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COGNITIVE BEHAVIORAL
THERAPY
R.RUPPAMERCY
M.Sc. NURSING II
YEAR
INTRODUCTION
DEFINITION
HISTORY
INDICATIONS
PROCESS OF CBT
TECHNIQUES OF COGNITIVE BEHAVIORAL
THERAPY
1. COGNITIVE RESTRUCTURING
OR
REFRAMING
 Developed in the 1950s by a renowned psychologist called Albert Ellis
 The main objective is to replace negative thought or habits with more positive (and therefore less stress-
inducing) ones.
 Instead of thinking about the one time they failed, cognitive restructuring urges them to think about the other
times they did well in tests
COGNITIVE RESTRUCTURING
EXERCISES
 Mindful meditations - focusing on a particular thing, say breathing for a set number of
minutes helps to clear the negative thoughts from your mind.
 Increased awareness of thoughts - taking notes of the negative emotions in your brain
improve your awareness of your own mind.
 Self – compassion - Be kind to yourself
 De – catastrophizing - asking yourself “what if?”
 Thought recording - identify any cognitive distortions that may have gone unquestioned
or unnoticed
2. GUIDED DISCOVERY
 Guided discovery is based on asking a series of questions that allows information to be
brought into client’s awareness rather than requiring a correct answer”.
 Padesky (1993) suggests that Socratic questioning consists of 4 stages
1) asking informational questions
2) listening attentively and reflecting back
3) summarising newly acquired information
4) asking analytic or synthesising questions to apply the new information to the client’s
original problem or thought
Socratic questioning - Is this thought realistic?
Am I basing my thoughts on facts or feelings?
Is the thought correct?
Am I viewing the situation as black and white, when it’s really more complicated?
Could I be misinterpreting the evidence?
Am I having this thought out of habit, or do facts support it?
3. EXPOSURE THERAPY
 Developed to help confront fears
 TYPES
 In vivo exposure – directly facing a feared object
 Imaginal exposure – imagining the feared object
 Virtual reality exposure – virtual reality technology
 Interoceptive exposure - deliberately bringing on physical sensations that are harmless,
yet feared.
TECHNIQUES
GRADED EXPOSURE
SYSTEMATIC
DESENSITIZATION
EXPOSURE RESPONSE PREVENTION
4. JOUNRALING AND THOUGHT RECORDS
 Thought records are an important part of cognitive behavioral treatment for many
problems.
 They make our negative automatic thoughts visible to us
 They help us to identify any problems with our thinking
 They can help us to make changes to our thinking
• Make a note of the date & time
• Record where you were
• Note who you were with
• Summarize what was happening
just before you noticed a change
in how you were feeling
• Emotion
What was going through my mind in
that moment?
What was I saying to myself?
Did I have an image/picture/memory
in my mind? (If you did: what did it
mean? What does it say about you?)
What implications did that situation
have for me or my future?
5. ACTIVITY SCHEDULING AND BEHAVIOR
ACTIVATION
 mean every behavior you find yourself doing, from eating, walking and watching T.V. to staring out of the
window and playing squash.
 After a week of completing the diary, take a look at it.
 What do you notice? Are there any patterns of inactivity which emerge. Are there any situations or people
which you avoid more than you realized. Did you do anything that you enjoyed?
 Check the schedule in the weekend for patterns of inactivity, avoidance or lack of routine
Schedule:
• Health related activities
• Fun
• Rest and relaxation
• socialization
6. BEHAVIORAL EXPERIMENTS
 Behavioral experiments are planned experiential and information gathering exercise, the purpose of which is
to test the accuracy of an individual’s beliefs (about themselves, others, and the world) or to test new, more
adaptive beliefs.
 Step 1: Identify the target cognition
 Step 2: Design an experiment
 Step 3: Outcome & learning
 Step 4: What next?
Testing
hypothesis A:
testing an
existing
(unhelpful)
belief.
Testing
hypothesis
B: testing a
new belief.
Discovery
experiments:
where the
individual does
not have a clear
hypothesis about
what might
happen.
Testing hypothesis A
vs. hypothesis B:
testing whether the
original (threatening)
belief or a newly
constructed (less
threatening) belief
better accounts for
the evidence
Surveys: used
where an
individual has a
belief about
what other
people think.
Direct
observation: where
an individual has a
hypothesis about
what might happen,
but does not feel
capable of testing it
directly for
themselves..
7. RELAXATION AND STRESS REDUCTION TECHNIQUES
8. ROLE PLAYING
 Role play improves problem
solving skills
 Gaining familiarity and
confidence in certain
situations
 Practicing social skills
 Assertiveness training
 Improving communication
skills
9. SUCCESSIVE APPROXIMATION
 Breaking up large tasks into a smaller chucks to make it easier to complete.
 Smoking cessation
 Fears/phobias
ADVANTAGES
 Can be as effective as medication in treating some mental health disorders and may be
helpful in cases where medication alone has not worked.
 Can be completed in a relatively short period of time compared to other talking
therapies.
 Focuses on re-training your thoughts and altering your behaviours, in order to make
changes to how you feel.
 The highly structured nature of CBT means it can be provided in different formats,
including in groups, self-help books and computer programmes.
 Skills you learn in CBT are useful, practical and helpful strategies that can be incorporated
into everyday life to help you cope better with future stresses and difficulties, even after
the treatment has finished.
DISADVANTAGES
 To benefit from CBT, you need to commit yourself to the process. A therapist can help
and advise you, but cannot make your problems go away without your co-operation.
 Attending regular CBT sessions and carrying out any extra work between sessions can
take up a lot of your time.
 Due to the structured nature of CBT, it may not be suitable for people with more complex
mental health needs or learning difficulties.
