Course leader: Cheryl.Jordan@kcl.ac.ukExt: 0207848 3285

Session 1Session 1 Concepts theories and models Concepts theories and models underpinning CBT practiceunderpinning CBT practice

Process of therapy Process of therapy

Session 2 Session 2 Assessment, formulation and Assessment, formulation and measurement. measurement.

Overview of cognitive behavioral Overview of cognitive behavioral techniquestechniques

Socratic techniqueSocratic technique

Session 3 Session 3 Cognitive behaviour approach to Cognitive behaviour approach to understanding and treating anxiety understanding and treating anxiety problems problems

Session4Session4 Cognitive behaviour approach to Cognitive behaviour approach to understanding and treating understanding and treating depressiondepression

Session 5 Session 5

Session 6 Session 6

CBT approaches to understanding CBT approaches to understanding and treating psychosisand treating psychosis

Third wave of CBTThird wave of CBT

To complete the course and receive the award students must successfully complete a 2500 word essay based on a case study which will be provided. The essay will focus on the student’s ability to present a cognitive behavioural formulation of the information presented in the case study, identifying maintaining factors and suitable targets for CBT work. The student will be asked to identify treatment strategies based on this formulation with reference to the evidence base for supporting these potential interventions.

The assignment should include the following: A brief explanation of CBT and its main principles.  Discuss the role of formulation within CBT work and its strengths/weaknesses.  Provide a description of your formulation of the case study (provided) with clear

identification and explanation of maintaining factors.  Identify from the formulation possible targets for CBT work.  Provide a rationale for and description of possible treatment strategies for these

identified targets with reference to the theory and evidence base underpinning these selected strategies.

 Brief consideration of potential obstacles or limitations to the success of these strategies.

   

► ►What is your current understanding of CBT

and its core characteristics?

Cheryl Jordan

“Man is not affected by events but by the views he takes of them” ( Epictetus)

“There is nothing good or bad but thinking makes it so” ( Hamlet, Shakespeare)

Cognitive principleEmotional reactions are strongly

influenced by cognitions

Behavioural principleWhat we do is crucial in maintaining or in changing psychological states

The continuum principleEmotional problems arise from exaggerated versions of Normal process

Here and nowFocus on what’s happening in the present and what processes are maintaining it.

Interacting systems

Characteristic cognitions in different problems

Depression: negatively biased views themes of loss and failure

Anxiety: Overestimation of threat

Anger ?

Collaborative Structured and active engagement Time limited Empirical in approach Problem orientated Guided discovery Behavioural methods In vivo work Summaries and feedback

Albert Ellis 1913-2007 considered as the second most influential psychotherapist in history ( USA,Canada)Carl Rogers ranked first Sigmund Freud was ranked third

AActivating event

Rational beliefFlexible Self/other acceptingHigh frustration tolerance

Irrational BeliefRigidSelf/other downingLow frustration tolerance

Consequenceshealthy negative emotionhelpful behaviourAdaptive Cognitions

ConsequencesUnhealthy negative emotionsUnhelpful behaviourBiased cognitions

A

Rational beliefI prefer to pass but it is possible I may not, if I do it proves I am a fallible Human and I can tolerate it

Irrational BeliefI want to pass therefore this must happen, If i don’t it’s Proof I am a total failureI can’t stand it

Consequencesconcerned Focus on task at handGiving it my best

ConsequencesanxietyProcrastinate I going to fail, I’ ll never cope

Completing assignment

Please read the chapter Fit the information given into the ABC

model

ANo current partner

Rational beliefI would prefer to be in a relationship, I can accept myself if i am not.

Irrational BeliefI want to be in a relationship, therefore I absolutely should be. The fact I am not is proof I am defective.

ConsequencesSadSeek out reinforcements

ConsequencesDepression no one wants me There is something wrong with me Think about past failed relationshipswithdraw

Watch the clip Keep the ABC model in mind, see if you can

identify the problem......

