Chapter 1 The CBT Model

Brief History

Brief History Aaron T. Beck Trained in psychoanalysis but had concerns about: Effectiveness Found psychoanalytic approach for depression to be conceptually inaccurate and did not reduce client distress Focusing too much on the past and long-term nature Resulted in clients thinking that they would always need professional help for their life stressors and problems Inhibits generalization and maintenance of change i.e., clients unable to develop their own independent problem-solving skills and manage future life stressors

Brief History Aaron T. Beck (late 1950s to 1960s) Found that his depressed clients had very quick and brief negative self-evaluative thoughts associated with their distressing emotions Negative Automatic Thoughts – modification of such thoughts improved depressed mood Developed a short-term and present-oriented form of therapy for depression that focused on modifying negative automatic thoughts and using problem-solving skills Conceptualization of depression – client distress due to a negative thinking pattern across three domains: self, world, and future

Brief History During this time (1950s-1970s), behavioral therapists were employing the work of experimental behaviorists Pavlov - classical conditioning Skinner – operant conditioning Watson – behavior = stimulus-response association Eyseneck and Wolpe – systematic desensitization, reciprocal inhibition, relaxation training Effective treatment for some anxiety disorders with minimal focus on cognitive processes

Brief History Simultaneously other theorists were also developing treatment programs that incorporated cognitive and behavioral components Meichenbaum – internal dialogue and self-instructional training Ellis and Harper – irrational thinking and rational emotive behavior therapy Bandura – social cognitive theory and reciprocal determinism Acknowledged the importance of internal events (i.e., thoughts) and their influence on emotions and behaviors, including the social environment

Brief History “Cognitive Therapy of Depression” (Beck, Rush, Shaw, & Emery, 1979) Research soon moved beyond depression to include other distressing mental health problems, especially anxiety-related disorders, with a more explicit integration of cognitive and behavioral methods CBT is now the most well-established theoretical approach for the most mental health problems More effective than other theoretical approach for treating anxiety and depressive disorders

CBT Model

CBT Model Figure 1.1 – Reciprocal Cognitive-Behavioral Model Visual depiction of how thoughts (including mental images), emotions (including physiological arousal), and behaviors are related and interact with the environment (including social interactions) Emotions and behaviors are influenced by how situations are perceived Thoughts act as a mediator between the situation and resulting emotions and behaviors, which then interact with the environment This interaction with the environment and its outcomes then reciprocally influence our thoughts and emotions For maladaptively functioning individuals, the reciprocal interaction of thoughts, emotions, and behaviors can negatively feed into each other

CBT Model

CBT Model Activity 1.1: Examples of Adaptive and Maladaptive Functioning (p. 4) See Figure 1.2 – Reciprocal Cognitive-Behavioral Model—Maladaptive Functioning Individual See Figure 1.3 – Reciprocal Cognitive-Behavioral Model—Adaptive Functioning Individual Discussion Questions 1.1 (p. 6) Activity 1.2: Develop Examples of Adaptive and Maladaptive Functioning (p. 6) Discussion Questions 1.2 (p. 7)

CBT Model

CBT Model

CBT Model General cognitive model (Beck & Haigh, 2014) The difference between adaptive and maladaptive functioning is largely quantitative, not qualitative All individuals have negative biases (or thoughts) and positive biases Maladaptive functioning individuals: Have negative biases that are extreme and amplify perceived threats Reduce positive positive biases and minimize rewards or gains Such biases tend to get exaggerated and eventually activated after experiencing stressors

CBT Model Primary goal of CBT is to help clients identify, evaluate, and modify their negative automatic thoughts and corresponding behaviors Metacognition – “think about thinking” Understand how thoughts, emotions (including physiological arousal), and behaviors are interrelated within themselves and between the environment

CBT Model Successful therapy = clients are able to independently make modifications to their thoughts and behaviors while developing effective coping and problem-solving skills Long-term generalization and maintenance of skills across multiple facets of life – Clients become their “own therapists”

CBT Model Important: CBT is not positive thinking! (e.g., “Don’t worry, be happy!”) CBT is about helping clients think more rationally Sometimes rational thoughts are negative and may require acceptance Emotionally distressed clients tent to have many thoughts that are negative and irrational Such thoughts are the ones that receive focus for modification *Although it is helpful to focus on the positive aspects of our lives, it can be detrimental to our well-being to ignore the reality of the negative aspects