Final cbt seminar

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Final cbt seminar

  1. 1. COGNITIVE BEHAVIOUR THERAPY Principles, Techniques & Practice PRESENTER : JYOTHSNA K A CHAIRPERSON : DR. AMEER HAMZA DISCUSSANT : DR. KAVITA JANGAM
  2. 2. OUTLINE OF THE PRESENTATION <ul><li>Introduction On CBT- Historical Background </li></ul><ul><li>Principles – Assumptions & Theoretical Basis </li></ul><ul><li>Components Of CBT </li></ul><ul><li>Techniques Of CBT </li></ul><ul><li>CBT Used In Various Disorders </li></ul><ul><li>Models Of Psychotherapy Using CBT </li></ul><ul><li>Indications And Contraindications For CBT </li></ul><ul><li>Research On CBT </li></ul><ul><li>CBT Practice With Children </li></ul><ul><li>CBT Practice With Adults </li></ul><ul><li>Advantages And Disadvantages </li></ul><ul><li>CBT – TRAINING AND SKILLS OF The THERAPIST </li></ul><ul><li>Simple Guidelines For Practice </li></ul><ul><li>CBT And Social Work </li></ul>
  3. 3. INTRODUCTION ON CBT- HISTORICAL BACKGROUND <ul><li>Men are disturbed, not by things, but by the principles and notions which they form concerning things </li></ul><ul><li>( Epictetus 55 - 135 AD) </li></ul>
  4. 4. <ul><li>Mental Illness is defined as “ All diagnosable mental disorders, health conditions characterized by alterations in thinking, mood, behaviour ( or some combination thereof) associated with distress and / or impaired functioning “ (Surgeon General’s Report, US Health and Human Services, 1999) </li></ul><ul><li>Mental health problems can be conceptualized as disruptions in the interactions between the individual, group, and the environment producing a diminished rate of positive mental health(Scanlon et al, 1997) </li></ul>
  5. 5. <ul><li>In a mental health setting, a multi-disciplinary team approach is practised in the treatment of mental illnesses/ mental health problems </li></ul><ul><li>The psychiatrists and nursing is mainly focusing on pharmacotherapy </li></ul><ul><li>The Psychiatric Social Workers and clinical psychologists look into psychosocial interventions </li></ul><ul><li>They offer variety of psychotherapies </li></ul>
  6. 6. We may broadly consider 4 psychotherapies PSYCHOTHERAPIES PSYCHODYNAMIC HUMANISTIC & EXISTENTIAL BEHAVIOURAL COGNITIVE
  7. 7. <ul><li>PSYCHODYNAMIC </li></ul><ul><li>Probes the past and does not tackle the immediate problem </li></ul><ul><li>Explores the unconscious </li></ul><ul><li>The goal is to bring insight into the client </li></ul><ul><li>It takes a long time </li></ul><ul><li>Methods used are free association, dream analysis and transference </li></ul><ul><li>HUMANISTIC & EXISTENTIAL </li></ul><ul><li>Client centred by Carl Rogers </li></ul><ul><li>Focus on self actualization and explore the meaning of existence </li></ul><ul><li>Emphasis on emotion and experience </li></ul><ul><li>emphasis on non-directive approaches to therapy </li></ul><ul><li>Empathy, warmth, active listening, unconditional positive regard </li></ul>
  8. 8. <ul><li>BEHAVIOURAL </li></ul><ul><li>There are no mental processes (will, mind) </li></ul><ul><li>Derived from classical and operant conditioning </li></ul><ul><li>The focus is on changing the behavior </li></ul><ul><li>Works on the immediate problem </li></ul><ul><li>Focuses on the present </li></ul><ul><li>Techniques based on classical, operant conditioning & learning </li></ul><ul><li>COGNITIVE </li></ul><ul><li>emphasis is on internal thought processes </li></ul><ul><li>Addresses cognitive distortions </li></ul><ul><li>challenges client’s distorted thinking through a process of checking beliefs against reality </li></ul>
  9. 9. COGNITIVE BEHAVIOURAL THERAPY
  10. 10. <ul><li>The fundamentals of cognitive behaviour therapy have been around since ancient Greeks </li></ul><ul><li>Cognitive Behavioural Theories evolved from bi-directional movements in the existing fields of cognitive psychology and behavioural science </li></ul><ul><li>The evolution of CBT took place in 3 stages </li></ul>
