Introduction to CBT The basic idea is that how we think (cognition) , how we feel (emotion) and how we interact (behaviour) all interact together. COGNITION EMOTION BEHAVIOR Therefore unrealistic negative thoughts can cause distress

History Two of the earliest proponents are ELLIS AND BECK Albert ellis- Rational Emotive Behaviour Therapy (REBT)- the primary cause of maladaptive bhvr is the continual repetition of certain irrational ideas e.g “If everyone does’t like me, I am worthless` One should be thoroughly competent, intelligent and achieving in all ways Therapist is regarded as the teacher and does not believe that a warm relationship with a client is necessary, its highly directive , persuasive and confrontative

History conti… 2. Aaron Beck- proposed that emotional disorders are frequently the results of irrational thoughts about oneself and the external would e.g Beck believes that depression is a result of three basic types of ideation (Beck`s cognitive triad ) which are: Negative views abt the self (e.g……..) Negative views abt the world (eg……) Negative appraisals of the future( eg…)

CHARACTERISTICS OF CBT Active participation of the client Collaboration-both working as a team Works on the problem in the here and now Focus on cognitions and behaviour Actively empowers the client-encourage the client Encourages the client to question Based on reality testing

CHARACTERISTICS OF CBT Goal oriented and problem focused Structured sessions with homework Time-limited Based on an evolving cognitive formulation Evidence based-models which are empirically validated Educational –teaching client skills to become their own therapist

Formulating in CBT SIMPLE MAITANANCE MODEL 5 PS MODEL

SIMPLE MAINTANCE MODEL Situation(modify/reduce impact) Cognitions(change negative thoughts Developing alternative beliefs) Physical sensations(relaxation Emotions(distress Management skill) and medication) Behaviour (change behaviour

5 P`s model Predisposing factors(vulnerability from past experiences) Precipitating factors(ie triggers immediately preceding onset) Presenting problems( what are the difficulties that the client has at the moment) Perpetuating factors Protective factors What is keeping presenting (family,education Problems work) Cognitions Affect behvr

ACTIVITY SCHEDULING(the behavioural part of cBt HOW INCERASING ACTIVITIES HELPS (all the below can lift mood) Takes mind off other problems Gain sense of control Feels less lethargic Increases motivation Gives opportunity to increase enjoyment Breaks rumination Gives sense of achievement Decrease social isolation

ACTIVITY SCHEDULING OVERVIEW Give rational Doing more helps to lift mood Monitor current activity levels(use a diary)and simple mood ratings and mood/pleasure ratings Review current activity level to see Overall pattern of activity-what is the client doing with their time Use diary(hourly,set time period) to plan ahead and schedule more helpful activities Demonstrate how to fill in the diary

Reviewing diaries Don’t be worried if client did not finish completing the diary Give them a lot of praise for the completed work Ask them what they learnt(any patterns,surprises) Use to find out more about their lives Generate a list of positive activities Use another diary to schedule more of these in the next week Opt for activities that are not reliant on others

Working with cognitions Guided discovery-therapeutic style of CBT Thinking biases Identify negative thoughts- find more helpful alternative

Guided discovery Therapist adopts an open and inquisitive stlye that helps clients to reach their own conclusions Help client get an alternative belief based on information provided Clients should generate their own solutions Don’t impose a point of view on the client

Guided discovery-main principles Four main steps Asking questions to uncover information outside the patient`s current awareness Accurate listening and reflection Summarising information Help client to apply new info to his beliefs

Thinking biases Beck identified distortions in thinking that maintain and exacerbate depression eg All or none thinking Overgeneralisation These can be changed by Psycho-education abt them Normalising of them Collaboratively identifying the client`s typical biases Noticing them in and out of the sessions Working to change any biases( identify the hot thought and PUT IT ON TRIAL. Use evidence for and against

Enhancing coping strategies Ask abt the general ways of coping( what do you do to make yourself feel better) Find out the effectiveness of each on a scale of 1-10

Distress management skills Self soothing strategies Use all senses-touch, sound ,smell Do something active Controlled breathing Breath in for 3 and breath out for 6 Relaxation Progressive relaxation techniques Imagery strategies Vivid imagery of a peaceful place ( include all 5 senses)