cognitive behavioural therapy. historical perspective psychotherapy and psychological approaches...

COGNITIVE BEHAVIOURAL THERAPY

COGNITIVE BEHAVIOURAL THERAPY

Historical perspective

• Psychotherapy and psychological approaches• Psychodynamic therapies v behavioral approaches• Emergence of Cognitive Therapy• Development of Cognitive Behavioural Therapies• Third wave CBT (Hayes 2004)

Evidence base

• Systematic reviews

• What works for whom

• NICE

• Depression

• PTSD

• OCD & BDD

Behavioural perspective

• We are products of our environment• The continuum principle- problems arise from

exaggerated or extreme versions of normal processes rather than pathological states which are different and inexplicable. (Wesbrook,Kennerley, Kirk, 2007)

• Intensity, frequency and duration• Behaviour is crucial in maintaining psychological

states

Learning TheoryLearning Theory

Classical conditioningOperant conditioningTwo Factor theory

Classical conditioningOperant conditioningTwo Factor theory

Practical application

• How many of your actions prior to coming have you thought about?

• How many did you not?• How much is habit?• Do you ever think of the consequences

or alternatives?• How much do we just respond?• How much is conditioned/learnt?

Cognitive Therapy

• AT Beck• Stoic philosophy Epictetus 135 AD• Men are disturbed, not by things but by the principles

and notions which they form concerning things• Some things are in our control and others not. Things

in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.

COGNITIVE MODEL OF EMOTIONAL RESPONSE: THE SIMPLEST VERSION

EVENT↓

INTERPRETATION OF EVENT↓

EMOTIONAL RESPONSE

SIMPLICITY V ELEGANCE

• TO BE ABLE TO THINK ABOUT YOUR THINKING

• UNDERSTAND HOW RESPONSES ARE MAINTAINED

• UTILISE PSYCHOLOGICAL EVIDENCE FOR THE MAINTENANCE OF DISTRESS

• HOW TO CHANGE• TO BECOME YOUR OWN THERAPIST

EXPERIENCE

BELIEFS AND ASSUMPTIONS

CRITICAL INCIDENT/

PRECIPITATING EVENT

COGNITION Thoughts and beliefs

AFFECT/ EMOTIONAL STATE

PHYSIOLOGY

BEHAVIOUR What one does or says

Generic CBT model

Through experience we develop core beliefs and assumptions.They are both functional and dysfunctional (helpful or unhelpful).Critical incidentEvokes negative thoughts behaviour, emotions and physiological changes

MAIN CHARACTERISTICS

• STRUCTURED• PROBLEM ORIENTATED• A-HISTORICAL• LEARNING MODEL • SCIENTIFIC METHOD• HOMEWORK• COLLABORATION• ACTIVE AND DIRECTIVE• SOCRATIC QUESTIONING• OPENNESS

APPLICATION

COMMON PSYCHIATRIC PROBLEMS

• DEPRESSION

• ANXIETY

• OCD

• PTSD

• PANIC

• PHOBIAS

NONE PSYCHIATRIC

• PAIN

• IBS

• DIABETES

• EPILEPSY

TECHNIQUES

• PSYCHOEDUCATION• EXPOSURE• RELAXATION• ACTIVITY SCHEDULING• IMAGERY• BEHAVIOURAL EXPERIMENTS• SYMPTOM INDUCTION• REATTRIBUTION- QUESTIONING EVIDENCE COUNTER

EVIDENCE, LABELLING, USE OF RATIONAL RESPONSES, COST BENEFIT ANALYSIS

PHOBIA

• PSYCHOEDUCATION

• EXPOSURE

• BEHAVIOURAL EXPERIMENTS

PANIC AND AGOROPHOBIA

OCD & BDD

SOCIAL ANXIETY

PTSD

GENERALISED ANXIETY

DEPRESSION

DEPRESSION