  11. 11. <ul><li>Phase I: BEHAVIOUR THEORY </li></ul><ul><li>Initially Behaviour Therapy in United Kingdom and then parallel in USA in 1950s </li></ul><ul><li>Criticisms to strict behavioural approaches in 1970s </li></ul><ul><li>Derived from ideas of Pavlov, Watson and Hull </li></ul><ul><li>Major contributors were J. Wolpe, Eysenck, Skinner </li></ul>
  12. 12. <ul><li>Earlier, concentrated on neurotic disorders in adults </li></ul><ul><li>Classical conditioning, operant conditioning and modelling </li></ul><ul><li>The techniques used are systematic desensitization, aversive conditioning and exposure/ flooding, token economy </li></ul>
  13. 13. Phase II: COGNITIVE THEORY <ul><li>Cognitive research in 1960s demonstrated biases of people in information processing </li></ul><ul><li>Leading proponents were Aaron Beck and Albert Ellis </li></ul><ul><li>Behaviour techniques used to teach client cognitive strategies Emerged in 1960s </li></ul><ul><li>Origin of RET by Ellis in 1962 </li></ul><ul><li>During the expansion of research, researchers understood link between cognitive factors and behaviour </li></ul>
  14. 14. <ul><li>Somewhat differed from behaviourism </li></ul><ul><li>Progressed to use alongside behaviour therapy and also emphasis on behavioural component of cognitive therapy </li></ul><ul><li>Ellis was early advocate of directive form of cognitive therapy (RET) </li></ul><ul><li>Albert Ellis – psychological problems stem from irrational and catastrophic thinking </li></ul><ul><li>Aaron Beck – psychological problems stem from distorted thinking based on underlying cognitive schemata </li></ul>
  15. 15. Phase III: CBT dominance <ul><li>Over the past 20 years, the cognitive and behavioural theories have become more inter-connected, emphasizing both behaviour and thinking </li></ul><ul><li>Cognitive-behavioural therapy is becoming the dominant paradigm in clinical psychology </li></ul>
  16. 16. <ul><li>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) </li></ul>
  17. 17. <ul><li>CBT is the integrative, unified theories of cognition and learning with treatment techniques derived from cognitive and behavioural therapies </li></ul><ul><li>Focused form of psychotherapy based on a model suggesting that psychiatric or psychological disorders involve dysfunctional thinking </li></ul>
  18. 18. <ul><li>The way an individual feels and behaves is influenced by the way he/she structures his/her experiences </li></ul><ul><li>Modifying dysfunctional thinking provides improvements in symptoms and modifying dysfunctional beliefs that underlie dysfunctional thinking leads to more durable improvement </li></ul>
  19. 19. PRINCIPLES – ASSUMPTIONS & THEORETICAL BASIS <ul><li>Individuals react to and interpret events in terms of their perceived significance: beliefs, expectations and attitudes effect behaviour </li></ul><ul><li>Cognitive deficiencies can cause emotional disorders </li></ul><ul><li>Faulty thinking is the cause of emotional and behavioural problems </li></ul>
  20. 20. <ul><li>BEHAVIOURAL PRINCIPLES </li></ul><ul><li>Basic assumption of behavioural theories is that maladaptive behaviours are learned and can be unlearned, and that new, more adaptive behaviours can be learned </li></ul><ul><li>Has been applied to a wide range of disorders and problems </li></ul>
  21. 21. <ul><li>COGNITIVE PRINCIPLES </li></ul><ul><li>Cognitive principle – it is interpretations of events, not events themselves, which are crucial. </li></ul><ul><li>Behavioural principle – what we do has a powerful influence on our thoughts and emotions </li></ul><ul><li>The continuum principle – mental health problems are best conceptualised as exaggerations of normal processes </li></ul>
