Hi! I am SHIV PRAKASH (PhD Research Scholar),This slide presentation, I have created it for teaching purpose. I have used this slide to present the concept of CBT for Nursing Student in the department of psychiatry, I.M.S. Banaras Hindu University in Varanasi. I hope this will be help full for everyone. Thank you!

1. SHIV PREKASH
PhD Research Scholar
Department of Psychiatry,
IMS, BHU, Varanasi
Uttar Pradesh, India

2. Burrhus Frederic Skinner [B. F. Skinner]
American Psychologist, Behaviorist
Operant Conditioning: Learning Theory
Ivan Petrovich Pavlov
Russian Psychologist
Classical Conditioning : Learning Theory
“Big” Names associated with Cognitive & Behavioral Therapy

3.  Albert Ellis, PhD in Psychology
 An American Psychologist
 Grandfather Of Cognitive Behavioral Therapy
 Rational Emotive Behavior Therapy
 Aaron Temkin Beck, MD, Psychiatrist
 University of Pennsylvania
 Father of Cognitive Therapy (1960)
 Beck Depression Inventory
 Self-report measures of Depression and Anxiety

4. Donald Meichenbaum, PhD
 One of the 10 most influential psychotherapists of the Century
 cognitive behavior modification [commonly as Cognitive-Behavioral Therapy]
 Private practice as a clinical psychologist
 An expert in the treatment of PTSD

5. Behaviour Therapy-:
“Behaviour therapy is the use of experimentally established principles of learning for the purpose
of changing unadaptive behaviour. Unadaptive habits are weakened and eliminated ; adaptive habit
are initiated and strengthened .”
J. Wolpe, 1969
Cognitive Therapy
“Cognitive therapy can defined as a treatment approach that attempts to modify maladaptive
behaviour by influencing a client’s cognitions (beliefs, schemas, self-statement and problems
solving strategies).”
Nietzel, Bernstein and Milich, 1994
Cognitive Behaviour Modification-:
“The term ‘cognitive-behavior modification’ encompasses treatments that attempt to change overt
behavior by altering thoughts, interpretations, assumptions, and strategies of responding”
Kazdin (1978)
“CBT is a process of teaching, coaching, and reinforcing positive behaviors. CBT helps people to
identify cognitive patterns or thoughts and emotions that are linked with behaviors.”
Continue……

6. Cognitive-Behavioral Therapy is an action-oriented form of psychosocial therapy
that assumes that maladaptive, or faulty , thinking patterns cause maladaptive
behavior and “negative” emotions . (Maladaptive behavior is that is counter-
productive or interferes with everyday living.) The treatment focuses on
changing an individual's thoughts (cognitive patterns) in order to change his or
her behavior and emotion state.
Derived from two main psychotherapies, behaviour therapy and cognitive therapy.
Behaviour therapy is based on the leading theories of Ivan Pavlov (classical
conditioning) and B. F. Skinner (operant conditioning) and was developed in the 1950s.
Cognitive therapy was developed in the 1960s by Aaron Beck and is closely linked to
Albert Ellis’ rational emotive therapy. Over the years these therapies have been
integrated and are referred to as CBT.
CBT is structured, time limited, problem and goal orientated. Emphasis on problems in
here and now. Homework is important and there is emphasis on relapse prevention
procedures.

7. Behavior-: What we do affects how we feel and think. The individual, who deals with an
upcoming exam by putting off his studies until the last minute, is likely to experience more
distress on the day of the exam than an individual who has studied well in advance. CBT helps
people to learn new behaviors and new ways of coping with events, often involving the learning
of particular skills.
Cognition-: "Cognition" is "the mental action or process of acquiring knowledge and
understanding through thought, experience, and the senses.“ It encompasses processes such as
knowledge, attention, memory and working memory, judgment and evaluation, reasoning and
"computation", problem solving and decision making, comprehension and production of
language, etc. Human cognition is conscious and unconscious, concrete or abstract, as well as
intuitive (like knowledge of a language) and conceptual (like a model of a language). Cognitive
processes use existing knowledge and generate new knowledge.
Emotions-: Somatic symptoms can accompany certain emotions: e.g. a person who is
panicking may experience palpitations, sweating, trembling and difficulty breathing.
Thinking-: Different people can think differently about the same event. The way in which we
think about an event influences how we feel and how we act. A classic example is that when
looking at a glass of water filled halfway, one person will see it half empty and feel discouraged
and the other sees it half full and feels optimistic.

