Basics of cognitive behavioral therapy

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Integration of Barlow's theory into CBT

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Basics of cognitive behavioral therapy

  1. 1. Basics of Cognitive-Behavioral Therapy: The Model and The Techniques Kevin D. Arnold, Ph.D., ABPP Director, The Center for Cognitive and Behavioral Therapy of Greater Columbus
  2. 2. The Basic CBT Model <ul><li>Psychopathology is bio-psycho-social </li></ul><ul><li>Feelings can be managed through addressing cognitions and behaviors </li></ul><ul><li>Psychopathology has deficits in behaviors and maladaptive or distorted cognitions </li></ul><ul><li>Underlying assumptions have been learned in an “if-then” format </li></ul><ul><li>Schemas create a construction that is maladaptive now, but not when first developed </li></ul>
  3. 3. Cognitive Triad <ul><li>Distorted Thoughts are those that are mood congruent but not reflective of the evidence in life </li></ul><ul><li>These are sometimes referred to as Automatic Thoughts </li></ul><ul><li>The thoughts fit basically into three categories: Self, Others/World, or Future </li></ul>
  4. 4. Cognitive Blockade <ul><li>Mood or other pathologic processes create a filtering of information that is state-dependent </li></ul><ul><li>Information, both internal and external, is filtered so that only mood congruent information is a) perceived, or b) valued. </li></ul><ul><li>Overcoming the impact of the blockade is a major goal of CBT </li></ul>
  5. 5. Treatment Method: General <ul><li>Cognitive Therapy is collaborative so that the patient and therapist are a team working on problems together </li></ul><ul><li>Cognitive Therapy is active and engages the patient through a treatment relationship that encourages but respects the patient through empathy </li></ul><ul><li>Cognitive Therapy uses the Socratic Method, using questions whenever possible </li></ul>
  6. 6. Socratic Method <ul><li>Questions are used in CBT to </li></ul><ul><ul><li>Help the patient become aware of thoughts </li></ul></ul><ul><ul><li>Examine thoughts to identify distortions </li></ul></ul><ul><ul><li>Replace distortions with health and evidenced based ideas </li></ul></ul><ul><ul><li>Plan to develop new thinking patterns </li></ul></ul>
  7. 7. Collaborative <ul><li>Therapy is guided by a team approach to problems </li></ul><ul><ul><li>The treatment conceptualization is created collaboratively as a basis for the treatment methods </li></ul></ul><ul><ul><li>The structure of the sessions is agreed upon as a way of keeping the collaborative work moving </li></ul></ul><ul><ul><li>Both agree on structure and direction </li></ul></ul>
  8. 8. Structure and Direction <ul><li>All sessions use the following template </li></ul><ul><ul><li>Setting an agenda </li></ul></ul><ul><ul><li>Bridging back to the previous session </li></ul></ul><ul><ul><li>Setting a target for the session </li></ul></ul><ul><ul><li>Application of the CBT techniques to the target </li></ul></ul><ul><ul><li>Summarization of the session </li></ul></ul><ul><ul><li>Setting homework </li></ul></ul><ul><ul><li>Feedback on the session </li></ul></ul>
  9. 9. Problem Orientation <ul><li>Conceptualization: Patients problems within a present, learning context </li></ul><ul><li>Selection of strategies and techniques </li></ul><ul><li>Assess the effectiveness of the CBT on the problem within its context. </li></ul>
  10. 10. Common Strategies in CBT <ul><li>Simplify </li></ul><ul><li>Do it now </li></ul><ul><li>You can’t know unless you experiment </li></ul><ul><li>If you are off track, do the opposite </li></ul><ul><li>Persistence will produce change </li></ul><ul><li>Break it down and take one thing at a time </li></ul><ul><li>Do that which you don’t expect yourself to do </li></ul><ul><li>Pull, don’t push/Flow </li></ul>
  11. 11. Educate <ul><li>CBT educates patients to be their own therapists </li></ul><ul><ul><li>Help the patient to learn how to learn </li></ul></ul><ul><ul><ul><li>It’s not resistance, it’s reluctance </li></ul></ul></ul><ul><ul><ul><li>It’s not resistance, it’s slowness </li></ul></ul></ul><ul><ul><li>Patients learn inductively </li></ul></ul><ul><ul><ul><li>Beliefs are hypothesis </li></ul></ul></ul><ul><ul><ul><li>Testing them can provide insight or new ways of thinking </li></ul></ul></ul>
  12. 12. The Key Elements <ul><li>Behavioral Experimentation </li></ul><ul><li>Daily Activity Records </li></ul><ul><li>Activity Scheduling </li></ul><ul><li>Pleasure Scheduling </li></ul><ul><li>Identify Distortions through Self-Monitoring (3 Column) and Labeling Automatic Thoughts </li></ul><ul><li>Test the Evidence </li></ul><ul><li>Challenge and Create New Thoughts (5 Column) </li></ul>
  13. 13. Cognitive Distortions <ul><li>Related to Mood </li></ul><ul><li>Don’t represent evidence or have gone unchallenged </li></ul><ul><li>Have not been evaluated, instead assumed to be true </li></ul><ul><li>Learned based on history </li></ul><ul><li>See Handout </li></ul>
  14. 14. Assessing the Automatic Thoughts <ul><li>Question, Question, Question </li></ul><ul><li>Listen, Listen, Listen </li></ul><ul><li>Downward Arrow </li></ul><ul><li>Imaging a Situation </li></ul><ul><li>Noticing Affect and Calling Out the Thoughts </li></ul>
  15. 15. What to Do <ul><li>Develop CBT competencies </li></ul><ul><li>Identify Useful Texts Like Leahy’s books </li></ul><ul><li>Take Training from one of the Centers </li></ul><ul><li>Continue with this Calendar </li></ul>

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