PSY2017

Therapeutic Applications of Cognitive Psychology,

Neuroscience & Individual Differences
Cognitive & Behavioural Therapies
 Cognitive Behavioural
Therapies
CBT is not a single therapy approach. It is an
umbrella term for a broad group of talking
therapies that aim to change behaviour and
emotions by changing the way that clients
understand, interpret and engage with events.

Now widely adopted within the NHS as the

treatment of choice for stress, depression, &
anxiety disorders. Also widely used for
behavioural change in educational, forensic and
health settings.
 Basic Characteristics of
C&B Therapy

• Structured and goal-directed;

• Based on an educational model;
• Work outside of therapy sessions tends
to be essential;
• Therapeutic Alliance necessary but not
sufficient.
 Outline
We will look in some detail at 3 examples:

Rational Emotive Behavioural Therapy

- REBT
Beckian Cognitive Behavioural Therapy
- CBT
Mindfulness Based Cognitive Behavioural Therapy
- MBCBT
 Varieties of C & B Therapy

1st Wave: Behavioural Therapies

Includes:
• Desensitization Therapies
• Behaviour Modification
 Varieties of C & B Therapy

2ndWave:
Cognitive Therapies
Includes:
• Cognitive Therapy
• Rational Emotive Behavioural Therapy
• Cognitive Behaviour Modification
 Varieties of C & B Therapy

3rd Wave:
Mindfulness & Acceptance Based Approaches

Includes:
• Mindfulness Based CBT
• Dialectical Behaviour Therapy
• Acceptance & Commitment Therapy
 Some
CBT
Principles
 Principle 1
Beliefs shape how
we feel about
events.
What
disturbs
people’s
minds is not
events, but
their
judgements
on events
Epictetus
(1st Century A.D)
“There is
nothing either
good or bad,
but thinking
makes it so.”

William Shakespeare,
Hamlet
Different people can attach
different meanings to a specific
situation. For example, consider a
situation where someone’s friend
treats them inconsiderately.
Different people can have different
emotional responses to precisely
the same event, depending on
how they think about it:
 Person 1 attaches the meaning.

‘That idiot has no right to treat me badly –

who the hell do they think they are?’

…and feels angry.

 Person 2 thinks…
‘This lack of consideration means that
my friend doesn’t like me’

…and feels depressed.

 Person 3 thinks…
‘I don’t deserve to be treated poorly
because I always do my best to be
considerate to my friend’

and feels hurt.

Person 4 believes the event means
that…

‘I must have done something serious to

upset my friend for them to treat me like
this’

…and feels guilty.

 Person 5 believes that…
‘This inconsideration is a sign that my
friend is losing interest in me’

…and feels anxious.

 Person 6 thinks…
‘Aha! Now I have a good enough reason
to be friends anymore, which I’ve wanted
for ages!’

…and feels happy.

 Person 7 believes that…
‘My friend must have found out
something terrible about me to treat me
in this way’

…and feels ashamed.

Cognition & Emotion
• Schacter and Singer (1962) conducted a well-
known study that demonstrates the role of
cognition in emotions.

• In their study, they manipulated participants’

arousal and the climate surrounding them

• Arousal was manipulated with injections of

adrenaline (epinephrine) as a “drug study”
 Cognition & Emotion
• The setting in which arousal occurred was
manipulated by hiring confederates
– Students trained to act happy or sad

– The confederates pretended they were participating in

the drug study

• Arousal was manipulated with injections of

adrenaline (epinephrine) as a “drug study”
– Participants injected with adrenaline were compared to
those injected with saline solution
Cognition & Emotion
• The confederates pretended they were
participating in the drug study

• Participants who received adrenaline experienced

increased arousal compared to those who did not

• The aroused participants also “felt” emotions

based on the actions of the confederate

– They felt good if the confederate was happy

– Participants with an angry confederate felt anger

 Principle 2
What we do has a
powerful influence on
our thoughts, feelings
and choices.
 For Example….
Changes in facial expression
can lead to changes in the
subjective experience of
emotions (Laird,1974).
 ‘Power Posing’
Carney, Cuddy and Yap (2010) found that
participants who were asked to adopt a
‘power’ pose reported higher confidence and
self-esteem than those who were asked to
adopt a more relaxed pose. Their saliva also
showed higher levels of testosterone and
lower cortisol.

