Cognitive Behavioral Therapya

8/12/2019 Cognitive Behavioral Therapya

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COGNITIVE BEHAVIORAL THERAPY


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3

Modern CBT Theory


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Difference between CT &CBT

In their approaches

CT- identifies unhealthy thought processes

and works to change them to a more positive

and realistic one.

CBT- it also targets behaviors, identifieshealthy behaviors and set goals to accomplish

those behaviors


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Characteristics of

Cognitive-Behavioral Therapies:

1. Thoughts cause Feelings and Behaviors.

2. Brief and Time-Limited.

3. Emphasis placed on current behavior.


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4. CBT is a collaborative effort between the

therapist and the client.

Client role- define goals, express concerns,

learn & implement learning

Therapist role- help client define goals, listen,

teach, encourage.

5. Teaches the benefit of remaining calm or

at least neutral when faced with difficult

situations. (If you are upset by your

problems, you now have 2 problems: 1) the

problem, and 2) your upsetness.


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6. Based on "rational thought." - Fact notassumptions.

7. CBT is structured and directive. Based onnotion that maladaptive behaviors are theresult of skill deficits.

8. Based on assumption that most emotionaland behavioral reactions arelearned. Therefore, the goal of therapy is tohelp clients unlearn their unwanted reactions

and to learn a new way of reacting.9.Homework is a central feature of CBT.


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Aims of Assessment

Initiate & develop therapeutic relationship

Establish suitability for CBT

Gather specific information recurrent difficulties

Elicit maintaining factors

Initial formulation

Socialise to CBT model Establish joint understanding of the presenting

problem


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Suitability for short term CBT

Ability to identify & describe negative thoughts

Awareness & differentiation of emotion

Compatibility with CBT rationale

Acceptance of personal responsibility for change

Alliance potential

Chronicity of problem

Security operations

Focality

Optimism/pessimism regarding therapy


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Typical CBT treatment session

Set collaborative agenda

Review time since last session

Feedback on last session

Review homework

Focus on major topics for the session

Set homework Potential problems with completing homework

Feedback on session


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Overview of a typical course of

therapy Assessment, Formulation

Treatment: start with symptom focused

intervention

Review: every six sessions, repeat measures

Discharge: repeat measures, relapse

prevention Follow up / booster sessions:

1,3,6,12 month ?


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Overview of a typical course of

therapy

Referral

Assessment: suitability, therapeutic relationship

Assessment (ongoing): problem analysis, wider

picture, measures Problem list & prioritise

Goals for therapy (SMART)

Formulation (ongoing): Sharing model,maintaining factors, predisposing factors,rationale for treatment


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Therapy Skills

Engagement

Warmth and empathy

Collaboration

Guided discoverysocratic questioning

Feedback and summarising

Agenda settingstructure and focus

Open and closed questioning


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Course of treatment

Identify specific problem list (& prioritise)

Eg. Poor sleep, relationship difficulties etc

Introduce cognitive modelhow it might apply to

client Goals (SMART)

Reduce symptoms through behavioural or simple

cognitive strategies

Identify and challenge NATs

Relapse prevention


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Homework

Identify a recent significant shift in mood

What was the situation?

How did you feel?

What was going through your mind at the

time?

What did you do?

What were the consequences?


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Cognitive Interventions

Restructuring thoughts and beliefs

Guided discovery

Thought diaries

Challenging NATs (looking at evidence)

Addressing thinking errors

Responsibility Pie

Cost/Benefit Analysis

Downward Arrow technique


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Cognitive Interventions

Education Eg. Written information on

thinking errors, disorder specific info

Continuous use of formulation

Imagery techniques

Role play & role reversal

Action Plan

Education in Body systems (symptoms)


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Behavioural Interventions

Very powerful method of bringing about

change

Key component of CBT intervention

Borrowed and adapted from Behaviour

Therapy

Incorporate different methodological

approaches


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Behavioural Experiments

Similar in BT / CBT, but fundamentally different

In BT, it is the end product, in CBT, a means to

an end ie. Cognitive change In BTgraduated, repeated and prolonged

exposure

In CBT - New ideas are put to the test. Meansof testing the validity thoughts, perceptions,

beliefs.


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Examples

Hyperventilation to simulate panic

Activity monitoring and scheduling

MetaphorsSouth American tribe?

Consider experiment for client with OCD,

believes something terrible will happen to

family if he doesnt neutralise his thought

by doing rituals for up to an hour


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Problem solving

Identify problem to be worked on

Think of as many solutions as possible

Consider each solutionpros & cons Pick solution that appears best

Small steps

Action & review


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Event

Event

Emotion

EmotionMeaning

we give

the event

Common Sense Model

Cognitive Model


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Negative Automatic Thoughts

Assumptions

Core beliefs


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Negative Automatic Thoughts

Stream of thoughts that we can notice if we try topay attention to them (automatic)

Negatively tinged appraisals or interpretationsmeanings we take from what happens around us or

within us Specific thoughts about specific events or situations

Brief, frequent, habitualoften not heard

Plausible and taken as obviously true, especially

when emotions are strong


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3rdWave of CBT

Acceptance and Commitment Therapy

Dialectical Behavior Therapy

Mindfulness-based Cognitive Therapy Mindfulness-based Stress Reduction

Mindfulness-based Relapse Prevention

Mindfulness-based Therapy for GAD


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THANK YOU

Documents

Cognitive Behavioral Therapya