Transcript Concepts, theories and models - KEATS (King’s e

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Session 1
Concepts theories and models
underpinning CBT practice
Process of therapy
Session 2
Assessment, formulation and
measurement.
Overview of cognitive behavioral
techniques
Socratic technique
Session 3
Cognitive behaviour approach to
understanding and treating anxiety
problems
Session4
Cognitive behaviour approach to
understanding and treating
depression
Session 5
CBT approaches to understanding
and treating psychosis
Third wave of CBT
Session 6
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To complete the course and receive the award students must successfully complete a
2500 word essay based on a case study which will be provided. The essay will focus on
the student’s ability to present a cognitive behavioural formulation of the information
presented in the case study, identifying maintaining factors and suitable targets for CBT
work. The student will be asked to identify treatment strategies based on this
formulation with reference to the evidence base for supporting these potential
interventions.
The assignment should include the following:
A brief explanation of CBT and its main principles.
Discuss the role of formulation within CBT work and its strengths/weaknesses.
Provide a description of your formulation of the case study (provided) with clear
identification and explanation of maintaining factors.
Identify from the formulation possible targets for CBT work.
Provide a rationale for and description of possible treatment strategies for these
identified targets with reference to the theory and evidence base underpinning these
selected strategies.
Brief consideration of potential obstacles or limitations to the success of these
strategies.
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► What
is your current understanding of CBT
and its core characteristics?
Cheryl Jordan
“Man is not affected by events but by the views
he takes of them” ( Epictetus)
“There is nothing good or bad but thinking
makes it so” ( Hamlet, Shakespeare)
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Cognitive principle
Emotional reactions are strongly
influenced by cognitions
Behavioural principle
What we do is crucial in
maintaining or in changing
psychological states
The continuum principle
Emotional problems arise from
exaggerated versions of
Normal process
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Here and now
Focus on what’s happening in
the present and what
processes are maintaining it.
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Interacting systems
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Characteristic cognitions in different
problems
Depression: negatively biased views
themes of loss and failure
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Anxiety: Overestimation of threat
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Anger ?
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Collaborative
Structured and active engagement
Time limited
Empirical in approach
Problem orientated
Guided discovery
Behavioural methods
In vivo work
Summaries and feedback
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Albert Ellis
1913-2007
considered as the second
most influential
psychotherapist
in history ( USA,Canada)
Carl Rogers ranked first
Sigmund Freud was
ranked third
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A
Activating event
Rational belief
Irrational Belief
Flexible
Self/other accepting
High frustration tolerance
Rigid
Self/other downing
Low frustration tolerance
Consequences
Consequences
healthy negative emotion
helpful behaviour
Adaptive Cognitions
Unhealthy negative emotions
Unhelpful behaviour
Biased cognitions
A
Completing assignment
Rational belief
Irrational Belief
I prefer to pass but it is
possible I may not, if I do
it proves I am a fallible
Human and I can
tolerate it
I want to pass therefore this
must happen, If i don’t it’s
Proof I am a total failure
I can’t stand it
Consequences
Consequences
concerned
Focus on task at hand
Giving it my best
anxiety
Procrastinate
I going to fail, I’ ll never cope
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Please read the chapter
Fit the information given into the ABC model
A
No current partner
Rational belief
I would prefer to be in a
relationship, I can accept
myself if i am not.
Irrational Belief
I want to be in a relationship, therefore
I absolutely should be. The fact I am
not is proof I am defective.
Consequences
Consequences
Sad
Seek out reinforcements
Depression
no one wants me
There is something wrong with me
Think about past failed relationships
withdraw
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Watch the clip
Keep the ABC model in mind, see if you can
identify the problem......
Cognitive
consequences
Un/healthy negative
emotion
Behaviour
( action
Tendencies)
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Think of the last time you felt angry about
something.
Can you remember what you felt most angry
about? went through your mind?
What did you do or feel like doing?