www.ted.com/talks/amy_cuddy_your_body_language_
shapes_who_you_are
 Principle 3
Psychological problems
can be understood as
exaggerations of
normal processes
Psychological Formulations
• Summarise the client’s core problems;
• Show how the client’s difficulties relate to one another, by
drawing on psychological knowledge;
• Explain, on the basis of psychological theory, why the
client has developed these difficulties, at this time and in
these situations;
• Give rise to a plan of intervention;
• Are drawn up collaboratively with the client;
• Are open to revision and re-formulation.
(Johnstone & Dallos, 2006)
Diagnosis Vs Formulation
Diagnosis Formulation

• Removes meaning • Creates meaning

• Removes agency (‘sick role’) • Promotes agency
• Removes social contexts • Can include social contexts
• Individualises • Includes relationships
• Keeps relationships stuck • Looks at relationship change
• Culture blind • Culture sensitive
• Disempowering • Collaborative
• Stigmatising • Non-stigmatising
• Social consequences • No social consequences
• Iatrogenic
 Principle 4
It is usually more fruitful
to focus on current
processes rather than
past events
 Here & Now
CBT approaches do not deny that personal
history has a profound influence on current
thinking and choices, however the target of
change is current thoughts, feelings and
behaviours.

We can’t change the past…We only have limited control

over the future… The ONLY place that we can make a
difference is NOW.
 Principle 5
Problems can be understood
as interactions between
thoughts, emotions,
behaviour and physiology and
the environment in which the
person operates.
 Principle 6
The practice of psychological
therapies should be guided
by finding out what works.
Empirical (research) evidence
guides the development of
therapy and theory.
 CBT Principles
• Beliefs shape how we feel about events.
• What we do has a powerful influence on our thoughts,
feelings and choices.
• Psychological problems can be understood as
exaggerations of normal processes
• It is usually more fruitful to focus on current processes
rather than past events
• Problems can be understood as interactions between
thoughts, emotions, behaviour and physiology and the
environment in which the person operates.
• CBT is guided by finding out what works. Empirical
evidence guides the development of therapy and theory.
 3 Levels of Cognition
• Negative automatic thoughts – specific thoughts that arise
spontaneously in various situations, which have a negative
effect on mood, and which are relatively accessible to
consciousness.
• Unhelpful assumptions – ‘rules for living’ that guide
behaviour and expectations in a variety of situations, and
which are often in conditional (if ... then ...) form.
• Core beliefs – very general beliefs about oneself, other
people or the world in general, which operate across a
wide range of situation but which are often not immediately
conscious.
Unhelpful
Cognitive Behavioural Methods
• Structured and goal-directed; Based on an educational
model;

• Many CBT methods aim to challenge unhelpful beliefs

and promote more realistic thinking;

• Consists of therapeutic techniques include education

about functional thinking; keeping a diary of feelings,
thoughts & behaviours; questioning & testing
perceptions, assumptions, & beliefs that might be
unhelpful/unrealistic; gradually trying out new ways of
behaving & reacting.
 PSY2017
Rational Emotive Behaviour Therapy
Rational Emotive Behaviour Therapy

