COGNITIVE BEHAVIORAL THERAPY

BY AOUN ALI WADHO

M-PHIL-1

ICP KARACHI

COGNITIVE THERAPY

Psychotherapy aimed at changing way of thinking Several approaches to cognitive-behavioral therapy Cognitive behavioral therapy (CBT)

Rational Behavior Therapy

Rational Living Therapy

Dialectic Behavior Therapy

Rational Emotive Behavior Therapy

COGNITIVE BEHAVIORAL THERAPY

It is a talking therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

CAUSATION AND PSYCHOLOGICAL DISORDERS

According Aron Beck distress can be caused by a combination of biological environmental Social early childhood experiences

Lack of experience

These factors, interacting in a variety of ways, and lead to later so that causes for disorders

AUTOMATIC THOUGHTS

The automatic thought is a key concept in Beck’scognitive psychotherapy.

Such thoughts occur spontaneously, without effort orchoice.

In psychological disorders, automatic thoughts are often distorted,extreme, or otherwise inaccurate.

Example, Nancy put off applying to department stores for a job as an assistant buyer. Unhappy with her job as a sales clerk,she had such thoughts as “I’m too busy now,” “When the holiday season is over,I will apply for a job,” and “I cannot get time off to go to other stores to get job

applications.” Recognizing these thoughts as excuses,

Cognitive Development model

Earlychildhood

experiences

Development oschemas, basic

beliefs, andconditional belief

Criticalincidents

Automaticthoughts

Emotions

Behaviors

Physiologicresponses

COGNITIVE SCHEMAS IN THERAPYschemas develop

from personal experience and interaction with others.

There are two types of basic cognitive schemas

positive (adaptive)

negative (maladaptive)

COGNITIVE CONCEPTUALIZATION

Current Situation

Automatic ThoughtsAbout self, world

And others

Physiology

Feelings

Behavior

Childhood And EarlyLife Events

Underlying Assumptions and Core Beliefs

Compensatory Strategies

EXAMPLE 1 SituationPartner says: “I need time to be with my friends”

Automatic ThoughtsAutomatic response:

“Oh no, he’s losing interest and is going to break up

with me….”

PhysiologyHeart racingLump in throatFeelingsSadnessWorryAngerBehaviorSeek reassuranceWithdrawCry

Childhood ExperiencesParental neglectand criticism

Underlying Assumptions & Core Beliefs“I’m flawed in numerous ways, which means I’m not worthy of consistent attention and care. People only care when they want something.”

Compensatory StrategiesBe independent and you’ll be safe.Watch out – people are careless with you.

EXAMPLE 2

SituationDisappointingexam result

Automatic Thoughts“I am not going to get through this program -

I’m not as smart as everyone else.

People willdiscover this and I will be humiliated.”

PhysiologyPit in stomachDry mouth

FeelingsWorry, shame,DisappointmentHumiliation.

BehaviorUse alcohol,Procrastinate with homework

Childhood Adversities

Parental standardsreinforce academic

achievement

Underlying Assumptions“If I don’t excel in school, I’m a

total failure”

Compensatory Strategies

Work extra hardto offset

incompetence.

COGNITIVE DISTORTIONS

• All-or-nothing thinking. By thinking that something has to be either exactly aswe want it or it is a failure, we are engaging in all-or-nothing, or dichotomous,thinking.

• Selective abstraction. Sometimes individuals pick out an idea or fact from anevent to support their depressed or negative thinking

• Mind reading. This refers to the idea that we know what another person isthinking about us

• Negative prediction. When an individual believes that something bad is goingto happen, and there is no evidence to support this, this is a negative prediction.

COGNITIVE DISTORTIONS

• Catastrophizing. In this cognitive distortion, individuals take one event they areconcerned about and exaggerate it so that they become fearful.

• Overgeneralization. Making a rule based on a few negative events, individualsdistort their thinking through overgeneralization.

• Labeling and mislabeling. A negative view of oneself is created by self-labelingbased on some errors or mistakes.

COGNITIVE DISTORTIONS

• Magnification or minimization. Cognitive distortions can occur when individuals magnify imperfections or minimize good points

• Personalization. Taking an event that is unrelated to the individual and making it meaningful produces the cognitive distortion of personalization.

