Cognitive behavioral therapy (CBT) By Mr Daniel Hansson

Activity Take this online cognitive test: Take this online cognitive test: Do you agree with the claims of the test? Why or why not? Do you agree with the claims of the test? Why or why not?

Cognitive behavioral therapy What is it? What is it? How can it be used to treat anorexia nervosa and major depression? How can it be used to treat anorexia nervosa and major depression? Supporting studies Supporting studies Evaluation Evaluation Conclusion Conclusion

What is CBT? CBT is based on cognitive and behavioral research CBT is based on cognitive and behavioral research Aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a systematic, goal oriented procedure in the present (no focus on the past) Aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a systematic, goal oriented procedure in the present (no focus on the past) The therapy is aimed to terminate at a certain point, usually no longer than 15 weeks. The therapy is aimed to terminate at a certain point, usually no longer than 15 weeks. The therapy is evidence based (based on empirical research The therapy is evidence based (based on empirical research

What is CBT? Assumes that disorders is caused by dysfunctional thought and behavioral patterns (habits) Assumes that disorders is caused by dysfunctional thought and behavioral patterns (habits) Uses cognitive techniques to change faulty thinking, e.g. meditation/mindfulness, thought stopping, self distancing (visualizing yourself in a negative experience that it is not happening to you but to someone else), distraction Uses cognitive techniques to change faulty thinking, e.g. meditation/mindfulness, thought stopping, self distancing (visualizing yourself in a negative experience that it is not happening to you but to someone else), distraction

Beck’s cognitive theory of depression Depressed people have acquired a negative schema of the world in childhood and adolescence through negative events Depressed people have acquired a negative schema of the world in childhood and adolescence through negative events When the person with such a schema encounters a situation that resembles the original conditions of the learned schema, the negative schema is activated When the person with such a schema encounters a situation that resembles the original conditions of the learned schema, the negative schema is activated

Beck’s cognitive triad Depressed individuals have negative thoughts of: 1. The self 2. The world/environment 3. The future

Cognitive restructuring A cognitive technique that attempts to replace faulty thinking with more accurate and beneficial ones by gaining awareness of bad thought habits, learning to challenge thought habits and change them to life enhancing thoughts and beliefs A cognitive technique that attempts to replace faulty thinking with more accurate and beneficial ones by gaining awareness of bad thought habits, learning to challenge thought habits and change them to life enhancing thoughts and beliefs

Example of using cognitive restructuring for depression Find the cause for the depression (such as “I lost my job”) Find the cause for the depression (such as “I lost my job”) Turn it into something more positive “but hopefully I will find a new job”, “the job was terrible anyway”, “now I have got time to find out what I want to do with my life” Turn it into something more positive “but hopefully I will find a new job”, “the job was terrible anyway”, “now I have got time to find out what I want to do with my life”

How can CBT be used to treat depression? The therapist helps the patient schedule enjoyable experiences, often with other people who can reinforce the enjoyment. The therapist helps the patient schedule enjoyable experiences, often with other people who can reinforce the enjoyment. Patient and therapist will look at obstacles and find ways to get past those obstacles by breaking the process down into smaller steps Patient and therapist will look at obstacles and find ways to get past those obstacles by breaking the process down into smaller steps Patients are encouraged to keep a record of the experience, noting how he or she felt and what the specific circumstances were. If it didn't go as planned, the patient is encouraged to explore why and what might be done to change it. Patients are encouraged to keep a record of the experience, noting how he or she felt and what the specific circumstances were. If it didn't go as planned, the patient is encouraged to explore why and what might be done to change it.

Examples of CBT techniques for reducing depression Require clients to engage in enjoyable, health activities. Make a list of things that you enjoy to do, homework for the week may include doing one thing from his list each day. Require clients to engage in enjoyable, health activities. Make a list of things that you enjoy to do, homework for the week may include doing one thing from his list each day. Homework assignments might include basic techniques such as writing three things you're grateful for at the end of day, writing down negative thoughts and trying to flip them into positive thoughts and starting each day by listing two things that you're excited about for that day. Homework assignments might include basic techniques such as writing three things you're grateful for at the end of day, writing down negative thoughts and trying to flip them into positive thoughts and starting each day by listing two things that you're excited about for that day. Rank their level of depression at the beginning of each session. They'll note the level of depression and focus on gradually reducing it. This technique keeps the client focused on the main issue for coming to therapy and helps the therapist to know whether or not other techniques are working. Rank their level of depression at the beginning of each session. They'll note the level of depression and focus on gradually reducing it. This technique keeps the client focused on the main issue for coming to therapy and helps the therapist to know whether or not other techniques are working.

