1. Disorder specific models
Panic (Clark, 1986)
Social Phobia (Clark & Wells, 1995)
Health Anxiety (Salkovskis & Warwick, 1986)
OCD (Salkovskis, 1994)
GAD (Wells, 1997)
PTSD (Ehlers & Clark, 2000)
Depression (Beck, 1967)
See also Core CBT Competencies list for recommended models:
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2. A vicious circle model of phobic anxiety
Situational Trigger
Physiological
Heart thumping
Sweating
Trembling etc.
Behavioural
Running away
“freezing”
Shouting for help etc.
Subjective
“I might fall”
“This is terrible”
Fear, embarrassment etc.
Symptoms
Reactions
Physiological
Heart thumping
etc.
Fatigue
Behavioural
Avoidance, withdrawing from demanding or pleasurable activities
Subjective
“I can’t cope”
“I must get out”
Lowered confidence worry, frustration, fear
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3. A cognitive-behavioural model for the maintenance of specific phobias
Vomiting is unbearably awful and
terrible for me
Avoidance
Encountering the phobic object / situation
Pre-attentive activation
Catastrophic beliefs
Autonomic arousal
High degree of conviction
Escape or safety behaviour
The catastrophe does not occur and anxiety reactions dissipate
Prevents disconfirmation
Conclusion drawn: The escape / safety behaviour prevent the catastrophe
The catastrophic belief is confirmed
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The phobia remains unchanged

4. A model of the development and maintenance of specific phobias
Biological preparedness, disposition, developmental stage, culture, experience (classical conditioning, vicarious learning), memories/images, beliefs
Assumptions
With increased vulnerability to
Trigger
Frightening object or situation
Anxious Cognitions
(thoughts and images concerning stimulus)
OVERESTIMATING THREAT AND CONSEQUENCES/ UNDERESTIMATING COPING AND RESCUE
Hyper vigilance about physical symptoms
Anxious mood
Physiological symptoms
Increasingly anxious cognitions about external triggers
Anxious cognitions about symptoms
(fear of fear)
Safety behaviours
(related to anxious thoughts about external trigger)
Safety behaviours
(related to fear of fear)
Secondary cognitions
From Chapter 8 of Oxford Guide to Behavioural Experiments in Cognitive Behaviour Therapy (Kirk & Rouf)
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Depression, hopelessness, loss of confidence, low self-esteem

5. Cognitive model of social phobia [Clarks and Wells (1995) and Wells and Clark (1997)]
Social Situation
Activates assumptions a
Perceived social danger
(negative automatic thoughts)
Processing of Self as a Social Object
Safety behaviours
Somatic & cognitive symptoms
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Wells, A., Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide.
Chichester: John Wiley & Sons Ltd.

6. Cognitive cycle of fear for panic disorder
Biological Vulnerability
Stressful Events
Alarm reaction
Tachycardia, dyspnea, chest pain, depersonalisation etc.
Catastrophic thoughts
“Oh, oh, oh..”
“I’m gonna die, pass out”
“Fall down, going crazy” F E A R
Increase in anxiety
Increase in symptoms
Conduct
Running away, escaping
Hyper surveillance
Avoidance
Anticipatory Anxiety
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7. A cognitive model of OCD (Wells 1997, p.242)
Trigger
Activates Meta-Beliefs
Appraisal of
Intrusion
Belief about rituals
Behavioural
Response
Emotion
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8. Cognitive Model of OCD (Salkovskis)
Intrusive thoughts, images, urges, doubts
Attention and reasoning biases (looking for trouble)
Neutralising actions (rituals, reassurances etc.)
Misinterpretation of
significance of intrusions –
responsibility for actions
Counterproductive “safety” strategies (though suppression, impossible criteria, avoidance etc.)
Mood Changes (distress, anxiety, depression)
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9. 5 Part Cognitive Behavioural Therapy Model
Environment
Thoughts
Emotions
Behaviours
Physical
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10. Cognitive Conceptualisation Diagram (Judith Beck, 1993)
Relevant Childhood Data
Core Belief(s)
Conditional Assumptions/Beliefs/Rules
Compensatory Strategies
Situation 1
Situation 2
Situation 3
Automatic Thought
Automatic Thought
Automatic Thought
Meaning of the A.T.
Meaning of the A.T.
Meaning of the A.T.
Emotion
Emotion
Emotion
Behaviour
Behaviour
Behaviour
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11. Negative Automatic Thoughts Physiological Changes
A Cognitive Model of Hypochondriasis (Adapted from Salkovskis, 1989; Warwick and Salkovskis, 1990)
Previous Experience
Dysfunctional Schemas Formed
Critical Incident
Activates Schemas
Negative Automatic Thoughts
Cognitive
Selective Attention
Rumination
Self-Focus
Thinking Errors
Anxiety
Depression
Anger
Behaviour
Reassurance Seeking
Avoidance
Bodily checking
safety / prevention
Physiological Changes
e.g Increased Arousal
Bodily Sensations
Sleep Disturbance
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12. How did “the problem” develop?
