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Cbt,  applied relaxation, & erp.vijit
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Cbt, applied relaxation, & erp.vijit

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  • 1. By-VIJIT AGARWAL4th PHARM.D
  • 2.  The cognitive behavioural therapy involves 4sequential steps.1. Identifying how the patient is thinking and thebeliefs about self, world and the future thatunderlie those thoughts.
  • 3. 2. Evaluate the accuracy of those cognitionsthrough examination of their logic, probability andpast evidence.
  • 4. 3. Generating alternatives, more accurateinterpretations, predictions, and ways of believing.
  • 5. 4. Using these perspectives (whenever anxietyand worry are detected), to support them.
  • 6. Two additional methods to givethe therapy are as follows…1. Tell the patient to make a ‘worryoutcome diary’ and any time they noticethemselves in worrying, writing downthe worry and what they are afraid ofmight happen. At the end of each day they can reviewthe prior entries and identify whether theoutcome relevant to the particular worryhas actually occurred or not.
  • 7.  With this technique the patient can self identifythat the worry outcome was turned out well,and they cope up better then they expectedwith the small number of bad things.
  • 8. 2. Patient are learning to spend more time inpresent rather then in their minds and the future.They are encouraged to give more positive valuesto their present moments.
  • 9. Patient can overcome their anxietyand worry by some of thefollowing ways… Do different kinds ofrelaxation exerciseslike meditation Avoid alcohol andcaffeine Listen to slow musicand, Make yourself calm.
  • 10. Better results
  • 11. AppliedRelaxation
  • 12.  It is the best and one of the proven stressmanagement technique and it was developedby Swedish Physician L.G. Ost.Guidelines for Practice:- Allow yourself sufficient time in a quite space topractice. Don’t rush yourself. Each new stage will help you relax more quicklyand more deeply.These stages includes …
  • 13. Stages Include…1. Progressive muscle relaxation2. Release only relaxation3. Que-control relaxation4. Rapid relaxation5. Applied relaxation
  • 14. 1. Progressive muscle relaxation It will help you to recognize the differencebetween tension and relaxation in each of themajor muscle group. It helps you to drain the tension from yourmuscles.
  • 15. 2. Release only relaxation It cuts off the tensing step in progressive musclerelaxation. This means you can cut the time byhalf. Give yourself 1 - 2 weeks to practice. Your goal should be relax your entire body inless than 10 minutes.
  • 16. 3. Que-control relaxation It will further reduces the time you need torelax. In this stage you will focus on your breathing. Give yourself 1 – 2 weeks time to practice. Your goal should be to relax your entire body inabout 7 minutes.
  • 17. 4. Rapid relaxation It will reduce the time to relax, less than 1minute. Give yourself 1 – 2 weeks time to practice. Your goal should be to relax your entire body inabout 3 minutes.
  • 18. 5. Applied relaxation The final stage of applied relaxation training involvesrelaxing quickly in the face of anxiety provokingsituations. If your breath speeds up, muscles tense up, or if youfeel your heart rate is increasing, begin these 3steps…1. Take 2 or 3 deep, even breaths2. Think these calming words to yourself as youcontinue to breath deeplyBREATH IN…….RELAXBREATH IN…….RELAX3. Scan your body for tension and concentrate onrelaxing the muscle
  • 19. Patient can be asked that howhe/she feels before and afterrelaxing for better treatmentwith the help of a simpleexercise…
  • 20. Keep Yourself Calm
  • 21. Exposure and responsePrevention It is one of the most popular and effective formof behaviour therapy for OCD. ERP involves exposing you to anxiety that isprovoked by your obscession and preventingthe patient to use the rituals, to reduce anxiety.
  • 22.  Eg - Exposure Response Prevention Therapyexposes a patient to their drug or alcoholtriggers but prevents them from getting high. ERP makes patient to confront their worst fear:accidental exposure to substance abusetriggers.
  • 23. Example of Obscession Repetitive thoughts (e.g., feelingcontaminated after touching anobject, doubting whether the stove wasturned off) Repetitive images (e.g., recurrent sexuallyexplicit pictures)
  • 24. Compulsions Repetitive activities (e.g., handwashing, checking, ordering, need to ask, needto confess) Repetitive mental acts (e.g., counting, repeatingwords silently, praying)
  • 25. Screening questions Do you have repetitive thoughts that make youanxious and that you cannot get rid of? Do you check things excessively? Do you feel the need to wash your handsfrequently? Do you keep things exceptionally clean?
  • 26. Relaxation, CravingRating, and Pulse A typical ERP session starts with about 5 minutes ofrelaxation exercises. After relaxing, the patient is asked to rate theircraving level before being exposed to theirtriggering stimuli. They use a 10 point scale to do thiswhere 10 represents a desire to use immediately. The patient’s pulse is also measured (pulse rategenerally increases as a patient’s craving level rises).
  • 27.  Once a patient has completed the first level ofstimulus exposure he proceeds to the next leveland repeats all of the steps. An ERP therapy session continues until thepatient has completed all of the stimulusexposure levels, or the session has to bestopped because of over stimulation. The typical user requires at least 30 ERP sessionsto complete the entire stimulus hierarchywithout experiencing any significant levels ofcraving.

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