8. Each of our clients have had unique experiences that shape who they are. Cognitive
behavioral therapists posit that from these life experiences, people develop core beliefs.
Core beliefs are the thoughts a person has that determine how they interpret their
experiences. For example, if someone has the core belief that "The world is a bad place",
they will believe that people who are kind have an ulterior motive (someone being kind
without reason just doesn't line up with their world view). Challenging these negative core
beliefs can help clients develop a healthier understanding of themselves and the world
around them.

9. Beck (1967) coined the term cognitive triad to describe the content of automatic negative
thoughts. Automatic thoughts are cognitions that stream rapidly through an individual’s
mind, whether spontaneously or in response to some prompt or stimulus. Automatic thoughts
may be triggered by affective arousal (i.e., anger, anxiety, or sadness), or conversely, affective
shifts are generally accompanied by automatic negative thoughts (Teasdale, 1983). Their
automatic nature refers to their speed of entry into awareness and their implicit believability. In this
way, automatic thoughts have emotional validity (Thase and Beck, 1993).
JHON
“Unhappy with his job”
“I’m too
busy now,”
“When the holiday
season is over,
I will apply for a job,”
AUTOMATIC THOUGHTS
Recognizing these thoughts as excuses, Jhon, with the help
of his therapist, identified automatic thoughts related to job
seeking, such as-::
 “I won’t present myself well”
 “Other people will be better than me.”

12. EVENT
Bill goes to
collection
APPRAISAL
“I can never do
anything right”
AFFECTIVE &
BIOLOGICAL
AROUSAL
“decreased sleep,
low energy”
BEHAVIORAL
INCLINATION
“I don’t want to
deal with it”
MALADAPTIVE
BEHAVIOR
“Withdrawal,
avoidance “

13. 1. Brief and Time Limited-: The average number of sessions clients
receive is approximately 16. CBT is brief because it is instructional and makes
use of homework assignments.
2. Present Centered-: What is happening with the client in the “here and now?”
3. Thought Focused-: “Helps client recognize and understand personal thoughts”
4. Practice and Homework-: Home work (including reading assignments) encourages
the client to practice the techniques learned.
5. Sound Therapeutic Relationship-: Establishes a trusting relationship and
builds rational self counseling skills in the client that helps the client learn to think
differently.

14. Outline of CBT Sessions:
Session 1-2: Assessment by Socratic questioning (The use of questions to reveal the self-defeating nature of
the client’s negative automatic thoughts) and identify cognitive triads (automatic thoughts, cognitive
distortion, faulty assumptions)
Session 3-4: case formulation and explain CBT model;
Session 5-7: keeping diaries and homework monitoring to look for cognitive errors, reattribution by
reviewing evidence, challenging cognitive errors, cost benefit analysis, forming action plans and
overcoming resistance
Session 8–10: BT involves identification of safety behaviours, entering feared situation without safety
maneuvers, applying relaxation techniques, activity scheduling, assertiveness training and reviewing results
Session 11 – 12: relapse prevention and termination.
Therapy-: Besides its special focus on the relationships between how we think, feel and behave, the
following are fundamental to the practice of CBT.
 Qualities of the Therapeutic Relationship
 Goal-setting
 Focus on the Present
 Structure
The methods of measurement used in CBT including: Direct observation, physiological
measures, standardized instruments and self report measures such as the Beck Depression
Inventory, the Beck Anxiety Inventory and Fear Questionnaire.