  22. 22. <ul><li>‘ Here and now’ principle – it is usually more fruitful to focus on current processes rather than the past </li></ul><ul><li>Interacting systems principle – it is helpful to look at problems as interactions between thoughts, emotions, behaviour and physiology and the environment in which the person operates </li></ul>
  23. 23. <ul><li>Basic assumption of cognitive theories is that maladaptive behaviour results from irrational or distorted ways of thinking – emphasis is on internal thought processes </li></ul><ul><li>Like psychodynamic theories, cognitive theories have been employed mostly with people with anxiety and mood disorders </li></ul><ul><li>Like behavioural theories, there is a strong research emphasis in cognitive theories </li></ul>
  24. 24. Components of CBT Thoughts Feelings and emotions Behaviours
  25. 25. Early Experiences Core Beliefs & Assumptions Critical Incident BECK’S COGNITIVE MODEL (1979) Negative Automatic Thoughts (NATS) Feelings Behaviour
  26. 26. NEGATIVE AUTOMATIC THOUGHTS <ul><li>Automatic thoughts are the thoughts that come to mind involuntarily and effortlessly </li></ul><ul><li>Most of our thoughts are automatic – they happen without being planned or intended </li></ul><ul><li>Clients may not even notice them unless you make a point of looking for them </li></ul><ul><li>They may or may not have an affect on client’s feelings, moods or behaviour </li></ul><ul><li>When they do, their effects can be beneficial, harmful or neutral </li></ul><ul><li>Some automatic thoughts can cause serious problems </li></ul>
  27. 27. MALADAPTIVE SCHEMAS <ul><li>Sometimes automatic thoughts turn out to have a shared theme called “schema” </li></ul><ul><li>They take the form of basic assumptions, attitudes or beliefs that influence a person’s thinking indirectly but powerfully </li></ul><ul><li>Eg : I am not a likable person </li></ul>
  28. 28. Cognitive Triad <ul><li>Negative view of self </li></ul><ul><li>Negative view of Negative World view of Future </li></ul>
  29. 29. Cognitive Distortions <ul><li>Labeling </li></ul><ul><li>Mind Reading </li></ul><ul><li>Exaggeration </li></ul><ul><li>Unrealistic Expectations </li></ul><ul><li>Belief in Entitlement </li></ul><ul><li>Belief in Absolute Fairness </li></ul><ul><li>Personalization </li></ul><ul><li>Minimization </li></ul><ul><li>Magnification </li></ul>
  30. 30. TECHNIQUES AND PROCESS OF CBT <ul><li>Essentially has 3 stages </li></ul><ul><li>Initial sessions </li></ul><ul><li>Middle sessions </li></ul><ul><li>Later sessions </li></ul>
  31. 31. INITIAL SESSIONS <ul><li>1-3 sessions </li></ul><ul><li>Developing a good therapeutic alliance </li></ul><ul><li>Check client’s mood </li></ul><ul><li>Assess client’s problems </li></ul><ul><li>Consider the most important problems </li></ul><ul><li>Clarify integral relationship between beliefs, affect and behaviour </li></ul><ul><li>Help client to identify automatic thoughts </li></ul><ul><li>Help clients to link automatic thoughts with emotion and behaviour </li></ul>
  32. 32. <ul><li>Outline the cognitive behavioural model </li></ul><ul><li>Take client’s consent to move further </li></ul><ul><li>Discuss client’s expectations of therapy </li></ul><ul><li>Agree between session assignments </li></ul><ul><li>Summarise session </li></ul><ul><li>Begin to socialize the client into the model </li></ul><ul><li>Emphasize on regular homework </li></ul><ul><li>Obtain feedback on session </li></ul>
  33. 33. MIDDLE STAGE <ul><li>Approximately 4-10 sessions </li></ul><ul><li>Help client to accept responsibility for personal change </li></ul><ul><li>Establish the extent to which the client engages in behaviours that temporarily relieve and/or enable avoidance of the problem but which are counterproductive </li></ul><ul><li>Continue to maintain a collaborative therapeutic relationship </li></ul>
