2. The staff will identify the main concept of Cognitive
Behavioral Therapy at the end of the presentation on
04/25/14.
The staff will identify the role of mindfulness and
positive thinking in CBT at the end of the presentation
on 04/25/14.
The staff will practice new skills of using CBT at the
end of the presentation on 04/25/14.
Objectives
3. Psychosocial theoretic basis of psychiatric therapy
Concepts of CBT and Mindfulness
ABCDE model
Role of mindfulness and positive thinking
CBT model and Personality Disorder
Recovery plan
CBT case study
Content
4. Buddhist psychology
Mindfulness
Sigmund Freud (1856-1939)
Founder of psychoanalysis
Abraham Maslow (1921-1970)
Maslow’s hierarchy of needs
Ivan Pavlov (1849-1936)
Classical conditioning phenomenon
Psychosocial Theoretic Basis of
Psychiatric Nursing
5. Albert Bandura (b. 1925)
Social Cognitive Theory: modeling, self-efficacy
Erick Erikson (1902-1994)
Psychosocial Development
Jean Piaget (1896-1980)
Theory of Cognitive Development
Aaron Beck (1960s)
Cognitive Behavioral Therapy
6. The term mindfulness is an English translation of the
Pali word sati. Pali was the language of Buddhist
psychology 2,500 years ago, and mindfulness is the
core teaching of this tradition. Sati connotes
awareness, attention, and remembering.
Mindfulness in Psychotherapy is (1) awareness, (2) of
present experience, (3) with acceptance.
Acceptance = nonjudgmental, kindness, friendliness
Mindfulness
7. What would you, as a new awareness or visitor to this new
body, notice about the sensations of breathing, as you breathe
in, then out? Notice the sensations in the abdomen, the chest, the
throat, the mouth and nose. You can notice how your attention
wanders, as thoughts come in, sometimes crowding in, and your
attention can follow those thoughts. Just notice as your attention
wanders, then gently bring your focus back to your breath. Minds
do wander, thoughts will come and thoughts will go, that is the
nature of the human mind. As a visitor, you can stand back, notice
those thoughts, feelings, sounds and sensations, and keep bringing
your attention back to your breath.
The Breath
8. Co-occurring disorders – presence of comorbid mental
illness and a substance use disorder in the same person
Goal of treatment – comprehensive recovery plan for the
complex problem
“We are all here for some special reason. Stop being a prisoner
of your past. Become the architect of your future.”
Robin Sharma
Co-occurring disorders
9. The Stages of Change Model has five phases:
Pre-contemplation: Avoidance. That is, not seeing a
problem behavior or not considering change.
Contemplation: Acknowledging that there is a problem but
struggling with ambivalence. Weighing pros and cons and
the benefits and barriers to change.
Preparation/Determination: Taking steps and getting ready
to change.
Action/Willpower: Making the change and living the new
behaviors, which is an all-consuming activity.
Maintenance: Maintaining the behavior change that is now
integrated into the person's life.
Relapse: Returning to the previous stage.
Motivational Interviewing
10. High expectations
Express empathy
Develop discrepancy
Roll with resistance
Support self –efficacy
“If you want light to come into your life, you need to
stand where it is shining.” Guy Finley
PRINCIPLES OF MOTIVATIONAL
INTERVIEWING
11. CBT – is a highly structured psychotherapeutic method used to alter
distorted beliefs and problem behaviors by identifying and replacing
negative inaccurate thoughts and changing rewards for behaviors
ABCDE MODEL
Activating Event – the actual event and the client’s immediate
interpretations of the event
Beliefs about the event – this evaluation can be rational or irrational
Consequences – how you feel and what you do or other thoughts
Dispute or challenge unreasonable expectations
Effective outlook developed by disputing or challenging negative
belief systems
What is CBT?
14. Black-and-White - Thinking or either / or thinking.
Making Unfair Comparisons – usually in the negative
Filtering – honing in on the negative, forgetting the positive.
