Cognitive behavioural approaches to mental health


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My presentation to 'Mental Health First Aiders' (lay people who have completed a short course to help them support someone in crisis), about CBT approaches to mental health.

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  • Experience – delivering CB approach sessions to people experiencing longterm unemployment. Focus on depression
  • Thought is usually a sentence, rather than a single word (which is a feeling)
  • Behaviours – might be avoidance, addictive, self harming, inactivity etc
  • Discuss an example of one of the ‘positive actions’ from the week – how did this make us think and feel?
  • Brainstorm – acting upon thoughts.
  • Being in touch with feelings, in touch with thoughts. How difficult was it to remember one thought they had today.
  • looking at other aspects of a situation – rational / more helpful thoughts
  • NOT counselling, although some counsellors are trained in it. NOT ‘Tell me about your dreams, childhood, relationship with mother etc’ More practical
  • (available online – also shows guidance for all other interventions and treatments – including exercise
  • Find out the waiting list for IAPT referrals
  • Brainstorm first
  • Counselling - particularly if depression cause by trauma or childhood events) Anxiety (particularly phobia, or avoidance behaviours) – Graded exposure form of behavioural therapy – ‘tolerating’ the anxiety associates with certain things, until it reduced
  • Cognitive behavioural approaches to mental health

    1. 1. Cognitive Behavioural Approaches to Mental Health Sophie Kennish – MSc Occupational Therapy Student, UEA
    2. 2. Session outline <ul><li>Icebreaker </li></ul><ul><li>What does CBT mean? </li></ul><ul><li>What are thoughts </li></ul><ul><li>CBT triangle </li></ul><ul><li>Actions / Behaviours </li></ul><ul><li>The CBT process </li></ul><ul><li>What CBT is (and isn’t!) </li></ul><ul><li>ACTIVITY! </li></ul><ul><li>Does CBT work? </li></ul><ul><li>CBT in Norwich </li></ul><ul><li>Bibliotherapy and CCBT </li></ul><ul><li>Pros and Cons of CBT </li></ul><ul><li>Some other alternatives </li></ul><ul><li>Homework </li></ul><ul><li>Discussion, role of MHFA / Associate </li></ul><ul><li>ANYTHING ELSE YOU’D LIKE TO COVER? </li></ul>
    3. 3. Icebreaker <ul><li>Your MIDDLE name (if you have one) </li></ul><ul><li>One thought you’ve had today (positive, negative or neutral) </li></ul><ul><li>One thing you’ve done this week to promote your positive mental wellbeing </li></ul><ul><li>Any experience / knowledge of CBT </li></ul>The powerpoint isn’t going to work!
    4. 4. Cognitive Behavioural <ul><li>Behavioural = Acting </li></ul><ul><li>Cognitive = Thinking </li></ul>
    5. 5. Example Thoughts I’m useless I’ll never achieve anything I’ll never get better It’s all my fault It’s going to go wrong They hate me Why does this always happen to me? Thoughts about you Thoughts about others Questions
    6. 6. CBT Triangle
    7. 7. Some actions / behaviours <ul><li>Self Harming </li></ul><ul><li>Phoning a friend </li></ul><ul><li>Going on a walk </li></ul><ul><li>Going to work </li></ul><ul><li>Drinking alcohol </li></ul><ul><li>Hiding under the duvet </li></ul><ul><li>Taking/not taking medication </li></ul>
    8. 8. What is the CBT process? <ul><li>CBT involves three stages: </li></ul><ul><ul><li>Identifying / acknowledging and writing down thoughts </li></ul></ul><ul><ul><li>Classifying these thoughts </li></ul></ul><ul><ul><li>Modifying these thoughts </li></ul></ul><ul><li>Also involves some understanding of our ‘core beliefs’ </li></ul>What was I just thinking about which made me so depressed?
    9. 9. What CBT is… <ul><li>Hard, and requires a lot of effort and time, including homework! </li></ul><ul><li>Something that’s ‘taught’ rather than ‘given’ </li></ul><ul><li>Realistic thinking; NOT “positive thinking” </li></ul><ul><li>Shorter term than traditional therapies </li></ul>
    10. 10. What CBT isn’t…