• Developed by Albert Ellis in 1950s

• Founded on teachings of ancient Greek,
Roman and Asian philosophers (Zeno,
Epicurus, Epictetus, Marcus Aurelius
Confucius, Gautama Buddha, Lao-Tsu)
• “I tried to take the most practical aspects of
their teachings” Ellis 1994
The A-B-C-D-E Model
 Ways of Thinking
Rational Irrational
• Empirically consistent with • Inconsistent with reality,
reality, testable lacks empirical validity
• Logical • Illogical
• Flexible • Dogmatic, inflexible
• Preferential: expresses a • Demanding: states
desire not a demand demand rather than a
desire. Albert Ellis termed
this “musturbation”
Rational Self-Evaluators
• Have a high acceptance of ambiguity
• Self-directing and self-correcting
• Flexible
• Self-interested in ways that take account of
their social role
• Accept feedback that is not always positive
 Irrational Self-Evaluators
• Self interested in ways that tend not to take account
of social responsibility;
• ‘Awfulise’ their experience of the world because their
demands are rarely met to their satisfaction;
• Employ irrational thinking when considering their
situation;
• Experience higher levels of stress than rational
evaluators;
 Self-Evaluation
• In reality most people will use a mixture of
irrational and rational beliefs in evaluating
themselves and their situation.
• It is those who tend more towards the
irrational who tend to have self-destructive
beliefs and show self destructive behaviours.
 Irrational Beliefs &
Self-Defeating Behaviours
Albert Ellis suggested that irrational beliefs fall into
one of three categories and lead to self-defeating
attitudes & behaviours:

1. Belief: “I absolutely must perform important tasks

well and be approved by significant others or else I
am an inadequate, worthless person”
• Result: Severe feelings of anxiety, depression, and
demoralisation often leading to severe inhibition.
 Irrational Beliefs &
Self-Defeating Behaviours
Albert Ellis suggested that irrational beliefs fall into
one of three categories and lead to self-defeating
attitudes & behaviours:

2. Belief: “I must live comfortable, unhassled, and

enjoyable life, otherwise it’s awful and I can’t stand
it!”
• Result: Severe feelings of low frustration tolerance,
often leading to compulsion, addiction, avoidance,
inhibition, and public reaction.
 Irrational Beliefs &
Self-Defeating Behaviours
Albert Ellis suggested that irrational beliefs fall into
one of three categories and lead to self-defeating
attitudes & behaviours:

3. Belief: “Other people, especially my friends and

relatives, must treat me kindly and fairly, or else they
are evil and must be punished.”
• Result: Severe feelings of anger, rage, fury, often
leading to antisocial, hostile and/or violent
behaviour.
Examples of Self-Defeating Rules:
‘I need love & approval from those around to me.’ ‘I must avoid
disapproval from any source.’
‘My worthiness depends on my achievements (or my
intelligence or status or attractiveness).’ ‘To be worthwhile as a
person I must achieve success at whatever I do.’
‘I should not feel angry, anxious, inadequate, jealous or
vulnerable.’
‘I must never fail or make a mistake.’
‘If I’m not loved, then life is not worth living.’
‘If I’m alone, then I’m bound to feel miserable & unfulfilled.’
‘I shouldn’t have to feel discomfort & pain.’
‘I must avoid life’s difficulties, unpleasantness, &
responsibilities.’
Examples of Self-Defeating Rules:
‘People should always be the way I expect them to be.’
‘People should always do the right thing. When they behave
obnoxiously, unfairly or selfishly, they must be blamed &
punished.’
‘I should always feel happy, confident, & in control of my
emotions.’
‘People will not love & accept me as a flawed & vulnerable
human being.’
‘My unhappiness is caused by things that are outside my
control – so there is nothing I can do to feel any better.’
‘I must worry about things that could be dangerous,
unpleasant or frightening – otherwise they might happen.’
‘Every problem should have an ideal solution.’
Handling Negative Emotions
Adversity may lead to negative emotions.
Some negative emotions are more rational than others.