  34. 34. <ul><li>Teach client about cognitive distortions </li></ul><ul><li>Shift focus of therapy from negative automatic thoughts to more helpful thoughts </li></ul><ul><li>Educate client about self-acceptance </li></ul><ul><li>Pass responsibility for therapeutic work over to the client </li></ul><ul><li>Encourage the client to become her own therapist </li></ul>
  35. 35. <ul><li>Refining and practicing social skills, problem solving skills, coping skills </li></ul><ul><li>Encourage client to continue with tasks between sessions </li></ul><ul><li>Prepare client for setbacks and ending therapy </li></ul><ul><li>Continue to give feedback and encouragement </li></ul>
  36. 36. ENDING STAGE OF THERAPY <ul><li>11-15 sessions </li></ul><ul><li>Shift focus to eliciting, examining and modifying deeper cognitive structures </li></ul><ul><li>Monitoring homework </li></ul><ul><li>Relapse prevention </li></ul><ul><li>prepare client for ending of therapy </li></ul><ul><li>Consider dependency issues </li></ul>
  37. 37. <ul><li>Help the client to summarise what has been learnt and understands appropriate techniques </li></ul><ul><li>Praise the client for genuine efforts </li></ul><ul><li>Decide when to end therapy consistent with the development of cognitive conceptualisation </li></ul><ul><li>Explore obstacles to ending </li></ul><ul><li>Develop action plan for potential problems </li></ul>
  38. 38. Techniques………… <ul><li>COGNITIVE BEHAVIOURAL ASSESSMENT </li></ul><ul><li>Education on CBT approach </li></ul><ul><li>Behavioural Interview </li></ul><ul><li>Interviews with key persons </li></ul><ul><li>Direct observations in clinical settings </li></ul><ul><li>Rating scales and questionnaires </li></ul><ul><li>Establish suitability for CBT </li></ul><ul><li>Gather specific information re current difficulties </li></ul><ul><li>Initial formulation </li></ul>
  39. 39. BEHAVIOURAL TECHNIQUES <ul><li>Relaxation </li></ul><ul><li>Rehearsing </li></ul><ul><li>Systematic desensitisation </li></ul><ul><li>Anger Management </li></ul><ul><li>Homework assignments </li></ul><ul><li>Cue response, graded exposure/flooding </li></ul><ul><li>Response prevention </li></ul><ul><li>Modelling </li></ul><ul><li>Stimulus control </li></ul><ul><li>Hypnotherapy </li></ul><ul><li>Habit Control </li></ul><ul><li>Aversion </li></ul><ul><li>Role play </li></ul>
  40. 40. COGNITIVE TECHNIQUES <ul><li>Education </li></ul><ul><li>De-catastrophising continuum </li></ul><ul><li>Letter writing </li></ul><ul><li>Imagery techniques </li></ul><ul><li>Cost benefit analysis of beliefs </li></ul><ul><li>Thought stopping </li></ul><ul><li>Experimentation </li></ul><ul><li>Self-monitoring </li></ul><ul><li>and recording </li></ul><ul><li>Dysfunctional Thought Record and Downward Arrow </li></ul><ul><li>Guided Discovery </li></ul><ul><li>Challenging irrational beliefs </li></ul><ul><li>Cognitive Restructuring </li></ul><ul><li>Coping skills and problem solving skills </li></ul><ul><li>Socratic questioning </li></ul><ul><li>Reframing the situation </li></ul>
  41. 41. CBT USED IN VARIOUS DISORDERS <ul><li>Mood Disorders </li></ul><ul><li>First developed as a treatment for depression </li></ul><ul><li>First line of psychotherapy for unipolar depression </li></ul><ul><li>Identifying negative automatic thoughts </li></ul><ul><li>Challenging thoughts </li></ul><ul><li>Behaviour and cognitive strategies to change thoughts and behaviour </li></ul><ul><li>Homework assignments </li></ul><ul><li>Monitoring outcome </li></ul><ul><li>Preventive strategies </li></ul>
  42. 42. <ul><li>Anxiety Disorders (OCD/ Panic/ Others ) </li></ul><ul><li>ABC analysis </li></ul><ul><li>Thought diaries </li></ul><ul><li>Teaching the techniques </li></ul><ul><li>Graded exposure/ Flooding/ imagery/ audio exposure </li></ul><ul><li>Response prevention </li></ul><ul><li>Homework and diary </li></ul><ul><li>Self monitoring </li></ul>
