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Cognitive-Behavioral Therapy (Theories & Methods (Central concepts…

- - - - Main
        
        Dysphoria/sadness
        
        Anhedonia
      - Other
        
        Weight disturbance
        
        Appetite disturbance
        
        Sleep disturbance
        
        Psychomotor retardation
        
        Fatigue
        
        Guilt
        
        Diminished concentration
        
        Suicidal thoughts
    - - Anger/hostility
      - Irritability
      - Social skills deficits
      - Seeking excessive reassurance and aversive feedback.
      - Physical illness
    - - Women: 10-25 %
      - Men: 2-12 %
      - Young adults (18-29) three times higher rates than in individuals over 60.
    - - Onset can occur at any age, but median age is 32.
      - More than 70 % have recurrent episodes.
      - Typical recovery time: 3-6 months.
      - High rates of successful treatment, but also high relapse rates.
    - - Those with MDD, 76 % have more than one disorder.
      - Often dysthymia, GAD, social anxiety disorder, and agoraphobia.
      - SAD often preceded MDD.
    - - Somatic symptoms should be investigated.
      - Anger is likely present in the therapeutic relationship.
      - Risk of suicide should be assessed.
      - Cultural differences in the manifestation and report of depressive symptoms should be considered.
      - Prior depressive episodes must be assessed.
  - - - Cognitive biases
        
        Memory
        
        Attention
        
        Interpretation
        
        Inhibition / Cognitive control
    - - Depression-vulnerable and non-vulnerable people might not differ much in their initial response to a negative life event, but they differ in their ability to recover from this initial response.
      - Rumination
      - Distraction
      - Reappraisal
      - Thought suppression
    - - Chronic activation of the HPA axis results in higher cortisol leves can disrupt the functioning in the regions of the brain responsible for emotion regulation and stress coping.
    - - Hyperactive ventral system.
      - Hypoactive dorsal system.
      - Deficits in areas associated with processing of reward stimuli.
    - - Depressed individuals seem to be stuck in maladaptive patterns of automatic reactions.
      - When depressed, individuals have difficulty disengaging from negative info.
      - Studies demonstrate that it is possible to train dysphoric people to disengage their attention from negative material, and that this leads to changes in mood, reduced reactivity to stressful events and a reduction in depressive symptoms.
      - Positive attentional biases can be trained, and interpretation training have been found to affect emotional responding. Thus, attentional training may be an effective part of treatment.
      - Reappraisal is an effective strategy to change individuals’ affect from negative to positive.
      - Therapists might foster clients’ improvement by facilitating emotional disclosure, irrespective of their preferred theoretical orientation.
      - Some propose that the client may change following therapy not because she acquires insights about previously unconscious conflicts, but because therapy provides her with a corrective emotional experience - the therapist reacts to the client in a way that is different and thus disconfirms the client’s expectations (and fears) of others based on the relationship with her parents.
    - - Inadequate parenting.
      - Early interpersonal adversities.
      - Major stressful events.
      - Interpersonal risk factors like reassurance seeking, interpersonal dependency, and adult insecure attachment style.
- - - - Psychoeducation
      - Insight-providing
      - Mastery / problem-solving
    - - Case formulation
      - Problem list
      - Registration methods
      - Analysis / restructuring
      - Behavioral methods
        
        Activation methods
        
        Exposure
        
        Behavioral experiment
      - Methods related to maxims, strategies, schemas, life events, distortions and modes
        
        Identification of general thinking and strategies.
        
        Changing maxims and strategies
        
        Changing schemas
        
        Working on historical life events
        
        Changing distortions
        
        Changing modes
- - - - Prevalence: 2-3 % for adults.
      - Life time risk: 17-18 %
      - Twice as frequently in women
    - - At least 2 years
      - Milder symptoms
    - - At least 2 years
      - Modrate-severe symptoms
    - - Episodes of mania, hypomania, depression or mixed state.
      - Strikes 1-2 % of the population.
      - Equally prevalent across sexes.
      - Onset in adolescence or early adulthood.
  - - - Genetic vulnerability.
      - Mania: Positive cognitive triad.
      - Depression: Negative cognitive triad.
      - Drug treatment.
      - Cognitive therapy typically starts during a depression.
      - Focus on psychoeducation, the therapeutic relation, and relapse prevention.
      - Typically a need for 25-30 sessions.
      - During mania, therapeutic conversation rarely has any effect.
      - Personal relapse prevention plan.
      - Reduction of stimuli and activity.
      - Grief processing.
    - - Standard CBT not suitable
      - Focus on the therapeutic relation and work on the dysfunctional assumptions and schemas.
      - Home work
      - Balance validation and challenge
      - Emotion regulation
    - - Drug treatment combined with psychotherapy.
      - Behavioral interventions are emphasized.
      - Short and intensive sessions.
      - Psychoeducation, activity planning, gradual task-solving, identifying negative thoughts, developing self-supporting thoughts.
    - - Active and structured.
      - Test negative thoughts, and correct distorted information processing.
      - Learning skills to modify thinking and behavior.
      - Cognitive interventions are emphasized with mild depression.