 Some critics argue that because CBT only addresses current problems and focuses on
specific issues, it does not address the possible underlying causes of mental health
conditions, such as an unhappy childhood.
 CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings
and behaviours), and does not address wider problems in systems or families that often
have a significant impact on an individual’s health and wellbeing.
CONCLUSION
Cognitive behavioral therapy is a clinically significant effective for anxiety and
depression. And underline the need for integrating mental health care. CBT helps people to
identify cognitive patterns or thoughts and emotions that are linked with behaviors. There
are many techniques such as modelling, homework and computer assisted therapy etc.
Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy

  • 7. TECHNIQUES OF COGNITIVE BEHAVIORAL THERAPY
  • 8. 1. COGNITIVE RESTRUCTURING OR REFRAMING  Developed in the 1950s by a renowned psychologist called Albert Ellis  The main objective is to replace negative thought or habits with more positive (and therefore less stress- inducing) ones.  Instead of thinking about the one time they failed, cognitive restructuring urges them to think about the other times they did well in tests
  • 9. COGNITIVE RESTRUCTURING EXERCISES  Mindful meditations - focusing on a particular thing, say breathing for a set number of minutes helps to clear the negative thoughts from your mind.  Increased awareness of thoughts - taking notes of the negative emotions in your brain improve your awareness of your own mind.  Self – compassion - Be kind to yourself  De – catastrophizing - asking yourself “what if?”  Thought recording - identify any cognitive distortions that may have gone unquestioned or unnoticed
  • 10. 2. GUIDED DISCOVERY  Guided discovery is based on asking a series of questions that allows information to be brought into client’s awareness rather than requiring a correct answer”.  Padesky (1993) suggests that Socratic questioning consists of 4 stages 1) asking informational questions 2) listening attentively and reflecting back 3) summarising newly acquired information 4) asking analytic or synthesising questions to apply the new information to the client’s original problem or thought Socratic questioning - Is this thought realistic? Am I basing my thoughts on facts or feelings? Is the thought correct? Am I viewing the situation as black and white, when it’s really more complicated? Could I be misinterpreting the evidence? Am I having this thought out of habit, or do facts support it?
  • 11. 3. EXPOSURE THERAPY  Developed to help confront fears  TYPES  In vivo exposure – directly facing a feared object  Imaginal exposure – imagining the feared object  Virtual reality exposure – virtual reality technology  Interoceptive exposure - deliberately bringing on physical sensations that are harmless, yet feared.
  • 13. 4. JOUNRALING AND THOUGHT RECORDS  Thought records are an important part of cognitive behavioral treatment for many problems.  They make our negative automatic thoughts visible to us  They help us to identify any problems with our thinking  They can help us to make changes to our thinking • Make a note of the date & time • Record where you were • Note who you were with • Summarize what was happening just before you noticed a change in how you were feeling • Emotion What was going through my mind in that moment? What was I saying to myself? Did I have an image/picture/memory in my mind? (If you did: what did it mean? What does it say about you?) What implications did that situation have for me or my future?
  • 14. 5. ACTIVITY SCHEDULING AND BEHAVIOR ACTIVATION  mean every behavior you find yourself doing, from eating, walking and watching T.V. to staring out of the window and playing squash.  After a week of completing the diary, take a look at it.  What do you notice? Are there any patterns of inactivity which emerge. Are there any situations or people which you avoid more than you realized. Did you do anything that you enjoyed?  Check the schedule in the weekend for patterns of inactivity, avoidance or lack of routine Schedule: • Health related activities • Fun • Rest and relaxation • socialization
  • 15. 6. BEHAVIORAL EXPERIMENTS  Behavioral experiments are planned experiential and information gathering exercise, the purpose of which is to test the accuracy of an individual’s beliefs (about themselves, others, and the world) or to test new, more adaptive beliefs.  Step 1: Identify the target cognition  Step 2: Design an experiment  Step 3: Outcome & learning  Step 4: What next? Testing hypothesis A: testing an existing (unhelpful) belief. Testing hypothesis B: testing a new belief. Discovery experiments: where the individual does not have a clear hypothesis about what might happen. Testing hypothesis A vs. hypothesis B: testing whether the original (threatening) belief or a newly constructed (less threatening) belief better accounts for the evidence Surveys: used where an individual has a belief about what other people think. Direct observation: where an individual has a hypothesis about what might happen, but does not feel capable of testing it directly for themselves..
  • 16. 7. RELAXATION AND STRESS REDUCTION TECHNIQUES
  • 17. 8. ROLE PLAYING  Role play improves problem solving skills  Gaining familiarity and confidence in certain situations  Practicing social skills  Assertiveness training  Improving communication skills
  • 18. 9. SUCCESSIVE APPROXIMATION  Breaking up large tasks into a smaller chucks to make it easier to complete.  Smoking cessation  Fears/phobias
  • 19. ADVANTAGES  Can be as effective as medication in treating some mental health disorders and may be helpful in cases where medication alone has not worked.  Can be completed in a relatively short period of time compared to other talking therapies.  Focuses on re-training your thoughts and altering your behaviours, in order to make changes to how you feel.  The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programmes.  Skills you learn in CBT are useful, practical and helpful strategies that can be incorporated into everyday life to help you cope better with future stresses and difficulties, even after the treatment has finished.
  • 20. DISADVANTAGES  To benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but cannot make your problems go away without your co-operation.  Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.  Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties.  Some critics argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.  CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviours), and does not address wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing.
  • 21. CONCLUSION Cognitive behavioral therapy is a clinically significant effective for anxiety and depression. And underline the need for integrating mental health care. CBT helps people to identify cognitive patterns or thoughts and emotions that are linked with behaviors. There are many techniques such as modelling, homework and computer assisted therapy etc.