Lecture#1 Cognitive Behavior Therapy (CBT Basics and Beyond Judith S. Beck)

0:01 Assalam alaikum everyone and welcome to my channel. I am Kainat Ali and I have a Masters degree in Clinical Psychology from Baria University Islamabad. So I am starting a lecture series in which I am going to be making slight presentations in lectures on all the therapies and lecture courses that I have studied and all the books that I have read. So if you are a Bachelors or Masters student of Clinical Psychology and you want to prepare for an exam and simply you want to learn, if you are an aspiring therapist or a clinical psychologist and you want to learn then I highly recommend you follow this series. Currently I am

0:48 preparing lectures on Cognitive Behaviour Therapy. Specifically like the basics and beyond which is a highly recommended book by Jit S Beck, on the basis of that book I'm gonna be making some lectures and I highly recommend that you listen to them. Just consider me your teacher who is basically giving you university lectures on YouTube. So without further a do we start our lecture. Allwright Today's lecture is a brief introduction and overview of Cognitive Behavior Therapy. Okay so let's start. So these are the five topics that

1:35 we will cover. Introduction What is CBT, Theoretical Framework, Course of Development of the Therapy. And what does our contemporary research tell us about CBT? Allright Introduction Aaron Beck was a psychiatrist and was trained in what was called the classical psychoanalytic school of thought. The dominant school of thought at that time was Freud's psycho analysis. So Aaron Beck was also under his influence and he also practiced the same therapy. But Aaron wanted that the assumptions of Freud's therapy should be tested and investigated on an empirical level and

2:20 all these assumptions should be given validation through scientific methods. Right? So his experimentation and scientific studying started during the time from late 1950 to early 1960. And he discovered that the core feature of depression clients is that they have distorted cognitions, that is, distorted thinking, their problems are arising in their thoughts and cognitions. That means his way of perceiving events, his lens of interpreting things is very negative. He is very dysfunctional. The problem is arising there. So he

3:07 developed a short-term therapy to treat his clients and he used reality testing to focus on the correct thinking processes. I mean, what is the correlation between the schemas and cognitions that are going on in the client's mind, the invisible statements and thoughts that are being generated in the mind, with the objective reality and with his subjective reality ? How much accuracy is there ? Right? Does your thought content match your reality or not? So because of this there was a significant perceptual change and a difference

3:53 in the emotional state and psychological well being and behaviour of the clients, that is, there was a lot of improvement. Now the definition of back is what is CBT? Right? Structure Short term present oriented psychotherapy for depression directed towards solving current problems and modifying this functional thinking and behaviour This is the correct loaded definition, let me explain the structure to you Now you have goal setting Initial, Mid and Termination Phase On the basis of goal setting you target the symptoms You identify the problem On the basis of thoughts and goals you will structure the session. As the goals keep getting accomplished, eventually you will reach near termination.

4:39 Present oriented. Right? The classical psycho analytical school of thought that you have, works on the unconscious phenomenon, past phenomenon, that you are the individual that you are, because of the conflicts that have been generated within these childhood, which are your five stages. But the approach of CBT is within the present: what are the cognitive processes, schemas, core beliefs right now ? Which negative thoughts are currently causing problems for the client? Ok? And then it was solved directly with therapeutic techniques. And then modifying this functional thinking and behaviour. Now the focus of CBT is on cognition and the main focus is on behaviour. Right? So the thinking cognitive

5:28 process and the behaviour process, both are connected and work is done on them. Dysfunctional thinking (negative automatic thoughts) are identified and changed, and the dysfunctional behavior that results from this is worked on with homework assignments outside of the session that your client has to practice. Right? The focus is on both. Now further means the first thing he did back then was on soul depression. Right? So further he expanded his framework to other disorders as well. The main assumptions of Beck's model were that it is, that it is the cognitive process.

