Cognitive Behavioral Therapy Margaret Kuchler Clinical Psychology Spring 2016 •“CBT is a process of teaching, coaching, and reinforcing positive behaviors. CBT helps people identify cognitive patterns or thoughts and emotions that are linked with behaviors” (Somers, 2007) http://www.beatthewinterblues.info/wp-content/uploads/2013/07/positive-thinking.jpg https://www.summitiop.com/wp-content/uploads/2014/04/Why-Cognitive-Behavioral-Therapy-Is-A-Useful-T ool-In-Outpatient-Rehab.jpg What is Cognitive Behavioral Therapy? •Highly effective form of psychotherapy •How a person thinks, feels, and acts is all interconnected •Used to treat many disorders such as depression, anxiety, eating disorders, obsessive compulsive disorder and others •CBT is an umbrella term: many different types for various disorders http://bayareacbtcenter.com/wp-content/uploads/2014/07/Untitled.png http://pacificcognitivebehavioraltherapy.com/wp-content/uploads/2015/10/CBT-image.png http://thepredominantlyinattentivelife.com/2013/10/14/cognitive-behavioral-therapy-overview/ History of CBT •First developed in 1960s by Aaron Beck, a psychotherapist •Early 1960- Beck developed an approach known as cognitive therapy from his research on depression •Beck’s observation of depressed patients revealed that they had a negative bias in their interpretation of particular life events, contributing to their cognitive distortions •Originally referred to as cognitive therapy because of the emphasis placed on thinking. –Now known as cognitive-behavioral therapy because the therapy employs behavioral techniques also Basic Principles of CBT •Present-oriented –Here and now approach •Teamwork –Collaborative effort between the therapist and patient •Therapist role- listen, motivate, teach patient, help patient set goals •Patient role- voice concerns, implement learning, define managable goals http://s1290.photobucket.com/user/forharriet/media/For%20Harriet/therapy_zps2bea600c.jpg.html Basic Principles of CBT •Socratic Questioning –Asking questions that guide patient and change maladaptive cognitive processes –Open ended questions •Change Record –Patient takes notes of automatic thoughts that occur and identify emotions associated with these thoughts –Identify errors & make changes Basic Principles of CBT •Structured/ time efficient –Short-term sessions 1x per week –Between 16-20 session total –Patient is aware from the beginning that it will come to an end •“Homework” –Activities that are completed outside of sessions with therapist – Rationale of CBT •Negative emotions are the result of cognitive processes developed through learning and temperament •Importance of examining ones cognitive beliefs and developing rational responses to those automatic negative thoughts •Cognitive triad: Negative automatic thoughts center around our understanding of: –The world –Ones own self –Ones future • Cognitive Triad http://s3-eu-west-1.amazonaws.com/tutor2u-media/subjects/psychology/studynote-images/depression-bec k-negative-triad.png?mtime=20151116202647 Cognitive Specificity Hypothesis •Distorted appraisals follow themes relevant to the specific psychiatric condition • Psychological disorders are each characterized in their own way –Depression: Negative view of self, world, and future. Core beliefs usually associated with helplessness, failure, incompetence, and lack of strong relationships and feelings of acceptance Cognitive Specificity- Depression •Negative Triad –Self: “I am unable to be loved by anyone” –Others: “People do not care about me or my wellbeing” –Future: “There is nothing positive to look forward to in my life” 3 levels of cognition •Consciousness –Decisions made with full awareness •Automatic thoughts –Private cognitions •Schemas –Core beliefs Depression •Mental Illness that affects ones overall health: especially their thoughts, behaviors, and feelings •Can have physical affects as well •One feels extreme sadness or despair for long periods of time https://i.ytimg.com/vi/J3L6Nwr8fp8/hqdefault.jpg Depressive Thinking •Beck’s cognitive triad •Distorted negative thinking about: –Self •Low self esteem –World •Nothing is meaningful –Future •Hopelessness •Helplessness • CPT Approaches to Treating Depression 1.Cognitive restructuring –“Inside out” approach –Change content of thoughts •2. Behavioral Activation –“Outside in” approach –Activity scheduling –Problem solving –Change the function/context of thinking –Make behavior less dependent on thinking or mood 1. Cognitive Restructuring Example –“Tonya has come for an initial appointment to the SBHC. During the risk assessment, Tonya reports a number of depressive symptoms, but no suicidal ideation. Tonya seems to display a lot of negative thinking and cognitive distortions. For example, she believes that “nobody” likes her and that s/he will “never” be successful in school. Her math teacher often compliments her work, but Tonya dismisses the teacher’s comments as him “just trying to be nice.” Tonya has good grades in all classes except for one, yet she only acknowledges her below average Chemistry grade.”, (National Assembly on School-Based Healthcare, 2005) • • Cognitive Restructuring Example •“Practice the process of Cognitive