11 - Cognitive Behavioral Therapy Techniques

Cognitive reappraisal or cognitive restructuring

CBT technique used to identify and change the way situations, experiences, events, ideas, and/or emotions are viewed in order to change their affective impact

neural mechanisms underlying cognitive reappraisal

primarily PFC and Amygdala, but generally competing views

studies using negative reappraisal to lower negative emotions in response to negative stimuli found that reappraisal:

Dampened activity in the amygdala

Activated the following regions:

→ PFC, including dmPFC, dlPFC, vlPFC:

executive functions, cognitive elaboration

→ Lateral temporal cortex: semantic and perceptual representation

→ Posterior parietal cortex: sustained attention

→ Orbitofrontal cortex (OFC): evaluation of emotional salience, selection of

behaviors

→ Anterior cingulate cortex (ACC): emotional state interpretation, motivated

behavior

→ Anterior insular cortex (AIC): conscious appraisal of bodily states to trigger

emotion regulation processes

EEG. studies using cognitive reappraisal correlating with specific types of electrical activity changes in the brain

For instance, a reduction in magnitude of late positive potential (LPP) was found in response to negative stimuli when applying emotion regulation instructions

caveat of reappraisal

Adaptive when stressors are uncontrollable (when

the person can regulate only the self)

Maladaptive when stressors can be controlled (when the person can change the

situation)

study on depression and reappraisal

For participants with uncontrollable stress, higher cognitive-reappraisal ability was associated with lower levels of depression

In contrast, for participants with controllable stress, higher cognitive- reappraisal ability was associated with greater levels of depression

is positive or negative reappraisal more effective

two conditions

Decrease Negative condition

Increase Positive condition

negative emotions were induced using images

reappraisal strategy was applied

After every trial, participants also rated their level of positive and negative affect and arousal

results

both conditions shortened duration of responses in amygdala, and lengthened response in prefrontal regions

negative reappraisal decreased intensity of amygdala activation, positive reappraisal did not

the intensity of activity in the medial prefrontal cortex—an area involved in cognitive control of emotion— increased only in the positive reappraisal condition

Participants actually reported the largest increase in positive emotion and

decrease in negative emotion following positive reappraisal, when they

were apparently engaging more deeply with the negative stimuli

reappraisal of negative thoughts in general indicated that participant’s self-ratings of mood tend to correlate highly with

neuropsychological measures of negative emotions such as

increase in activation of the amygdala

reduction of activity in control centers in the prefrontal

in new variants of cbt, you use emotions to guide your thoughts rather than other way around

View that emotions are a foolproof guidance system telling you whether you are thinking a thought that is in line with your own best interests
How does it feel when you criticize someone? How does it feel

when you are praising someone or something out of a genuine

sense of appreciation?

Becoming more aware of the “feeling tone” behind thoughts makes it much easier to choose the positive thoughts and let go of the negative

one way to become more aware of the feeling tone behind thoughts

is to reach for the “best feeling thought” that one can access at any given moment (on a deep, not superficial level, of course!)

It’s about becoming more aware of your emotions and giving yourself permission to feel good/prioritizing feeling good

This also means focusing more on how you feel and less on what other people may think

grounding reappraisal in reality

study investigating specific reappraisal strategies

Participants asked to use positive or negative reappraisal strategies and given examples of each

Negative emotions were induced using images from IAPS

After every trial, participants also rated their level of positive and negative affect and arousal, skin conduction was measured as well

participants were asked to describe specific reappraisal tactics that they used

results

Positive reappraisal led to greater increases in positive affect and smaller decreases in skin conductance than negative reappraisal

Participants who tried to challenge the reality or authenticity of what they saw showed smaller increases in positive emotion than participants who used other tactics, such as changing how they viewed future consequences of the situation

One big factor determining whether you see a situation as stressful or as a challenge is your

beliefs about the eventual outcome

This tactic in a way epitomizes what optimism is all about: seeing challenges as

stepping stones to success, rather than as insurmountable obstacles

Classic study of female breast cancer survivors found that one of key factors that distinguished them from those who died was their view that their lives had been altered for the better after developing the disease

Two-thirds of survivors (including many who had been given poor prognosis for recovery) reported this

