Both approaches combine to formCBT. Everything conducted within CBT is evidence based,

Introduction

stated in the empirical principle (Westbrook, Kennerley & Kirk, 2007).

Throughout this assignment I aimed to change my exercise behaviour over a five week
Processes of change

period. I attempted to do so by increasing frequency of exercise using a behavioural

experiment. I drew upon cognitive behavioural therapy (CBT) frameworks and was able to

When change occurs, individuals have been found to progress through five stages,

appreciatethe process of change. The focus of this assignment will be reflections about the

highlighted in the cycle of change (Prochaska &DiClemente, 1982). The first stage is pre-

process experienced, part of the evaluation principle in CBT (Westbrook, Kennerley &

contemplation in which the individual sees little reason to change, accompanied by feeling

Kirk, 2007). Reflections relate to frameworks used, what I have learnt from the process and

unable to change. During this stage, clinicians provide information detailing positive aspects

how it may translate to clinical experience. Personal experiential work enhances a therapists

of change. The second stage is contemplation in which the patient can see the need to

personal development, aiding better practice (Bennett-Levy et al, 2005) and reflecting on

change. They are inquisitive about change, identifying pros and cons, but are unable to see

one-self during such processes is at the heart of CBT (Bennett-Levy, Thwaites, Chaddock

how it can be achieved. Clinicians will be reinforcing how change is possible. The third stage

& Davis, 2009).

is action in which the individual accepts need for change and sets goals. Engagement with
change commences while the individual monitors progress. Clinicians provide

Behavioural experiments are widely used in CBT to alleviate distress. BEsare influenced by
encouragement, praise and support, particularly when new barriers arise. The fourth stage is

the behavioural principle; taken from behavioural therapy (BT), stating behaviour
maintenance in which the individual is striving to consolidate change. There is a battle with

influences thought and emotion (Westbrook, Kennerley & Kirk, 2007). Historically BT
relapse so support from the therapist is crucial. The fifth potential stage is relapse; the

presented itself as a reaction to Freuds work on psychoanalysis, reported through narratives.

patient feels a sense of failure and may regress to old behaviour. Goals are neglected coupled

Behavioural therapists were not impressed by lack of empirical evidence-something which

with self-efficacy (Prochaska &DiClemente, 1982). These stages have been shown when

was of great importance to their epistemology. BT used empiricism to gain knowledge of

making a change within therapy or independently; demonstrated with smoking cessation

people and believed observable behaviour indicates how people feel. BT could only progress
(Prochaska & DiClemente, 1983). Furthermore, individuals typically progress through the

so far without recognising inner workings of our minds such as thoughts, beliefs and
stages in order; however some may regress throughout the stages then progress again

interpretations; such processes are inescapable for individuals (Westbrook, Kennerley &
(Prochaska & Diclemente, 1982). By acknowledging stages, therapists can be aware of what

Kirk, 2007). Cognitive therapy (CT) emerged as a result during the 1970s in the cognitive
input they should give and when.

revolution, focusing on these processes with Aaron Beck and Albert Ellis as influential
figures (Beck, 1962; Ellis, 1962; Beck, Rush, Shaw & Emery, 1987). BEs within CBT take

When this assignment was presented, I identified myself in the contemplation stage. I was

the same empirical stance of BT, but embraces the unobservable processes identified in CT.

aware I should increase exercise frequency but focused more on negative aspects such as not

2


3


an understanding of myissue, I created a formulation of my current situation, shown in figure

having enough time, loss of fitness and physical exhaustion without focusing on the

2.
positivesdespite being aware of them. My regular exercise is sporadic and I have been living
outside my value of I only live once, I need to look after myself. I see this as a conflict.
When I then began engaging, I noticed myself in the action stage. Aside from needing to

participate in change for this assignment, I acknowledged benefits. I made an effort to focus

Thoughts

Environment

on the positive aspects of exercising more. For me, these included improved mental and

Im being lazy My back will hurt

physical state and social time with friends.

I should exercise

Im not as good anymore.

