1. COGNITIVE BEHAVIOURAL THERAPY
CHAPTER 2 UZM. PSK. ÖZLEM ATAOĞLU

2. “İnsanlar bir şeyler yüzünden değil, o şeylerle ilgili düşünceleri yüzünden acı çekerler” EPIKTETOS

3. Cognitive behavioural therapy is based on the philosophy of Epiktetos
He was actually a slave in Phrygia, 100 DC. After his release, he started to spread his philosophy
According to him, our happiness and freedom is related to how extent we understand our control over things
Once you understand this, you will reach inner peace

4. According to Epiktetos, the things that give harm to us are actually not the events, itself but how we understand and interpret them
Even though CBT is based on this philosophy, it is more than that
It suggests that the environment we live in, people we are related to, biology, emotions, cognitions, behaviours are affected by each other which constitutes our mental health
What CBT works on is cognitions and behaviours

5. CBT’S DEFINITION AND HISTORY
Who is the founder of cognitive therapy?
Albert Ellis, a New Yorker psychologist, found Rational Emotive Behavioural Therapy (REBT) in 1960s. He was the first person who refers to cognition
We know CBT from Aaron T. Beck who suggested that the cognitions conceptualize mental/psychological pathologies

6. Cognitive theory focuses on cognitive functioning to explain psychological disorders
What do we mean by cognitive functioning?
The individual’s self, environment, experiences and future expectations, perceptions, interpretations, and cognitions
Our environmental inputs (senses and perceptions) are processed in our brain and turn into cognitive images
We have cognitions and beliefs about those cognitive images
Those beliefs produce our emotions which lead to our behaviours

7. In order to produce cognition, behaviour and emotions we need to first be aware of the stimulant
Once we become aware, our cognitive process starts  it is more like a lens that we see through the world and ourselves
If it evokes an urge or a cognition/interpretation, we feel an emotion (or may be more) then we head towards a behaviour
Cognitive therapy is interested in how a person sees the self, others and the future

8. How can we understand if an emotion or a behaviour is abnormal?
Cognitive therapy suggests that while we are experiencing some disturbing behaviours, it can rather be due to the situation that the person experiences or to the cognitive processes the person has adopted
In this case you need to compare the situation with the emotional reaction
If the emotional reactions are disproportional to the situation, then we can say this is something related to the process
How can we understand it is disproportional?

9. If the cognitive processes that constitutes the way we see and interpret the world are distorted or unfunctional then we start to experience problems
If a person perceives a situation as dangerous, the emotional reaction will be fear and anxiety
If a person perceives a situation nonreversible, unchangeable and responsible from this situation, the emotional reaction will be pessimistic, depressed, mournful and guilty

10. APPLICATION / TECHNIQUES
Psychoeducation: Teaching about CT, schemas, basic cognitive model, cognitive distortions. Give education on symptoms, goal settings, etc. Use a board, draw diagrams, charts, etc.
Socratic Questioning: The aim is to find the underlying basic, fundamental belief/assumption, with every question we try to make it more concrete, make the patients find rational alternative responses, exaggerations, overgeneralizations, etc.
Refuting & Replacing Maladaptive Thoughts: We tend to “find” and “catch” the evidence that support our belief rather than the one undermines them. To overcome this, the patient need to challenge them constantly. Sometimes patients catastrophize their scenarios, we need to show them more “catastrophic, humiliating” situations. How can we show them?
Direct questioning, Worst case scenario, Behavioural Experiment, Thought Recording Sheets

11. Relaxation Training: Tensing and releasing various groups of muscles while focusing on sensations of relaxation – relax in emotions, lower the arousal level
Systematic Desensitization: After teaching relaxation, name the condition, create the hierarchy that provokes anxiety. First by imagining, then apply to real life situations
Exposure & Response Prevention: Idea is the same with SD but we don’t use relaxation techniques. Flooding can be used.

12. Social Skills Training: Some people lack social skills to satisfy their interpersonal relationships. That leads to anger, depression, anxiety
Depending on the level of the patient, start from introducing self, offering to eat lunch, talk about daily routines, debate on a topic
Assertiveness  telling appropriately what you need/feel/want by not passing others’ boundaries

13. Behavioral Rehearsal & Homework: Easy, daily activities can be really hard to perform. We grade the task into assignments, can be practiced within the session
Aversion Therapy & Punishment: Condition the patient’s unwanted behaviour with a noxious behaviour/circumstance/physiological reaction