Cognitive Behaviour Therapy (CBT)

INTRODUCTION

• CBT is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure.
• CBT combines the Cognitive Therapy developed by Aron Beck and Behaviour Therapy techniques.
• Thoughts cause Feelings and Behaviors
  
• Emphasis placed on current behavior.
  
• CBT is a collaborative effort between the therapist and the client.
  
  •   Client role - define goals, express concerns,   learn & implement learning
    
  •   Therapist role - help client define goals, listen,   teach, encourage.
    
• Based on "rational thought." - Fact not assumptions.
  
• CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits.
  
• Homework is a central feature of CBT.
  
• Cognitive therapies do not appear to work as well with those who are cognitively impaired.
  

DEFINITION

• Focused form of psychotherapy based on a model suggesting that psychiatric/psychological disorders involve dysfunctional thinking
• The way an individual feels and behaves in influenced by the way s/he structures his experiences.
• Modifying dysfunctional thinking provides improvements in symptoms and modifying dysfunctional beliefs that underlie dysfunctional thinking leads to more durable improvement

INDICATIONS

Cognitive therapy was originally developed for use in the treatment of depression.
• Personality disoders
  
• Seasonal affective disorders
  
• Generalized anxiety disorders
  
• obsessive-compulsive disorders
  
• Mood disorders-depression
  

MAJOR CONCEPTS & PROCEDURE
The General Cognitive Model


The Cognitive Triad

• Negative view of the self (e.g., I’m unlovable, ineffective)
  
• Negative view of the future (e.g., nothing will work out)
  
• Negative view of the world (e.g., world is hostile)
  

Automatic Thoughts

• Negative thoughts about yourself, your world, or your future
  
• Examples of automatic thoughts
  
  • Catastrophizing - extreme consequences of events
    
  • All or nothing - seeing things in black and white - no grey areas
    
  • Emotional reasoning - if I feel it, it must be true
    

Self-defeating (irrational) beliefs as per Ellis

Ellis suggested that a small number of core beliefs underlie most unhelpful emotions and behaviours. Core beliefs are underlying rules that guide how people react to the events and circumstances in their lives. Here is a sample list of such of these:
1. I need love and approval from those around to me.
2. I must avoid disapproval from any source.
3. To be worthwhile as a person I must achieve success at whatever I do.
4. I can not allow myself to make mistakes.
5. People should always do the right thing. When they behave obnoxiously, unfairlyor selfishly, they must be blamed and punished.
6. Things must be the way I want them to be.
7. My unhappiness is caused by things that are outside my control – so there is nothing I can do to feel any better.
8. I must worry about things that could be dangerous, unpleasant or frightening – otherwise they might happen.
9. I must avoid life’s difficulties, unpleasantness, and responsibilities.
10. Everyone needs to depend on someone stronger than themselves.
11. Events in my past are the cause of my problems – and they continue to influence my feelings and behaviours now.
12. I should become upset when other people have problems, and feel unhappy when they’re sad.
13. I shouldn’t have to feel discomfort and pain.
14. Every problem should have an ideal solution.

Helplessness

• I am inadequate, ineffective, incompetent, can’t cope
  
• I am powerless, out of control, trapped
  
• I am vulnerable, likely to be hurt, weak, needy
  
• I am inferior, a failure, a lower, not good enough, defective, don’t measure up.
  

Hopelessness

• I am unlikable, unwanted, will be rejected or abandoned, always be alone
  
• I am undesirable, unattractive, ugly, boring, have nothing to offer
  
• I am different, defective, not good enough to be loved by other, a nerd
  
The Cognitive Model


The Basic Goals of CBT
• To challenge the thoughts about a particular situation by identifying the cognitive traps
  
• To help the patient to identify less threatening alternatives
  
• To test out these alternatives in the real world
  
• To challenge the assumptions that lead to the automatic thoughts
  


The Basic Tenets of CBT
• Cognitive specificity
  
• Socratic dialogue
  
• Collaborative empiricism
  

Conclusion

• Cognitive behavioral therapy (CBT) is an established treatment for a number of psychiatric disorders.
• The CBTs are the best-studied psychological treatments of major depressive,
  panic, generalized anxiety, and obsessive-compulsive disorders. (Friedman, Thase & Wright, 2008)
• The CBTs have become one of the standard psychosocial treatment approaches for mental disorders.

References

1. Kaplan HI, Sadock BJ. Synopsis of Psychiatry , Behavioral Sciences/ Clinical Psychiatry. 9th ed. Hong Kong :William and Wilkinson Publishers ;1998.
2. Friedman ES, Thase ME, Wright JH. Cognitive and behavioral therapies, in Psychiatry, Third Edition. Edited by Allan Tasman, Jerald Kay, Jeffrey A. Lieberman, Michael B. First and Mario Maj. John Wiley & Sons, Ltd, 2008.
3. Sims, A. Symptoms in the Mind: An Introduction to Descriptive Psychopathology (3rd ed). Elsevier, 2002.

Posted in: Mental Health Nursing,Psychology