• Appropriate • Inappropriate
• Sadness (I lost something I • Depression (I’m no
cared about) good, worthless)
• Remorse (I’m sorry) • Guilt (I’ve sinned)
• Concern (I need to take care • Anxiety (I’ll never be
of this) able to handle this)
 Therapeutic Goals
• Primary goal is to help people realise they can live
more rational and productive lives.
• Avoid having more of an emotional response to an
event than is warranted.
• Help people change self-defeating habits of
thoughts or behaviour.
• Encourage clients to be more tolerant of themselves
rather than dwell on mistakes or miscues.
 Techniques
• Before changes can be made, clients must learn
the basic ideas of REBT and understand how
thoughts are linked with emotions and behaviours.
• Highly didactive and very directive.
• Counsellors teach their clients an REBT view of the
anatomy of an emotion – feelings are a result of
thoughts, not events, and self-talk influences
emotion.
• This is known as Rational Emotive Education (REE).
• Critical for clients to be able to dispute irrational
thoughts.
Disputing Thoughts or Beliefs
• Cognitive Disputation - the use of direct questions,
logical reasoning, and persuasion.
– May challenge clients to prove their responses
are logical.
– May incorporate the use of “Why?” questions.
Disputing Thoughts or Beliefs
• Imaginal Disputation - relies on the client’s ability to
imagine.
– Employs a technique called rational emotive
imagery (REI).
– Client imagines a situation likely to be upsetting
and examines his/her self-talk.
Disputing Thoughts or Beliefs
• Behavioural Disputation - involves behaving in a
way that is the opposite of the client’s usual way of
thinking.

– If successful, a new Effective Philosophy will

emerge.

This process is most effective when all three

methods of disputation are used in conjunction.
Strengths & Contributions
• Clear, easily learned and effective.
• Can be easily combined with other techniques.
• Relatively short-term.
• Has generated a great deal of research and
literature.
• Has continued to evolve over the years as its
processes and techniques have been refined.
 Limitations & Criticisms
• May be too closely associated with its founder
Albert Ellis.
• REBT’s directive and confronting way of working
with clients is a limitation for some.
• Imposes a view of ‘correct’ experience and emotion
onto clients.
 PSY2017
Beckian Cognitive Therapy
 CBT Principles
1. Beliefs shape how we feel about events.
2. What we do has a powerful influence on our thoughts,
feelings and choices.
3. Psychological problems can be understood as
exaggerations of normal processes
4. It is usually more fruitful to focus on current processes
rather than past events
5. Problems can be understood as interactions between
thoughts, emotions, behaviour and physiology and the
environment in which the person operates.
6. CBT is guided by finding out what works. Empirical
evidence guides the development of therapy and theory.
 Cognitive Therapy
Developed by Aaron Beck in 1970s. Now widely adopted within
the NHS as the treatment of choice for stress, depression, &
anxiety disorders. Also widely used for behavioural change in
forensic and health settings.

The goal of CT is to correct unhelpful information processing and

help clients modify their assumptions that maintain their
maladaptive behaviours and emotions.
ØCollaborative Empiricism: Therapist & client are co-investigators.
ØGuided Discovery: Guided by the therapist, the client engages
in experiments that result in more adaptive ways of thinking.
ØTherapy is present-centered, directive, active, and problem-
oriented.
 Cognitive Therapy
• Sociotropy & Autonomy
– 2 dimensions of personality that lead to vulnerability to
depression and anxiety
• Sociotropic dimension characterised by dependence on
interpersonal relationships and need for closeness &
nurturance
• Autonomous dimension characterised by independence &
organised around goal setting, self-determination, and self-
imposed obligations
• Cognitive Triad
– Tendency for depressed individuals to have a negative view
of the self, the world, and the future
 PSY2016 & PSY3019

“I am helpless & inadequate”

Negative View of Self

Depression

“The future is hopeless” “All of my experiences

result in failure”
Negative View of Future Negative View of STUFF

Negative Cognitive Triad

 Cognitive Therapy
• CT approaches maintain that how one thinks largely
determines how one feels and behaves.
• Cognitive Schemas
– Structures that consist of an individual’s fundamental core
beliefs and assumptions about how the world operates (such
as those in the negative triad).
• Automatic Thoughts
– Involuntary, unintentional, and preconscious thoughts that are
hard to regulate
• Cognitive Distortions
– Systematic errors in reasoning
Unhelpful Thinking Styles
Unhelpful Thinking Styles
Unhelpful Thinking Styles
A Sequence of Automatic Thoughts

A.T. Beck (1999), Prisoners of Hate, New York: Perennial

 Cognitive Therapy Methods
• CBT methods aim to challenge “dysfunctional”
beliefs and actions and promote more realistic
thinking and adaptive behaviour;