6:15 The perception of the person is what causes more psychological problems than the event itself. Right? Events are neutral. That is our own unique perception. Correctly, that means it is the exam bean. And the treatment is based on a cognitive formulation that takes into account your maladaptive beliefs, behavioral strategies and maintaining factors that characterize a specific disorder. Correct? So these are the elements of cognitive formulation. When you use this therapy, it is mandatory for you to do this. Every disorder has its own maladaptive beliefs. It has its own behavioral strategies and some of its own maintaining factors.

7:00 If we take the example of anxiety disorder, then in the manipulatory beliefs and its automatic thoughts, there is more of ah catastrophization. The distortion that's there, the cat catastrophization is coming. Negative thoughts about the future are that something bad will happen or if I do this, I will become a mess. Someone will say something to me, someone will harm me. Etsectra Etsectra right? The behavioral strategy is becoming more avoidance-oriented. Protective behaviors are coming into play. Ok? Because now you are feeling afraid, you will probably avoid things. And that means that if we take the example of borderline personality disorder, the cognitive distortion that occurs there is black and white thinking. Ok? The core beliefs we have about ourselves are

7:45 very negative. He is negative about others too. Then there is negativeness about the world too. Behavioral strategies to cope with that. Self harm comes to you. You get very aggregated behaviors. Etxtra is a signature of every disorder. Meaning cognitive are his beliefs and schemas and behaviors. From which you come to know that it is a specific disorder. Right? And then you conceptualize the case and understand your individual client and their specific underlying beliefs and patterns. The behavior patterns they have. Every human being is unique. What demographic is he from? Which gender are you from ? What religious background are you from? Meaning, what is his religious orientation? What

8:33 kind of belief system does he have? In which culture has he been groomed? Ok? Etra means all of the unique factors which will very strongly determine what his core beliefs and values ​​are, his lens because all these factors are influencing as well. Along with that he also has his own individual uniqueness. So you have to understand what are his negative thoughts and the underlying beliefs under that negative thinking that are bogging him down and what are his signature behaviors that he employs that are dysfunctional. Correct. Here is an example of an app that is a client within the book. So his negative thought process is 'I am a failure' and the automatic thought that comes to him. Right? And

9:21 then engaged in extensive behavior avoidance. Now his behavior avoidance is coming. So his perceived incompetence, look at perceived incompetence and failure wouldn't be a parent. But his avoidance ironically strengthens his belief of failure. Now look what is being discussed here. The negative automatic thought is coming that I am a failure. Ok? The behavior is coming. Avoidance and Perceived Incompetence. It is his core belief about himself that he is incompetent. He is worthless. Correct. So he gets negative thoughts which affect his behavior. Because he is a failure. He is not doing anything right. He avoids , he procrastinates. Either it does n't work at all or very low quality work is done at the last moment. When he does this to escape his core belief, it causes the

10:06 alien effect because he has now generated evidence that his work is so bad or non-existent that he is, in fact, incompetent. He ca n't do anything properly. Correct? So his behavior is strengthening his belief. So, when we are talking about cognition, which means the thinking process and belief process is going on and then when we are talking about behavior, there is a cyclic relationship between them. They support each other. If you think negatively, you will behave negatively; If you behave negatively , you will think negatively. So Aaron is targeting these very things so that we do not remain trapped in this same cycle. Do n't sit in such self-filling prophecy. But instead now

10:54 we are going to target these cognitions specifically and we are also going to work on the behaviors. Now when we talk about our field of psychology, our field has branched out from philosophy. So, philosophical maxims are used in many of our therapeutic frameworks. So the maximum Stoic philosopher Epiktetis used in this therapy is that men are disturbed not by things but by the views which they take of them. So what I mean by this is literally that the theoretical framework and the assumption is that the events are neutral and they do not disturb you, but the way you interpret and perceive those events

11:40 disturbs you. Ok? So this is the maximum taken from Stoicism and then it is incorporated in a very empirical way into therapy. One ironic thing I find is that it is said that contemporary therapy does not work and no argument is given in its opposition that it is correct. Many useless arguments are given. And the same people who pop the philosophy of Stoicism. Right? Not the actual one but using the pop culture philosophy. Right? Here our philosophical roots are coming from here and we are using that maximum empirically and correctly. Right? So you also have to understand the roots. And Aaron was also inspired by this thing.

