Cognitive Behaviour Therapy

Judith Beck

Christine Padesky Donald Miechenbaum

CBT: Basic Principles

1. The cognitive principle Interpretations of events

Event Emotion

Event Cognition Emotion

2. The behaviour principle: What we do has powerful influence on our thoughts & emotions.

CBT: Basic Principles

Normal Mental illness

3. The continuum principle: Mental health problems as exaggerations of normal processes

CBT: Basic Principles

4. The here and now principle: Focus on current processes rather than the past

CBT: Basic Principles

THE INTERACTING SYSTEMSGeneric problem development model

6. The empirical principle: Evaluation of theories and therapy based on observation and evaluation

CBT: Basic Principles

LEVELS OF COGNITION Negative Automatic

Thoughts (NATs)‘’I’m being boring; I don’t know what to say. They think I’m stupid; I’m a

failure; She doesn’t like me’’

Dysfunctional assumptions‘’If people get to know me, then they

will find out how useless I am & reject me; I must be good at

everything I do, Otherwise my uselessness will be revealed’’

Core beliefs‘’I am unlovable; I am useless’’

More specific

More general

More accessible

Less accessible

Easier to change

Harder to change

COGNITIVE DISTORTIONSCognitive Distortion Definition Example

Arbitrary Interference Drawing conclusions without sufficient evidence, or when the evidence is actually contradictory.

Believing that you had been laid off for a job because of personal incompetence, although the company has gone out of business.

Over Generalisation Drawing a general conclusion on the basis of a single incident.

Concluding that you will never succeed after failing on the first attempt.

Selective Abstraction Attending to a detail while ignoring the total context.

Feeling rejected because a friend who was rushing to catch a bus did not stop to talk.

Personalisation Erroneously attributing an external event to yourself.

Thinking that people who are laughing are laughing at you.

Polarised Thinking (Dichotomous) Thinking in extremes, in a black-or-white or-all-or-none fashion.

Believing that you are a pauper after having lost your wallet.

Magnification and Minimization Viewing something as far more or less important than it is.

Thinking that you are poor writer after getting back a paper with several corrections.

TEMPLATE FORMATION

THE PROCESS OF ASSESSMENT

TECHNIQUES

Socratic Dialogue Helps to reveal what clients already know but not yet

considered, or forgotten.

Cognitive Techniques

1. Distraction2. Identifying cognitive biases3. Appraising onto thoughts & images4. Testing NATs and images5. Modifying core beliefs6. Behavioural experiments

Distraction

We can concentrate on one thing at a time.

- Breaking unhelpful cycles of thought- Changing attitudes towards negative

congnitions

Distraction: Practice

• Physical Exercise: Walk, Yoga, Pelvic floor • Refocusing: Focus on external world• Mental Exercises: Counting backwards, Recite

mantra, reconstruct an image/song, imagery of a scene

• Just counting thoughts: without much attention

Identifying Cognitive Biases

Through Dysfunctional Thought Record(DTR)

Dysfunctional Thought RecordDate/Time

Situation Automatic Thoughts

Emotions Adaptive response

Outcome

1) What actual event / stream of thoughts / daydreaming / recollection led to unpleasant sensations?

2) What (if any) distressing physical sensations did you have?

1) What thoughts / emotions went through your mind?

2) How much did you believe each one at the time?

1) What emotions (sad, anxiety, anger) did you feel at the time?

2) How intense (0-100%) was the emotion?

1) What cognitive distortions did you make?

2) Use Qs given to compose a response to the automatic thoughts3) How much do you believe each response?

1) How much do you believe each automatic thought?

2) What emotions do you feel now? How intense (0-100%)

3) What will/did you do?

Qs to help Alternative Response

1) What is the evidence that the AT is true? Not true?

2) Is there any alternative explanation? 3) What’s the worst that could happen? could I

live through it? What is the best that can happen? What is the most realistic outcome?

Qs to help Alternative Response(contd.)

4) What is the effect of my believing the AT? What could be the effect of my changing my thinking?

5) What should I do about it? 6) If ____ (a friend) was in the situation & had

this thought, what would I tell him/her?

Appraising ATs & Images

• Taking a step back or ‘decentring’: view cognitions as mental events rather than as expressions of reality. Focus on process than content.

• Understanding the origin of a cognition• Weighing up pros and cons• What is the worst, and how do you cope?• Identifying cognitive themes

Testing ATs & Images:Behavioural Experiments

Automatic Thought Behavioural Experiment

I don’t know what to say to him.

I can’t (get myself to) call for a doctor’s appointment

There are no jobs I’m qualified for.

If I get more and more dizzy, I’ll pass out.

Client role-plays herself while therapist plays the other part.Client makes phone call in the office.

Client reviews wanted ads with therapist.Client creates dizziness through hyperventilating while spinning in a chair.

Modifying Core Beliefs

• Historically test the source of core belief.• Carry out BEs to test the core belief• Record the evidence that a core belief is not

100% true.• Identify alternative (more helpful) core belief.• Rating confidence in new core beliefs.

Physical Techniques

• Relaxation• Controlled breathing• Physical exercises• Applied tension (useful in phobic anxiety

due to blood / injury)

• Sleep

BEHAVIOURAL EXPERIMENTS

Planned experiential activities, based on experimentation or observation, undertaken by clients in or between therapy sessions.

Types of Behavioural Experiments

E.g. Client doing something to see whether predicted consequences follow.

E.g. Client doing something to see what happens in an open – ended way.

Testing clear hypothesis

E.g. A survey of other people’s reactions.

Open-Ended Discovery

E.g. The therapist collapses in a supermarket so client can see what happens.

Client primary role as actor (Generating Information)

Client primary role as an observer (Receiving Information)

Experience

Conceptualisation

Planning Observation

THE ADULT LEARNING CYCLE