Restructuring with Tonya. –Describe the relationship between ways of thinking and depressive symptoms –Help Tonya to identify her cognitive distortions –Identify ways of countering cognitive distortions –Have Tonya practice countering these distortions”, (National Assembly on School-Based Healthcare, 2005) – • Behavioral Restructuring Example –“Tonya has come for an initial appointment to the SBHC. During the risk assessment, Tonya reports a number of depressive symptoms, but no suicidal ideation. Tonya reports not engaging in any activities that she used to. For example, she used to spend time with friends after school, and used to enjoy reading. She hasn’t done either recently, and just seems bored most of the time. She also reports having difficulty concentrating in class because she is constantly thinking about her problems.”, (National Assembly on School-Based Healthcare, 2005) • • Behavioral Restructuring Example •“Practice the processes of Activity Scheduling and Thought Stopping with Tonya. –Discuss with Tonya activities she used to enjoy. –Identify specific enjoyable activities for Tonya to do this week. –Identify times and places for each activity, and discuss potential obstacles. –Explain the process of Thought Stopping to Tonya, and discuss how Tonya could use this strategy when she has intrusive thoughts.”, (National Assembly on School-Based Healthcare, 2005) • Orienting Patient to CBT •What are the therapy strategies? •The evidence for the treatment? •The evidence for the processes of change? •What are the causes of their problem and how are they linked to the change strategies? •Identify causes of their problems to reduce self shame or blame • Important Components of CBT •Good therapist/patient relationship •Educate patient through modeling •Diagnose mental illness and set clear goals •Use proven evidence to support treatment decisions •Structured treatment sessions •Clear, limited treatment length •Homework to promote generalization General CBT Session •Agenda setting process –Selecting items that can lead to productivity in a single session –Homework assignments •Psycho-education –Use patients own experiences to demonstrate CBT principles and procedures –Identify automatic thoughts –Materials used to explain the relationship b/w cognitions and emotions –Readings and other educational aids Structure of typical therapy session 1.Mood check 2.Setting agenda 3.Bridge from last session 4.Discuss today’s agenda items 5.Homework assignment 6.Summarization of session 7.Feedback from patient Why is homework so important? http://nightingalecenter.com/wp-content/uploads/homework.jpg http://www.buzzle.com/img/articleImages/324464-48324-29.jpg •Test of patient motivation •Provides opportunity to practice •Data collection •Relationship with significant others •Prevents possible relapse •Provides continuity between sessions • Increasing homework compliance •Assign homework collaboratively •Provide patient with rationale for the given homework •Detailed instructions –Time, place, duration, frequency –Verify that the patient will be capable of completing assignment •Discuss with patient how likely they are to complete it – Other Components to CBT Treatment •Physical exercise •Meditation or relaxation techniques •Adequate and routine sleep schedule http://www.noonlife.com/wp-content/uploads/2014/07/background.jpg http://juicemigourmet.com/wp-content/uploads/meditation.jpg Video Example •Example of CBT session •Mother of a young child diagnosed with depression •https://www.youtube.com/watch?v=fCZpUIEUsys&feature=youtube_gdata_player • Sources •1. (2011, February 23). Managing depression with 10 Minute CBT. Retrieved from https://www.youtube.com/watch?v=fCZpUIEUsys&feature=youtube_gdata_player •Barlow, D. H., & Nathar, P. E. (2010). The Oxford handbook of clinical psychology. New York, NY: Oxford Press. •Beck, J. S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). New York: Guilford Press. •Beck, P. J. (2012, January 16). Structure of a CBT Session. Retrieved from http://www.huffingtonpost.com/judith-s-beck-phd/cognitive-therapy_b_1224375.html •Dryden, W., & Neenan, M. (2010). Chapter 1 An overview of cognitive therapy. In Cognitive Therapy in a Nutshell. Sage Publications. •History of Cognitive Behavior Therapy - CBT | Beck Institute. (n.d.). Retrieved from https://www.beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy/ •Hofmann, S. G. (2012). An introduction to modern CBT: Psychological solutions to mental health problems. Chichester, West Sussex, U.K.: Wiley-Blackwell. • References •Mental health education and training initiative 2005 learning session II [PPT]. (n.d.). Washington, DC: National Assembly on School- Based Health Care. •Ronen, T., & Freeman, A. (2007). Cognitive behavior therapy in clinical social work practice. New York: Springer Pub. •Somers, J. (2007). Cognitive behavioural therapy: Core information document. Victoria: British Columbia, Ministry of Health. •Wright, J. (2006). Cognitive Behavior Therapy: Basic Principles and Recent Advances. FOCUS, IV(2), 173-178. Retrieved from http://jpo.wrlc.org/bitstream/handle/11204/3878/Cognitive Behavior Therapy_Basic Principles and Recent Advances.pdf?sequence=3 •