CBT Final terms/concepts

Cognitive Model

The idea that reactions are shaped more by perception of a situation than the situation itself; distorted cognitions begin in childhood and reflect core beliefs.

Stress-vulnerability model

Increased stress makes automatic thoughts more influenced by dysfunctional beliefs/schemas due to biased information processing.

Cognitive Restructuring

Identifying, evaluating, modifying intermediate and core beliefs, ultimately revising schemas.

Guided Discovery

Using Socratic questioning to help clients uncover automatic, intermediate, and core beliefs.

Four Stages of Guided Discovery

(1) Socratic questioning, (2) Active listening, (3) Summarizing, (4) Synthesis/analysis.

Levels of Cognition

Automatic thoughts → Intermediate beliefs → Core beliefs → Schemas.

Automatic Thoughts

Quick interpretations of events; mediate between situation and emotion.

Intermediate Beliefs

Rules/attitudes (“shoulds,” “musts”) that link automatic thoughts to core beliefs.

Core Beliefs

Deep, global, rigid beliefs about self, others, world, future.

Schemas

Habitual information filters shaping perception; broad, rigid, confirmation

Schema Activation

Reinforces confirming information and ignores contradictory information.

Downward Arrow Technique

Starting with a hot thought and repeatedly asking what it means until reaching a core belief.

Hot Thoughts

Unrealistic, emotion-laden thoughts about self/others/world/future.

Criteria for Hot Thoughts

(1) Unrealistic evaluation, (2) Explains emotion, (3) Contains distortion.

Cognitive Distortions

Biased ways of thinking that reinforce distress (e.g., all-or-nothing thinking, mind-reading, personalization)

Role of Cognitive Distortions

Maintain distress by reinforcing harmful beliefs and ignoring contradictory evidence.

Goals of Cognitive Therapy

Identify/challenge thoughts; develop balanced thoughts; change thinking, feeling, behaving.

Therapeutic Process in CT

Case formulation, monitor thoughts, start with automatic thoughts → deeper beliefs, restructure schemas.

Identifying Hot Thoughts Steps

Elicit specific event, automatic thought, probing questions, reflect, connect thought–feeling–behavior, use 4-factor model, collaborate.

Value of Memory/Imagery

Access vivid emotions, sensations, and meaning more easily.

4-factor model use

Explore connections across thoughts, emotions, behaviors, physical sensations.

Socratic Dialogue

Collaborative questioning to examine assumptions and alternative perspectives.

Qualities of Good Socratic Questions

Clear, open-ended, specific, uses client language, not interrogative, allows reflection.

Developmentally Sensitive Socratic Questions

Match client age/needs; use visuals, metaphors, stories.

Guided Discovery Intended Outcomes

Increased self-knowledge, uncover assumptions, broaden perspective.

Four Phases of Guided Discovery

Identification → Clarification → Evaluation → Redefinition.

Creating Balanced Thoughts

Replacing hot thought with a more accurate, evidence-based thought.

Cognitive Restructuring

Process of modifying intermediate/core beliefs and schemas; engine of CBT change.

“Examine the Reality of Your Thoughts” Steps

Identify hot thought → explain evidence-search → rate belief → gather evidence for/against → develop balanced thought → re-rate.

Purpose of Examining Evidence

Interrupt automatic reactivity; develop new ways of thinking.

Three Questions for Evidence Against Thought

Contradicting evidence? Probability? Alternative perspective?

Consolidating Balanced Thoughts

Reinforces new thinking; increases memorability and emotional resonance.

Home Assignments in CBT

Build continuity, collect data, practice skills; must relate to 4-factors and be clearly defined

Limitations of CBT

Misunderstood as rigid; may miss relational moments; may not fit all clients; cultural/trauma sensitivity needed.

Good Settings for CBT

Structured, time-limited environments; diagnosis-specific protocols; client preference for practical/lively approach.

Emotional Literacy

Ability to understand and express feelings.

Emotional Management Strategies

Skills like breathing, imagery, relaxation, metaphors, distraction, mindfulness; need variety for different situations.

CBT Formulations

Shared understanding of problem onset/maintenance to guide treatment.

