cognitive behavioral therapy

COGNITIVE BEHAVIORAL THERAPY and MINDFULNESS

Alla Swenson“If you can change your mind, you can change

your life.” William James

The staff will identify the main concept of Cognitive Behavioral Therapy at the end of the presentation on 04/25/14.

The staff will identify the role of mindfulness and positive thinking in CBT at the end of the presentation on 04/25/14.

The staff will practice new skills of using CBT at the end of the presentation on 04/25/14.

Objectives

Psychosocial theoretic basis of psychiatric therapy

Concepts of CBT and Mindfulness ABCDE model Role of mindfulness and positive thinking CBT model and Personality Disorder Recovery plan CBT case study

Content

Buddhist psychologyMindfulness Sigmund Freud (1856-1939) Founder of psychoanalysis Abraham Maslow (1921-1970) Maslow’s hierarchy of needs Ivan Pavlov (1849-1936) Classical conditioning phenomenon

Psychosocial Theoretic Basis of Psychiatric Nursing

Albert Bandura (b. 1925) Social Cognitive Theory: modeling, self-efficacy Erick Erikson (1902-1994)Psychosocial Development Jean Piaget (1896-1980)Theory of Cognitive Development Aaron Beck (1960s)Cognitive Behavioral Therapy

The term mindfulness is an English translation of the Pali word sati. Pali was the language of Buddhist psychology 2,500 years ago, and mindfulness is the core teaching of this tradition. Sati connotes awareness, attention, and remembering.

Mindfulness in Psychotherapy is (1) awareness, (2) of present experience, (3) with acceptance.

Acceptance = nonjudgmental, kindness, friendliness

Mindfulness

What would you, as a new awareness or visitor to this new body, notice about the sensations of breathing, as you breathe in, then out?  Notice the sensations in the abdomen, the chest, the throat, the mouth and nose.   You can notice how your attention wanders, as thoughts come in, sometimes crowding in, and your attention can follow those thoughts.  Just notice as your attention wanders, then gently bring your focus back to your breath.  Minds do wander, thoughts will come and thoughts will go, that is the nature of the human mind.  As a visitor, you can stand back, notice those thoughts, feelings, sounds and sensations, and keep bringing your attention back to your breath.

The Breath

Co-occurring disorders – presence of comorbid mental illness and a substance use disorder in the same person

Goal of treatment – comprehensive recovery plan for the complex problem

“We are all here for some special reason. Stop being a prisoner of your past. Become the architect of your future.” Robin Sharma

Co-occurring disorders

The Stages of Change Model has five phases: Pre-contemplation: Avoidance. That is, not seeing a

problem behavior or not considering change. Contemplation: Acknowledging that there is a

problem but struggling with ambivalence. Weighing pros and cons and the benefits and barriers to change.

Preparation/Determination: Taking steps and getting ready to change.

Action/Willpower: Making the change and living the new behaviors, which is an all-consuming activity.

Maintenance: Maintaining the behavior change that is now integrated into the person's life.

Relapse: Returning to the previous stage.

Motivational Interviewing

High expectations Express empathy Develop discrepancy Roll with resistance Support self –efficacy

“If you want light to come into your life, you need to stand where it is shining.” Guy Finley

PRINCIPLES OF MOTIVATIONAL INTERVIEWING

CBT – is a highly structured psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative inaccurate thoughts and changing rewards for behaviors

ABCDE MODEL Activating Event – the actual event and the client’s immediate

interpretations of the event Beliefs about the event – this evaluation can be rational or

irrational Consequences – how you feel and what you do or other thoughts Dispute or challenge unreasonable expectations Effective outlook developed by disputing or challenging negative

belief systems

What is CBT?

