COGNITIVE BEHAVIOURAL THERAPY

Historical perspective Psychotherapy and psychological approaches Psychodynamic therapies v behavioral approaches Emergence of Cognitive Therapy Development of Cognitive Behavioural Therapies Third wave CBT (Hayes 2004)

Evidence base Systematic reviews What works for whom NICE Depression PTSD OCD & BDD

Behavioural perspective We are products of our environment The continuum principle- problems arise from exaggerated or extreme versions of normal processes rather than pathological states which are different and inexplicable. (Wesbrook,Kennerley, Kirk, 2007) Intensity, frequency and duration Behaviour is crucial in maintaining psychological states

Learning Theory FClassical conditioning FOperant conditioning FTwo Factor theory FClassical conditioning FOperant conditioning FTwo Factor theory

Practical application How many of your actions prior to coming have you thought about? How many did you not? How much is habit? Do you ever think of the consequences or alternatives? How much do we just respond? How much is conditioned/learnt?

Cognitive Therapy AT Beck Stoic philosophy Epictetus 135 AD Men are disturbed, not by things but by the principles and notions which they form concerning things Some things are in our control and others not. Things in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.

COGNITIVE MODEL OF EMOTIONAL RESPONSE: THE SIMPLEST VERSION EVENT ↓ INTERPRETATION OF EVENT ↓ EMOTIONAL RESPONSE

SIMPLICITY V ELEGANCE TO BE ABLE TO THINK ABOUT YOUR THINKING UNDERSTAND HOW RESPONSES ARE MAINTAINED UTILISE PSYCHOLOGICAL EVIDENCE FOR THE MAINTENANCE OF DISTRESS HOW TO CHANGE TO BECOME YOUR OWN THERAPIST

Generic CBT model Through experience we develop core beliefs and assumptions. They are both functional and dysfunctional (helpful or unhelpful). Critical incident Evokes negative thoughts behaviour, emotions and physiological changes

MAIN CHARACTERISTICS STRUCTURED PROBLEM ORIENTATED A-HISTORICAL LEARNING MODEL SCIENTIFIC METHOD HOMEWORK COLLABORATION ACTIVE AND DIRECTIVE SOCRATIC QUESTIONING OPENNESS

APPLICATION

COMMON PSYCHIATRIC PROBLEMS DEPRESSION ANXIETY OCD PTSD PANIC PHOBIAS

NONE PSYCHIATRIC PAIN IBS DIABETES EPILEPSY

TECHNIQUES PSYCHOEDUCATION EXPOSURE RELAXATION ACTIVITY SCHEDULING IMAGERY BEHAVIOURAL EXPERIMENTS SYMPTOM INDUCTION REATTRIBUTION- QUESTIONING EVIDENCE COUNTER EVIDENCE, LABELLING, USE OF RATIONAL RESPONSES, COST BENEFIT ANALYSIS

PHOBIA PSYCHOEDUCATION EXPOSURE BEHAVIOURAL EXPERIMENTS

PANIC AND AGOROPHOBIA

OCD & BDD

SOCIAL ANXIETY

PTSD

GENERALISED ANXIETY

DEPRESSION