Physical Reactions

Sadness, frustration,
anxiety/fear,
shame/disappointment

Blushing, increased heart rate, shaky,

butterflies


At the start of CBTand therefore at the beginning of my journey to change, an assessment is

Emotions

Im not fit enough anymore

carried out, where information about the problem is sought. Sometimes this is achieved by

Behaviour

using a timeline. I created a timeline to reflect upon frequency of exercise behaviour from

2004 to present day; shown in figure 1. It highlights as time goes on, exercise frequency

Avoid exercising, plan then fail to

exercise.

decreased.

Figure 2. My hot cross bun formulation illustrating processes prior to change. Taken from the hot cross bun


Exercising 4 times
 (athletics
a week
and judo)


model (Padesky & Greenberger, 1995)

Decrease to twice a week

(only judo)

Minor car crash, hardly any exercise

(sometimes none, sometimes once a
week- very sporadic)

This formulation shows thoughts triggered negative emotions andrelated symptoms. My


2004


2005

2006

2007

2008

2009

2010

2011

2012

Present day




behaviour wasavoidant or actions were unsuccessful. Each point on the cycle maintained
each other and in order for behaviour change to occur this cycle neededaltering.

Decrease to at least once a week (judo at University)

After formulating my maintenance cycle, I set a goal to provide structure for the five weeks.

In CBT goals should be SMART(Westbrook, Kennerley & Kirk, 2007):Specific,

Figure 1.Timeline showing exercise frequency from 2004- present day.

Measureable, Attainable, Realistic/Relevant and have a Time frame. This is shown in table
The therapist then collaboratively creates a formulation, attempting to make sense of the

1.0. I also used an ABC chartto monitor beliefs and emotions from a specific situation by

issue. The formulation can be conducted using the interacting systems principle, explained

identifying an activating event (A), and acknowledging subsequent thoughts and beliefs (B)

by the hot cross bun model (Padesky & Greenberger, 1995) incorporating physiological

and emotions, behaviour or physiological responses (C) (Ellis, 1962).

symptoms, emotions, behaviour and thoughts to create a maintenance cycle. In order to gain
4


5


Specific
Measureable
Attainable
Realistic/relevant
Time


By the end of the five weeks, I want to increase exercise behaviour to at least
once a week and feel good about it.
I will measure this by keeping a diary of activity in the form of ABC charts
This goal will be a challenge due to perceptions of self being not as good as I
used to be.
This goal is realistic and I am willing to achieve it. In addition, it is relevant to
my values of looking after myself.
16th October -20th November (my 5 week time frame)

others and the world (Bennett- Levy et al, 2004 as cited in Westbrook, Kennerley & Kirk,
2007). The thought tested may be derived from formulations or an ABC chart.
In order to set up the experiment, I identified a belief to be tested; If I exercise I will get
upset because Im not as good as I used to be. I used a graded hierarchy approach to prevent
feeling overwhelmed. I broke activities down into stages; details of each stage can be seen in

Table 1.0 My SMART goal for the five weeks.

figure 3. Stage 1 is the easiest with stage 4 being the hardest.

Facilitating change

Week one

With my SMART goal set, intervention started. Week one of my plan to facilitate change

wasnt successful. I planned toexercise twice, but didnt. Subsequently, two similar entries

were in my ABC diary. On both occasions triggering events were having the opportunity to

relax. Ithought I wouldrather be doing something else and had specific thoughts of Im tired

and I want to relax, consequently I failed to exercise;I experiencedemotions of guilt and

sadness.