  43. 43. <ul><li>Eating disorders </li></ul><ul><li>Assessing key features of eating disorder </li></ul><ul><li>Psycho education </li></ul><ul><li>Rationale for treatment </li></ul><ul><li>Prescribing normal eating patterns </li></ul><ul><li>Self monitoring and meal plan </li></ul><ul><li>Initial cognitive interventions </li></ul><ul><li>Challenging body image issues, modifying self concept </li></ul><ul><li>Practicing, reviewing and self dependency, relapse prevention </li></ul>
  44. 44. Personality Disorders <ul><li>Success rate better in BPD </li></ul><ul><li>Assessment </li></ul><ul><li>Therapy uses less Socratic and more confrontative </li></ul><ul><li>Skills training </li></ul><ul><li>More research is on the way </li></ul>
  45. 45. Sexual dysfunctions <ul><li>Assessment </li></ul><ul><li>Problem formulation </li></ul><ul><li>Education </li></ul><ul><li>Counselling </li></ul><ul><li>Homework assignments </li></ul><ul><li>Termination </li></ul>
  46. 46. Alcohol use/ substance use disorders <ul><li>Behaviour self control </li></ul><ul><li>Cues exposure related training </li></ul><ul><li>Self monitoring </li></ul><ul><li>Relapse prevention </li></ul><ul><li>Follow up </li></ul>
  47. 47. Families and Couples <ul><li>Assessment of beliefs about relationship </li></ul><ul><li>Modification of unrealistic expectations in the relationship </li></ul><ul><li>Correction of faulty attributions in relationship interactions </li></ul><ul><li>Communication training and problem solving training </li></ul>
  48. 48. SOMATIZATION PROBLEMS <ul><li>Reduce physiological arousal through relaxation </li></ul><ul><li>Activity Scheduling focused on pleasurable activities </li></ul><ul><li>Increase the awareness of emotions </li></ul><ul><li>Modify dysfunctional beliefs </li></ul><ul><li>Enhance communication of thoughts and emotions </li></ul><ul><li>Reduce family reinforcement of illness behaviour </li></ul>
  49. 49. PREMENSTRUAL SYNDROME <ul><li>Psychoeducation </li></ul><ul><li>Analysis of negative thoughts and anxious preoccupation </li></ul><ul><li>Imparting coping skills </li></ul><ul><li>Teaching anger management </li></ul><ul><li>Relaxation techniques </li></ul><ul><li>Management of anxiety/ depressive symptoms </li></ul><ul><li>Encouraging positive thinking </li></ul>
  50. 50. Chronic pain, Neurological & Neurosurgical Problems <ul><li>Interventions for depression in patients with Parkinson’s Disease </li></ul><ul><li>Interventions for patients with anxiety after surgery for brain tumors and injuries </li></ul><ul><li>Interventions for grief and anxiety in patients with cancer </li></ul><ul><li>Pain management Migraine and headaches using relaxation and cognitive techniques </li></ul>
  51. 51. MODELS OF PSYCHOTHERAPY USING CBT COGNITIVE THERAPY RATIONAL EMOTIVE BEHAVIOUR THERAPY MINDFULNESS & MBCT DIALECTICAL BEHAVIOUR THRAPY ACCEPTANCE & COMMITMENT THERAPY MULTIMODAL THERAPY BEHAVIOUR THERAPY CBT
  52. 52. INDICATIONS FOR CBT <ul><li>Neurotic disorders </li></ul><ul><li>Client to have insight to some extent </li></ul><ul><li>Good therapeutic relationship </li></ul><ul><li>Considered effective treatment for depression </li></ul><ul><li>Also considered first line of psychotherapy for anxiety disorders, sexual dysfunctions as in uncomplicated cases </li></ul><ul><li>Cases of schizophrenia with negative symptoms </li></ul>
  53. 53. CONTRAINDICATIONS FOR CBT <ul><li>Generally not indicated for people with thought disorders </li></ul><ul><li>People with compromised intelligence </li></ul><ul><li>People with organic brain disorders </li></ul><ul><li>People who do not have good grasp of therapy language </li></ul><ul><li>People not accepting the premise of the treatment </li></ul><ul><li>Schizophrenia cases with positive symptoms </li></ul><ul><li>Severe suicidal ideas </li></ul>
  54. 54. RESEARCH ON CBT <ul><li>Conclusions based on systematic Cochrane Review </li></ul><ul><li>“ Cognitive interventions combined with exercise is recommended for chronic low backache in carefully selected patients after active rehabilitation programmes during 2 yrs time have failed” </li></ul><ul><li>(Van Tulder et al., 2006) </li></ul>