15. ELEMENTS OF CBT
CBT has several defining elements. They are as follows:
1. THE PATIENT AS AN ACTIVE PARTNER-: The client/ patient must be involved in the
therapeutic process not as an observer or as an occasional visitor, but as a core and key
participant.
2. MOTIVATIONAL: The therapist needs to take responsibility for helping to motivate the
client toward a change in behavior, affect, or thinking. The therapist must be able to set up the
format, and rationale for the client to consider change of value.
3. DIRECTIVE-: The therapist must be able to develop a treatment plan and then to help the
client to understand, contribute to, and see the treatment plan as a template for change.
4. HIGHLY STRUCTURED SESSIONS-: CBT is structured in two ways. First, the overall
therapy follow structure that approximates the treatment plan. Sessions have identifiable
beginning, middle and end.
5. PROBLEM-ORIENTED: CBT focuses on discrete problems rather than vague and
amorphous goals of feeling good, getting better, or increasing self-esteem
continue………..

16. 6. COLLABORATIVE: Therapeutic collaboration cannot be 50/50. for severe depressed
client the possibility to generate 50% of the therapeutic effort is impossible. Initially, the
collaboration may be 90/10. For each client, the therapist must evaluate the client’s ability
and motivation for the therapy.
7. PSYCHO EDUCATION: The therapist works as a change agent. Many to problems that
bring people therapy involve skills deficits. The therapist may have to teach by direct
instruction , modeling, role playing.
8. SOLUTION-FOCUSED: The CBT therapists works with the client on generating
solutions not simply gaining insight into the problem.
9. DYNAMICS: The dynamic level of CBT is to help clients to identify, understand, modify
their schema. The schema are the basic templates for understanding one’s world. Schema
may be personal, religious, cultural, gender-related.
10. TIME-LIMITED: Each therapy session should, ideally , stand alone. A time-limited
focus is not a number of sessions, but rather way of looking at therapy.
11. TREATEMENT AS EXPERIMENTS-: Therapeutic procedures are usually presented
as experiments which , even if they fail to produce improvement, will help the patient find
more about his condition.
continue…………

17. 12. HOME WORK ASSIGNMENTS-: Patients practice new behaviours between session
with the therapist , or carry out experiments to test explanations suggested by the sessions.
13. MONITORING OF PROCESS-: Assessment of progress does not rely soley on patient’s
verbal account but typically includes the checking of daily record kept by the patient. And
sometimes formal rating scales.
1. DISTRACTION-: That is focusing attention away from distressing thoughts. This is
done my attending to something in immediate environment ( for example, the objects
in a shop window), by engaging in a demanding activity (such as mental arithmetic),
or producing a sudden sensory stimulus (for example snapping a rubber band on the
wrist). This techniques is also known as “thought stopping”.
continue………….

18. 2. NEUTRALIZING-: The emotional impact of anxiety-provoking thoughts can be
reduced by rehearsing a reassuring response, for example, ‘my heart is beating fast I
feel anxious, not because I have heart disease.’ To make it easier to focus on
reassuring thoughts may carry ‘prompt card’ on which the reassuring thought were
written.
3. CHALLENGING-: It is used to change maladaptive thoughts and beliefs. It is no
enough to present evidence to the contrary because (as noted above) such thoughts
and beliefs often persist because people think in illogical ways. They over generalize
from single instances, and they pay more attention to evidence that supports their
believe than evidence that contradicts them.
4. REASSESSING-: Some beliefs persist because patients overestimate he extent of
their responsibility for events that have multiple determinants. Patients can reassess
their role by Constructing pie charts that shows all the determinants. For example,
mother who feels responsible for ensuring that every member of her family is content
would make a ‘pie chart’ showing the contribution of all the factors that determine
their state of mind. By allocating appropriate sectors to each of these factors before
entering her own contribution , she discovers that the room for the latter is than she
supposed.

19. 5. Socratic Questioning-: Questioning allows the therapist to stimulate the
client’s self awareness, focus in on the problem definition, expose the
client’s belief system, and challenge irrational beliefs while revealing the
clients cognitive processes.
6. Self-Monitoring-: Also called diary work, self-monitoring is used to
record the amount and degree of thoughts and behaviors. This provides
the client and therapist information regarding the degree of a client’s
negative affirmations.
7. Behavioral Experiments-: The experiment process includes
experiencing, observing, reflecting, and planning. These steps are
conducted through thought testing, discovery, activity, and/or observation.
7. Systematic Desensitization-: Systematic Desensitization pairs relaxation
with exposure to something stressful. Clients are taught to relax in anxiety
producing situations.