Men are disturbed, not by principles and notions which ...

Men are disturbed, not by
things, but by the
principles and notions
which they form
concerning things

 Roman (Greek-born) slave & Stoic philosopher

 Cognitive Therapy is a system
of psychotherapy that
attempts to reduce excessive
emotional reactions and self-
defeating behaviour, by
modifying the faulty or
erroneous thinking and
maladaptive beliefs that
underlie these reactions

 Beck et al 1976, 1979, 1993

 Collaborative (builds trust)

 Active

 Based on open-ended
questioning

 Highly structured and focused

Event ‘Common Sense’ Model

Emotion

Event Cognitive Model Emotion

Meaning
we give
the event



 Cognitive principle – it is
interpretations of events, not
events themselves, which are
crucial.

 Behavioural principle – what we do
has a powerful influence on our
thoughts and emotions

 The continuum principle – mental
health problems are best
conceptualised as exaggerations
of normal processes

 ‘Here and now’ principle – it is usually more
fruitful to focus on current processes rather
than the past

 Interacting systems principle – it is helpful to
look at problems as interactions between
thoughts, emotions, behaviour and
physiology and the environment in which the
person operates





ENVIRONMENT MOOD /
FEELINGS
THOUGHTS
BIOLOGY

BEHAVIOUR

ENVIRONMENT

On Plane
Turbulence

THOUGHTS

We might crash

BIOLOGY MOOD / FEELINGS
Anxious 90%
Heart racing
Palpitations
Rapid breathing
Difficult to breathe –
choking sensation

BEHAVIOUR

Reassurance
seeking



Negative Automatic Thoughts
Assumptions
Core
beliefs

 Stream of thoughts that we can notice if we
try to pay attention to them (automatic)

 Negatively tinged appraisals or
interpretations – meanings we take from
what happens around us or within us

 Specific thoughts about specific events or
situations

 Brief, frequent, habitual – often not heard
 Plausible and taken as obviously true,

especially when emotions are strong

 Shifts in Affect

 Distinguish between thoughts and emotion
and behaviour

 Check for images

 Negative cognitive triad

◦ Biased views of

 Oneself
 I am bad, useless, unlovable, worthless, a failure

 The world in general
 Nothing good happens, life is just a series of trials

 The future
 It will always be like this, nothing I can do will make any
difference, what’s the point of anything?

 Negative filter

◦ Remembering events

◦ Interpreting current events / situations

◦ Overgeneralising from small negative event to broad
negative conclusion

 Help the client counteract negative
cognitive biases, and develop more
balanced view of herself, the world, and the
future

 Restore activity levels – especially those that
give sense of pleasure or achievement

 Increase active engagement and problem
solving

 Identify specific problem list (& prioritise)

◦ Eg. Poor sleep, relationship difficulties etc

 Introduce cognitive model – how it might
apply to client

 Goals (SMART)

 Reduce symptoms through behavioural or
simple cognitive strategies

 Identify and challenge NATs

 Relapse prevention

 Referral
 Assessment: suitability, therapeutic

relationship
 Assessment (ongoing): problem analysis,

wider picture, measures
 Problem list & prioritise
 Goals for therapy (SMART)
 Formulation (ongoing): Sharing model,

maintaining factors, predisposing factors,
rationale for treatment

 Assessment, Formulation

 Treatment: start with symptom focused
intervention

 Review: every six sessions, repeat
measures

 Discharge: repeat measures, relapse
prevention

 Follow up / booster sessions:

 1,3,6,12 month ?

 Mood check
 Set collaborative agenda
 Review homework
 Focus on major topics for the session
 Negotiate homework
 Potential problems with completing

homework
 Feedback on session

 Engagement
 Warmth and empathy
 Collaboration
 Guided discovery – socratic questioning
 Feedback and summarising
 Agenda setting – structure and focus
 Open and closed questioning

 Ability to identify & describe negative thoughts
 Awareness & differentiation of emotion
 Compatibility with CBT rationale
 Acceptance of personal responsibility for change
 Alliance potential
 Chronicity of problem
 Optimism/pessimism regarding therapy

 The concept of measures is central to the
CBT approach, as it enables both client
and practitioner to evaluate the impact of
interventions (Grant et al 2004)

 They are important in the process of
assessment and aid the practitioner to
develop a credible formulation for the
client, so that appropriate cognitive and
behavioural interventions can be used

 Assessment – to provide information

 Baseline – subsequent measures will show
extent of change

 Effectiveness – helps to (objectively)
demonstrate effectiveness of therapy, and
allow modification of treatment

 Feedback

 Knowledge - data collection & suggests
areas for future research

 Standardised – developed for particular
populations and problems

◦ Eg. Beck Depression Inventory
◦ Beck Anxiety Inventory
◦ Agoraphobic Cognitions Questionnaire

• Individualised – allow for more specific

information for assessment and formulation.

– Eg. Problem definition, Targets of therapy, Diaries,
% Belief Ratings, Ratings of specific emotions

 Restructuring thoughts and beliefs

◦ Guided discovery
◦ Thought diaries
◦ Challenging NATs (looking at evidence)
◦ Addressing thinking errors
◦ Cost/Benefit Analysis
◦ Downward Arrow technique

 Education Eg. Written information on
thinking errors, disorder specific info

 Continuous use of formulation
 Imagery techniques
 Role play & role reversal
 Action Plan
 Education in Body systems (symptoms)

 Very powerful method of bringing about
change

 Key component of CBT intervention

 Borrowed and adapted from Behaviour
Therapy

 Incorporate different methodological
approaches

 Similar in BT / CBT, but fundamentally
different

 In BT, it is the end product, in CBT, a
means to an end ie. Cognitive change

 In BT – graduated, repeated and prolonged
exposure

 In CBT - New ideas are put to the test.
Means of testing the validity thoughts,
perceptions, beliefs.

 Identify problem to be worked on
 Think of as many solutions as possible
 Consider each solution – pros & cons
 Pick solution that appears best
 Small steps
 Action & review





 No formulation No CBT
 Use CB techniques
◦ Bibliotherapy: e.g. Mind Over Mood
◦ Challenge negative thoughts
 Court Case
 Evidence
 More balanced/alternative thought
 Downward arrow
◦ Behavioural experiments / exposure
◦ Activity Diaries
◦ Relaxation?

 www.get.gg

◦ Self help

 Workbooks
 online CBT programmes – printable forms etc
 Online

 Professional links

 CBT organisations
 Therapist manuals online
 Books