Supposed “benefits” included

→ Realizing what was truly important in life and reordering priorities

→ Giving fuller expression to their feelings

→ Developing a greater appreciation of the preciousness of life

future gain reappraisal tactic

One big factor determining whether you see a situation as stressful or as a challenge is your beliefs about the eventual outcome

This reappraisal strategy is also about perceiving failure as feedback that will allow you to

→ Learn what you need to learn to succeed

→ Develop clarity about what you want

reframing our view of stress

Study: In the midst of a banking crisis and massive restructuring, bank managers were asked to watch one of two videos

1) video that depicted stress as debilitating to performance

2) video that provided details on ways in which stress enhances the human brain and body, by increasing cortisol, focus of attention, etc.

results

Participants who had viewed the “enhancing” video experienced a significant drop in stress levels and health problems and a significant increase in work efficiency

In a Gallup World Poll, those who were stressed but not depressed reported being energized and satisfied with their lives

This is the opposite of the lethargy reported by those who were depressed but not stressed

New York Times article on Harvard MBA grads 15 years after graduation

Majority were not happy campers: complained about jobs that were unfulfilling, tedious, or just plain bad; disaffected children; and billable hours in divorce court…

However, there were a few people seemed to have wound up with jobs that were both financially and emotionally rewarding

Most of these had something in common: they tended to be the ones who failed to get the jobs they wanted when they graduated, who had been passed over by the big prestigious companies

They were forced to scramble for work and they learned from their own setbacks … and wound up richer, more powerful, and more content than everyone else!

study on preschoolers found that

Those who were the most outgoing, socially competent, and well liked

- Showed high activity in brain circuit that triggers stress hormones on

first day of school

- Showed decline in stress hormone levels as the year went on

Opposite pattern was found in preschoolers who were unhappy and

socially isolated

reframing our view of work

Csikszentmihalyi found that people actually have more peak experiences (moments of highest happiness and fulfillment) at work but say they prefer leisure time

Suggests that our association of effort with pain and leisure with pleasure is so deep-rooted that it distorts our perception of the actual experience!

But this severely limits our potential for happiness because in order to be happy, we must not only experience positive emotions but also recognize them as such

We need to learn to reframe our work and our education as a privilege rather than as a duty 

study on hospital cleaners

group A:

- Viewed their work as a job, boring and meaningless

- Saw their work merely as removing the garbage and

dirty linen

group B:

- Viewed their work as contributing to the patients’

well-being and smooth functioning of the hospital

- Engaged in more interactions with nurses, patients, and their visitors,

taking it upon themselves to make the patients and hospital staff feel better

Group B hospital cleaners were happier than Group A and happier than doctors who didn’t experience their work as meaningful

How we perceive the work can matter more than the work itself

defensive pessimism

Some people actually use fear of failure to motivate themselves to succeed

in the short run it can work as a motivational strategy, but research indicates that after three years in college, defensive pessimists report:

lower GPA’s

more physical and psychological symptoms

behavioral activation for depression

clients are asked to rate the degree of pleasure and accomplishment they feel during specific activities

Establish and maintain regular routines that encompass activities that receive a high score, rather than leave them to chance

behavioral activation for stress/anxiety

An hourly self-monitoring chart is used to track activities and the impact on mood they create for a full week

Behavioral activation helps clients to develop an understanding of the relationship between actions and emotions, with actions being seen as the cause of emotions

Particular emphasis is placed on evaluation of effects of rumination

Attending to experience is taught as an alternative to rumination

Additionally, focus is given to quality sleep, and improving social functioning

fmri study on behavioral activation therapy for depression

patients with MDD
Were given an average of 11.5 sessions of Brief Behavioral Activation Therapy for Depression (BATD)

Then completed a forced-choice reaction time task while in fMRI pre- and post-treatment

− A bullseye target stimulus was occasionally embedded within alternating

blocks of sad and neutral pictures

− Participants had to press one button for target images and another button

for non-targets as quickly as possible

results

fMRI revealed that behavioral activation was associated with functional changes in structures that mediate responses to rewards (i.e., targets in study), including:

paracingulate gyrus

right caudate nucleus

paracingulate and orbital frontal gyri

Behavioral activation improved functioning of unique reward structures