Formulation Types

Mini, maintenance, 4-system, onset formulations.

Problem-Solving steps

Define problem → Brainstorm → Evaluate → Try & review.

Reality Therapy Goal

Help clients make better choices to meet needs, develop healthy relationships, and gain life control.

Choice Theory

Behavior is chosen; we control thinking/acting directly and feelings/physiology indirectly.

Basic Needs (5)

Survival, Love/Belonging, Power/Achievement, Freedom, Fun.

Quality World

Personal mental images of ideal life; guide choices.

Misdirected Wants Example

Pursuing actions that reduce ability to meet needs.

WDEP Model

Wants → Doing → Evaluation → Planning.

2nd vs 3rd Wave CBT Similarities

Collaborative, goal-oriented, homework, action-oriented.

2nd Wave (CT/CBT) Focus

Change thought content, challenge distortions.

3rd Wave (ACT/DBT) Focus

Change thought process; acceptance, mindfulness, values.

DBT Treatment Stages (“House”)

(1) Behavioral control → (2) Emotional experiencing → (3) Ordinary living → (4) Sustained joy.

Dialectics in DBT

Two truths can coexist; synthesis creates change.

Dialectical Poles

Seeing alternative realities to reduce rigidity and increase options.

Four DBT Pillars

Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness.

Wise Mind

Balance of emotional and reasonable mind.

Avoidance in Depression

Reduces positive events, increases negative ones, decreases energy, worsens mood.

Behavioral Activation Goal

Be more active (not “feel better”); feelings follow behavior.

Activity Criteria

SMART, meaningful, reinforcing, routine-building, graded.

Avoidance in Anxiety

Negatively reinforced; shrinks life; increases fear.

Exposure Therapy Goal

Learn new info, reduce unrealistic predictions, build tolerance—not eliminate anxiety.

Exposure Steps

Identify fears → psychoeducation → rationale → hierarchy → exposures → relapse prevention.

Emotional Processing Theory

Must activate fear structure to change it.

Habituation

Repeated neutral exposure reduces fear.

Yerkes-Dodson Law

Optimal performance at moderate arousal.

Intermediate Beliefs

“If/then,” “should”; structure thinking.

Core Beliefs

Central identity beliefs; rigid; shaped early.

Early Maladaptive Schemas

Childhood-formed patterns from unmet needs.

Behavioral Experiments for Intermediate Beliefs

Test predictions to disconfirm rigid rules.

Challenging Core Beliefs

Continuum methods, positive data logs, behavior change.

Schema Therapy

Integrative approach for personality patterns; modifies maladaptive schemas.

Schema Domains (5)

Disconnection, Impaired Autonomy, Impaired Limits, Other-Directedness, Overvigilance.

Schema Modes

Child, Dysfunctional Coping, Dysfunctional Parent, Healthy Adult.

Trauma

Events overwhelming ability to cope; lasting effects.

Five Trauma Symptoms

Intrusion, Avoidance, Cognition/Mood Change, Arousal/Reactivity, Dissociation.

TF-CBT PRACTICE Components

Psychoeducation, Relaxation, Affective regulation, Cognitive coping, Trauma narrative, In-vivo exposure, Conjoint sessions, Enhancing safety/growth

CT-PTSD Methods

Reclaim life, change appraisals, update memories, stimulus discrimination, behavior change, site visits, relapse planning.

Clinician Misbeliefs That Impair Treatment

“Too complex,” “talking retraumatizes,” “stabilization always needed,” “PTSD can’t be remote,” etc.

Mindfulness

Present-moment, purposeful, nonjudgmental awareness.

Acceptance

Experiencing events without avoidance or over-control

ACT Purpose

Accept internal experiences, choose values, take action.

Experiential Avoidance

Avoiding unpleasant experiences → maintains/worsens suffering.

Relational Frame Theory

Thoughts arise from learned associations, not present reality.

MBCT Doing Mode

Problem-solving, rumination, trying to “fix” feelings.

MBCT Being Mode

Direct experience, nonjudgment, allowing sensations/thoughts.

Conscious Thought Processing

Observing thoughts without judgment.

Decentering

Seeing thoughts as mental events, not facts.