Figure 3. Stages in my behavioural experiment using graded hierarchy approach

In CBT, psychoeducation has shown to be effective at reducing symptomsof depression,

Per
cei
ve
d
diff
icul
ty

4.Exercisingonmyownmorethanonceaweek
3.Exercisingonmyownonceaweek
2.Exercisingwithothersmorethanonceaweek
1.Exercisingwithothersonceaweek


In week two I planned to attend Zumba with my sisters once. In addition to planning, I laid

anxiety and distress (Donker, Griffiths, Cuijpers & Christensen, 2009); I reminded myself of

my clothes out before going out to encourage me to engage; this was my activating event and

the benefits of exercise by researching them.

was successful. Thoughts experienced were I had fun with my sisters and I enjoyed myself
and feel happy. Happiness is a positive emotion, so I experienced subsequent action
behaviours like smiling and laughing. This motivated me because I spontaneously went for a
run with a friend later that week. Again thoughts were positive and encompassed emotions of

Week two

happiness and pride.

I felt more positive in week two, given the research I had done, but felt I should conduct a

Week three

BE. BEs are designed to test the validity of a persons existing beliefs about themselves,

6


7


This week I attempted to move up the hierarchy to stage two, where I attempted to exercise

Zumba because of getting home late from university. Instead I planned to go swimming with

with others more than once this week. Despite technically completing this last week, I was

a friend. I enjoy swimming, but I tend to get ear infections, so in advance I purchased ear

reluctant to rush to stage three.

plugs to prevent this being an avoidance tactic. I explained to my friend about this assignment
and told her its important to me to attend. She text me a motivational message beforehand

Again, I planned to go to Zumba with my sisters, but I also planned to go for a run with one

whichreminded me of all the positives of exercising and subsequently I attended swimming. I

of them. Similar thoughts to last week, including I had fun were experienced, along with

thought I felt good because my friend said she was proud of me. I planned with the same

positive emotions. The encouragement of my sisters also helped, especially when running.
My sister told me how she needed external motivation, so we helped each other, which again

friend to go for a run later in the week, which I succeeded with.

elicited happiness and good feelings about me. This is the opposite to my belief in question

I was aware that the following week I should have attempted to move back up to stage three

so change was happening.

and begin exercising on my own. I drew upon my positive emotions and instead of driving to
town one day, I walked. I called this a 2.5 stage to the hierarchy. The walk was about half an

Week four

hour but I managed to do it on my own effortlessly. I am confident with walking this distance

In week four I moved to stage three on the hierarchy, which was to exercise on my own once.

compared to running. After, I felt emotions of pride.

I accepted I wouldnt include Zumba (as my sisters were there) but would still attend as I
Reflection

enjoy it. I planned to go for a short run later in the week. However, due to traffic on my way
home from university, I was late home and couldnt attend Zumba. This eventimpactedmy

Overall, I have found the process of facilitating behaviour change difficult. Although I didnt

mood, because in my thought diary, I wrotetraffic meant I couldnt go to Zumba. I added

reach stage four in the hierarchy, I felt positive after exercise which disproved the belief I

the stupid people in the traffic jam made me late, externalising the problem, even though it

was testing.

may have been something uncontrollable. I think this, in turn impacted on my emotions for

I found the hot cross bun formulation to be extremely useful throughout the process. I was

the rest of the week, meaning when I was planning to go for a run, I didnt. I felt I had failed

able to refer to it when filling out my ABC chart to track how thoughts changed and if

and experienced emotions of sadness and disappointment.

emotions became more positive. In CBT it is important to secure a formulation to refer to

throughout. Conversely, I found setting a SMART goal somewhat useful in providing overall
structure to the five weeks; however I didnt find myself referring to it throughout the

Week five
process.

Because of the difficulty I experienced in week four, I decided to move back to stage two:
trying to exercise more than once a week with others. I accepted I wouldnt be able to attend
8


9


I found the BE challenging but the graded hierarchy made it more manageable and made

