Health and Well-Being | Psychological Treatment | ERQ

CBT scientific approach

Both the client and therapist take a scientific approach to the problem by focusing on measurement and hypothesis testing

Main focus of CBT measurement and hypothesis testing

CBT involves measuring thoughts and behaviours and testing whether beliefs and expectations are accurate

Role of the client in CBT

The client actively participates by observing their thoughts completing homework recording information and working with the therapist to test their beliefs

Role of the therapist in CBT

The therapist guides the client in identifying automatic thoughts measuring them investigating whether they are realistic and developing more rational alternatives

Example of a problem brought to CBT

A client tells the therapist that they have recently been experiencing prolonged periods of bad mood

What does the therapist investigate during periods of bad mood

The therapist investigates the automatic thoughts the client experiences during episodes of prolonged low mood

Automatic thoughts

Thoughts that occur automatically and are not usually consciously noticed unless a person intentionally focuses on them

Why might a client be unaware of their automatic thoughts

Automatic thoughts happen without deliberate awareness so the client may not recognise what they are thinking during episodes of low mood

Why is identifying automatic thoughts important in CBT

Identifying automatic thoughts allows the client and therapist to investigate the thoughts that may contribute to negative moods

First CBT homework assignment

The client keeps a diary to record their automatic thoughts whenever they recognise that they have been experiencing a really low mood

What should the client do when they recognise a really low mood

They should find a quiet place remember everything they had been thinking about during the previous five minutes and write those thoughts down

Why should the client find a quiet place

Finding a quiet place allows the client to focus and remember their thoughts from the previous five minutes

How much of their previous thinking should the client record

The client should try to remember and record everything they had been thinking about during the five minutes before recognising their low mood

How frequently should the automatic thought diary be completed

The client should complete the diary at least once a day

Purpose of the automatic thought diary

The diary helps the client identify recurring automatic thoughts and recognise themes that may be associated with their low mood

What happens during the next CBT meeting

The client and therapist analyse the notes recorded in the automatic thought diary together

What might the client discover when analysing their automatic thoughts

A prominent recurring theme may be a feeling of worthlessness

Example of worthlessness in automatic thoughts

When completing a school assignment the client focuses on its flaws and worries that their teacher will not be pleased with it

How does the client respond to school assignments in the example

The client focuses on perceived flaws in their work and expects negative feedback from their teacher

What does the therapist investigate after identifying worthlessness

The therapist investigates whether the clients automatic thoughts and expectations are unrealistic

Second CBT homework assignment

The client keeps a log of automatic expectations and records the actual outcomes so that their predictions can be compared with reality

Purpose of the automatic expectations log

The log allows the client to test whether their negative predictions and expectations are realistic by comparing them with what actually happens

What should the client predict for each school assignment

The client predicts the grade they expect to receive and the feedback they expect their teacher to give

What should be recorded alongside each prediction

The client records the actual grade received and the actual feedback given by the teacher

What is compared in the expectations log

The clients predicted grades and teacher feedback are compared with the actual grades and feedback they receive

How long does the client keep the expectations log

The client collects information in the log over a period of one month

What happens after one month of recording expectations

The client and therapist examine the log together and objectively analyse whether the predictions were realistic

How should the client and therapist analyse the expectations log

They should examine the recorded predictions and actual outcomes impartially rather than relying on assumptions or negative expectations

What questions are investigated when analysing the expectations log

They investigate whether the predictions were realistic and identify exactly what was unrealistic about them

Why is identifying unrealistic expectations important

It helps the client recognise inaccurate thinking patterns that may contribute to their negative mood

What happens after unrealistic expectations have been identified

The client works on replacing unrealistic expectations with more rational expectations

Rational expectations

More balanced and realistic expectations that replace inaccurate negative predictions

How does CBT help replace unrealistic expectations

The client discusses their thinking with the therapist and completes further homework assignments and behavioural exercises

What activities help the client develop more rational expectations

Discussions with the therapist home assignments and behavioural exercises

How does the client practise changing their behaviour

The client works on their behaviour through repeated practice and exercises in a structured way

Piano practice analogy in CBT

Changing behaviour in CBT is compared to practising the piano because improvement requires consistent effort and repeated practice

Gym programme analogy in CBT

Changing behaviour is compared to following a gym programme because progress requires regularly completing planned exercises

Why are behavioural exercises important in CBT

They allow the client to practise new behaviours and reinforce more rational ways of thinking through repeated effort

Overall sequence of the CBT process

Identify automatic thoughts record them in a diary analyse recurring themes test expectations against actual outcomes identify unrealistic thinking and replace it with more rational thoughts through practice

How does CBT use hypothesis testing

The client makes predictions about what will happen records the actual outcomes and examines whether the original expectations were accurate

How does CBT use measurement

The client records automatic thoughts predicted outcomes actual grades and teacher feedback so that their thinking can be examined using evidence

Why does CBT involve homework

Homework allows the client to collect evidence about their thoughts and expectations between therapy sessions and actively practise changing them

Why does CBT require active participation

The client must observe their own thoughts record information evaluate predictions and practise alternative behaviours rather than relying entirely on the therapist

CBT client decision making

CBT places great importance on the clients own decision making and ability to make choices throughout therapy

CBT client agency

CBT emphasises the clients agency which means their ability to take control of their actions decisions and progress during therapy

CBT compared with other therapies

Unlike some other forms of therapy CBT places a large importance on the clients own decision making and agency

Therapeutic alliance

The working relationship and partnership established between the therapist and the client during therapy

Importance of the therapeutic alliance in CBT

The therapeutic alliance between the therapist and client is considered one of the major factors contributing to the success of therapy

Client and therapist relationship in CBT

The therapist and client work together as partners with the client actively participating in decisions and the therapeutic process