  55. 55. <ul><li>Randomized trial study among 204 patients with somatoform disorders in primary care setting in Spain revealed effectiveness of group and individual CBT (Rosa Magallon et al, 2008) </li></ul><ul><li>Results of a meta analytical investigation CBT for adolescent depression supported the efficacy of CBT(J B Klein, 2008) </li></ul><ul><li>Meta- analytical study on CBT with children with OCD revealed further need for enhanced use of CBT ( Jennifer Freeman, 2007) </li></ul>
  56. 56. <ul><li>A study on CBT for survivors after brain injury with anxiety disorders, showed that survivors made significant improvement (Williams, Evans and Fleminger, 2003) </li></ul><ul><li>CBT for Irritable Bowel Syndrome has efficacy in primary care as per randomized trial control study in 149 patients in UK primary care centre (Tom Kennedy et al, 2005) </li></ul><ul><li>Results of applying Social Cognition Model with 50 adults with HIV positive in Tamil Nadu, showed need for further cognitive behavioural based interventions with such groups ( Nalini T et al, 2006) </li></ul>
  57. 57. <ul><li>A study by NIMHANS on HIV and Psychiatric disorders indicated a need for psychosocial interventions like CBT (Dr. Prabha Chandra & Dr. Geeta Desai, 2005) </li></ul><ul><li>A study by NIMHANS regarding CBT for Bronchial Asthma revealed that it helps in the management of asthma ( Prasad Rao et al, 2002) </li></ul><ul><li>NIMHANS study on effectiveness on CBT for neurotic depressives on 25 samples using Beck’s approach revealed reduction in negative thoughts and depressive features (Nalini NR & Dr. Subbukrishna, 1996 ) </li></ul>
  58. 58. CBT PRACTICE WITH CHILDREN <ul><li>Research shows children suffer from a variety of Anxiety Disorders </li></ul><ul><li>CBT is considered the first line of treatment parallel to pharmacotherapy </li></ul><ul><li>Cognitive approaches to parents of children with eating disorders, ODD, LD and sleeping disorders help parents in better management of such children </li></ul>
  59. 59. <ul><li>CBT is also used in cases of children with ADHD, panic disorder, phobias, OCD, PTSD </li></ul><ul><li>Also for children and adolescents with unipolar depression </li></ul><ul><li>Treatment option for aggressive behaviour in youth </li></ul>
  60. 60. CBT PRACTICE WITH ADULTS <ul><li>In case of adults, CBT is extensively used for depression </li></ul><ul><li>There are more studies supporting good outcome in OCD </li></ul><ul><li>Persons with alcohol and substance use disorders can be helped through CBT </li></ul>
  61. 61. <ul><li>Other wide range of disorders like PTSD, other anxiety disorders and phobias, personality disorders, eating disorders and sexual dysfunctions </li></ul><ul><li>Effective in somatization problems, couples problems, family problems </li></ul>
  62. 62. ADVANTAGES AND DISADVANTAGES <ul><li>Advantages of Cognitive Behavior Therapy </li></ul><ul><ul><li>It has established human thought processes as data or events that can be studied. </li></ul></ul><ul><ul><li>It validated a number of relaxation techniques. </li></ul></ul><ul><ul><li>It has enhanced the rational therapies such as Rational Emotive Behavior Therapy. </li></ul></ul><ul><ul><li>Uses the systematic scientist-practitioner model </li></ul></ul>
  63. 63. <ul><li>Disadvantages of Cognitive Behavior Therapy </li></ul><ul><li>It has been harshly judged by feminists, multiculturalists and ecologists because it mirrors masculine and Euro-American worldviews and does not adequately take culture into consideration. </li></ul><ul><li>It requires a lot of training and skill. The therapist needs to not only understand cognitive techniques but also have a vast understanding of behavioral and learning theories. </li></ul><ul><li>The therapist needs to have strong discipline and there is less tolerance for error. </li></ul>
