctuating emotional states
• Exhibit forms of self-harm, prone to suicide

• Acceptance and commitment therapy: based assumption that problems arise because language fails to acknowledge contextual basis of meaning --> cognitive inflexibility

• Enhanced cognitive flexibility:

• Acceptance thoughts/ feelings
• Cognitive defusion: altering the undesirable functions of thoughts
• Being present and experience world directly
• Self as context --> self/ identity as a flow
• Consciously chosen values
• Committed action --> effective patterns of behaviour reflect personal values

• Motivational interviewing (“change talk”): way of helping client overcome ambivalent/ resistance about making necessary changes in their life

• Principles:

• Empathy
• Developing discrepancy
• Acceptance/ “rolling with resistance”
• Client autonomy (capacity to arrive right decision for themselves)

• Mindfulness-based cognitive therapy: effect protecting person against susceptibility to depression, by enabling them become aware of what is happening, stay present in moment rather that ruminating on negative past events.
• Functional analytical psychotherapy: client/ therapist relationship as “laboratory” for identifying dysfunctional patterns of relating and trying out new ones --> develop more satisfying relationships in everyday life
• Compassion-focused therapy: focus experience/ behaviour around shame/ self-loathing/ self-criticism --> identify/ understand harsh self-criticism and lack of self-acceptance
• Behavioural activation therapy: set of dysfunctional behaviours changed one step at a time --> identify trigger situations that elicit depressive thoughts/ behaviours and replace these patterns with more productive alternative strategies
• Schema therapy: provides helping the client make link current dysfunctional thoughts/ childhood experiences of dysfunctional relationship/ patterns of interpersonal difficulty.

• Cognitive schema: deeply held statements that reflect assumptions person holds about the world
• Schema: pattern of cognition, memory, behaviour and emotion that arises when basic childhood needs are not meet
• Abandonment: maladaptive schema with assumption others will not provide ongoing support/ protection because you are emotionally unstable/ unpredictable/ unreliable