12:25 Apart from that, he was also greatly influenced by the work of other famous theorists of that time like Adler, Karen Horney, Ellis, Kelly, Lazarus and Bandura while developing his framework which is the underlying theory of CBT which is a theoretical framework. The Cognitive Model Arguments Dysfunctional [MUSIC] Thinking This functional thinking which influences the patience, mood and behavior is common to all psychological disturbances. Now look at this, psychological disturbance and dysfunctional thinking, I mean this is the main

13:10 focus right when people learn to evaluate their thinking in a more realistic and appropriate way, they experience improvement in their emotional state and in their behavior, I mean there are certain things happening here which I will explain. The assumption is that if your internal cognitive schemas, beliefs and thinking patterns are negative. So it will influence a person's mood and his behavior. The way he feels and then the way he acts will be highly influential. This also proves that our thoughts are so powerful to the point that they start dictating the course of our life. Which decision will you take, which decision will you not take, what will you wear, what will you not

13:57 wear? Will you take that job, accept that proposal, have that difficult conversation. All these things literally depend on your thought process. Right, if they are dysfunctional then everything else will become dysfunctional. Right? But when people learn to evaluate these thoughts in a more realistic and adaptive way, it means that there is a change in their emotional state and behavior, which is what the therapy proposes, if we do their cognitive reframing and teach them the skill set on how to deal with their negative thoughts and core beliefs, then automatically their emotional state and behavior changes.

14:42 So I will just tell you briefly the chain connection and in CBT we have automatic thoughts which leads to your emotions, your feelings right and which then repeatedly leads to your behaviour automatic thoughts are negative emotions negative automatic thought I am a failure emotion you feel sad you feel rejected behaviour will be negative. You start to withdraw or you start to avoid and scroll on your phone or go to sleep. Ok ? This is a simple chain connection. And in CBT yes behaviour is a central focus. But the main focus is your cognitive

15:30 phenomenon. If you attack this part of the circuit. If you bring a change here then the current flow in the rest of the circuit will be smoothed out. If this gets cured then your emotional state will also get corrected and your unwanted behaviour will also get corrected. It will become functional. The butt will not be dysfunctional. Why? Because now there is nothing that is stopping you. Right? Now, which is a very important thing, which is cognition, there are three levels of both, optimal healthy and maladaptive unhealthy. I will go through this briefly otherwise this is a very important element which we will study further. Number one is your automatic thoughts, which are the most

16:18 superficial level. There is an upper level. I am too tired to do anything. Correct. These are those thoughts that keep sprouting in your mind without any conscious effort. Those thoughts which keep coming to your mind automatically. Those are your automatic thoughts. Correct. Then number two comes your intermediate beliefs, which go to a deeper level. You have underlined assumptions. That's like if I try to initiate relationships I will get rejected. Ok? Basically, your automatic thoughts come out inspired from this level. Right? So, it means that you have made assumptions and hypotheses. You feel in your subjective reality that this will happen. Right? That if I try to

17:06 initiate a relationship or friendship, I will get rejected. Your admission has been made. So on that basis you are now getting automatic thoughts. Like I am too tired to do anything. Because you think everything will fail like that. You will get rejected. Then such thoughts start coming to your mind that friend, I don't feel like doing anything. I am so tired, I can't do it. Right? So it means that there is a connection between these things. Right? Now we go to the third level. That is the most important of your core beliefs, which are the deepest level. Meaning this is your main lens through which you perceive everything. When you view and absorb the entire world within your subjective reality. Right? So here come three beliefs: about

