Learning to use cognitive strategies An Introduction to CBT Learning to use cognitive strategies

What is CBT? Helps to understand and explain behaviour Psychological Approach Helps to understand and explain behaviour Provides a framework for changing unhelpful behaviours CBT proposes relationships between Unhelpful thinking/knowledge structures Unpleasant feelings states Unhelpful/altered behaviour Physical symptoms

Core Principles of CBT Based on an ever evolving formulation Requires a sound therapeutic alliance Collaboration and active participation Goal orientated and problem focussed Educative model- skills acquisition Guided discovery/Socratic Process Emphasises the present

Misconceptions about CBT Only intelligent and articulate clients benefit from CBT CBT does not focus on feelings CBT is basically positive thinking CBT is too simple CBT is not interested in the clients past or childhood CBT does not make use of the relationship as a means of client change Too Simple- Parsimony/Okhams Razor “I you can explain something adequately without introducing further complexity, then the simple explanation is the best explanation” CBT-Relationship Therapeutic relationship is necessary to promote client change, but not sufficient to produce optimum change. Increased focus on interpersonal process

Epictetus 55 - 135 AD Men are disturbed, not by things, but by the principles and notions which they form concerning things Roman (Greek-born) slave & Stoic philosopher

"There is nothing either good or bad, but thinking makes it so". Who said…? "There is nothing either good or bad, but thinking makes it so". It is not events per se which determine our feelings, but the meanings we attach to these events

Meaning we give the event Event Emotion ‘Common Sense’ Model Event Emotion Cognitive Model Meaning we give the event Event Emotion

You’re walking down the High Street, and someone you know walks by without acknowledging you…

4 interpretations – 4 emotions I don’t want her to see me, I won’t know what to say – she’ll think I’m stupid & boring Nobody wants to talk to me, no-one likes me She’s got a nerve being so snooty! She’s probably still hung over from that party last night!

Negative Automatic Thoughts Assumptions Core beliefs

Thinking in Emotional Disorders Self World Future

Five Areas Model (Chris Williams) Environment Altered Thinking Altered Physical Symptoms Altered Feelings Altered Behaviour

Five Areas Model: Example Supermarket “I can’t cope” “I’m going to panic” “I’m going to collapse/faint” Increased HR + Breathing Sweating + Dizziness Tightness in chest Fear/Anxiety Terror Try to escape/avoid Lie on the floor

Cognitive Model of Depression Early Experiences Cognitive Model of Depression Core Beliefs & Assumptions     Beck (1979) Critical Incident Negative Automatic Thoughts (NATS) Behaviour Feelings

Feelings & commonly associated thoughts

Goals of therapy Help the client counteract negative cognitive biases, and develop more balanced view of herself, the world, and the future Restore activity levels – especially those that give sense of pleasure or achievement Increase active engagement and problem solving

Overview of a typical course of therapy Assessment, Formulation Treatment: start with symptom focused intervention Review: every six sessions, repeat measures Discharge: repeat measures, relapse prevention Follow up / booster sessions: 1,3,6,12 month ?

Typical CBT treatment session Set collaborative agenda Review time since last session Feedback on last session (Bridging) Review homework Focus on major topics for the session Set homework Potential problems with completing homework Feedback on session

The Therapeutic Process in CBT Cognitive therapists believe that if we teach patients to become more accurate in the way that they interpret their thoughts and situations, we can help them feel better. Stories/examples Dog dirt story Optimism pessimism myth

Therapy Skills Engagement Warmth and empathy Collaboration Guided discovery – Socratic questioning Feedback and summarising Agenda setting – structure and focus Open and closed questioning Downward arrow technique