Cognitive Behavioral Therapies

overlying idea of cognitive behavioral therapy

Change occurs by learning to modify dysfunctional thought patterns. Once a patient understands relationship between thoughts and behaviors, patient is able to modify to a more flexible way of thinking. Different feelings when you have different thoughts.

Role of the therapist

Collaborative teacher. Teaching someone how to change their thinking while working collaboratively with client. Therapist helps client with skill building.

Structure of Sessions

Sessions are very structured: checking in with client around homework, how they are, and then moving on to skill building.

TX goal

#1 relieve symptoms understand pattern of thoughts/evaluating different thoughts/give skills on healthier ways of thinking/patients are able to develop healthy coping skills for future stressors

MAIN CONCEPT

negative cognitive triad

1. Negative view of self (I am not worth anything/I am unlovable)

2. Negative view of the world (everybody hates me/the world is a hostile place/there is not room for me)

3. View of prospects for the future (there are no hopes for my future)

Automatic thought

thoughts which occurs during situations without us having to think about it. CBT teaches and identify/explore and alter automatic thoughts

MALADAPTIVE AUTOMATIC THOUGHTS

Automatic thoughts - these thoughts are typically center around negative themes/distorted reflected and accepted as true

SCHEMAS

People create rules about how the world works which impacts how automatic thoughts are generated (underlying beliefs) how automatic thoughts are created

OVERGENERALIZATION

A single negative event becomes pervasive in someone’s life. Overgeneralization of how others things might turn out. ( Type of negative thought- single event/mistake which shapes how we see how to might do in the future/unable to see as a single event

ARBITARY INFERENCE

Cognitive distortion which leads to drawing conclusions without evidence or facts to support the conclusion. Using limited information provided to make negative judgements.

SELECTIVE ABSTRACTION

A single mistake that makes the rest of the event/review instead of looking at the whole picture and overall positives etc. negative. Focus on the negative points and not the positives. 

PERSONALIZATION

Seeing yourself as a cause of negative external event. our actions triggered event

POLAZIRZED THINKING

Thinking in extremes and seeing things in black and white.

INTERVENTIONS

Teach client about CBT and negative triad 

SOCRATIC QUESTIONING

Questions to challenge clients irrational beliefs and how they came into that conclusion. Evidence which led to the answer

REFRAMING

way of thinking differently about assumptions allowing people to feel differently to lighten anxiety and depression

COGNITIVE RESTRUCTURING

teaching clients to identify irrational, distorted, or maladaptive beliefs, question the evidence and generate alternative responses.

HOMEWORK

to assist in cognitive restructuring clients are often assigned homework.

SELF-MONITORING

“diary work” to self monitor used to record thoughts. giving people skills to identify and alter negative thinking patterns

BEHAVIORAL EXPERIMENTS

give tasks to clients to test different assumptions includes assigned different assignments to clients/paying attention to what is observed in that activity.

SYSTEMIC DESENSITIZATION

pair relaxation with exposure to things that are stressful (PTSD/Panic disorder) real life or imagery in session

ANXIETY MANGEMENT TRAINING

using imagery to practice relaxation skills until anxiety is reduced

ASSERTIVE TRAINING

teaches to specify desires and needs using minimal effective response to assert their position. Used with unassertive or overly aggressive people. (I statements/communication skills/role playing)

BEHAVIORAL ACTIVATION

Schedule activities and incentives (use for passive clients) activity may be difficult for them to accomplish

COMMUNICATION SKILLS TRAINING

helping people manage conflict (mostly used in couples therapy to talk about feelings and problems) Teach to listen/not jump in with problem solving/identify when they are getting overly aroused/take time outs

DOWNWARD ARROW

moves downwards to get into the underlying core belief people have

EXPOSURE

clients faces their fears/exposure to stressful situation and use of coping skills to manage stressful situations.

FINDING ALTERNATIVES

Client is taught to review all possible options interpreting a situation or resolving a problem

LABELING DISTORTIONS

teaching clients to recognize and label distortions such as overgeneralizations which could lead to problems with interpretations of events 

MASTERY/PLEASURE RATINGS

Clients use of activity chart and rate how enjoyable the activity was for the client. What they think it might be like and what it is actually like.

