Summaries per chapter with the 1st edition of Cognitive Behavior Therapy: Core Principles for Practice by O'Donohue & Fisher - Bundle
What are the core principles of cognitive behavior therapy (CBT) - Chapter 1
What is special about CBT?
Cognitive behavior therapy (CBT) can be seen as the only paradigm in psychotherapy. Something can call itself a paradigm if it has proven to have problem-solving capacity. When it is not proven to be effective it is called a theory. On top of this, CBT is also effective for many types of disorders, in contrast to specific treatment forms such as EMDR (only used for PTSD symptoms). Other advantages of CBT are that it is a fast form of treatment, which also makes it cheaper, and that it can be described in a manual, so that it can be scaled and easier to teach to others. A disadvantage of a manual is that it may be difficult to apply to all disorders because one disorder is not the other, but it is impossible to make a different manual for each disorder. One must also be able to understand the manual and the main and side issues in it well, making the understanding of the underlying idea and principles of change and therapy especially important.
For instance: exposure and modification of beliefs are important in anxiety disorders, skills training and crisis management (contingency management) are important in developmental disorders and autism spectrum disorders.
Therapy is not an art that some can and others cannot do. In that respect it can be called a technique in which the active components of change are skilfully applied. A therapist must therefore ask himself every session which techniques for change he is applying in therapy. This also means that therapists cannot just choose a therapy that interests them, they must apply therapies that have been shown to be effective. In this process, unspecific factors such as empathy and warmth, are of great importance. Therapeutic eclecticism is also excluded (adding techniques to CBT from therapies that are not proven effective), unless components of other empirically proven therapies are added.
Another advantage of making the core principles of effective therapy explicit is that it can lead to the development of new, alternative ways to apply these principles. Individual therapy is often expensive and inaccessible, but by knowing effective principles one can look for ways to make these principles available in a more accessible way (for example self-help books and e-health).
What are the principles of CBT?
CBT started with a few principles in the 1950s (Skinner: contingency management; Wolpe: relaxation and exposure in its systematic desensitization), but now consists of many principles that are all interrelated. The principles consist of different layers, starting on the surface with ideas of philosophy and science, folowing with the theories of CBT, underneath them empirical laws, then the principles derived from other sources, principles (general rules describing potential working mechanisms, for example exposure), and finally techniques (making a principle concrete, for example systematic desensitization).
The 13 main principles:
- Job analysis and contingency management
- Skills training
- Exposure
- Relaxation
- Cognitive restructuring
- Problem solving
- Self-regulation
- Behavioral activation
- Social skills
- Emotion regulation
- Communication
- Positive psychology
- Acceptance
What is Function Analysis (FA)? - Chapter 2
Function analysis is the identification of significant, verifiable, causal functional relationships applicable to a specific set of behaviors of an individual. This promotes the precise linking of complaints to an effective intervention. FA can complement current diagnosis and treatment when the client does not exactly fit within a disorder or when no good therapy is available for the disorder. FA is an alternative to the "diagnose and treat paradigm" (if treatment fails, re-diagnose, then apply other therapy).
What is exposure therapy and when is it used? - Chapter 4
A treatment principle is a specific mechanism by which treatment procedures lead to change. Exposure therapy is not a principle as it is not a mechanism for symptom relief, but a procedure to reduce extreme anxiety and related emotions. Irrational fear arises when a sense of danger is given to a safe stimulus. In exposure, a person is exposed to the fearful stimulus to lessen the fear response. There are three types of exposure: in vivo (in real life), imaginal and interoceptive. These types can be applied in various ways, varying in length (short-long), arousal during exposure (low-high), fashion (in vivo-imaginary). Systematic desensitization, for example, is imaginary, short and low in arousal. Flooding, on the other hand, is in vivo and has high arousal. Exposure is usually applied in a hierarchical fashion, starting with the least fearful stimulus and ending with the most fearful stimulus.
What is cognitive restructuring and when is it used? - Chapter 6
Cognitive models of psychopathology assume that problems in behavior and emotion arise from biases in the interpretation or evaluation of events. Biases also perpetuate or amplify problems, as seen in depression. Cognitive biases are therefore seen as mediators in depression. The biases lead to schematic processing: the tendency to filter information through a specific lens. A scheme is a concept that influences the way information is processed. For example, if someone tells you that Anne is extroverted, and you see Anne in a movie, you will find her even more extroverted and come up with additional information to confirm this image.
What is problem solving therapy and when is it used? - Chapter 7
Social problem solving (SPS) is a multidimensional process in which individuals try to find an effective way to deal with a wide variety of stressful problems encountered in daily life. There can be different coping responses for different situations and times. According to SPS theory, the outcomes of SPS are determined by: 1. Problem orientation, and 2. Problem-solving style.
What is behavioral activation and when is it used? - Chapter 9
Behaviorists see positive reinforcement (PR) as fundamental to human experiences. It is a first and continuous influence on behavior, emotion and cognition. When one is under the influence of PR one feels uncontrolled, unforced, so free. According to behaviorists, the meaning of behavior is found in the reinforcers, consequences and antecedents of behavior. A meaningful life consists of contact with diverse, stable and personally meaningful positive reinforcers. The goal of behavioral activation (BA) is to bring someone into contact with these reinforcers, thereby reducing symptoms and giving more meaning to life. BA uses primary (activity scheduling to get in touch with PR) and secondary techniques (overcoming obstacles, choosing good activities).
What is positive psychology? - Chapter 13
Positive psychology is the study of optimal functioning with the aim of better understanding and applying things that help individuals and societies to flourish. The perspective of positive psychology seeks a balance between working on weaknesses and paying attention and strengthening strengths. Before the Second World War, there was attention for positive psychology, but after the Second World War this attention disappeared and there was only research into the treatment of psychopathology. The focus was on the disease model, which only looked at weaknesses and deficiencies. It wasn't until around 1998 that positive psychology came back through Seligman. Positive psychology uses a number of principles: Strengths theory, Broaden and Build Theory of positive emotions, Complete State model of Mental Health and the Four-front approach to client assessment.
What does the term acceptance mean within CBT? - Chapter 14
Acceptance has taken a prominent place in CBT. Firstly, because it has been shown that acceptance has advantages over non-acceptance and secondly, it has been found that negative thoughts and emotions cannot be changed and therefore may need to be accepted. There are various definitions of acceptance, ACT (acceptance and commitment therapy) describes it as "taking an open, receptive, non-judgmental attitude." DBT (dialectical behavior therapy) adds that experience should not be held on or attempted to get rid of it. Experiential avoidance is the opposite of acceptance. Avoidance of private experiences (thoughts, feelings, memories, physical sensations and behavioral tendencies) is only effective in the short term, but can cause problems in the long term.