Introduction
Short-term structured therapy
Uses active, collaboration between the patient and the therapist to achieve the therapeutic goals.
Altering maladaptive thinking
concentrates on unconscious processes and past events
Verbal techniques and behavioral techniques
in depressive disorders (with or without) suicidal ideation
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Classification
Techniques to interrupt cognitions
Techniques Used to counterbalance emotional effects of cognitions
Techniques intended to alter cognitions
Problem solving techniques
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Techniques to interrupt
cognitions
In distraction, patient forcefully attends to
something other than the intrusive thoughts.
Distraction’s two common forms are:
First shouts aloud and after practice repeats silently
to himself
Mildly painful sensation is produced
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Techniques used to
counterbalance emotional
effects of cognitions
A suitably chosen statement, produced by
a conscious effort to balance the intrusive
thought.
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Techniques intended to
alter cognitions
By Beck and consists of three stages:
To:-
Identify maladaptive cognitions
Identify logical ‘errors’ allowing maladaptive cognitions
Persist and to challenge the underlying assumptions which generate maladaptive cognitions in the first place
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Problem Solving
Techniques
Define the problem,
Divide it into manageable parts,
Think of alternative solutions,
Select the best solution,
Carry it out, and
Examine the result 30/04/2015 www.drjayeshpatidar.blogspot.in 7
Cognitive Therapy in
Psychiatric Disorders Obsessive Compulsive Disorder (OCD)
Major Depression
Anxiety Disorder
Eating Disorder
Schizophrenia
Phobias
Panic Disorders
Post-Traumatic Stress Disorder (PTSD)
Suicidal Behavior
Other Indications 30/04/2015 www.drjayeshpatidar.blogspot.in 8
Obsessive Compulsive
Disorder (OCD)
Challenging obsessional thoughts,
Thought stopping; and
Challenging negative automatic thoughts
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Challenging obsessional
thoughts
Challenge the obsessional thoughts (i.e.
those thoughts concerned with harm,
aggression and contamination)
Techniques involve
Either self-instructional training (SIT)
Rational emotive therapy (RET) techniques.
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Either self-instructional training (SIT)
Instructs patients to determine how anxious
they feel, to observe and record their
obsessioinal thoughts, and to replace their
thoughts by productive self-statements.
Rational emotive therapy (RET) techniques
- Focuses on challenging the belief in the
obsessional thoughts through rational
disputations.
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Thought Stopping
Disrupting obsessions and thought
processes by using a cue word (i.e.
Stop).
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Challenging Negative
Automatic thoughts
NATs were often precursors to disturbed
imagery.
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Major Depression
Cognitive techniques are used to alter
cognitions and not merely to arrest or
counterbalance them.
These methods are used because
depressive thoughts are very difficult to
arrest and evoke a particularly strong
emotion reaction that is difficult to
counteract.
Cont.. 30/04/2015 www.drjayeshpatidar.blogspot.in 14
Specialized techniques
Scheduled Activity
Active scheduling of activities structures time and enables the patients to observe their own potential effectiveness.
Graded Task Assignment
Success in graded tasks changes patient’s self-concepts.
Masterly and pleasure Therapy
Patients keep records of all activities and designate each masterly experience with ‘M’ and each pleasure experience with a ‘P’, thus increasing their awareness of positive experiences. Cont… 30/04/2015 www.drjayeshpatidar.blogspot.in 15
Cognitive Reappraisal
Cognitive reappraisal involves the identification of maladaptive cognitions and attitudes.
Alternative Therapy
By encouraging alternative explanations for negative experiences, patients are helped to recognize their biases. By considering alternative ways of handling psychological and situational problems, patients find solutions to the problems previously considered insoluble.
Cognitive Rehearsal
By imagining that they are carrying out an activity, patients report obstacles and conflicts that are then discussed.
Homework Assignments
Assignments are given are each session to counteract the depressive symptoms. Patients keep records of the negative cognitions in one column and of the rational responses in another. 30/04/2015 www.drjayeshpatidar.blogspot.in 16
Anxiety Disorder
Cognitive techniques used include Distraction
Thought stopping,
Counterbalance emotional effects.
Most anxiety disorders have prominent physical symptoms, which are an accompaniment of high arousal, cognitive techniques are generally combined with relaxation training.
Cont…
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Anxiety management Training
First phase
Taught both to relax and to increase anxiety by imagining in a vivid way and he learns how to change quickly from provoking anxiety to reducing it.
Second Phase
The patient is helped to identify further situations that arouse anxiety, to imagine them, and to terminate the resulting anxiety by relaxing.
Third Phase
The patient focuses on the sensations associated with anxiety with act as stimuli for further anxiety.
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Eating Disorder
Patients with eating disorders have
maladaptive assumptions
The evaluation of cognitive therapy for bulimia
nervosa, thought uncontrolled, has shown that
the treatment is both acceptable and effective.
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Schizophrenia
Many cognitive – behavioral techniques
Technique of reality testing (Hole et al 1979),
Belief modification techniques (Walts et al 1983),
Intensive cognitive therapy (Perris 1988),
Improving coping abilities (Fowler and Morley 1090), and
Cognitive behavioral techniques (Kington and Turbington – 1991, 1994)
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Phobia
Effectives as systematic desensitization
The change in the behavior following cognitive
therapy with these patients seems to follow a
cognitive change of reattribution of anxiety
from the phobic stimulus itself to the person’s
irrational ideals about the stimulus.
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Panic Disorders
The therapy is focused on the tendency
of the patient to make catastrophic
misinterpretation about bodily sensations
or mental experiences.
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Post-Traumatic Stress
Disorder (PTSD)
Several cognitive behavioral techniques
Desensitization to the trauma,
Cognitive restructuring,
Problem solving approach, and
Stress inoculation training.
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Suicidal Behavior
The therapist concentrates on the patient’s
misery and hopelessness.
A major emphasis is given to problem solving
techniques such as define the problem,
generating alternatives to solve the problem,
and implementing the solution.
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Other Indications
Cognitive therapies have also been used in the treatment
Dissociative (and conversion) disorders and
Paranoid disorders
Solving real life problems
Including marital problems,
Substance abuse, and
Stress disorders
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Limitation
Cognitive therapy is contraindicated
Patients with poor reality testing (e.g. with psychotic features),
Impaired reasoning and retention abilities, and
Borderline or other severe personality disorders. 30/04/2015 www.drjayeshpatidar.blogspot.in 26