Cognitive
consequences
Un/healthy negative
emotion
Behaviour
( action
Tendencies)
Hit, shout, sulk, kick the cat,
Recruits allies against others
Overestimates
Extent to which other
person acted
Deliberately.
See’s malicious
intent in action of othe
Self right other wrong
Unable to see
others point of view
Plots to exact revenge
Trained as a psychoanalytic
analyst at the Philadelphia
Psychoanalytic Institute.
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(1921-….)
Early
Experience
Core Beliefs
Rules and
Assumptions
Self, world, others
If ……. Then……..
I must………
Critical
Incident
Emotion
physiology
thinking
Behaviour
Early
Experience
Core Beliefs
Rules and
Assumptions
Critical
Incident
Emotion
Low energy
Somatics
Withdraw
ruminates
I am not as lovable as other people
I should be in a relationship
if not then …………
Relationship not working out
Seeing others in relationships
depression
thinking
Behaviour
What am I doing wrong
Think about past
Relationships ,
no one wants me.
Negative automatic thoughts
Assumptions
Core Schema
Trigger: critical incident
Thoughts
Mood
Physical
Behaviour
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Have a look at the film clip and map the
information to the model.
What event triggered her reaction?
What negative automatic thoughts is this lady
experiencing? How is this effecting her mood?
Behaviour?
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Survey by Wright and Davis(1994), found that clients wanted
their therapists to:
Offer physically safe, private, confidential setting free from
distractions
Be respectful
Treat concerns seriously
Prioritise client interests over own
Be competent
Share information
Permit client to make own choices
Be flexible not assume the client fits a theory
Review progress
Pace , not rush or keep changing appointments
What works in Therapy? –
Traditional view
Techniques, 15%
Therapeutic
Relationship, 30%
Expectancy (Placebo
effects) , 15%
Adapted from
Lambert (1992)
Extratherapeutic
change, 40%
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How would you define each of these?
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Consider what you think about the basic
principles of CBT. Do they make sense to
you?
What do you think of the theory underpinning
CBT? does it make sense ? Does it fit with
your experience?
1) Therapeutic relationship: engage and facilitate collaborative
working process
2) Comprehensive assessment: Detailed picture of problem
within context of person’s life experiences and history
3) Problems & Goals: agree on a ‘CB’ definition of problem set
goals
4)Clinical Ratings: baseline ratings symptoms distress disability
progress evaluated set time frame and target
5) Formulation; Develop shared understanding of problem and
it’s maintenance.
6) Treatment rationale: explanations of how and why CBT could work
with the problem
7) Interventions: aims reduce symptoms, increase coping
8) Evaluation: Of interventions for effectiveness
9) Relapse prevention: Maintain gains prevent relapse
10) Discharge.
11) Follow-up: further reflection on practice learnt . Set new long term
goals
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Phobic disorders
Anxiety disorders (GAD panic disorder)
Obsessive compulsive disorder
Mild-moderate depression
Post-traumatic stress disorder
Eating disorder
Substance abuse (alcohol, cocaine)
Sexual dysfunction
Habit & impulse control disorders
Psychosis
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Bipolar disorders
Delusional disorders
Personality disorders
Severe depression
Depression and anxiety associated with long
term chronic health problems
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Observe your own experience and/or those
of the clients you work. If you or they are
upset about something See if you can
identify what they/you are upset about, what
patterns of thinking, feeling and behaving are
occurring?
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Branch R, Dryden W 2008, The cognitive
behaviour counselling Primer. Athenoeum
Press, UK.
Dryden W, 2001 10 steps to positive living.
Sage. London
Hawton K, Salkovskis P, Kirk J, Clark D,
1993, Cognitive behaviour therapy for
psychiatric Problems. Oxford University
Press.Oxford.
Beck A T, The current state of Cognitive
Behaviour Therapy.Archive of Gen Psy
2005;629-539