Cognitive Behavioural Therapy (CBT)

We finally got back to lectures this week following the Easter break.  The lecture was on Cognitive Behavioural Therapy (CBT) with the second part next week. CBT is often rubbished in the therapists world as it is seen by some as an approach that doesn’t quite go deep enough. The approach is also en vogue in the NHS.  Some would say because it is effective, others because it is cheap. It was therefore interesting to see how the lecture would be presented.   

An interesting quote: Epictetus (from the 1st Century) ‘we are disturbed not by events but by the view we take of them”

Kant (1787) was the first to talk about ‘Schemas’. In 1987, a review of cognitive approaches available listed no less than 17 different cognitive therapies. There are many similarities between them. Differences mostly in techniques/strategies. Two most influential/well known are: Ellis -REBT Beck –CBT. Big names today are: Greenberg & Pedesky.

Some thoughts! “All that we are is the result of what we have thought. The mind is everything. What we think, we become”. “When you change the way you look at things the things you look at change”. “Happiness is something that you are and it comes from the way you think”. “Life is a mirror and will reflect back to the thinker what s/he thinks into it”. “Without an untrained mind nothing can be accomplished”.

For the Transpersonal Perspective it is about re-discovering old wisdom. Shamanic principles –Energy flows where attention goes.  New Age Movement –Intention, attention and affirmations. Part of an holistic approach to the person which includes physical, mental, emotional and spiritual

The main assumptions of CBT

Our experience is a product of five interacting elements:
Cognitions
Emotions
Physiology
Behaviour
Environment

  • Personal cognitive processes of interpretations, inferences and evaluations influence our experience and environment.
  • These cognitive processes (and resulting behaviour) are accessible to consciousness and can be changed.

Important Concepts

Information Processing Model–states that problems occur during emotional disturbance resulting in errors of processing.
Cognitive Content Specifity–suggests that each emotional state has it’s own specific patterns of negative thinking.
Cognitive Vulnerability–relates to idiosyncratic predisposition to distress that varies from person to person.
Safety Seeking Behaviours –can be conscious and unconscious, overt and covert.

Levels of thought
Automatic thoughts–moment by moment thoughts = inner ‘voice’/dialogue = easily accessible to consciousness
Underlying Assumptions–out of conscious awareness recognised by conditional statements.
Core Beliefs–absolute and dichotomous (opposed) thinking such as strong/weak, good/bad.

Case Conceptualisation
“One of the hallmarks of a genuine cognitive therapist is the use of a case conceptualisation”
Dryden & Neenan (2006. P.33.)
“Two common reasons why clients do not improve are that the therapist has not conceptualised the problem in a helpful way…or made an accurate and complete diagnosis”
Padesky & Greenberg (1995, p27.)

THE ABC Model of Case Conceptualisation

Activating Event/Antecedents
The situation/history of the complaint
Beliefs/thoughts
Automatic thoughts/underlying assumptions/Core Beliefs
Consequences
The unwanted symptoms/behaviours/feelings etc

Nuts n’ Bolts
• Suitability for short term CBT
• Five areas assessment
• Case conceptualisation/Diagnosis
• Treatment plan
• Inventories/Diaries/Thought records/Behaviour Experiments
• Guided Discovery/Socratic Questioning
• Mindfulness Meditation
• Maintenance of gains

Resources
http://moodgym.anu.edu.au/
www.livinglifetothefull.com
http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/cbt.aspx