17:52 yourself, about others and the world. We also call this a cognitive triard, which we will study further. Right? So it means like I am helpless, believe about yourself, other people will hurt me, believe about others. The World Is Dangerous, Belief About the World. Right? So, that means if your belief about yourself is negative then it will influence other negative beliefs too. Negative about others and then negative about the world too. Right? And this means that someone has one dominant belief which is negative. But then he influences others as well. So this is our tri-ad negative beliefs about self, others and the future or the world. Right? So,

18:41 this is the lens through which you see and perceive the entire world. This is the main from which everything is sprouting and coming out. If I give you an example of a tree, then I am trying to draw these roots. They are the core believes. The Trunk Is The Intermediate Believes. And the branches coming out from it are your automatic thoughts. Without the roots you will neither have a trunk nor will you have branches. So this is the main core. And this is the best way in CBT. If work is done on all three levels. But if you make modifications at this level, then the total change occurs. Because now neither your

19:28 trunk is existing nor your branches are existing. Right? Now fostering improvements in clients' mood and behavior, you will work at all three levels. Ok? Automatic thoughts and underlying dysfunctional beliefs that produce ongoing change. Ok? Modifying means both automaticity and thoughts and your dysfunctional beliefs, because of which a very strong change takes place. Right as I mentioned. Now the example is that you continuously underestimate yourself and your abilities. The possibility is that a core belief is that I am incompetent. Right? So if you modify this belief, it is right. So it means you should

20:14 start seeing yourself in a more realistic light. Your entire perception will alter in all those situations where your core belief used to get activated. Where you used to get triggered. Ok? So, the negative thoughts, the negative themes that used to come automatically in thoughts and competence will become almost non-existent. So it means like I am good. I am not good at the specific task. Correct. I can do a lot of things. well. If I am a person aware I can probably learn what I need to. I have strengths and weaknesses like everyone else. Where you used to blame yourself for every bad thing that because I am lazy, incapable, I am uncompetitive. I can't do any work properly. Ok? Now if you are not able to do any work here, now you have a very realistic approach. Because your core

21:01 belief has changed. I can do a lot. If I try, I will learn. I have flaws and I also have good abilities. Ok ? So, meaning now you have become realistic. Your dysfunctional thought process has changed. Your emotions have changed. And your behavior as a result changes. Again, you changed this chain automatic thoughts here. The resulting emotional state of yours has changed and then the resulting behavior of yours has now changed. Ok? Yes behavior is the concern. But we will mostly target cognitions here. When we tapped in to this part in the circuit

21:48 and changed it. Automatically there was a transformation in your flow or current. Emotions became stable. Ok? Negative emotionality got reduced a lot and by its extension the behaviour became functional because nothing is stopping you now, nothing is hindering you due to which you do dysfunctional behaviour, right, so like this is like the main circuit of CBT, which is a chain connection, right and the temporary evidence that we have, what does our current research tell us with reference to CBT, I mean that the first outcome study was published in 1977. Ok? And

22:34 since then there has been a lot of research. There are more than 2000 outcome studies on this point. Studies have demonstrated that CBT has excellent efficacy for a wide range of psychiatric disorders, psychological problems, and medical problems with psychological components. Right? Meaning it is empirically verified. One of the best empirically based therapies. Many studies have also shown that CBT helps prevent and reduce severity of future episodes A study by Vern Brachschel and colleagues on 20th November 2019 for example showed that outpatients with a range of psychiatric disorders who were treated with CBT and routine care continued to improve between five and 20 years after

23:21 the end of therapy more so than those who received medical treatment Right so this is a section from within the book. Right? And here I have told you that the efficacy is very good. And that means the results of the treatment are showing you improvement. Correctly, I mean if we look at the course of development of therapy from 1950 till contemporary times, what was the development process of therapy regularly? So Beck wanted to test psychoanalytic assumptions to see how accurate it was empirically. Freud used to say that the

24:07 reason for depression and neurosis is that we have a wish to suffer, that is, hostility that is turned inward towards the self is the reason of neurosis. So when Beck investigated this, he investigated the dreams of depressed clients and the prediction, the hypothesis was that patients who have depression will have a greater theme of hospitality in their dreams than those who do not have depression. Ok? So there were two groups. So the findings that came out were contrary to his hypothesis and predictions. She found that the dreams of depressed clients contain fewer themes of hospitality and for