Personalizing - The Self-Blame Game
Mind-Reading – thinking we know what others think (negatively)
Catastrophising – imagining the worst case scenario
Overgeneralising – “I always mess up…”
Confusing Fact with Feeling – “If I think or feel this way then my
thoughts/feelings must be correct'.
Labelling – I’m a loser vs. I made a mistake.
'Can't Standitis' – being unnecessarily intolerant
Distortions in thinking
15. Activating Event
Ask for a problem
Define and agree on the target problem
Assess the consequences of the problem
Assess the activating event
Identify and assess any secondary emotional problems
Belief System
Teach the connection between the beliefs and
consequences
Assess beliefs
Rational CBT sequence
16. Consequences
Connect irrational beliefs and emotional consequences
Dispute
Dispute irrational beliefs
Prepare the patient to deepen conviction in rational beliefs
Effective outlook
Encourage the patient to put new learning into practice
Check homework
Facilitate the working-though process
“All things are difficult before they are easy.” Thomas Fuller
http://www.getselfhelp.co.uk/freedownloads2.htm
17. Techniques used in CBT
Therapeutic relationship
Cognitive
Behavioral
Problem solving
Emotional
Biological
Interpersonal
Environmental
Supportive
CBT for Personality Disorder
18. I am inadequate, ineffective, incompetent, can’t
cope, helpless, can’t get what I want/need.
I am powerless, out of
control, trapped, vulnerable, week, needy, a victim.
I am a failure, a loser, not good enough.
Helpless Core Beliefs
19. I am unlikable, unwanted, will be rejected or
abandon, always be alone.
I am undesirable, unattractive, ugly, boring.
Unlovable Core Beliefs
20. I am worthless, unacceptable, bad, crazy, broken, a
waste.
I am evil. I don’t deserve to live.
Worthless Core Beliefs
22. Situation:
Therapist asks Joe about goals for therapy.
Automatic thoughts: “Why is she asking me that? It’s so
superficial. Setting goals won’t help. My problems are too
deep. She should know that”.
Reaction: emotional – anger; physiological – tension in
face, arms, shoulders; behavioral – shrugs, avoids eye
contact, says nothing.
23. Situation:
Therapist and Joe discuss his difficulties organizing and paying
her bills.
Automatic thoughts: “My therapist is thinking I am stupid.
How dare she judge me!”
Reaction: emotional – anger; physiological – clenches her fist;
behavioral – criticizes therapist.
24. New idea
High expectations
Positive reinforcement: praise, reassurance,
encouragement
Empathy
Professionalism vs hostility
Non-verbal/verbal
Inspiration
“The purpose of our lives is to be happy”.
Dalai Lama
Communication and personal
attitude
26. Avoid polar opposite beliefs; guide patient toward
adopting something in the middle.
“I am bad”, to “I am okay”.
“I am incompetent”, to “I have strengths and
weakness like everyone else”.
“I am defective”, to “I am normal”.
Develop a New Core Beliefs
27. Physical, emotional, and spiritual healing
Learn stress reduction therapy
Radically change diet or marriage
Take control over your health: willingness to change, do
research, be proactive
Follow your intuition: body knows what it needs to
heal, change your body-mind-spirit
Use herbs and boost your immune system
Be active physically
The key factors that can make a
real difference
28. Increase positive emotions: love yourself, life, and others
Embrace social support: "In poverty and other misfortunes
true friends are sure refuge”. Aristotle
Discover your spiritual beliefs
Have strong reason for living
Create your love and happiness and spread to others
“Happiness is an attitude. We either make ourselves
miserable, or happy and strong. The amount of work is the
same.”
Francesca Reigler
29. Boyd, M. (2008). Psychiatric Nursing. Wolter Kluwer
Health/Lippincott Williams & Wilkins. Philadelphia,
Baltimore, New York, London.
German, C., Siegel, R., Fulton, P. (2005). Mindfulness and
Psychotherapy. The Guilford Press, New York, London.
Winston, A., Rosenthal, R., Pinsker, H. (2012). Learning
Supportive Psychotherapy. American Psychiatric
Publishing. Washington DC, London.
References