What made me vulnerable in the first place?
Triggers for the most recent episode
“The problem”
Things that keep “the problem” going
(These might include things that I do to control the problem)
Positive things that I’ve got going for me
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13. “The Vicious Flower” Cognitive Model of OCD (Salkovskis, Forrester & Richards, 1998)
Early Experiences
Making you vulnerable to OCD
Critical Incidents
What started the OCD off
Activates
Assumptions, General Beliefs
E.G Not preventing disaster is as bad as making it happen
Better safe than sorry
Intrusive Thoughts, Images, Urges, Doubts
Neutralising Actions
Rituals, reassurance, mental argument
Attention and Reasoning Biases
Looking for trouble
Misinterpretations of significance of intrusions – responsibility for action
Counterproductive “Safety” Strategies
Thought suppression, impossible criteria
Mood Changes
Distress, anxiety, depression
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14. Depression Model (Beck 1967, 1976)
Early Experiences
Core Beliefs and Assumptions
Critical Incident
Assumptions Activated
Negative Automatic Thoughts
Symptoms of Depression
Behavioural
Motivational
Affective
Cognitive
Somatic
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15. Depression (Westbrook, Kennerley & Kirk, 2007)
Increased hopelessness
Depressed Mood
Negative thinking & Physical symptoms such as fatigue, poor concentration etc.
Loss of pleasure & achievement
More Negative view of self
Reduced Activity
Nothing Changes
Reduced coping & problem- solving
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16. Anxiety Maintenance (Westbrook, Kennerley & Kirk, 2007)
1. Perceived threat:
Exaggerated and/or inappropriate
Internal or external event
4. Fear remains intact: the alarming belief is unchanged
2. Client’s best attempt to protect him/herself from threat
3. Strategy gives short-term relief, but fails to challenge the anxiety-related belief
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17. DEPRESSION Depression Mode Negative view of self, world and future
Morrey, 2010
1. Automatic Negative thinking
2. Ruminations and self- attacking
3. Motivation and Physical symptoms
Depression Mode
Negative view of self, world and future
4. Unhelpful behaviours
5. Mood / emotion
6. Withdrawal and avoidance
DEPRESSION
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18. Cognitive-Behavioural Model of Body Dysmorphic Disorder (Veale, 2001)
Trigger
(e.g. reflection)
Mirror-checking and selective attention
Negative appraisal of internal body image
Processing of self as an aesthetic object
Mirror checking
Avoidance and safety behaviours to change or camouflage appearance
Rumination on ugliness or “defectiveness” and comparison to ideal
Mood (depression & disgust)
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19. What made me vulnerable in the first place
Core Beliefs – about myself, others and the world
Rules I live by…
Helpful Unhelpful
Current Problem
What triggered the problem
What helps me cope
Helpful Unhelpful
What maintains the problem now
Thoughts
Physical sensations Emotions
Behaviours
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20. Cognitive Model of Postnatal Depression [Milgrom A. , Martin P. R
Cognitive Model of Postnatal Depression [Milgrom A., Martin P.R., Negri L.M (1999) Treating Postnatal Depression: A psychological Approach for Health Care Professionals. Wiley. Chichester. Adapted from Beck’s Cognitive Model of Depression (1979)]
Vulnerability Factors
Cultural Factors
Precipitating Factors, including Biological Factors
Post Natal Depression
Exacerbating & maintaining factors
Depression and other emotions
Anxiety, Anger, Sadness
Mediational Cognitive Factors
Negative Automatic Thoughts
Poor parenting self-efficacy
(mediational = appraisal process)
Behaviour / Coping Strategies
Lethargy, Indecision, Social Withdrawal, Martial Conflict,
Difficulty dealing with infant
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21. Working hypothesis Treatment Plan
Diagnosis / symptoms
Formative influences
Situation / interpersonal issues
Working hypothesis
Treatment Plan
Biological, genetic and medical factors
Strengths / assets
Typical automatic thoughts, emotions and behaviours
Underlying schemas
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22. Events, Stimuli, Situations
“Vicious Flower” Generic conceptualisation (Salkovskis, Warwick and Deal 2003)
Anxiety
Worry
Processes
Images
Threat Appraisal
Meaning
Physical
Sensations
Memories
Safety
Behaviours
Selective
Attention
Events, Stimuli, Situations
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23. Clark’s cognitive model of panic with maintenance cycles added (adapted from Clark, 1986)
INTERNAL / EXTERAL TRIGGER
PERCIEVED THREAT
ANXIETY
(Emotions)
MISINTERPREATION
PHYSICAL / COGNITIVE SYMPTOMS
AVOIDANCE AND SAFETY BEHAVIOURS
(Including Selective Attention)
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24. A cognitive Model of GAD (Wells, 1995)
Trigger
Positive meta-beliefs activated (Strategy Selection)
Type 1 Worry
Negative meta- beliefs activated
Type 2 Worry (Meta-worry)
Behaviour
Emotion
Thought control
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25. Positive beliefs about worry
Cognitive-behavioural model of generalized anxiety disorder [From Dugas, M.J., Gagnon, F., Ladoucer, R. & Freeston, M.H. (1998) Generalized Anxiety Disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, ]
Situation
What if..?