Throughout the process, I encountered difficulty maintaining motivation. External motivation

change more likely. Despite this, Irelapsed in week three but I believe this could have been

such as family and friends aided success in engaging in exercise. I often spoke with family

prevented by including more stages to the hierarchy should I go through this process again. I

members and my boyfriend about positives of exercise, which helped. When I discussed this

think I over estimated how easy it would be for me to move up through the stages. This

assignment with peers, my worries about the behaviour change were relieved somewhat

highlights how in CBT attention should be put on including stages which are achievable and

because they validated my emotions, however because my family were unaware of the detail

realistic, otherwise, like me the individual may experience a sense of discouragement and

of CBT frameworks, they were less validating, saying things such as just do it! When

failure, resulting in lack of progress. I expected the process of moving through thesestages to

relating this to clinical experience, I believe its important to identify a support network

be quicker than it was; I found maintaining the exercise stated at each stage difficult, making

outside of therapy sessions, explain the workto them and draw upon this support should one

progression challenging. In week three I relapsed and didnt exercise at all. I can now

feel lacking in motivation as they can give you the boost you need and validate difficulties.

empathise with individuals who go through CBT and relapse too and having experienced the
Other factors impeding on change included emotional factors; I found it hard having to face

disheartening feeling, can understand the need for the support of the therapist to guide them
up to how little I exercise now compared to the amount I used to partake in. This elicited

and provide encouragement. When I succeeded, I could feel a sense of increased selfemotions of sadness and upset. However, events such as a minor car crash and medical issues

efficacy. The thoughts in my ABC chart were more positive and I went on to achieve more.
have been obstacles which have made engaging in more exercise difficult. In a clinical

The problem was maintaining this week by week.

setting, the individual may have intense emotional factors, which impede on change to a

During the process I have found it demandingreflecting to the extent that is needed within

greater extent. When we are emotional, our thoughts become irrational eliciting negative

CBT, specifically when monitoring thoughts derived from particular situations and then

automatic thoughts and in turn we may make negative appraisals about ourselves, resulting in

reflecting on emotions experienced. I felt uncomfortable and self-conscious. I found I was

negative emotions and behaviour.

asking myself questions to delve deeper in to reflection. For me, this demonstrated how
Environmental factors alsohad an impact on whether or not I engaged in exercise. It had been

important techniques such as guided discovery and socratic dialogue can be within a therapy
particularly windy and rainy the previous few weeks, which played a part in me missing

session because you are prompted to think deeper, whereas when you are alone it can be hard
planned exercise simply because I thought Id rather be inside. Other factors such as

to achieve (Wells, 1992).When relating to clinical experience, an individual partaking in CBT

university work load, seeing my boyfriend and spending time with my family got in the way

may have similar difficulties when reflecting and completing charts and diaries like the ABC
of me exercising. Arguably these could be seen as avoidant tactics, which may be the focus of

chart. Especially if it is the first time the individual has had to do this. So for someone going
sessions within CBT.

through this process, they must be aware of how best to deal with emotions that may arise.
Summary
11

10


By using the frameworks common in CBT, I was able to facilitate change of my exercise
behaviour by increasing frequency over the five weeks. I was somewhat successful with this
and provided evidence against my belief tested in the BE, which overall has given me a sense
of achievement. I encountered difficulties applying theory to practice, but when I succeeded,
I felt positive emotions. When I wasnt,I experienced a sense of failure so am able to
empathise with people who have CBT and appreciate how difficult the process of change can
be, even with a seemingly trivial issue.

References

Beck, A. T. (1976).Cognitive therapy and the emotional disorders.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1987). Cognitive therapy of depression.The Guilford Press.

Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective Practice in CognitiveBehavioural Therapy: The Engine of
Lifelong Learning.

Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2005). Oxford guide to behavioural experiments in
cognitive therapy. Oxford University Press.

Donker, T., Griffiths, K. M., Cuijpers, P., & Christensen, H. (2009). Psychoeducation for depression, anxiety and psychological distress: a
meta-analysis. BMC medicine, 7(1), 79.

Ellis, A. (1962), Reason and emotion in psychotherapy. Oxford, England: Lyle Stuart.

Greenberger, D., & Padesky, C. A. (1995). Mind over mood: Change how you feel by changing the way you think. The Guilford Press.

Prochaska, J. O., & DiClemente, C. C. (1982).Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy:
Theory, Research & Practice, 19(3), 276.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: toward an integrative model of
change. Journal of consulting and clinical psychology, 51(3), 390.

