cognitive behavioral therapya
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COGNITIVE BEHAVIORAL THERAPY
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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