A typical session of CBT The session begins with a check on the patient's mood and symptoms. The session begins with a check on the patient's mood and symptoms. Together, the patient and therapist set an agenda for the meeting. Together, the patient and therapist set an agenda for the meeting. Once the agenda is set, they revisit the previous session so they can bridge to the new one. Once the agenda is set, they revisit the previous session so they can bridge to the new one. The therapist and patient review the homework assignment and discuss problems and successes. The therapist and patient review the homework assignment and discuss problems and successes. Next they turn to the issues on the agenda, which may or may not all get addressed. Next they turn to the issues on the agenda, which may or may not all get addressed. New homework is set. New homework is set. The session ends with the therapist summarizing the session and getting feedback from the patient. The session ends with the therapist summarizing the session and getting feedback from the patient. A typical session lasts 50 minutes to an hour. A typical session lasts 50 minutes to an hour.

How can CBT be used to treat Anorexia nervosa? To treat the mental and emotional elements of an eating disorder. This type of therapy is done to change how you think and feel about food, eating, and body image. It is also done to help correct poor eating habits and prevent relapse To treat the mental and emotional elements of an eating disorder. This type of therapy is done to change how you think and feel about food, eating, and body image. It is also done to help correct poor eating habits and prevent relapse During therapy, the patient can expect to learn about your illness, its symptoms, and how to predict when symptoms will most likely recur. During therapy, the patient can expect to learn about your illness, its symptoms, and how to predict when symptoms will most likely recur. The patient will be asked to keep a diary of eating episodes, binge eating, purging, and the events that may have triggered these episodes. The patient will be asked to keep a diary of eating episodes, binge eating, purging, and the events that may have triggered these episodes. The patient will be encouraged to eat more regularly The patient will be encouraged to eat more regularly The patient will be asked to change the way she thinks about her symptoms. The patient will be asked to change the way she thinks about her symptoms. The patient will be encouraged to change self-defeating thought patterns into patterns that are more helpful The patient will be encouraged to change self-defeating thought patterns into patterns that are more helpful The patient will be encouraged to handle daily problems differently. The patient will be encouraged to handle daily problems differently.

How can cognitive therapy be used for anorexia nervosa? Anorectic patients are initially very adverse of receiving treatment. The psychologist must develop an accepting and warm relationship with the patient Anorectic patients are initially very adverse of receiving treatment. The psychologist must develop an accepting and warm relationship with the patient The counselor must accept the patient’s belief about her body image as genuine for her (initially you may not refute or challenge it) The counselor must accept the patient’s belief about her body image as genuine for her (initially you may not refute or challenge it) Cognitive distortions must be gently challenged Cognitive distortions must be gently challenged You may question the patient what would happen if her worst expectation would come true (such as gaining weight) and if she would appreciate her friends less if they were gaining weight (questioning the double standard of the patient) You may question the patient what would happen if her worst expectation would come true (such as gaining weight) and if she would appreciate her friends less if they were gaining weight (questioning the double standard of the patient) Give suggestions for how to deal with problems in life and experiment Give suggestions for how to deal with problems in life and experiment

Supporting studies Goldapple (2004) Goldapple (2004) Riggs (2007) Riggs (2007) Bowers (2008) Bowers (2008)

Evaluation CBT is more effective for anxiety and depression than eating disorders and more effective for bulimia nervosa than anorexia nervosa CBT is more effective for anxiety and depression than eating disorders and more effective for bulimia nervosa than anorexia nervosa Is ineffective for treatment of schizophrenia and bipolar disorder Is ineffective for treatment of schizophrenia and bipolar disorder There are few well controlled studies on the effectiveness of CBT for depression There are few well controlled studies on the effectiveness of CBT for depression As effective for depression as drug therapy for milder forms of depression As effective for depression as drug therapy for milder forms of depression Time and cost efficient Time and cost efficient Empirical support for its effectiveness Empirical support for its effectiveness As effective as other psychotherapies As effective as other psychotherapies

Conclusion Is most effective if it is used in conjunction with behavioral therapy (CBT) and drug therapy