1. Cognitive Behavioral Therapy/Techniques
NURS 329 Psychiatric Mental Health Nursing

2. Objectives
Describe the interaction between thoughts, behaviors, and feelings.
Describe the aims and 4-step process of CBT
Identify cognitive distortions
Recognize treatment strategies used in CBT

3. Terms
Cognitive behavioral therapy (CBT) is a therapeutic approach that addresses the relationship among thoughts, feelings, behaviors, & physiology.
Cognitive distortions are inaccurate, irrational thoughts.
Cognitive restructuring is the examination & reframing of one’s interpretation of the meaning of an event.

4. Psychologic Effects of Stress
Research documents a relationship exists between high stress levels, negative mood states, a person’s cognitive coping style & the importance of interventions that control these states in person’s with chronic diseases.

5. History of CBT Principles
Introduced officially in 1979 by Aaron T. Beck, but actually started as early as 1964 by Beck and principles were appearing in the 50’s and 60’s (desensitization and relaxation training)

6. 2 central tenets
“cognitions have a controlling influence on our emotions and behavior”
“how we act or behave can strongly affect our thought patterns and emotions”
(Wright, Basco, & Thase, 2006, p. 1)

7. Interacting Systems in Human Behavior

8. Aims of CBT Increasing a desired activity Reducing unwanted behavior
Increasing pleasure
Enhancing social skills

9. The Process of CBT
Cognitive restructuring to help people experience a range of feelings when they are stuck in powerful negative mood states.
The health care provider acts as a guide in the process.
The client performs the intervention on themselves.

10. CBT Process The process contains 4 Steps. Awareness Automatic Thoughts
Cognitive Distortions/errors
Choosing Effective Coping

11. Identifying Emotions
The way we feel is very important. Positive feelings promote health while negative feelings contribute to ill health.
Family & cultural influences determine how we deal with & express emotions.
Exaggerated emotions interfere with good problem solving & can require the need of someone to assist in processing these emotions to attain a good outcome.

12. Automatic Thoughts
Automatic thoughts occur in response to a situation.
A.Beck talks about Automatic Thoughts
A.Beck part 2
Common characteristics of AT include:
Knee-jerk responses to perceived stressor.
Usually negative in content
Quick, fleeting, a kind of shorthand is involved
Usually these thoughts are not in our conscious awareness
Often these thoughts are unrealistic, illogical, & distorted.

13. What are some examples of automatic thoughts?

14. Relationships Between Thoughts & Emotions
Cognitive restructuring (CR) allows the person to become aware of the emotions & automatic thoughts related to a particular emotion & its connection to stress.
When the person focuses on the underlying themes it allows them to reflect on the meaning and choose how they want to respond.
Through CR the person can learn to reduce the intensity, frequency & length of time these distortions are experienced.

15. Relationship Between Thoughts & Emotions
The goal is to help the person become aware of the relationship between emotional themes to stress triggers & cognitive distortions.
Journal keeping that reflects on the thoughts & feelings related to stressful events is a valuable way to identify automatic thoughts & underlying emotions.

16. Automatic Thoughts Stop, take a breath & Reflect. Ask:
What is going on?
How do I feel?
What are my automatic thoughts? Do they contain “shoulds, always, oughts, and nevers?”

17. Cognitive Distortions
10 General Categories:
All or Nothing (dichotomous) Thinking -all good or all bad
Overgeneralization- never ending in nature
Mental filtering- awfulizing the situation
Disqualifying the positive- rejecting the positive
Jumping to conclusions- mind reading expected
Magnification- exaggerating the outcome
Emotional reasoning- assuming feelings reflect the truth about the situation or person.
Should statements- monkey on the back
Labeling –name calling
Personalization- blaming oneself inappropriately for the situation or the event.
(Stuart, 2013, p. 564, Table 27.5)

18. Treatment Strategies Anxiety reduction Relaxation training Biofeedback
Desensitization

19. Treatment Strategies Cognitive Restructuring
Monitoring thoughts and feelings
Questioning the evidence
Examining alternatives
Decatastrophizing
Reframing
Thought stopping

20. A patient states “I am always the one getting into trouble”.
What type of cognitive distortion is this?
How could the nurse respond to this statement?

21. Treatment Strategies Learning new behavior Modeling Shaping
Token economy
Social skills training
Aversive therapy
Contingency contracting

22. Treatment Strategies
When a person develops a large number of positive coping skills, their perspective of a stressful situation shifts to viewing the event as a challenge rather than a stressor.
This sense of control diminishes the effects of stressful situations or persons.
Developing positive coping skills is a significant piece of treatment, as people need to replace the strategies with more effective, healthy ones.

23. Summary CBT is a form of psychotherapy and is an EBP for many problems
Techniques to apply in the context of patient interactions
Remember that thoughts, behaviors, and feelings are influential on one another