• Consists of therapeutic techniques include

education about functional thinking; keeping a diary
of feelings, thoughts & behaviours; questioning &
testing perceptions, assumptions, & beliefs that
might be unhelpful/unrealistic; gradually trying out
new ways of behaving & reacting.
Initial Assessment – Social Anxiety

https://www.youtube.com/watch?v=XH2tF8oB3cw&t=445s
Initial Assessment -Depression

https://www.youtube.com/watch?v=JKUFWK6iSsw
CBT:
Formulation
Beliefs shape how
we feel about
events.
 Thought Challenges &
Downward Arrow

https://www.youtube.com/watch?v=W3hMmZQAdhw&t=47s
 Thinking Critically
• Automatic Thoughts Diary
– A “Daily Record of Dysfunctional Thoughts”
– The client answers the following questions whenever
they experience a negative feeling
• In what situation did the feeling occur?
• What (automatic) thought passed through your mind?
• What type of cognitive distortion can you identify in your thinking?
• How could you rationally and constructively respond to the
thought?
• How might your new response change your emotions?
 Thought Diaries
Clients are asked to record occasions when
they experience negative or puzzling
emotions.

They are also asked to record what was

happening at that time, along with their
associated thoughts and images.

Together these provide the raw data for

problem-solving.
 Thought Diaries
Clients are then requested to formulate
alternative explanations.

Underlying beliefs are either irrational or

incorrect. However, inference that are
formulated when emotions are strong may be
responsible for a client’s emotional distress or
difficulties in changing their behaviour.
 Thought Diaries
The intention behind the intervention is to
encourage clients to examine and question their
inferences.

Clients are also asked to rate how strongly they

agreed with their ‘automatic thinking’ both before
and after they examined the belief.

They are then asked to identify whether examining

the inference has resulted in a change in
emotional response, either in terms of type or
degree of response.
 Thought Diaries
If there is little difference, the presenting
concerns have not fully been addressed. This
would indicate that an important meaning or
core belief has yet to be identified. Further
probing will be necessary.
Thought Diaries
Clients are also asked to note down how
much they agree with the alternative belief. If
the alternative is trite or seems unconvincing
to the client, it is unlikely to be powerful
enough to effect a lasting change. Again,
further work will be required.
 Strengths/Contributions
• Effective within a short time period.
• Has generated a great deal of research & literature.
• Numerous RCT studies have provided support for
the effectiveness of CT (particularly in working with
depression, stress & anxiety disorders).
• Can be combined with other approaches.
• Has evolved over the years as its processes and
techniques have been refined.
 Limitations & Criticisms
• Potentially imposes a view of ‘correct’ experience
and emotion onto clients.
• May change specific behaviours and thought
patterns but not address the underlying cause.
• Not all clients may be able to understand the
concepts or be motivated to change thought
patterns.
• Might not address some unconscious (inaccessible)
influences on behaviour.
• Evidence concerning long term efficacy is unclear.
 PSY2017
Behavioural Experiments
“Waste no more
time arguing about
what a good
person should be.
Be one.”

Marcus Aurelius,
Roman Emperor and Stoic
Philosopher, 180 A.D.
 What we do has a
powerful influence on
our thoughts, feelings
and choices.
 Behavioural Experiments
Behavioural Experiments are planned
activities, based on experimentation
or observation, undertaken by clients
in session or between sessions.

They test existing beliefs and/or help

test more adaptive beliefs.
 Behavioural Experiments
Behavioural experiments can:
• Test client’s old, negative & unhelpful existing beliefs

• Test client's new and more helpful beliefs

• Provide experiential learning and promote adaptive

behaviours- "learning by doing"

• Increase the chances that clients will feel new ways of

understanding and behaving as well as knowing them
 Setting up
Behavioural Experiments
• Make sure that experiments are thoroughly planned -
don't just say "why don't you try it out"?
• Make sure it is clear what beliefs are being tested, and
how much the client believes them now
• Encourage the client to be specific about what they
will do, where and when
• Think about what problems are likely to be
encountered and how to deal with them
• Set up experiments to be “no-lose” – “we learn
whatever happens”
 Evaluating
Behavioural Experiments
• After the experiment, explore the outcome – what
happened, which beliefs were vindicated, what the
client has learnt – how much their beliefs and
motivations have changed

