2 RationaleAn individual is not a passive recipient of stimuli. They are actively engaged in interpreting events in terms of their own unique set of values, beliefs, expectations and attitudes i.e cognitionsThese cognitions influence the picture the person has of their world past, present and future
3 Cont..Changes in the clients affective state are directly due to the way they make sense of events around them. It is not the external reality that causes the problems but the way in which the person interprets the reality.Cognitive Therapy enables the individual to become aware of and correct their unhelpful thinking patterns. Leading to Clinical improvement
4 Automatic Negative Thoughts These are thoughts or images which are present in specific situations. This can be when an individual is anxious, depressed etcE.g Someone who is concerned about what somebody thinks of them (social evaluation) may have an automatic negative thought such as “ They don’t think I’m interesting”
5 Dysfunctional assumptions These are more general beliefs which a person holds about the world and themselves. This cam lead them to interpret situations in often negative and dysfunctional ways. These not only lead to negative thoughts but also faulty cognitive processing. These could be the thinking styles we adopt such as :-Arbitrary influence – Drawing conclusions in absence of specific evidence.Overgeneralisation – Making sweeping statements based on one single event.Dichotomous thinking – Black and white thinkingEtc etc
6 The Cognitive Model EARLY LIFE EXPERIENCES FORMATION OF DYSFUNCTIONAL ASSUMPTIONS CRITICAL INCIDENT/ACTIVATING EVENTASSUMPTIONS TRIGGEREDAUTOMATIC NEGATIVE THOUGHTSSYMPTOMS FORMBEHAVIOURAL AFFECTIVE PHYSIOLOGICAL
7 Collaborative empiricism The therapist is seen as the expert collaborator assisting the client in identifying and altering dysfunctional thoughts. And attitudes.Things are not done to the client, but with them. The client is informed throughout of the purpose and nature of each stage of intervention and encouraged to judge the therapy by it’s results, rather than just trust in the therapist.The therapist is not an expert on the accuracy of the client’s view of the world.
8 Initial Interview Aim To screen out inappropriate referrals Establish a therapeutic allianceInstil hopePresent the modelGet agreement to try it - collaborative
9 FactKnowledge of CBT and perceived benefits of treatment is associated with improved outcomes
10 What is the problem ? Symptoms Impact on life Related negative thoughtsHow did the problem developAgree a problem listWhat is the client doing that may be maintaining the problem.
11 GoalsWrite a list of realistic goals. SMART Specific, measurable, achievable, realistic, targeted. Discuss and agree the goals with client
12 Cognitive Therapy Orientation to Model Cover practical arrangements Beck’s CBT Model brieflyInstallation of hope, the possibility of change
13 Start TherapySpecifically select the first issue and agree an inter session task.Generally introduce client to the style of the approach and the use of appropriate language
14 Approaches in TherapyTo identify. Challenge and test faulty thinking patterns, to enable the client to change dysfunctional thoughts and behavioursAssessmentEducationSelf MonitoringActivity schedulingBehavioural experimentsGuided discoverySocratic questioningHomeworkExposure therapyInference chaining
15 Subsequent sessions Agree topics to be discussed What has happened since last session, feedback on last session, Homework review.Session topics, Strategies, specific problems, manageable chunks of long term problemsHomework, What it is , rationale, identify anticipated difficulties and discussSession review, What has been learnt, encourage client to summarise. Any misunderstandings, correct any errors