CLINICAL 14.ppt

People are disturbed, not by things, but by the principles and notions which they form concerning things

Roman (Greek-born) slave & Stoic philosopher

Cognitive Therapy is a system of psychotherapy that attempts to reduce excessive emotional reactions and self-defeating behaviour, by modifying the faulty or erroneous thinking and maladaptive beliefs that underlie these reactions

Beck et al 1976, 1979, 1993

Collaborative (builds trust)ActiveBased on open-ended questioning

Highly structured and focused

Event

Event

Emotion

EmotionMeaning we give the event

‘Common Sense’ Model

Cognitive Model

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 meNobody wants to talk to me, no-one likes me•She’s got a nerve being so snooty!She’s got a nerve being so snooty!

•She’s probably still hung over from She’s probably still hung over from that party last night!that party last night!

Cognitive principle – it is interpretations of events, not events themselves, which are crucial.

Behavioural principle – what we do has a powerful influence on our thoughts and emotions

The continuum principle – mental health problems are best conceptualised as exaggerations of normal processes

ENVIRONMENT

THOUGHTS

BIOLOGY MOOD / FEELINGS

BEHAVIOUR

ENVIRONMENTOn Plane

Turbulence

THOUGHTSWe might crash

BIOLOGYHeart racingPalpitations

Rapid breathingDifficult to breathe – choking sensation

MOOD / FEELINGSAnxious 90%

BEHAVIOURReassurance

seeking

Negative Automatic Thoughts

Assumptions

Core beliefs

Negative cognitive triad◦Biased views of Oneself

I am bad, useless, unlovable, worthless, a failure The world in general

Nothing good happens, life is just a series of trials The future

It will always be like this, nothing I can do will make any difference, what’s the point of anything?

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

Identify specific problem list (& prioritise)◦ Eg. Poor sleep, relationship difficulties etc

Introduce cognitive model – how it might apply to client

Goals (SMART) Reduce symptoms through behavioural or

simple cognitive strategies Identify and challenge NATs Relapse prevention

Referral Assessment: suitability, therapeutic relationship

Assessment (ongoing): problem analysis, wider picture, measures

Problem list & prioritise Goals for therapy (SMART) Formulation (ongoing): Sharing model, maintaining factors, predisposing factors, rationale for treatment

Set collaborative agenda Review time since last session Feedback on last session Review homework Focus on major topics for the session Set homework Potential problems with completing homework

Feedback on session

Engagement Warmth and empathy Collaboration Guided discovery – socratic questioning

Feedback and summarising Agenda setting – structure and focus Open and closed questioning

Initiate & develop therapeutic relationship Establish suitability for CBT Gather specific information re current difficulties

Elicit maintaining factors Initial formulation Socialise to CBT model Establish joint understanding of the presenting problem

Identify a recent significant shift in mood

What was the situation? How did you feel? What was going through your mind at the time?

What did you do? What were the consequences?

Assessment – to provide information Baseline – subsequent measures will

show extent of change Effectiveness – helps to (objectively)

demonstrate effectiveness of therapy, and allow modification of treatment

Feedback Knowledge - data collection & suggests

areas for future research

Standardised – developed for particular populations and problems◦Eg. Beck Depression Inventory◦Beck Anxiety Inventory◦Agoraphobic Cognitions Questionnaire

• Individualised – allow for more specific Individualised – allow for more specific information for assessment and information for assessment and formulation. formulation. – Eg. Problem definition, Targets of therapy, Eg. Problem definition, Targets of therapy,

Diaries, % Belief Ratings, Ratings of specific Diaries, % Belief Ratings, Ratings of specific emotionsemotions

This presentation gives you an introduction to the rationale of CBT

It does not enable you to perform CBT Using Cognitive Behavioural

interventions may be helpful for your clients

CBT - Guided self-help?