Basics of cognitive behavior therapy

Discussing the basics of cognitive behavior therapy in very short

1. Basics of Cognitive Behavior Therapy Dr. Ahsan Aziz Sarkar MD-2 & FCPS-2 Trainee Assistant Registrar, NIMH

2. Cognitive Behavior Therapy It is a structured, short term, present oriented psychotherapy directed towards solving current problems and modifying dysfunctional thinking and behavior.

3. Theory underlying CBT Dysfunctional thinking (which also influences mood and behavior) is common to all psychological disorders. When people learn to evaluate their thinking in realistic and adaptive way they experience improvement. CBT works at a deeper level of cognition to bring long lasting changes.

4. Theory Underlying CBT Core beliefs Intermediate beliefs (rules, attitude, assumption) Situation Automatic thoughts Reaction (emotional, physiological, behavioral)

5. Theory Underlying CBT I am incompetent I should give up if the challenge seems great Reading a new text This is too hard Discouragement, heaviness in body, watching TV

6. Application of CBT Depression Anxiety Disorder OCD ADHD Eating Disorder Personality Disorder Substance Use Disorder

7. Application of CBT Couple Problem Family Problem Pathological Gambling Complicated Grief Anger and Hostility

8. Principles of CBT Sound Therapeutic Relationships Collaboration and active participation of patient Goal oriented and problem focused Initially emphasizes the present Educative Time limited Structured

9. CBT Structure Usually 6-14 sessions Initially weekly sessions, later biweekly or monthly Sometimes 2-5 years, booster session Before beginning CBT patient’s evaluation and assessment, problem conceptualization are done.

10. Structure of Sessions Initial part: M ood check S et the agenda O btain an update R eview homework P rioritize the agenda Middle Part: Work on specific problem and teach CBT skills

11. Structures of Sessions End part S ummarization of the session New homework E licit Feedback

12. Identifying Automatic thoughts Automatic thoughts coexists with a more manifest stream of thoughts, arise spontaneously, quite brief, not based on reflection or deliberation. What was going through your mind? Emotion, detailed description, visualization, role play, suggesting opposite thoughts, meaning of the situation

13. Identifying intermediate and core beliefs May actually articulate belief as automatic thought Downward arrow technique Half assumption by therapists Common theme among automatic thoughts Directly asking the patient Belief questionnaire

14. Thinking Errors All or none thinking/polarized/dichotomous Catastrophizing Disqualifying the positive Emotional reasoning Labeling Magnification/minimization Mental filter/selective abstraction

15. Thinking Errors Mind reading Overgeneralization Personalization Should and must statement Tunnel vision

16. Modifying belief Socratic Questioning Examining advantages and disadvantages Behavioral Experiments to test belief Cognitive Continuum to modify belief

17. Modifying belief Intellectual-emotional role play Using other people as reference point Acting “as if” Using self-disclosure

18. Modifying belief Using extreme contrasts Using stories, movies, metaphors Historical tests of the belief Restructuring early memories

19. Additional cognitive and behavioral techniques Problem solving and skills training Making decision Refocusing/distraction Relaxation (progressive muscle relaxation, imagery, controlled breathing)

20. Additional cognitive and behavioral techniques Mindfulness Exposure Role playing Self comparison and credit lists

21. Homework Assignment Behavioral activation/activity scheduling Monitoring, evaluating and responding to automatic thoughts Problem solving Behavioral skills or experiments Bibliotherapy

22. Termination of therapy Responding to concern about tapering and termination of therapy Reviewing what has been learned Self-therapy session Booster session

23. Reference Cognitive B ehavior Therapy: Basics and Beyond by Judith Beck (2 nd ed.) Shorter Oxford Textbook of Psychiatry (6 th ed.) Kaplan and S adock’s Synopsis of Psychiatry (11 th ed.) Oxford Handbook of Psychiatry (3 rd ed.)

24. Thank You