Wells, A. (1992). Stress. In A. Freeman & F. Dattilio (eds.): Comprehensive casebook of cognitive therapy. New York: Plenum Press

Westbrook, D., Kennerly, H. & Kirk, J. (2007).An Introduction to Cognitive Behaviour Therapy: Skills and Applications. Sage: London.


12


M ajut sau nu? Ce dovezi exist pentru a

( Ex.Trebuie absoltutist)

Suprarea , Tristeea, Regretul, Emoii

disfuncionale mai puin intense

Dezamgirea, ngrijorarea,

cuprind de exemplu:

Emoiile negative funcionale

Comportamenteadaptative

Ce dovezi exist pentru a susine credina mea iraional? Sunt acestedovezi consistente cu realitatea?

( ex. eu sunt o fiin uman , care poate grei n anumite situaii)

EVITAREA EVALURII GLOBALE I FOCALIZAREA PE COMPORTAMENTUL CONTEXTUAL

TOLERANA CRESCUT LA FRUSTRARE ( ex. nu mi place , dar pot s support i s m bucur de alte lucruri)

EVALUAREA CA NEPLCERE( ex. este ru, neplcut)

PREFERINELE NON-DOGMATICE ( ex. dorine. Ateptri)

Pentru a gndi mai raional urmrii

Ce trebuie s fac pentru a testa i modifica CI contientizabile i / sau prelucrrile incontiente care asociaz A i C

Este credina mea logic?

E NOUL EFECT

Emoiinegativesaupozitive
funcionale

Pentru a restructura CI ntrebaii-vCe effect are aceast convingere asupra mea?M ajut sau nu?

ASOCIERI INCONTIENTE AUTOMATE ( ex. fr CI contiente) NTRE A i C

Evaluarea globalex. Eu sau (ceilali/ lumea) sunt ru, lipsit de valoare

ITOLERANALA FRUSTRARE ( ex. nu suport)

CATASTROFAREA( ex. este groaznic, ngrozitor, oribil)

B-CI pentru a identifica ci urmrii: CERINE ABSOLUTISTE( ex.trebuie absolutist),

( ex. dorine, ateptri)

Ce effect are aceast convingere asupra mea? Preferinele non-dogmatice

CERINE ABSOLUTISTE

Pentru a gndi mai raional urmrii:

B-CR CREDINE IRAIONALE

Pentru a restructura CI ntrebaii-v

DISPUTAREA, RESTRUCTURAREA CI

Depresia, Furia-Mnia. Ruinea Gelozia, Vinovia

Printre emoiile negative dezaptative se numr: Frica-Anxietatea

Principalelecomportamentedezaptative:

Principaleleemoiinegativedezaptative/disfuncionale:

C CONSECINE

Pentru a identifica CI urmrii:

B-CI ( cogniii convingeri iraionale)

A poate fi un eveniment trecut , present sau viitor

A poate fi intern( emoie) , sau extern , real sau imaginar

probleme( ex. c ear vedea o camer video)

Rezumai pe scurt situaia A , n legtur cu care v facei

A EVENIMENT/ SITUAIE ACTIVATOARE

MODELUL ABC COGNITIV

COPYRIGHT International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health,
Babe-Bolyai University, Cluj-Napoca, Romania

MODELUL ABC - COMPORTAMENTAL

A
Stimuli

ANTECEDENTE

Prelucrri informaionale

cunotine procedurale

autoeficacitate

expectane

CONSECINE

Principalele ntriri pozitive:

Principalele ntriri negative:

Principalele pedepse:

Rezumai pe scurt situaia (A) n legtur cu care v facei probleme (ex. ce ar vedea o
camer video?)
A poate fi intern (ex. o emoie) sau extern, real sau imaginar
A poate fi un eveniment trecut, prezent sau viitor

B COMPORTAMENTUL OPERANT

MODIFICAREA ANTECEDENTELOR I A
CONSECINELOR

ntriri pozitive
ntriri negative
pedeaps

B NOUL COMPORTAMENT