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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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