Positive beliefs about worry
Worry
Mood State
Life
Events
Negative problem orientation
Cognitive avoidance
Anxiety
Demoralization Exhaustion
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26. Low Self-Esteem: A Map of the territory (Fennell, 1999)
(Early) Experience
Events, relationships, living conditions which have implications for ideas about the self
The Bottom Line
Assessment of worth/ value as a person
Conclusions about the self, based on experience: this is the kind of person I am
How Low Self-esteem Develops
Rules for living
Guidelines, policies or strategies for getting by, given the truth of the Bottom Line Standards against which self-worth can be measured
Trigger Situations
Situations in which the Rules for Living are, or may be, broken
Activation of the Bottom Line
Depression
Negative Predictions
What keeps Low Self-esteem Going
Anxiety
Self-critical thoughts
Unhelpful behaviour
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Confirmation of the Bottom Line

27. Based on Wells 1997, adapted by Stopa
Social Situation
What went through your mind at that time? What was the worst you thought could happen? What did you think people would notice / think about you? What would that mean/ what would be so bad about that?
Thoughts
4. When you are afraid (feared event) will happened what happens to your attention? Do you become more self-conscious? As you focus on yourself, what do you notice? Do you have an image of how you feel you are coming across? What does that look like?
3. As you became anxious, and thought that (feared event) might happen, did you do anything to try to prevent it from happening? Did you do anything to try to prevent people from noticing?
2. When you thought (feared event) might happen, what did you notice happening in your body? (Suggest symptoms of anxiety)
Self-focus
5. As you did (safety behaviours) did that make you focus more or less attention on yourself?
6. As you noticed yourself becoming more anxious, what effect did that have on your attention?
Safety Behaviours
Anxiety Symptoms
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7. When you did (safety behaviours)
what effect did that have on your anxiety?

28. Strategies Intended to Control Threat / Symptoms
A. Ehlers., D.M Clarke. (2000) A Cognitive Model of posttraumatic stress disorder. Behaviour Research and Therapy 38, p
Characteristics of trauma / Sequelae Prior Experiences/ Beliefs/ Coping State of individual
Cognitive Processing during Trauma
Influences
Negative Appraisal of Trauma and / or its Sequleae
Nature of Trauma Memory P E R S I T N D
Matching Triggers
Current Threat
Intrusions
Arousal Symptoms
Strong Emotions
Strategies Intended to Control Threat / Symptoms
Arrows indicate the following relationships:
Influences = Leads to = Prevents change in =
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29. A cognitive-behavioural model for the maintenance of specific phobias
Various objects / situations are perceived as potentially harmful
Avoidance
Encountering the phobic object / situation
Pre-attentive activation
Catastrophic beliefs
Autonomic arousal
High degree of conviction
Escape or safety behaviour
The catastrophe does not occur and anxiety reactions dissipate
Prevents disconfirmation
Conclusion drawn: The escape / safety behaviour prevent the catastrophe
The catastrophic belief is confirmed
© Think CBT Ltd.