OPPOSITE ACTION

Do something that is counter intuitive (e.g. when feeling angry say something kind or decent)

PROBLEM-SOLVING TRAINING

Teaches step by step approach how to problem solve/identify problem/generating options to solve the problem/best solution/implementation of best solution/check in how the solution worked to solve the problem

RELAXATION TRAINING

teaching relaxation skills to relax muscles/bodies to practice implementation of skills.

SUCCESSIVE APPROXIMATION

goals are broken down into smaller goals to ensure success at each step along the way to reach desired goals

THREE-COLUMN TECHNIQUE

Client collects automatic thoughts and lists the situation in which the thought occurred, the automatic thoughts and the associated feelings.

THOUGHT RECORD

expands on the three column technique to practice skills used to alternative automatic thoughts(behavioral/emotional of changing the thought

PHASE OF TREATMENT

BEGINNING

established therapeutic relationship/explain CBT/setting collaborative goals/assess and define the problem and negative thought patterns/

EARLY/MIDDLE

identify negative thought patterns, uncover negative schemas, assign homework to self-monitor thoughts, moods and behaviors/label cognitive distortions, reframe thoughts/learn and practice new skills and behaviors.

END

review gains, identify skills learned, rehearse for new situations and anticipate future struggles.

RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT)

THEORY OF CHANGE

Change occurs by changing irrational beliefs to rational beliefs which could improve clients emotional and behavioral functioning

ROLE OF THERAPIST

instructor/confrontational/direct

TREATMENT GOALS

Alter illogical beliefs and thinking patterns to overcome psychological problems and mental distress

KEY CONCEPTS

A - activating event: something happens in the environment around you

B - Beliefs: Holding onto a belief about the even or situation

C - Consequence: You have an emotional response to your belief

COMMON IRRATIONAL BELIEFS

Other people need to be perfect if they don’t then I would be upset about it/upset about how others are not perfect/we must be perfect and we can’t make mistakes. Feeling others are responsible for your happiness and we have no control over that/dependent on external forces.

SELF-ACCEPTANCE

I have good and bad points/I am allowed to have flaws/Because of my good and bad I am not worse than others

OTHER ACCEPTANCE

sometimes others will not treat me fairly/there is no law that others have to treat me fairly at all times. People who don’t treat me fairly are no  more worthy or less worthy than any other person.

LIFE ACCEPTANCE

Life does not always work out the way we want it to. life will not always be pleasant. it is never awful or completely unbearable

BEGINNING

provide psychoeducation about REBT/identify irrational thought patterns and beliefs and the resulting feelings and behaviors (more direct)

MIDDLE

once underlying feelings have been identified the next step is to challenge these mistaken beliefs. therapist is to dispute these beliefs using direct and even confrontational methods.  Albert Ellis suggested that rather than simply being warm and supportive, the therapist needs to be blunt, honest, and logical in order to push people toward changing their thoughts and behaviors. Clients are also encouraged to change unwanted behaviors using such things as meditation, journaling, and guided imagery.

END

review progress made and apply learned skills to anticipated future struggles

DIALECTIC BEHAVIORAL THERAPY (DBT)

(individual/group/contact with mft between sessions)

THEORY OF CHANGE

change happens through mindfulness, developing skills to manage distress tolerance and emotional regulation and improving interpersonal problem resolving skills. emphasis on accepting uncomfortable thoughts instead of struggling with them.

ROLE OF THERAPIST

Ally/validate and offer alternatives/coach

TREATMENT GOALS

goal is for clients to improve emotional and cognitive regulation

KEY CONCEPTS AND INTERVENTIONS

MINDFULNESS

Practice of being fully aware and present in this one moment ACCEPTANCE OF THE FEELING

DISTRESS TOLERANCE

how to tolerate pain in difficult situations NOT TO CHANGE IT

INTERPERONAL EFFECTIVENESS

learning assertiveness training and being able to say “no” while maintaining self-respect and relationships with others (can stem from CBT communications skills training/assertiveness skills training)

EMOTIONAL REGULATION

how to change emotions that you want to change

HOMEWORK

clients are assigned skill building tasks between session

BEGINNING

move client from out of control to achieving behavioral control. teach mindfulness and distress tolerance. Focus on addressing self harming behaviors 

MIDDLE

fuller emotional experiences/experience emotions at a deeper level/define life goals leading to self-respect/peace and happiness

END

finding a deeper meaning through spiritual existence