Status of CBT

ABC MODEL

Black-and-White - Thinking or either / or thinking. Making Unfair Comparisons – usually in the negative Filtering – honing in on the negative, forgetting the positive. Personalizing - The Self-Blame Game Mind-Reading – thinking we know what others think

(negatively) Catastrophising – imagining the worst case scenario Overgeneralising – “I always mess up…” Confusing Fact with Feeling – “If I think or feel this way

then my thoughts/feelings must be correct'. Labelling – I’m a loser vs. I made a mistake. 'Can't Standitis' – being unnecessarily intolerant

Distortions in thinking

Activating Event Ask for a problem Define and agree on the target problem Assess the consequences of the problem Assess the activating event Identify and assess any secondary emotional problems Belief System Teach the connection between the beliefs and

consequences Assess beliefs

Rational CBT sequence

Consequences Connect irrational beliefs and emotional consequences

Dispute Dispute irrational beliefs Prepare the patient to deepen conviction in rational

beliefsEffective outlook

Encourage the patient to put new learning into practice Check homework Facilitate the working-though process“All things are difficult before they are easy.” Thomas Fuller http://www.getselfhelp.co.uk/freedownloads2.htm

Techniques used in CBT Therapeutic relationship Cognitive Behavioral Problem solving Emotional Biological Interpersonal Environmental Supportive

CBT for Personality Disorder

I am inadequate, ineffective, incompetent, can’t cope, helpless, can’t get what I want/need.

I am powerless, out of control, trapped, vulnerable, week, needy, a victim.

I am a failure, a loser, not good enough.

Helpless Core Beliefs

I am unlikable, unwanted, will be rejected or abandon, always be alone.

I am undesirable, unattractive, ugly, boring.

Unlovable Core Beliefs

I am worthless, unacceptable, bad, crazy, broken, a waste.

I am evil. I don’t deserve to live.

Worthless Core Beliefs

Situation

Automatic thoughts and images

Reaction: emotional, behavioral, physiological

General Cognitive Model

Situation:Therapist asks Joe about goals for therapy.Automatic thoughts: “Why is she asking me that? It’s so superficial. Setting goals won’t help. My problems are too deep. She should know that”.Reaction: emotional – anger; physiological – tension in face, arms, shoulders; behavioral – shrugs, avoids eye contact, says nothing.

Situation:Therapist and Joe discuss his difficulties organizing and paying her bills. Automatic thoughts: “My therapist is thinking I am stupid. How dare she judge me!” Reaction: emotional – anger; physiological – clenches her fist; behavioral – criticizes therapist.

New idea High expectations Positive reinforcement: praise, reassurance,

encouragement Empathy Professionalism vs hostility Non-verbal/verbal Inspiration

“The purpose of our lives is to be happy”. Dalai Lama

Communication and personal attitude

Assessment Nursing diagnoses Plan development Intervention Evaluation

Nursing Process

Avoid polar opposite beliefs; guide patient toward adopting something in the middle.

“I am bad”, to “I am okay”. “I am incompetent”, to “I have strengths and

weakness like everyone else”. “I am defective”, to “I am normal”.

Develop a New Core Beliefs

Physical, emotional, and spiritual healing Learn stress reduction therapy Radically change diet or marriage Take control over your health: willingness to

change, do research, be proactive Follow your intuition: body knows what it needs to

heal, change your body-mind-spirit Use herbs and boost your immune system Be active physically

The key factors that can make a real difference

Increase positive emotions: love yourself, life, and others Embrace social support: "In poverty and other misfortunes

true friends are sure refuge”. Aristotle Discover your spiritual beliefs Have strong reason for living Create your love and happiness and spread to others

“Happiness is an attitude. We either make ourselves miserable, or happy and strong. The amount of work is the same.” Francesca Reigler

Boyd, M. (2008). Psychiatric Nursing. Wolter Kluwer Health/Lippincott Williams & Wilkins.

Philadelphia, Baltimore, New York, London.German, C., Siegel, R., Fulton, P. (2005). Mindfulness and Psychotherapy. The Guilford Press, New York, London.Winston, A., Rosenthal, R., Pinsker, H. (2012). Learning Supportive Psychotherapy. American Psychiatric Publishing. Washington DC, London.

References