Judith BeckChristine Padesky Donald Miechenbaum
CBT: Basic Principles 1. The cognitive principle Interpretations of events Event EmotionEvent Cognition Emotion
CBT: Basic Principles2. The behaviour principle: What we do has powerful influence on our thoughts & emotions.
CBT: Basic Principles3. The continuum principle: Mental health problems as exaggerations of normal processes Normal Mental illness
CBT: Basic Principles4. The here and now principle: Focus on current processes rather than the past
THE INTERACTING SYSTEMSGeneric problem development model
CBT: Basic Principles6. The empirical principle: Evaluation of theories and therapy based on observation and evaluation
LEVELS OF COGNITION Negative Automatic More accessible Easier to More specific change 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 general Less Harder to accessible change
COGNITIVE DISTORTIONSCognitive Distortion Definition ExampleArbitrary Interference Drawing conclusions without Believing that you had been laid sufficient evidence, or when the off for a job because of personal evidence is actually contradictory. incompetence, although the company has gone out of business.Over Generalisation Drawing a general conclusion on Concluding that you will never the basis of a single incident. succeed after failing on the first attempt.Selective Abstraction Attending to a detail while Feeling rejected because a friend ignoring the total context. who was rushing to catch a bus did not stop to talk.Personalisation Erroneously attributing an external Thinking that people who are event to yourself. laughing are laughing at you.Polarised Thinking (Dichotomous) Thinking in extremes, in a black- Believing that you are a pauper or-white or-all-or-none fashion. after having lost your wallet.Magnification and Minimization Viewing something as far more or Thinking that you are poor writer less important than it is. after getting back a paper with several corrections.
DistractionWe 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 BiasesThrough Dysfunctional Thought Record (DTR)
Date/ Situation Automatic Emotions Adaptive OutcomeTime Dysfunctional Thought1)Record 1) What actual Thoughts 1) What 1) What What response 1) How much event / stream thoughts / emotions cognitive do you believe of thoughts / emotions went (sad, anxiety, distortions did each daydreaming / through your anger) did you you make? automatic recollection led mind? feel at the thought? to unpleasant time? 2) Use Qs given sensations? 2) How much to compose a 2) What did you believe 2) How response to the emotions do 2) What (if any) each one at the intense (0- automatic you feel now? distressing time? 100%) was thoughts How intense physical the emotion? 3) How much (0-100%) sensations did do you believe you have? each response? 3) What will/did you do?
Qs to help Alternative Response1) 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 ExperimentsAutomatic Thought Behavioural ExperimentI don’t know what to say to him. Client role-plays herself while therapist plays the other part.I can’t (get myself to) call for a Client makes phone call in the office.doctor’s appointment Client reviews wanted ads withThere are no jobs I’m qualified for. therapist. Client creates dizziness throughIf I get more and more dizzy, I’ll pass hyperventilating while spinning in aout. 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 EXPERIMENTSPlanned experiential activities, based on experimentation or observation, undertaken by clients in or between therapy sessions.
Types of Behavioural Experiments Client primary role as actor (Generating Information)E.g. Client doing E.g. Client doing somethingsomething to see whether to see what happens in anpredicted consequences open – ended way.follow.Testing clear hypothesis Open-Ended DiscoveryE.g. A survey of other E.g. The therapist collapsespeople’s reactions. in a supermarket so client can see what happens.Client primary role as an observer (Receiving Information)
THE ADULT LEARNING CYCLE ExperiencePlanning Observation Conceptualisation