The phobia remains unchanged

30. Maintaining Cycles Safety Behaviours (e.g. OCD client)
Fear/threat
e.g. house burning down
Safety Behaviour
e.g. repeated checking of appliances
Failure to disconfirm threat
(attributed to safety behaviour)
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31. Maintaining Cycles Reduced activity (depressed client)
Depressed mood
Negative Thoughts
(What’s the point?’, ‘I can’t be bothered with anything’)
Reduced activity
General reduction in achievement, activity levels, social withdrawal
Loss of Positive Rewards
(Loss of sense of pleasure/social contacts)
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32. Maintaining Cycles Perfectionism (e.g. depressed client)
Negative self beliefs
(e.g. I am worthless)
Has high standards
(‘If I don’t get 100% success in everything I do I’ve failed’)
Unable to achieve standards/derive satisfaction from achievement
(‘Nothing I do is good enough’)
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33. Maintaining Cycles Catastrophic Misinterpretation (e.g. panic client)
Symptoms
e.g. heart racing, chest tight, breathless
Misinterpretation
‘I’m having a heart attack’
Increased anxiety
Anxiety symptoms increased
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34. Maintaining Cycles
Scanning/hypervigilence (e.g. health anxiety client)
Worry about illness
e.g. fear of cancer
Scanning/checking
e.g. headaches
Sensations noticed or produced
Interpreted as confirmation of illness
‘I might have a brain tumour’
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35. Maintaining Cycles Escape/avoidance (e.g. social anxiety)
Feared situation
e.g. parties, social gatherings
Escape/avoidance
e.g. turn down invites, others see them as dull, where possible, avoid eye contact/talking to others if have to go
Failure to change belief
(Client continues to believe boring)
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36. Maintaining Cycles Fear of fear (e.g. GAD client)
Anxiety
(any cause)
Aversive anxiety symptoms
Heart racing, tense, nausea
Anticipatory fear of becoming anxious
‘I can’t cope with anything’
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37. Maintaining Cycles Performance Anxiety
Worry about performance
e.g. public speaking
Anxiety symptoms affect performance
e.g. hands shaking, speech hesitant, dry throat
Apparent confirmation
‘I was right, I’m terrible at public speaking’
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38. Maintaining Cycles Self-fulfilling prophecies
Negative beliefs about others
(e.g. ‘Other people dislike me’)
Behaviour changes towards others
(e.g. appear tense/hostile, withdrawn)
Behaviour elicits negative response from others
e.g. others appear uncomfortable, stop social approaches
Apparent confirmation of negative beliefs/predictions
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39. ‘Vicious Flower’ model (Salkovskis, Warwick & Deale, 2003)
Images
Emotion
Memories
Worry Processes
Threat Appraisal/
Meaning
Selective Attention
Allows you to integrate core concern and the different processes that this drives (engine & cogs)
Physical Sensations
Safety Seeking Behaviours
Events, stimuli, situations
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40. ‘Vicious Flower’ model (Salkovskis, Warwick & Deale)
Standing in the corner at party, looking odd, wild staring eyes, drenched in sweat. People laughing and pointing
School – called ‘weirdo’. Ignored. Told I had staring eyes. Mocked
Anxiety; panic
Rumination; thinking over past events (what went wrong) and rehearsing future ones (what to say, etc)
People think I am weird; I will end up rejected and alone
Focus on self & how
I appear. Ignore any
friendly remarks from
others (‘just being kind’)
Hold arms down to hide sweat; avoid eye contact. Avoid parties or stay in kitchen out of the way & leave early. Cross road to avoid people. Look at road. Keep eyes semi-closed
Sweating, restlessness, shaky hands
Parties, social occasions, memories of social events
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41. 6 Cycles Maintenance Model – A ‘Vicious Flower’ for Depression (Moorey, 2010)
1. Automatic negative thinking
6. Motivation and physical symptoms
2. Ruminations & self attacking
Depression Mode
Negative view of self, world & future
More helpful across a range of situations, as opposed to each 5 areas model being better suited to a specific situation
5. Unhelpful behaviours
3. Mood/emotion
4. Withdrawal and avoidance
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42. Longitudinal Formulation
Depression:
Early experience
Core beliefs/assumptions
Critical Incident(s)
Activation of beliefs/ assumptions
Negative Automatic Thoughts (NATs)
Feelings Physical
Behaviour
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43. Longitudinal Formulation
Depression:
Deprived of affection; Lack of attention vs. siblings
There’s something wrong with me; I’m unlovable
Break up of relationship
Activation of beliefs/ assumptions
I’m unlovable, If I get into relationship it goes wrong
Upset Lethargic, heavy
Withdraw
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44. Longitudinal Formulation
Anxiety:
Learning Experience
Generic cognitive theory of anxiety disorder
Ref: Wells, A. (2007) Cognitive Therapy of Anxiety Disorders. Chichester: John Wiley & Sons
Danger Schemas Formed
Critical Incident
Schema Activated
Negative Automatic Thoughts
Anxiety Symptoms
Behavioural Responses
Cognitive Biases
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45. Longitudinal Formulation
Highly anxious mother: not allowed out alone until age 16; fear of abduction, etc)
Anxiety:
Learning Experience
Generic cognitive theory of anxiety disorder, Wells, A. (2007) Cognitive Therapy of Anxiety Disorders. Chichester: John Wiley & Sons
The world is dangerous; people will harm me; I am vulnerable; worrying keeps me safe
Danger Schemas Formed
Critical Incident
Neighbour’s house burgled
The world is dangerous
(& I am vulnerable)
Schema Activated
I will be next; I need to get more locks; I need to have the police’s number handy; what if it happens when I’m alone at night?
Negative Automatic Thoughts
Heart pounding; rapid breathing; sweating; restless; racing thoughts; rumination
Anxiety Symptoms
Plan escape routes & location of weapons; check locks frequently; have mobile by bed; buy alarm system
Behavioural Responses
Selective abstraction (neighbour’s house less secure)
Catastrophising
Cognitive Biases
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