Cognitive consequences

Behaviour( action

Tendencies)

Un/healthy negative emotion

Think of the last time you felt angry about something.

Can you remember what you felt most angry about? went through your mind?

What did you do or feel like doing?

Cognitive consequences

Behaviour( action

Tendencies)

Un/healthy negative emotion

OverestimatesExtent to which other person acted Deliberately.See’s malicious intent in action of otherSelf right other wrongUnable to see others point of viewPlots to exact revenge

Hit, shout, sulk, kick the cat,Recruits allies against others

Trained as a psychoanalytic analyst at the Philadelphia Psychoanalytic Institute.

(1921-….)

EarlyExperience

Core Beliefs

Rules andAssumptions

CriticalIncident

Emotion

thinking

Behaviour

physiology

Self, world, others

If ……. Then……..I must………

EarlyExperience

Core Beliefs

Rules andAssumptions

CriticalIncident

Emotion

thinking

Behaviour

Somatics

I am not as lovable as other people

I should be in a relationship if not then …………

Relationship not working outSeeing others in relationships

depression

What am I doing wrongThink about past Relationships , no one wants me.

Withdrawruminates

Low energy

Core Schema

Assumptions

Negative automatic thoughts

Trigger: critical incident

Thoughts

Mood

Behaviour

Physical

Have a look at the film clip and map the information to the model.

What event triggered her reaction? What negative automatic thoughts is this

lady experiencing? How is this effecting her mood?

Behaviour?

Survey by Wright and Davis(1994), found that clients wanted their therapists to:

Offer physically safe, private, confidential setting free from distractions

Be respectful Treat concerns seriously Prioritise client interests over own Be competent Share information Permit client to make own choices Be flexible not assume the client fits a theory Review progress Pace , not rush or keep changing appointments

Therapeutic Relationship, 30%

Extratherapeutic change, 40%

Expectancy (Placebo effects) , 15%

Techniques, 15%

What works in Therapy? – Traditional view

Adapted from Lambert (1992)

How would you define each of these?

Consider what you think about the basic principles of CBT. Do they make sense to you?

What do you think of the theory underpinning CBT? does it make sense ? Does it fit with your experience?

1) Therapeutic relationship: engage and facilitate collaborative working process

2) Comprehensive assessment: Detailed picture of problem within context of person’s life experiences and history

3) Problems & Goals: agree on a ‘CB’ definition of problem set goals

4)Clinical Ratings: baseline ratings symptoms distress disability progress evaluated set time frame and target

5) Formulation; Develop shared understanding of problem and it’s maintenance.

6) Treatment rationale: explanations of how and why CBT could work with the problem

7) Interventions: aims reduce symptoms, increase coping

8) Evaluation: Of interventions for effectiveness

9) Relapse prevention: Maintain gains prevent relapse

10) Discharge.

11) Follow-up: further reflection on practice learnt . Set new long term goals

Phobic disorders Anxiety disorders (GAD panic disorder) Obsessive compulsive disorder Mild-moderate depression Post-traumatic stress disorder Eating disorder Substance abuse (alcohol, cocaine) Sexual dysfunction Habit & impulse control disorders Psychosis

Bipolar disorders Delusional disorders Personality disorders Severe depression Depression and anxiety associated with

long term chronic health problems

Observe your own experience and/or those of the clients you work. If you or they are upset about something See if you can identify what they/you are upset about, what patterns of thinking, feeling and behaving are occurring?

Branch R, Dryden W 2008, The cognitive behaviour counselling Primer. Athenoeum Press, UK.

Dryden W, 2001 10 steps to positive living. Sage. London Hawton K, Salkovskis P, Kirk J, Clark D,

1993, Cognitive behaviour therapy for psychiatric Problems. Oxford University Press.Oxford.

Beck A T, The current state of Cognitive Behaviour Therapy.Archive of Gen Psy 2005;629-539