Tag: Cognitive Behavioral Therapy

Dirty Dozen on Cognitive Behavioral Therapy by Jim Amos MD

Origins of CBT

–Psychoanalytic theory dominant in 1960s

–A. Beck, the creator of CBT, was trained as a psychoanalyst

–Conducted experiments in late 1950s and early 1960s intended to support psychoanalytic constructs-found the opposite to be true

CBT Definitions & Assumptions

–Focused therapy based on model that psychological disorders involve dysfunctional or unhelpful thinking

–We often feel what we think and behave accordingly

–Assumes that modifying dysfunctional thinking improves or resolves symptoms

–Modifying dysfunctional beliefs that underlie dysfunctional thinking produces more sustainable change

Overview

–Pragmatic, action-oriented treatment approach

–Initially developed for depression and anxiety

–Empirically validated brief psychotherapy shown effective in over 350 outcome studies

–Effective in treatment of many medical and psychiatric conditions

Examples of Automatic Thoughts

–I should be doing better in life

–I’ve let him/her down

–I can’t handle it

–I feel like giving up

–Something bad is sure to happen

–I’ll never be able to get this done

Examples of Maladaptive Schemas

–I must be perfect to be accepted

–I’m a fake

–I’m unlovable

–I must always be in control

–Other people will take advantage of me I’m stupid

Key Behavioral Concepts

–Depressive behavior can be modified with behavioral techniques

–Exposure therapy and related methods can be effective interventions for anxiety disorders

–Behavioral interventions can be useful for helping patients improve coping, social, and problem-solving skills

Principles of CBT

–Overall goal is to help achieve remission of disorder by solving problems and relieving symptoms.

–Achieved through collaborative empiricism

–Approach which teaches patients to view reality more clearly by examining their distorted cognitions

–Correcting faulty ideas leads to improvement in mood and function

–CBT is educative in nature; it teaches patients to be their own therapists. CBT is goal oriented.

CBT Methods

–Socratic questioning

–Stimulate curiosity to engage in learning, less didacticIdentifying cognitive errors

–Thought change record

–Guided discovery-series of inductive questions to reveal unhelpful thought patterns

–Examining the evidence

–Generating rational alternatives

–Role play and rehearsal

Behavioral Methods Used in CBT

–Activity and pleasant event scheduling

–Graded task assignments

–Exposure and response prevention

–Relaxation training

–Breathing training

–Coping cards;example: suicide safety plans

References

–Dewan, M. J., MD,, B. N. Steenbarger, PhD,, et al., Eds. (2004). The Art and Science of Brief Psychotherapies: A Practitioner’s Guide. Core Competencies in Psychotherapy. Washington, DC, American Psychiatric Publishing, Inc.

–Garland, A., R. Fox, et al. (2002). “Overcoming reduced activity and avoidance: a Five Areas approach.” Advances in Psychiatric Treatment 8(6): 453-462.

–Temple, S., PhD, and S. Stuart, MD (2010). Psychotherapy for the hospitalized medically ill patient. Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. J. J. Amos, M.D., and R. G. Robinson, M.D. New York, Cambridge University Press: 242-248.

References cont.

–Whitfield, G. and C. Williams (2003). “The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings.” Advances in Psychiatric Treatment 9(1): 21-30.

–Williams, C. and A. Garland (2002). “A cognitive–behavioural therapy assessment model for use in everyday clinical practice.” Advances in Psychiatric Treatment 8(3): 172-179.

–Williams, C. and A. Garland (2002). “Identifying and challenging unhelpful thinking.” Advances in Psychiatric Treatment 8(5): 377-386.