COGNITIVE BEHAVIORAL THERAPY

Modern CBT Theory

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, identifies healthy behaviors and set goals to accomplish those behaviors

Characteristics of Cognitive-Behavioral Therapies:

1. Thoughts cause Feelings and Behaviors.
2. Brief and Time-Limited.

3. Emphasis placed on current behavior.

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.

6. Based on "rational thought." - Fact not assumptions.

7. CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits. 8. Based on assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting.

9. Homework is a central feature of CBT.

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

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

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

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 ?

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

Therapy Skills
Engagement Warmth and empathy Collaboration Guided discovery socratic questioning Feedback and summarising Agenda setting structure and focus Open and closed questioning

Course of treatment
Identify specific problem list (& prioritise)
Eg. Poor sleep, relationship difficulties etc

Introduce cognitive model how it might apply to client Goals (SMART) Reduce symptoms through behavioural or simple cognitive strategies Identify and challenge NATs Relapse prevention

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?

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

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)

Behavioural Interventions
Very powerful method of bringing about change Key component of CBT intervention Borrowed and adapted from Behaviour Therapy Incorporate different methodological approaches

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 BT graduated, repeated and prolonged exposure In CBT - New ideas are put to the test. Means of testing the validity thoughts, perceptions, beliefs.

Examples
Hyperventilation to simulate panic Activity monitoring and scheduling Metaphors South 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

Problem solving
Identify problem to be worked on Think of as many solutions as possible Consider each solution pros & cons Pick solution that appears best Small steps Action & review

Common Sense Model

Event
Cognitive Model

Emotion

Event

Meaning we give the event

Emotion

Negative Automatic Thoughts

Assumptions Core beliefs

Negative Automatic Thoughts

Stream of thoughts that we can notice if we try to pay attention to them (automatic) Negatively tinged appraisals or interpretations meanings we take from what happens around us or within us Specific thoughts about specific events or situations Brief, frequent, habitual often not heard Plausible and taken as obviously true, especially when emotions are strong

3rd Wave 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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