CBT Midterm Study Guide

1. What is a theoretical orientation? How is a theoretical orientation

different from therapy strategies?
A theoretical orientation is a theory that orients you and your
psychotherapy. It includes you assumptions about human behavior and
change. A theoretical orientation is different from therapy strategies
used in interventions because strategies can be conceptualized from
multiple theoretical frames.
2. How is the behavioral orientation assumptions about change
(ontology) different from the cognitive-behavioral orientation
assumptions about change? In therapy, differentiate how change is
brought about.
The behavioral orientation assumptions about change theorize that
change is based on the consistency of stimulus in the environment
(reinforcement and punishment). The use of the Environmental model,
which states the environment actively shapes the individual this leads
to the learning of new behaviors, is a common ontological
conceptualization. The belief that individuals are passive/ acted on by
the environment and humans change by learning are assumptions of
the behavioral orientation. CBT is based on two hypotheses. The
mediation hypothesis states that thoughts mediate our behaviors and
emotional responses. The change hypothesis states that because the
mediation hypothesis exists we can intentionally change the way we
respond to events. Cognitions influence control over our emotions and
behaviors AND our behaviors strongly affect out though patterns and
emotions. Therefore the behaviorist would focus on changing the
environmental cues while CBT is more concerned with changing
internal thought patterns and understanding how thought emotions
and behaviors are connected.
3. What is the difference between reinforcement and a punishment?
Reinforce will increase the frequency; duration, intensity and/or
quickness of behavior while a punishment will decrease the frequency,
duration, intensity and/or quickness of behavior.
4. According to the ontology of the Behavioral Orientation, how is
avoidant behavior understood and changed?
Avoidance behavior is maintained because the behavior is negatively
reinforced by the decrease in anxiety when the fear stimulus is no
longer present once the avoidance behavior occurs. Behaviorists

believe the cycle must be broken by extinguishing the avoiding

behavior by not allowing the avoidant behavior to be reinforced and/or
reinforcing an alternate behavior of facing the stimulus. The technique
of systematic desensitization is used.
5. According to the ontology of he CBT orientation, how is avoidant
behavior understood and reinforced?
Avoidance behavior is maintained because the behavior is negatively
reinforced by the decrease in anxiety when the fear stimulus is no
longer present once the avoidance behavior occurs. The CBT approach
focuses more on the thoughts and how they are affecting the avoidant
behavior and emotions.
6. What are the two assumptions of CBT?
CBT is based on two central assumptions: cognitions influence control
over our emotions and behaviors AND our behaviors strongly affect out
though patterns and emotions.
7. What are the 3 levels of cognitive process?
Highest level: consciousness- a state of awareness in which decisions
can be made on a rational basis. Allows for: monitoring and assessing
interactions with the environment, linking past memories with current
experiences and controlling and planning future actions.
Second level: automatic thoughts- cognitions that stream rapidly
though our minds when were in the midst of situations or are recalling
events. These thoughts are typically not subjected to rational analysis.
Third level: schemas- core beliefs that act as templates or underlying
rules for information processing. Schemas serve a critical function in
allowing us to filter, screen, code, and assign meaning to information
from the environment.
8. How are problems different from symptoms in the CBT frame?
Problems may be related to a patients symptoms and diagnosis. A
problems is what the patient perceives is the problem i.e.) problem: I
am constantly thinking about my trauma symptom: ruminating.
Terminology:
CBT Access Hypothesis: states that the content and process of our
thinking is knowable. Thoughts are not unconscious or preconscious
or somehow unavailable to awareness. Rather, cognitive behavioral

approaches endorse the idea that, with appropriate training and

attention, people can become aware of their own thinking.
Mediation Hypothesis: states that thoughts mediate our behaviors and
emotional responses.
Change Hypothesis: states that because the mediation hypothesis
exists we can intentionally change the way we respond to events.
Realist Assumption: a general philosophical perspective that states
that a real world or an objective reality exists independently of our
awareness of it. People can come to know the world more accurately
and operate within this principal.
Conscious Thought: A state of awareness in which decisions can be
made on a rational basis. Allows for: monitoring and assessing
interactions with the environment, linking past memories with current
experiences and controlling and planning future actions.
Automatic thoughts- cognitions that stream rapidly though our minds
when were in the midst of situations or are recalling events. These
thoughts are typically not subjected to rational analysis.
Schemas- core beliefs that act as templates or underlying rules for
information processing. Schemas serve a critical function in allowing us
to filter, screen, code, and assign meaning to information from the
environment.
Cognitive Errors:
a. Selective abstraction: (ignoring the evidence) a conclusion is
drawn after looking at only a small portion of the available
information. Important information is ignored to confirm the
persons POV.
b. Overgeneralization: a conclusion is made about one or more
isolated incidents and then is extended illogically to cover
broad areas of functioning.
c. Arbitrary inference: coming to a conclusion in the face of
contradictory evidence r in the absence of evidence. i.e.) I
have a 25% chance Im going to get bit by a dog: BG info: I
live on a street with no dogs and have not seen a dog in 3
years.
d. Personalization: external events are related to oneself when
there is little evidence for doing so. Excessive responsibility or
blame is taken for negative events.
e. Magnification and minimization: the significance of an
attribute, event, or sensation is exaggerated or minimized.

f. Absolutistic: (dichotomous or all-or-nothing thinking)

judgments about oneself, personal experiences, or others are
placed into one of two categories: all bad/all good, total
failure/complete success, completely flawed/perfect.
Conceptualization: the integration of information. From CBT frame
hypothesize about the contextual, cognitive, affective, and behavioral
relationship. I.e.) clients beliefs, automatic thoughts, cognitive
patterns, and possible schemas about their environment result in the
present emotional and behavioral symptoms.
Formulation: the art of linking together the client information with
practice, theory, and research. This helps guide treatment with a
logical approach. Steps: 1. Develop a problem list. 2. Develop the initial
case formulation that includes individual differences that may affect
treatment outcome. 3. Communicate the case formulation and
assessment results with the client.
People to know
Albert Ellis: credited with being the first to apply the therapeutic
approach of CBT (1955). He broke from psychoanalytic tradition,
finding the approach too non-directive and inefficient. He is the father
of Rational-Emotive-Behavior Therapy (REBT) unveil this approach 10
years prior to Aaron Becks introduction of CBT. RBET s an actionoriented approach that posits that it is out thinking about events that
leads to emotional and behavioral upset. REBT emphasizes the
present, and individuals are taught how to examine their thinking
patterns, which create unhealthy emotions and self-defeating
behaviors.
Aaron Beck: psychiatrist at UPENN. He studies psychoanalysis; he
assumed his research would validate psychoanalytic conceptualization
of depression- it did not. He found that depressed individuals
experiences streams of spontaneous negative thoughts including:
negative ideas about themselves, the world, and the future. This
observation was names the negative cognitive triad)
DEMONSTRATIONS
1. Explain to the client the therapy modality- what is CBT? What will
treatment sessions look like?
2. Assess the clients history of symptoms; Give at least 3
differentials, medical condition and drug use.
3. Asses to rule out differentials, medical condition and drug use.
4. Summarize and communicate the symptoms and working
diagnosis to the client
5. Asses for problems

6. Collaborate with the client a problem list and prioritize

7. Collaborate with the client the formulation: how you view the
problem/ underlying themes of problems
8. Set up a list of 3 goals for therapy (include one immediate or
quick goal).
9. Share with the client the idea of homework
10.
Provide the client with homework
11.
Check up on the clients homework
12.
Provide hope and positive expectation of change