24:52 greater themes of defectiveness, deprivation and loss. He recognizes that these themes pertain to what his clients are thinking when they are awake. So, what he found is that there is no hostility as Freud had said. So his hypothesis, his assumption has become invalid. So he found out many themes which were related to his negative thinking. She saw these themes in her dreams, and noticed that her clients in sessions with her manifested these thought processes through their conversations. Both things are the same in dream and awake periods. So, I mean, now he has started asking this question. Freud's idea was rejected. So how could depression be understood? Correct. So he discovered that there are two types of

25:40 thinking among clients. There is a free association stream and a stream of quick evaluative thoughts that relate to the clients' own self. Here is an example of a female client who was sharing her sexual experiences. Right? And when the session was over she spontaneously reported that she was feeling awkward. So Beck gave this interpretation in a classical psycho-analytic style. You thought I was criticizing you. The client said this: No I was afraid, I was boring you. Correct. So, the dynamic going on here is that the client is assuming the thought of the therapist that what I think your thinking is that I'm boring. His assumption is that my

26:25 therapist is getting bored with me. Although it was totally opposite because the therapist's assumption was that the client might be thinking that I am criticizing him. So from here he realized that there are thinking processes, there are assumptions which are unique for every individual. And this client is feeling anxious and reporting this feeling only because her thought process is like this. I was afraid that I might bore my therapist. So he drew the connection from here that yes there are internal cognitions which affect our feelings and by extension also affect our behaviour. So this was Yuri's moment.

27:11 Further meaning that all of the clients experience automatic negative thoughts that are closely tied to their emotions. Right? There will be negative thinking, there will be negative emotions. Right? Which we saw in the example. So, it means I begin to help my clients identify, evaluate and respond to their unrealistic and manipulatory thinking when he did so they rapidly improve. So these three things are basically a part of the therapeutic process in therapeutic CBT - identifying thoughts, evaluating your thoughts, validating their accuracy, i.e. how many percent of it is true, i.e. doing a cost benefit analysis, right and then learning that skill set of how to respond to my thought processes,

27:58 negative thoughts and how to generate alternative thoughts. Right? This is a complete therapeutic process. So, it meant that it was based on unrealistic and negative maladaptive thinking and because of this, the emotional and behavioural state of his clients started improving rapidly. Now the main study that was done at this time was a randomized control study among depressed clients. True, there was a group that was being given CBT. The second group was given imipramine to treat depression. And this was the first time a study compared talk therapy with a medication. And this was proved by the study, especially a follow-

28:43 up study was done, it was proven that cognitive behavior therapy is actually more effective than medication. And that means that even in preventing relapse, CBT was more effective than Imipramine, the anti-depressant. Correct. So it means that CBT results are coming at this level. At that time, in the 1970s and 1960s, an empirical grind started and further these studies were expanded and disorders like anxiety, substance abuse, personality disorders, couple problems, hostility by polar disorder and other conditions were included using the same study process of randomized study, so that means, their process was,

29:31 first they made clinical observations about the disorders, then they outlined the main factors and key cognitions, which were the signature thoughts, underlying beliefs and emotions and behaviors that they observed in that particular clinical observation, which occur in particular disorders. They then tested their theories, adapted treatments, and conducted randomized and controlled trials to study whether CBT works for these disorders. Right? And well this was the end of the lecture right. And I really hope that you learn something from today's lecture. Insha Allah I will continue the series of Cognitive Behaviour Therapy in the future.

30:16 If you have any questions you can ask in the comment section. If you want me to continue this. If you are interested then please subscribe and like. And you know be a part of this channel. I can guarantee you one thing that you will learn a lot. I will give you everything in the format of lectures. So it would be literally like that you are taking a class at a university. Anyway I will see you in my next lecture. And for now Allah Hafiz.