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

2. 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

3. 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

4. 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

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

6. "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

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

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

9. 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!

12. Negative Automatic Thoughts
Assumptions
Core beliefs

14. Thinking in Emotional Disorders
Self
World
Future

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

16. 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

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

18. Feelings & commonly associated thoughts

19. 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

20. 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 ?

21. 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

22. 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

23. 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