cognitive behavioural therapy. historical perspective psychotherapy and psychological approaches...
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COGNITIVE BEHAVIOURAL THERAPY
COGNITIVE BEHAVIOURAL THERAPY
Historical perspective
• Psychotherapy and psychological approaches• Psychodynamic therapies v behavioral approaches• Emergence of Cognitive Therapy• Development of Cognitive Behavioural Therapies• Third wave CBT (Hayes 2004)
Evidence base
• Systematic reviews
• What works for whom
• NICE
• Depression
• PTSD
• OCD & BDD
Behavioural perspective
• We are products of our environment• The continuum principle- problems arise from
exaggerated or extreme versions of normal processes rather than pathological states which are different and inexplicable. (Wesbrook,Kennerley, Kirk, 2007)
• Intensity, frequency and duration• Behaviour is crucial in maintaining psychological
states
Learning TheoryLearning Theory
Classical conditioningOperant conditioningTwo Factor theory
Classical conditioningOperant conditioningTwo Factor theory
Practical application
• How many of your actions prior to coming have you thought about?
• How many did you not?• How much is habit?• Do you ever think of the consequences
or alternatives?• How much do we just respond?• How much is conditioned/learnt?
Cognitive Therapy
• AT Beck• Stoic philosophy Epictetus 135 AD• Men are disturbed, not by things but by the principles
and notions which they form concerning things• Some things are in our control and others not. Things
in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.
COGNITIVE MODEL OF EMOTIONAL RESPONSE: THE SIMPLEST VERSION
EVENT↓
INTERPRETATION OF EVENT↓
EMOTIONAL RESPONSE
SIMPLICITY V ELEGANCE
• TO BE ABLE TO THINK ABOUT YOUR THINKING
• UNDERSTAND HOW RESPONSES ARE MAINTAINED
• UTILISE PSYCHOLOGICAL EVIDENCE FOR THE MAINTENANCE OF DISTRESS
• HOW TO CHANGE• TO BECOME YOUR OWN THERAPIST
EXPERIENCE
BELIEFS AND ASSUMPTIONS
CRITICAL INCIDENT/
PRECIPITATING EVENT
COGNITION Thoughts and beliefs
AFFECT/ EMOTIONAL STATE
PHYSIOLOGY
BEHAVIOUR What one does or says
Generic CBT model
Through experience we develop core beliefs and assumptions.They are both functional and dysfunctional (helpful or unhelpful).Critical incidentEvokes negative thoughts behaviour, emotions and physiological changes
MAIN CHARACTERISTICS
• STRUCTURED• PROBLEM ORIENTATED• A-HISTORICAL• LEARNING MODEL • SCIENTIFIC METHOD• HOMEWORK• COLLABORATION• ACTIVE AND DIRECTIVE• SOCRATIC QUESTIONING• OPENNESS
APPLICATION
COMMON PSYCHIATRIC PROBLEMS
• DEPRESSION
• ANXIETY
• OCD
• PTSD
• PANIC
• PHOBIAS
NONE PSYCHIATRIC
• PAIN
• IBS
• DIABETES
• EPILEPSY
TECHNIQUES
• PSYCHOEDUCATION• EXPOSURE• RELAXATION• ACTIVITY SCHEDULING• IMAGERY• BEHAVIOURAL EXPERIMENTS• SYMPTOM INDUCTION• REATTRIBUTION- QUESTIONING EVIDENCE COUNTER
EVIDENCE, LABELLING, USE OF RATIONAL RESPONSES, COST BENEFIT ANALYSIS
PHOBIA
• PSYCHOEDUCATION
• EXPOSURE
• BEHAVIOURAL EXPERIMENTS
PANIC AND AGOROPHOBIA
OCD & BDD
SOCIAL ANXIETY
PTSD
GENERALISED ANXIETY
DEPRESSION
DEPRESSION