• Be enthusiastic and positive about the clients

efforts and stay curious

• Encourage the client to plan the next step

Behavioural Experiments

https://www.youtube.com/watch?v=ExNs8o8A4fI
 PSY2017
Case Example
Cognitive Therapy Example

Vumile, a 19 year old male student, who

has come to counselling because he is
anxious in social situations.
 Vumile considers his present life to be
“miserable” and feels envious of other students
who seem to live sociable and exciting lives.
Vumile spends most of his time studying, playing
computer games and watching TV. He hardly
ever attends a social event. He has a few
friends, but he experiences them as critical
because they frequently comment on how quiet
and withdrawn he is and have often described
him as “antisocial.”
 He can not recall receiving any love or
emotional support from his parents, a nurse and
a schoolteacher, whom he reports frequently
had violent quarrels. Some mornings as a child
Vumile would wake up and find chairs broken
and holes punched into the doors. In his early
teens he learned that these conflicts were
precipitated by his father’s affairs with other
women.
 Both parents used corporal punishment on
him unpredictably and for minor offences (on
one occasion he was beaten for losing 50
pence). Vumile would be hit by a belt, including
the metal buckle, and with metal chains. On
some occasions blood was drawn. Vumile used
the metaphor of a boss and a slave to describe
his relationship with his father. His mother was
inconsistent as she would unpredictably behave
in a critical and cruel manner. He has two
younger brothers with whom he reports feeling
no meaningful bond.
 He comes across as quiet and timid and
reports that others have found his voice so quiet
that they always respond with “Huh?” As a result
he feels even more afraid to speak up. He has
never dated a woman. Although he appears to
be resigned to this lonely way of life, he
genuinely hopes that counselling might bring
about change. He said,
“I want to be able to go out and have fun without
worrying about what others are thinking about
me. . . . I really want to know how to go about
approaching a girl I like without freezing up and
saying something stupid because I’m so
nervous.”
 Vumile sees himself as small, puny, visibly shaking
with anxiety, and with a strange, inaudible voice; and
he believes he looks and sounds ridiculous. All this
gives rise to severe anxiety symptoms. If a woman
struck up a conversation with him, he would not be
able to concentrate and would freeze up. Vumile
displays safety behaviours that may exacerbate the
problem. He hangs around on the edge of groups
hoping not to be noticed. When in a group, he averts
his gaze so as not to see who is laughing at him.
When someone engages him in interaction, he avoids
eye-contact and looks past the person’s shoulder.
These behaviours seem to contribute to his peers
mocking him and calling him “antisocial.”
 Situations
Walking past a crowd of people; Walking into a library or
restaurant; socialising with students in halls; making a speech in
front of others; Going to pubs or clubs; Speaking to a female
peer

Threat-Related Thoughts
I am boring, anti-social, inadequate
I won’t succeed
They’ll think ‘you’re such a loser’
They will feel pity for me

Self-Focus
Small-puny
Shaking with anxiety
Strange inaudible voice

Safety Behaviours Anxiety Experiences

Avoids speaking up Feels hot, Perspires
Stays at the edge of the group Shakes
Averts Gaze Butterflies in stomach
Holds body still Heart Pounding
Wears bulky clothes Feels Faint
Vumile’s Cognitive Therapy
1. Psychoeducation – explanations of how
behaviours, thought, feelings and physiology
interact to maintain anxiety
2. Review of thoughts, looking for exceptions,
methods for noticing, challenging and
replacing unhelpful beliefs
3. Behavioural experiments – trying something
new to affect changes to beliefs and feelings.
 Vumile’s Outcomes
1. Reduction of pessimistic thoughts about the
outcomes of socialising.
2. Anxiety remained in many social situations
but less frequently prevented Vumile from
engaging.
3. Continued with behavioural experiments as
they generated positive information about
Vumile’s social skills and provide hope for
future.