1. Third Wave CBT Approaches
SPRING 2014
PSYC 451

2. What are these waves about?
First wave: Behaviour therapy in the 1950s.
focus on classical conditioning and operant learning
The ‘second wave’ (classical) cognitive therapy
a focus on information processing
The ‘third wave’
Focus on metacognition, cognitive fusion, emotions, acceptance, mindfulness, dialectics, spirituality and therapeutic relationship
Replacing or cautiously using content-oriented cognitive interventions and skills deficit models
A revival of behavioral principles such as operant conditioning
Source: Kahl, Winter, and Schweiger (2012)
Curr Opin Psychiatry Nov;25(6): doi: /YCO.0b013e328358e531.
The third wave of cognitive behavioural therapies: what is new and what is effective?
Kahl KG, Winter L, Schweiger U.

3. C B T Motivational Interviewing Mindfulness Based Cognitive Therapy
Many others
Mindfulness Based Cognitive Therapy
Functional Analytic Psychotherapy
Cognitive Therapy for OCD
Exposure with response prevention
Beck’s Cognitive Therapy
Metacognitive Therapy
Barlow’s Unified Protocol
Prolonged Exposure
Dialectical Behavior Therapy
Schema Therapy
Acceptance and Commitment Therapy
Mindfulness Based Stress Reduction
Rational Emotive Behavior Therapy

4. Cognitive and Cognitive-Behavioral Psychotherapies
Source:
Follette, W. C., Darrow, S. M., & Bonow, J. T. (2009).
Cognitive Behavior Therapy: A Current Appraisal. In W. T. O’Donohue & J. E. Fisher (Eds.) , General principles and empirically supported techniques of cognitive behavior therapy (pp ). Hoboken, NJ: John Wiley & Sons.

5. Cognitive Approach Main Assumption: Cognitive therapy: Pioneers:
Faulty thinking patterns / dysfunctional ways of interpreting events and situations lead to maladaptive behavior and negative emotions
Cognitive therapy:
“All the approaches that alleviate psych distress through the medium of correcting faulty conceptions and self-signals”
Pioneers:
Alfred Adler, Albert Ellis, and Aaron Beck

6. ELLIS – Rational Emotive Therapy ABC Model
(Adversity/
Activating Event) B
(Irrational and
self-defeating
Beliefs) C
( Dysfunctional
Consequences)

7. Beck’s Cognitive Theory of Depression
Schemas
Automatic Thoughts
Cognitive Triad
Depression
Stressful life
events

8. Beck’s assumptions
Each disorder is associated with a specific negative content
(Table 3.1)
Depression --- cognitive triad
Hypomania --- exaggarated positive view
Anxiety --- personal danger
Phobia --- danger connected with specific; avoidable situations
Paranoia – abuse, persecution, injustice
Obsessions --- doubting or warning
Compulsions --- self commands to ward off danger and obsessive doubting
There is no single cause of depression or other psychological disorders.

9. Schemas – Vulnerability Factors
Organized knowledge structures that influence how we perceive, interpret, and recall information.
Negative cognitive schemas (such thoughts as “I am unlovable”) lead to increased vulnerability for occurrence and recurrence of depression.
Especially important for cognitive therapists for prevention of relapse

10. Anxiety as an example Foa and Kozak (1986)
Fear structures or schemas could be useful
But if overactive, lead to anxiety problems and are then maintained
by failure to contact the feared and
impairment in interpreting related information

11. Examples of Automatic Thoughts (the products of our schemas when they are activated)
(Handout from Williams, Teasdale, & Kabat-Zinn, 2007)

12. Common Cognitive Distortions (Ways in which we interpret information)

13. Generic cognitive model of emotional disorders
Vulnerability
Development of latent cognitive content and structures
Onset
Negative affect
Activation of dysfunctional cognitive structures
Intrusive cognitive content
Psychological disorder
Maintanence
Interactions between negative affect and dysfunctional cognitive and behavioral patterns
TABLE 3.2

14. Two areas/dimensions of personality, thus depression
Sociality -- Sociotropic DAS leading to dependent depression
Indiviudality – Achievement oriented DAS leading to autonomous depression

15. Alternative theories of depression that informed CBT
Helplessness Theory (Abramson, Seligman, & Teasdale, 1978)
Negative expectations about outcome and feeling no control over these outcomes
Hopelessness Model: Stable, global, internal attributions
(I am no good forever in almost all circumstances and there is not much I can do about it)

16. Alternative theories of depression that informed CBT
Social theory of depression (Brown & Harris, 1978): Protective factors, provoking agents, vulnerability factors
Provoking agents (long term difficulties, loss, threat of loss)
Protective factors (good intimate relationships) could help – leading to higher self esteem
Vulnerability factors (other losses in life) do not help – leading tıo lower self-esteem

17. Alternative theories of depression that informed CBT
Social theory of depression (Brown & Harris, 1978): Protective factors, provoking agents, vulnerability factors
Integrative theory of depression (Lewinsohn, 1974): Rate of response contingent reinforcement; macro, micro- stressors, and chronic difficulties
Negative life events (micro, macro, chronic nature) could lower the rate of reinforcements and contact with aversive events increase
If unable to compensate, the individual becomes more self-centered (biased attention to self)
Protective schemas may not work, individual assumes more responsibility for negative outcomes, becomes more self-critical, social network may fail, as a result vicious cyle

18. Methods in traditional CBT
Behavioral (earlier in therapy)
Building more adaptive behavior patterns by having clients do
things to put their thoughts to test for accuracy.
Intellectual
Identification and evaluation of cognitions
Experiential
Exposing clients to psychologically impactful events that would contradict their self-defeating thoughts (behavioral experiments)

19. Stages typical in CT Providing treatment rationale
Training client in self-monitoring
Behavioral activation (activity scheduling, graded task assignments etc)
Identifying automatic thoughts, beliefs, and cognitive distortions
Systematic evaluation of beliefs, targeted cognitions to evoke change
Collaborative empiricism
Exploring and studying the assumptions underlying cognitive triad
Termination preparations / relapse prevention
Helping continued efforts to use scientific stance in testing cognitions

20. Role of the Therapist
Educational stance (initial phase: psychoeducation)
Empathic and supportive
Directive and objective,
Collaborative empiricism (Socratic questioning, disputing thoughts or beliefs)

21. Goals of Therapy Psychoeducation
Help clients learn to recognize when they engage in those thoughts
Teach them skills for challenging maladaptive thoughts and for replacing them with more accurate and adaptive ones

22. How does CT work? Mediational Factors as Assessed in Research
Examples for Depression:
Dysfunctional attitudes:
‘If I fail partly, it is as bad as being a complete failure’
‘If a person asks for help, it is a sign of weakness’
Automatic thoughts
‘I am no good’
Attributional style
Internal, stable, and global attributions (I am no good forever in almost all circumstances and there is not much I can do about it)
Hopelessness

23. How does CT work? Mediational theories of CT (Ingram & Hollon, 1986)
Deactivation model:
Therapy works to deactivate the negative/maladaptive schemas while non-depressive schema is activated
Retrieval competition account (Brewin, 2006)
Multiple cognitive structures compete for activation
Accommodation model
Change in maladaptive schema is achieved
Compensation model
Maladaptive schema is unchanged while a new schema is formed that offsets the effects of depressive schema
Hollon and colleagues conclude that there is more support for the latter two models (accommodation and compensation), as ct has been shown to prevent relapse.

24. Summary of Empirical Data
CBT works compared to waitlist or comparison groups
CBT produces almost equivalent results to other active treatments
Measurements that assess CBT components need to be refined for better construct validity