    11. 11. Let’s try out some CBT <ul><li>Two groups </li></ul><ul><li>Handout – thought identification </li></ul><ul><li>Cards with example thoughts written on them </li></ul><ul><li>Match up the thought to the thought type using the worksheet – 15 minutes (don’t worry if you don’t manage them all) </li></ul><ul><li>If you find this easy (you won’t!), try thinking of alternative, more helpful thoughts to the ones on the cards </li></ul><ul><li>NB – Not all of them fit into neat little boxes! </li></ul>
    12. 12. Does CBT work? (Here’s the science…) <ul><li>Yes! “Low-intensity psychosocial interventions” are effective for people with mild-moderate depression and anxiety </li></ul><ul><li>Recommended by NICE guidelines ‘Best Practice’ - Based on high quality data </li></ul><ul><li>As effective as Prozac? </li></ul><ul><li>Group exercise programmes are also effective! </li></ul>
    13. 13. CBT in Norwich <ul><li>IAPT Service – “Improving Access to Psychological therapies” – Short term low level CBT for mild-moderate anxiety, depression </li></ul><ul><ul><li>Referral from GP or health professional </li></ul></ul><ul><ul><li>[email_address] , 01603 421 688 </li></ul></ul><ul><li>Local Counsellors may be trained in CBT approaches - BABCP (British Association of Behavioural and Cognitive Psychotherapy) </li></ul><ul><li>Private practices – Psychologists - £££! </li></ul><ul><li>Long waiting lists! </li></ul><ul><li>Group CBT </li></ul>
    14. 14. Bibliotherapy <ul><li>CBT self help approaches </li></ul><ul><li>Gilbert Overcoming Depression : a Self-help Guide Using Cognitive Behavioural Techniques </li></ul><ul><li>Padesky & Greenberger Mind Over Mood: Change How You Feel By Changing the Way You Think </li></ul><ul><li>Books on prescription, available at the city libraries </li></ul>
    15. 15. CCBT- The future? <ul><li>Some websites offer computerised CBT ‘courses’ </li></ul><ul><li> </li></ul><ul><li> - This one is free if you sign up! </li></ul><ul><li> </li></ul><ul><li>No human contact (if you don’t want any) </li></ul>
    16. 16. Pros and Cons of CBT <ul><li>It’s quick, and doesn’t involve dredging up the past. This means it’s cheap (for the NHS) and (quite) easily accessible (for patients). </li></ul><ul><li>It can work really effectively if people are able to put the effort in </li></ul><ul><li>Effective with people with mild-moderate depression, also for use in anger management, relationships, other mental health problems </li></ul><ul><li> Some people need longer term therapies, but are given CBT as this is what the NHS can afford </li></ul><ul><li> It can be seen as a bit of a ‘cure-all’, without consideration to the complexity of people’s lives </li></ul><ul><li> It focuses so much on the thoughts rather than the ‘doing’ </li></ul>
    17. 17. Alternatives to CBT <ul><li>Other talking therapies such as counselling </li></ul><ul><li>Medication </li></ul><ul><li>Graded exposure / “flooding” </li></ul><ul><li>Occupational Therapy – ‘doing’ rather than ‘thinking’. </li></ul><ul><li>Exercise </li></ul><ul><li>Five Ways to Wellbeing </li></ul><ul><li>A combination of different interventions </li></ul>
    18. 18. Homework! <ul><li>Try to become more aware of your thoughts by jotting them down, even if they sound ridiculous. Try to connect them with a certain situation, feeling or behaviour. </li></ul><ul><li>Try to rationalise thoughts by working out why they’re ‘faulty’ and providing alternative ‘helpful’ thoughts </li></ul><ul><li>Try some ‘thought experiments’; doing something that you’ve been dwelling on for a while. Is it as bad as you imagined? </li></ul><ul><li>Perhaps next time we can feedback on how we found this </li></ul>
    19. 19. Discussion <ul><li>What do you think about CBT? </li></ul><ul><li>As a MHFA, how would you use what you’ve learnt today to support? </li></ul><ul><li>Can this approach be applied to people with other mental health problems (Bipolar Disorder, Schizophrenia)? </li></ul>
    20. 20. Thanks for listening! Time for a tea break! Please fill in the evaluation forms (be as nasty as you like, so I can improve!)