DENISE HASHEMPOUR

Cognitive Model

Rationale

An 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 cognitions

These cognitions influence the picture the person has of their world past, present and future

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

Automatic Negative Thoughts

These are thoughts or images which are present in specific situations. This can be when an individual is anxious, depressed etc

E.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”

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

The Cognitive Model

EARLY LIFE EXPERIENCES 

FORMATION OF DYSFUNCTIONAL ASSUMPTIONS

CRITICAL INCIDENT/ACTIVATING EVENT 

ASSUMPTIONS TRIGGERED 

AUTOMATIC NEGATIVE THOUGHTS 

SYMPTOMS FORM 

BEHAVIOURAL AFFECTIVE PHYSIOLOGICAL

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.

Initial Interview

Aim To screen out inappropriate referralsEstablish a therapeutic allianceInstil hopePresent the modelGet agreement to try it - collaborative

Fact

Knowledge of CBT and perceived benefits of treatment is associated with improved outcomes

What is the problem ?

SymptomsImpact on lifeRelated negative thoughtsHow did the problem developAgree a problem listWhat is the client doing that may be

maintaining the problem.

Goals

Write a list of realistic goals. SMARTSpecific, measurable, achievable, realistic, targeted.Discuss and agree the goals with client

Cognitive Therapy

Orientation to ModelCover practical arrangementsBeck’s CBT Model brieflyInstallation of hope, the possibility of change

Start Therapy

Specifically 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

Approaches in Therapy

To identify. Challenge and test faulty thinking patterns, to enable the client to change dysfunctional thoughts and behavioursAssessmentEducationSelf MonitoringActivity schedulingBehavioural experimentsGuided discoverySocratic questioningHomeworkExposure therapyInference chaining

Subsequent sessions

Agree topics to be discussedWhat 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