CORE BELIEFS• Core beliefs underlie and produce automatic

thoughts.• These assumptions influence information

processing and organize understanding about ourselves, others, and the future.

• These core beliefs remain dormant until activated by stress or negative life events.

• Categories of core beliefs (helpless, worthless, unlovable)

Automatic ThoughtsCore Beliefs

EXAMPLES OF CORE BELIEFS

• Helpless core beliefs• I am inadequate, ineffective, incompetent, can’t cope• I am powerless, out of control, trapped• I am vulnerable, weak, needy, a victim, likely to be hurt• I am inferior, a failure, a loser, defective, not good enough, don’t measure up

• Unlovable core beliefs • I am unlikable, unwanted, will be rejected or abandoned, always be alone• I am undesirable, ugly, unattractive, boring, have nothing to offer• I am different, flawed, defective, not good enough to be loved by others

• Worthless core beliefs• I am worthless, unacceptable, bad, crazy, broken, nothing, a waste• I am hurtful, dangerous, toxic, evil• I don’t deserve to live

SAMPLE THOUGHT LOGSituation Thoughts Emotions Rational

ResponseOutcome

Going on vacation—Ask a colleague to do some work for me

She’ll say no…I’m not doing a good jobThe boss thinks I take too much time off

Anxiety (70%)Guilt (40%)Sadness (20%)

Cognitive Distortions:All/nothingMindreadingFortune-TellingOver-generalization

I haven’t taken a day off in 6 months. We work as a team, so it’s also her job to track the samples.

Anxiety (10%)Guilt (0%)Relief (40%)

GOALS OF THERAPY

• Remove biases or distortions in thinking so that individuals may function more effectivelyAttention is paid to the way individuals process information, which may maintain feelings and behaviors that are not adaptivePatients’ cognitive distortions are challenged, tested, and discussed to bring about more positive feelings, behaviors, and thinking

• Changing cognitive schemas can be done at three different levelsschema reinterpretation

THERAPEUTIC PROCESS

Guided discovery

The three-question

technique.

1. What is the evidence for the belief?

2. How else can you interpret the situation?

3. If it is true, what are the implications?

Specifying automatic thoughts

Homework

Session format

.

Termination.

THERAPEUTIC TECHNIQUES

• idiosyncratic meaning. Different words can have differentmeanings for people, depending on their automatic thoughts and cognitiveschemas

• Challenging absolutes. Clients often present their distress through makingextreme statements such as “Everyone at work is smarter than I am.” Such statements use words like everyone, always, never, no one, and all the time

• Reattribution. Clients may attribute responsibility for situations or events tothemselves when they have little responsibility for the event

THERAPEUTIC TECHNIQUES

• Labeling of distortions. Previously, several cognitive distortions such as all-or nothing thinking, overgeneralization, and selective abstraction were described. Labeling such distortions can be helpful to clients in categorizing automatic thoughts that interfere with their reasoning

• Challenging all-or-nothing thinking. Sometimes clients describe things as all ornothing or as all black or all white

• Listing advantages and disadvantages. Sometimes it is helpful for patients towrite down the advantages and disadvantages of their particular beliefs or behaviors

THERAPEUTIC TECHNIQUES

• Cognitive rehearsal. Use of imagination in dealing with upcoming events can be helpful

• Decatastrophizing. Clients may be very afraid of an outcome that is unlikely to happen. A technique that often works with this fear is the “what-if” technique. It is particularly appropriate when clients overreact to a possible outcome,

Assessment in Cogniti

ve Therap

y

•Interview•Self-monitoring•Thought sampling•Scales and questionnaires.

APPLICATIONS OF CBT

• Mood Disorders • Unipolar Depression (1979)• Bipolar Disorder (1996)• Dysthymia and Chronic MDD (2000)

• Anxiety Disorders

• GAD (1985)• Social Phobia (1985)• Panic Disorder (1986)• OCD (1988)• PTSD (1991)

• Emotional Disorders (2006)

APPLICATIONS OF CBT (CONTINUED…)

• Eating Disorders (1981)• Marital Problems• Behavioral Medicine

• Headaches (1985)• Insomnia (1987)• Chronic Pain (1988)• Smoking Cessation• Hypochondriasis• Body Dysmorphic Disorder