Introduction to CBT - General Principles

CBT - Characteristics

• Semi‐structured, time‐sensitive, active

• Based on a case conceptualization

• Focused on skill development

• Oriented toward a hypothesis‐testing approach

• Clinician and client work collaboratively with a focus on a strong relationship

• All interventions aim at cognitive change

• Guided by 10 general principles

General Principles of CBT - No. 1

Cognitive behavior therapy is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms.

General Principles of CBT - No. 2

Cognitive behavior therapy requires a sound therapeutic alliance.

General Principles of CBT - No. 3

Cognitive behavior therapy emphasizes collaboration and active participation.

General Principles of CBT - No. 4

Cognitive behavior therapy is goal oriented and problem focused

General Principles of CBT - No. 5

Cognitive behavior therapy initially emphasizes the present.

General Principles of CBT - No. 6

Cognitive behavior therapy is educative, aims to teach the patient to be her own therapist, and emphasizes relapse prevention.

General Principles of CBT - No. 7

Cognitive behavior therapy aims to be time limited.

General Principles of CBT - No. 8

Cognitive behavior therapy sessions are structured.

General Principles of CBT - No. 9

Cognitive behavior therapy teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.

General Principles of CBT - No. 10

Cognitive behavior therapy uses a variety of techniques to change thinking, mood, and behavior.

Importance of Therapeutic Relationship

Like most other therapies, the therapeutic relationship is a necessary and critical component of CBT:

• Empathic

• Understanding

• Warm

• Genuine

• Direct and sensitive

Stages of Traditional Exposure Therapy

• Psychoeducation

• Joint formulation

• Creation of the fear hierarchy

• Systematic enaction of hierarchy

  • Can be ordered, random, top-down… depends on the client

• Process/integrate new learning (can include some cognitive work)

• Relapse prevention

Importance of CBT Psychoeducation

• Necessary for understanding anxiety disorders in a way that leads to a clear rational for using exposure therapy

• Providing and ensuring buy in of treatment rationale/psychoeducation increases compliance

• Leads to a shared road map for functional assessment/treatment planning

• Allows therapist and patient to understand how to optimize learning during exposure

• Effective in preventing relapse by teaching patient how to be their own therapist

• Facilitates troubleshooting (e.g., non-adherence, therapist discomfort)