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Event Emotion
Cognitive Model
Meaning
Event we give Emotion
the event
You’re walking down the High
Street, and someone you know
walks by without acknowledging
you…
4 interpretations – 4 emotions
I don’t want her to see me, I won’t know what to say – she’ll think I’m stupid &
boring
ENVIRONMENT
THOUGHTS
BIOLOGY MOOD /
FEELINGS
BEHAVIOUR
ENVIRONMENT
On Plane
Turbulence
THOUGHTS
We might crash
BIOLOGY
Heart racing MOOD / FEELINGS
Palpitations
Anxious 90%
Rapid breathing
Difficult to breathe –
choking sensation
BEHAVIOUR
Reassurance
seeking
Feelings & commonly associated thoughts
Groups
Think of a recent situation or event which resulted in a negative mood shift
– Anxiety
– Sadness
– Anger
Cognitive Model
Core Beliefs &
of Depression Assumptions
Beck (1979)
Critical Incident
Negative Automatic
Thoughts (NATS)
Behaviour Feelings
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
Identifying NATs
Shifts in Affect
Distinguish between thoughts and emotion and behaviour
Check for images
Cognitive Model of Depression
Negative cognitive triad
–Biased views of
◦ Oneself
– I am bad, useless, unlovable, worthless, a failure
◦ The world in general
– Nothing good happens, life is just a series of trials
◦ The future
– It will always be like this, nothing I can do will make any difference, what’s the point of anything?
Negative filter
– Remembering events
– Interpreting current events / situations
– Overgeneralising from small negative event to broad negative conclusion
Goals of therapy
Help the client counteract negative cognitive
biases, and develop more balanced view of herself,
the world, and the future
Restore activity levels – especially those that give
sense of pleasure or achievement
Increase active engagement and problem solving
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
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
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 ?
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
Therapy Skills
Engagement
Warmth and empathy
Collaboration
Guided discovery – socratic questioning
Feedback and summarising
Agenda setting – structure and focus
Open and closed questioning
Aims of Assessment
Initiate & develop therapeutic relationship
Establish suitability for CBT
Gather specific information re current 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
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?
Measures
The concept of measures is central to the CBT
approach, as it enables both client and practitioner
to evaluate the impact of interventions (Grant et al
2004)
They are important in the process of assessment and
aid the practitioner to develop a credible formulation
for the client, so that appropriate cognitive and
behavioural interventions can be used
Why Measures?
Assessment – to provide information
Baseline – subsequent measures will show extent of change
Effectiveness – helps to (objectively) demonstrate effectiveness of
therapy, and allow modification of treatment
Feedback
Knowledge - data collection & suggests areas for future research
What measures?
Standardised – developed for particular populations
and problems
–Eg. Beck Depression Inventory
–Beck Anxiety Inventory
–Agoraphobic Cognitions Questionnaire