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COGNITIVE BEHAVIOURAL THERAPY

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Page 1: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

COGNITIVE BEHAVIOURAL THERAPY

COGNITIVE BEHAVIOURAL THERAPY

Page 2: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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)

Page 3: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

Evidence base

• Systematic reviews

• What works for whom

• NICE

• Depression

• PTSD

• OCD & BDD

Page 4: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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

Page 5: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

Learning TheoryLearning Theory

Classical conditioningOperant conditioningTwo Factor theory

Classical conditioningOperant conditioningTwo Factor theory

Page 6: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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?

Page 7: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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.

Page 8: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

COGNITIVE MODEL OF EMOTIONAL RESPONSE: THE SIMPLEST VERSION

EVENT↓

INTERPRETATION OF EVENT↓

EMOTIONAL RESPONSE

Page 9: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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

Page 10: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

EXPERIENCE

BELIEFS AND ASSUMPTIONS

CRITICAL INCIDENT/

PRECIPITATING EVENT

COGNITION Thoughts and beliefs

AFFECT/ EMOTIONAL STATE

PHYSIOLOGY

BEHAVIOUR What one does or says

Page 11: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

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

Page 12: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

MAIN CHARACTERISTICS

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

Page 13: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

APPLICATION

Page 14: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

COMMON PSYCHIATRIC PROBLEMS

• DEPRESSION

• ANXIETY

• OCD

• PTSD

• PANIC

• PHOBIAS

Page 15: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

NONE PSYCHIATRIC

• PAIN

• IBS

• DIABETES

• EPILEPSY

Page 16: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

TECHNIQUES

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

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

Page 17: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

PHOBIA

• PSYCHOEDUCATION

• EXPOSURE

• BEHAVIOURAL EXPERIMENTS

Page 18: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

PANIC AND AGOROPHOBIA

Page 19: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

OCD & BDD

Page 20: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

SOCIAL ANXIETY

Page 21: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

PTSD

Page 22: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

GENERALISED ANXIETY

Page 23: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

DEPRESSION

Page 24: COGNITIVE BEHAVIOURAL THERAPY. Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence

DEPRESSION