Client responsibility in CBT

The client is encouraged to take responsibility for what is happening and actively participate in bringing about change

Client goal setting in CBT

The client is encouraged to set their own goals rather than having every goal determined by the therapist

Client control over therapy

The client is encouraged to take control of the details of the therapeutic process and make decisions about how they work towards their goals

Why does CBT encourage client responsibility

It helps the client become actively involved in their own improvement instead of depending entirely on the therapist

Example of a CBT homework assignment involving pleasurable activities

The client is asked to spend one hour each day enjoying pleasurable activities in order to learn how to dissociate from the pressures of work

Purpose of spending time on pleasurable activities

The activity is intended to help the client learn how to separate themselves from work pressures and experience enjoyment without constantly focusing on work

What does dissociate from work pressures mean in the CBT example

It means mentally separating from the demands and pressures of work so the client can focus on pleasurable activities and relaxation

Why might the one hour pleasurable activity assignment be difficult

The client may continue thinking about unfinished work and struggle to stop focusing on work related responsibilities

What happens when the client attempts the pleasurable activity assignment

The client keeps thinking about unfinished work continues ruminating and fails to relax

Rumination in the CBT example

The client repeatedly thinks about unfinished work instead of being able to focus on pleasurable activities and relax

Why is the client unable to relax in the example

Their repeated thoughts about unfinished work prevent them from mentally disengaging from work pressures and enjoying the activity

How should the client respond when the homework assignment is too difficult

The client is encouraged to modify their goals and change the assignment into something more manageable

How can the pleasurable activity assignment be modified

The client can reduce the required time from one hour each day to twenty minutes each day

Original duration of the pleasurable activity assignment

One hour each day

Modified duration of the pleasurable activity assignment

Twenty minutes each day

Why should the client modify an unmanageable assignment

Adjusting the assignment makes the goal more achievable and allows the client to work towards improvement at a manageable level

Client flexibility in CBT

The client is encouraged to adjust goals and homework assignments when they discover that the original expectations are too difficult to manage

Self efficacy

The belief that one is capable of successfully carrying out actions and bringing about change

Importance of self efficacy in CBT

It is important to instil a sense of self efficacy in the client so they believe they are capable of making changes in their own lives

How does CBT develop self efficacy

It encourages clients to make their own decisions set manageable goals take responsibility and actively work towards change

Why should CBT assignments be manageable

Achievable assignments can help clients develop confidence in their ability to complete tasks and make progress

Who is the main driver of long term change in CBT

The client rather than the therapist is the main driver of change in the long term

Why is the client the main driver of long term change

The client must continue taking responsibility making decisions and applying what they have learned outside therapy sessions

Role of the therapist in long term CBT change

The therapist supports and guides the client but the client is ultimately responsible for driving their own long term change

Overall importance of client agency in CBT

Client agency encourages independence responsibility decision making self efficacy and active involvement in achieving long term change

Historical context of CBT development

CBT was developed when psychotherapy was still dominated by intensive approaches such as psychoanalysis

Psychotherapy approaches before CBT

Psychotherapy was dominated by heavy approaches such as psychoanalysis which required many hours of analysis and interpretation

Psychoanalysis

An intensive form of psychotherapy involving extensive analysis and interpretation of psychological experiences often exploring childhood memories

Time required by traditional psychoanalysis

Psychoanalysis often required many hours of analysis and interpretation

Focus of traditional psychoanalysis

Traditional psychoanalysis often involved exploring childhood memories to understand psychological difficulties

Why was CBT different from traditional psychoanalysis

CBT offered clients more immediate and tangible results compared with intensive approaches that required many hours of analysis

Modern client expectations

Clients increasingly want results quickly and want to feel that something is changing positively even after one or two therapy sessions

Why do clients want early positive changes

Clients want to recognise that therapy is helping them relatively quickly rather than waiting through many sessions without noticing improvement

Risk when clients do not notice early improvement

Clients may stop attending therapy if they do not feel that anything is changing in a positive way

How did CBT address the demand for quick results

CBT provided clients with quick tangible results that allowed them to notice positive changes earlier

Tangible results in CBT

Results that clients can recognise and experience as actual improvements in their thoughts feelings or behaviour

How does CBT empower clients

CBT allows clients to feel empowered by encouraging them to recognise their own ability to make positive changes

Agency in CBT

The clients belief in their own ability to take action and change things for the better

Why is client agency important in CBT

It helps clients believe that they have the ability to influence their circumstances and actively improve their lives

Development of computerized CBT

Computerized CBT developed as a way of delivering CBT through technology rather than relying entirely on face to face sessions

Traditional face to face CBT

CBT delivered through direct in person interaction between the client and therapist

Alternative ways of delivering CBT

Face to face interaction can be replaced by video call sessions or even simple text chat

Video call CBT

CBT delivered remotely through video calls allowing clients to interact with a therapist without physically attending appointments

Text chat CBT

CBT delivered through written communication allowing clients to complete therapy interactions through text chat

How can video calls improve access to CBT

Clients can participate in therapy without having to leave their homes

How can text chat improve access to CBT

Clients can communicate with therapists and participate in CBT remotely without attending face to face appointments

Main advantage of remote CBT

Clients can receive therapy from home without needing to travel to a therapist

Potential disadvantage of remote CBT

Effectiveness may decrease slightly compared with traditional face to face therapy

Trade off when delivering CBT remotely

A small decrease in treatment outcomes may be acceptable if it allows therapy to reach a much broader group of people

What determines whether remote CBT is worthwhile

Whether the reduction in effectiveness is sufficiently small compared with the improvement in accessibility

Computerized CBT CCBT

CBT delivered through computerized programmes rather than relying entirely on traditional face to face interaction