  64. 64. CBT –SKILLS AND TRAINING OF THERAPIST <ul><li>Assessment </li></ul><ul><li>Accurate Empathy </li></ul><ul><li>Being ‘with’ the client </li></ul><ul><li>Get the client’s meaning </li></ul><ul><li>Communicate empathic understanding </li></ul><ul><li>Communicate unconditional positive regard </li></ul>
  65. 65. <ul><li>The minimum requirement as in abroad is a diploma in CBT -3 months course </li></ul><ul><li>The students or practitioners of ther froms of psychotherapy can attend the workshops whenever conducted </li></ul><ul><li>The graduation and post graduation in psychology offers training </li></ul><ul><li>Clinical practice and adequate supervision and guidance from well established practitioners </li></ul>
  66. 66. SIMPLE GUIDELINES FOR PRACTICE <ul><li>Assessment </li></ul><ul><li>Building Therapeutic Relationship </li></ul><ul><li>A B C Analysis </li></ul><ul><li>Problem formulation </li></ul><ul><li>Listing hierarchy and working on priority </li></ul><ul><li>Planning and Structuring sessions </li></ul><ul><li>Guiding the client in implementation </li></ul><ul><li>Homework and review </li></ul><ul><li>Termination </li></ul>
  67. 67. Social Work Practice and CBT <ul><li>Client’s shift from passive recipient to active partner in treatment </li></ul><ul><li>Need for incorporation of diversity issues into interventions </li></ul><ul><li>Call for evidence based practice </li></ul>
  68. 68. <ul><li>Social workers should look for short-term, concrete, operational, and effective treatment methods which are measurable </li></ul><ul><li>learn to routinely apply initial assessment tools as well as evaluation methods to research their own treatment outcomes </li></ul><ul><li>a powerful need exists to teach clients specific skills that will enable them to resolve and cope with their own problems </li></ul>
  69. 69. Social work and CBT – Commonalities <ul><li>CBT and SW shares common components </li></ul><ul><ul><li>Individualism – focusing on individual </li></ul></ul><ul><ul><li>Rational thinking – understanding of thinking, emotions and behaviours of client </li></ul></ul><ul><ul><li>Select objects for change – assessment </li></ul></ul><ul><ul><li>Assessment, evaluation and interventions planning </li></ul></ul><ul><ul><li>Prediction in treatment </li></ul></ul><ul><ul><li>Developing skills for behaviour change </li></ul></ul><ul><ul><li>Empowerment – to solve problems using skills </li></ul></ul><ul><ul><li>(CBT – Clinical Social work practice; Tammie Ronen & Arthur Freeman, 2006) </li></ul></ul>
  70. 70. CBT application by the students in Dept PSW <ul><li>An analysis of case records done in Psychiatric Social Work Department </li></ul><ul><li>Case Records from 2004 to 2009 </li></ul><ul><li>60 case records were analysed </li></ul><ul><li>CBT was used in 50 cases out of 306 cases </li></ul><ul><li>The following was the impression based on symptom reduction </li></ul>
  71. 71. outcome Other therapies sessions Therapy Diagnosis Moderate to Good Family/ Supportive 25 CBT/CT Depression Moderate Family/ Supportive 12 CBT/CT Bipolar Affective Disorder Moderate Family/ Supportive 20 CBT Social Anxiety Disorder Good Family/ Supportive 25 ERP Obsessive Compulsive Disorder
  72. 72. CONCLUSION <ul><li>CBT is an integrative therapeutic approach that assumes that cognitions, physiology and behaviours are all functionally interrelated. </li></ul><ul><li>The treatment aims at identifying and modifying biased and distorted thought processes, attitudes and attributions as well as problematic behaviours via techniques actively involving the client participation in cognitive restructuring, self monitoring </li></ul><ul><li>As such the treatment goal is to develop more rational and adaptive cognitive structure as a pathway to rid off maladaptive patterns of behaviour and improve affect </li></ul>
  73. 73. THANK YOU

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