Hofmann cbt latest thinking slides

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CBT: Latest ThinkingCBT: Latest Thinking

Stefan G. Hofmann, Ph.D.Stefan G. Hofmann, Ph.D.

Professor of PsychologyProfessor of Psychology

Boston UniversityBoston University

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What is the Cognitive Model?What is the Cognitive Model?

Men are not moved by things, but the view they take of themEpictetus (Greek Stoic Philosopher, 55-134 AD)

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What is the Cognitive Model?What is the Cognitive Model?

Men are not moved by things, but the view they take of themEpictetus (Greek Stoic Philosopher, 55-134 AD)

Things (Stimulus)

View of Things(Cognitive Appraisal)

Being Moved(Emotional Response)

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What is the Cognitive Model?What is the Cognitive Model?

If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.

Marcus Aurelius (121-180 AD; Meditations)

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What is the Cognitive Model?What is the Cognitive Model?

If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.

Marcus Aurelius (121-180 AD; Meditations)

Anything External(Stimulus)

Estimate of Thing(Cognitive Appraisal)

Distress and Pain(Emotional Response)

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What is the Cognitive Model?What is the Cognitive Model?

There is Nothing Either Good or Bad, but thinking makes it so.

William Shakespear (Hamlet)

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What is the Cognitive Model?What is the Cognitive Model?

Something(Stimulus)

Thinking(Cognitive Appraisal)

Something isGood or Bad

(Emotional Response)

There is Nothing Either Good or Bad, but thinking makes it so.

William Shakespear (Hamlet)

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MaladaptiveCognitiveAppraisal

TriggerSubjective Experience

Physiological Symptoms

BehavioralResponse

Maladaptive Beliefs

Attentional Processes

Generic CBT ModelGeneric CBT Model

Adapted from: Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford, UK: Wiley-Blackwell.

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Spider willattack me

Spider or object thatlooks likespider

Feelingof fear anddisgust

Heart racing

Escaping

Spiders are dangerous

Scanning environmentfor spiders or monitoringspider

Spider PhobiaSpider Phobia

Adapted from: Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford, UK: Wiley-Blackwell.

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I am having a heart attack

Heartis beating fast Feel

Anxiety

Heart is beating even faster

Get out of situation, Look for help

I have to be in control of my body at all time

Focus on heart

Panic DisorderPanic Disorder

Adapted from: Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford, UK: Wiley-Blackwell.

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MaladaptiveCognitiveAppraisal

TriggerSubjective Experience

Physiological Symptoms

BehavioralResponse

Psychoeducation,CognitiveRestructuring

Exposure

BehavioralModification

Acceptance

Relaxation

BehavioralActivation

BreathingRetraining

AttentionModification

SituationModification

Maladaptive Beliefs

AttentionalProcesses

Mindfulness Meditation

Adapted from: Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford, UK: Wiley-Blackwell.

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Emotion Regulation Emotion Regulation Strategies (I)Strategies (I)

Adapted from: Gross, J.J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281-291.

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Emotion Regulation Emotion Regulation Strategies (II)Strategies (II)

Adapted from: Gross, J.J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281-291.

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From: Hofmann et al. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29, 409-416.

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Adapted from: Doehrmann, O., Ghosh, S. S., Polli, F. E., Reynolds, G. O., Whitfield-Gabrieli, S., Hofmann, S. G., Pollack, M., & Gabrieli, J. D. (2013). Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry, 70, 87-97.

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From: Doehrmann, O., Ghosh, S. S., Polli, F. E., Reynolds, G. O., Whitfield-Gabrieli, S., Hofmann, S. G., Pollack, M., & Gabrieli, J. D. (2013). Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry, 70, 87-97.

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NMDA ReceptorNMDA Receptor

Glutamate Glycine

Extracellular

Intracellular

Adapted from: Hofmann et al. (2012). Enhancing exposure-based therapy from a translational research perspective. Behaviour Research and Therapy, 45, 1987-2001.

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NMDA ReceptorNMDA Receptor

Glutamate Glycine

Ca2+

LTP

NMDA ReceptorExtracellular

Intracellular

Adapted from: Hofmann et al. (2012). Enhancing exposure-based therapy from a translational research perspective. Behaviour Research and Therapy, 45, 1987-2001.

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NMDA ReceptorNMDA Receptor

Glutamate

Ca2+

D-cycloserine

LTP

NMDA ReceptorExtracellular

Intracellular

Adapted from: Hofmann et al. (2012). Enhancing exposure-based therapy from a translational research perspective. Behaviour Research and Therapy, 45, 1987-2001.

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SPAI Scores

Pre-Test Post-Test 1-mo FU

SP

AI

-to

tal S

core

s

60

80

100

120

140

Placebo (N = 13)D-cycloserine (N = 10)

From: Hofmann et al. (2006).  Augmentation of exposure therapy for social anxiety disorder with d-cycloserine. Archives of General Psychiatry, 63, 298-304.

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ConclusionConclusion The most effective contemporary psychotherapy (CBT) is The most effective contemporary psychotherapy (CBT) is

founded on cognitive appraisal models. founded on cognitive appraisal models.

Cognitive reappraisal is a powerful emotion regulation Cognitive reappraisal is a powerful emotion regulation strategy. Modern psychotherapy approaches have also strategy. Modern psychotherapy approaches have also incorporated emotion regulation strategies (e.g., incorporated emotion regulation strategies (e.g., mindfulness techniques).mindfulness techniques).

These strategies can complement and enhance traditional These strategies can complement and enhance traditional CBT.CBT.

Neuroscience methods can augment and predict outcome Neuroscience methods can augment and predict outcome for these treatments.for these treatments.

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