Cognitive Behavioural Therapy DENISE HASHEMPOUR

Definition of psychotherapy (Dryden, 1996) ….a process of intervening with a client within the context of a professional relationship with the goal of understanding the clients problem, preventing or ameliorating problems and/or promoting positive personality growth and development

What do you understand about CBT?

What is CBT Cognitive and Behavioural Psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self-help material

What is CBT Cognitive Behaviour Therapy (CBT) is an approach to help people experiencing a wide range of mental health difficulties. The basis of CBT is that what people think affects how they feel emotionally and also alters what they do. Babcp 2005 Cognitive Behavioural Therapy is described as an active, directive, time limited and structured approach which is used to treat a variety of psychiatric disorders. Beck, Rush, Shaw & Emery (1979)

CBT Therapists look at five areas of life when helping a person with their problems :- Thoughts, moods, behaviours, biology and environment, but places emphasis on identifying and evaluating thoughts and on behavioural change. Educating clients to understand how and why they think in the way that they do, implements lasting change.

FACT It can be short and fixed term It specifically focuses on problems It gives patients outcomes they value The therapist has a framework and structure to help patients achieve goals It has developed through extensive empirical research and actively continues to develop A two way street between research informing good practice / practitioners influencing research Patients given information of therapeutic models and processes Patients are actively involved at all stages It is effective regardless of intellectual, social psychological and physical ability

Cont. CBT target problems in the here and now with far less therapeutic time devoted to early life experiences CBT addresses problems in a direct and targeted way Therapeutic relationship is essential but unlike other modalities it is not seen as the main vehicle for change. Focus is placed on collaborative working on jointly agreed problems. It is highly structured – Based on a formulation Flexible due to constant evaluation of the outcome of interventions CBT therapist do not interpret or seek unconscious motivations. CBT aim to bring cognitions and beliefs into attention and encourage people to gently re-evaluate their thinking through ‘guided discovery’. CBT is based on a shared model of understanding – psycho-educational approach i.e. shard formulation, self-evaluation CBT as a model is increasingly being recommended in evidence-based guidelines. (Taken from papers published by BABCP and Grazebrook and Garland 2005)

CBT has been successfully applied to the treatment of a wide range of psychiatric disorders such as depression, and anxiety disorders. It has also been shown that CBT yields more durable effects than medicines once they are discontinued. Barlow & Lehman 1996, Barlow et al 2000, Marks et al 1993

Cognitive Biases Can lead a person to over-estimation of the likelihood of harm occurring A belief about being vulnerable to danger An intolerance of uncertainty, ambiguity and change The need for control

Automatic thoughts Therapists help client recognise and change pathological thinking at two levels of information processing: automatic thoughts and schemas. Cognitions that stream rapidly through our minds when we are in the midst of a situation or recalling an event – EW can help bring these thoughts into consciousness Core beliefs that act as a template or underlying rule for assessing information.

Thought It is important not to assume the automatic thought is wrong rather question the validity of the evidence underpinning the thought, rather than a direct challenge of the thought or the client.

5 Areas Model Chris Williams 2005 The model aims to communicate key CBT principles concerning understanding of the problem, and changing thinking and behaviour in a simple and straightforward way to help patients and practitioners alike to make sense of symptoms. Using everyday language.

5 Areas Model – Basic principles Situation/Event Cognition Behaviour Emotion Physical

Features of a Cognitive Model :- 1) Component parts of the model The Cognitive Triad   View of self View of the world and others View of the future Also known as underlying assumptions

Cont 2) Faulty Information Processing   Systematic errors of reasoning that maintain the patient’s belief in the validity of the problem. 3) Automatic thought 4) Schemas 5) Interaction with the Cognitive model Cognition & Emotion

Stages of CBT Engagement and introduction to the model of CBT Assessment and identification Formulation of problem Treatment plan and application Consolidation and review of progress Relapse prevention