cognitive behaviour therapy

cognitive behaviour therapy 

operates on the premise that maladaptive patterns of thinking influence the way we feel (physically and emotionally) and behave 

general aim of CBT

identify and modify unhelpful patterns in thinking in order to alleviate unpleasant feelings and promote helpful responses 

cognitive model

situation: what was happening, automatic thought: what the person thought, emotion experienced: what the person felt, behaviour performed: what the person did 

common types of unhelpful automatic thoughts 

catastrophizing, mind-reading, all of nothing thinking, selective attention, overgeneralisation

automatic thought - catastrophizing

a negative possible is treating as disastrous and unmanageable 

automatic thought - mind-reading

the person assumes they know what others think without sufficient evidence 

automatic thought: all or nothing thinking

 performance in judged as complete success or complete failure 

automatic thought: selective attention

threat or failure is notice while neutral or positive information is missed

automatic thought: overgeneralization

one event is used to draw a broad conclusion about the future or the self 

CBT will not work unless the patient is willing to change 

common principles of CBT

• formulation of clients and their problems in cognitive terms 

• treatment protocols are manualised —> set instructions for how to do it, but therapy is nuanced and spontaneous 

• empirical validation of treatment (outcomes/progress towards goals are measured) 

• short term, collaborative and active

• problem-focused and goal oriented 

• treatment emphasises the present moment 

• therapist as teacher who educates the patient to identity, evaluate and respond to thoughts and beliefs, and to problem solve and make devisions mare effectively in order to bring about desired change. 

• create opportunities for new learning in therapy 

• generalise changes outside of therapy situations 

• principles are made explicit to the client 

phases of therapy

thorough preliminary assessment (symptom set, severity, risk assessment), first, second and third round

cbt - first round

includes concentration on psycho-education and non-cognitive behaviour techniques (relatively straightforward and easier to achieve success but those with depression experience difficulty initiating change) 

cbt - second round

focuses on cognitive techniques and problem solving

cbt - third round

 generalisation outside of therapy and relapse prevention

activity scheduling

goals, rationale, self-monitoring, activity scheduling

cbt - activity scheduling: goals

 increase behaviour, create and identity positive reinforcement 

cbt - activity scheduling: rationale

 therapist provides rationale to the client about “depression cycle”

cbt - activity scheduling: self-monitoring

client records actual behaviour for several days including pleasure and mastery ratings. Proving that not everything is all bad (automatically subverts an all or nothing mindset)

cbt - activity scheduling

planning one’s day and week in advance, after showing competence at activity scheduling develop a to-do list of practical tasks   

sleep problems

a behavioural assessment should include habits around sleeping, stimulant usage, sleeping patterns, and more 

• explains the sleepy cycle to clients

helpful strategies for sleep management

• most effective intervention for sleep problems is getting up at the same time every day 

• decrease stimulant use generally and avoid stimulant use completely after evening meal 

• establish firm times for going to bed and getting up 

• no screens in bed

• if not falling asleep in 30 minutes, try again later 

distraction techniques: 

another simple behavioural technique for depression eg. Interrupt negative rumination and inactivity. Distraction techniques can be established individually for each of your clients 

• pleasurable activities list doubles as distraction techniques

CBT steps, regarding identifying automatic thoughts and responding to them 

• evaluate the validity of the thought (evidence?) 

• evaluate the utility of the thought (is the thought useful?) 

respond to automatic thoughts, do problem solving if thoughts are true

techniques to identify/eliclit automatic thoughts 

ask the question: what was going through your mind just then? In following circumstance 

• when the therapist notices a shift/identification in emotion 

• client is describing situation in which they experienced an emotion shift

• using imagery to enhance client’s memory 

• doing a role-play of specific interaction 

working with thoughts: socratic questioning 

evidence, perspective, probability, utility, distance, action

socratic questioning - evidence

what supports the thought? what does not support it, or suggests that it is not completely true?

socratic questioning - perspective

is there another reasonable way to understand the situation?

socratic questioning - probability

what is the worst, best and most realistic outcome? how likely is each?

socratic questioning - utility

what is the effect of telling yourself this? would another response help you act more effectively?

socratic questioning - distance

what would you say to someone you care about in the same situation?

socratic questioning - action

what would be useful to do next? what information could you gather?

phase three: relapse prevention

occurs throughout therapy (coping cards, homework sheets, hand outs etc. —> becomes material for relapse prevention program

following enhance relapse prevention: 

• reinforcing client capabilities by attributing progress to the patient 

• stresses techniques/tools learned in therapy are for lifelong use 

• discussing possible setbacks the client might experience in future