Transcript Document
The role of CBT in paediatric disorders. Dr Caroline Dibnah Clinical Psychologist NW Surrey CAMHS What is CBT? Cognitive Behavioural Therapy is: Evidence-based Collaborative Goal-oriented Structured Active Basic CBT model Padesky & Greenberger, 1995 Levels of Cognition (1) Automatic thoughts • Easiest to identify • Situation specific, e.g. appraisal of an event or a physical symptom • Linked to emotion • Thinking errors can occur leading to misinterpretation of events. Levels of Cognition (2) Assumptions • Rules for living • Tend to be conditional • Common themes are high standards, approval from others, control • When a situation occurs when conditions can’t be met affects emotions Levels of Cognition (3) Core Beliefs / Schemas • • • • Global Absolute Formed in childhood & adolescent by experience Give us our rules for living and effect how we perceive the world. • Related to how people think about themselves, the world around them and other people. Cognitive Behavioural Therapy Identifying, understanding and breaking the vicious circle that is established between the person’s cognitions, moods, physical symptoms, behaviours and environment. Why CBT? Shown to be effective Depression Generalised anxiety disorder Health anxiety IBS Chronic pain Panic disorder OCD Bulimia Nervosa Chronic Fatigue Syndrome Cancer Why CBT? Variation in the impact of illness Cognitions can account for differences in responses to illness Chronic medical problems are associated with psychological problems When to use CBT Helping patients manage psychological symptoms Adjusting to life with a chronic illness Beliefs about illness that effect recovery Trauma Medically unexplained symptoms Case Study 1 Anxiety and poor management of diabetes 14 year old boy. Lives with his mother and younger brother. Parents are divorced, some contact with father. Diagnosed with Type-I diabetes 2 years ago. Feels very angry about having the diagnosis. Management has become increasingly poor, not checking blood levels and skipping some injections. Two bereavements in the past year; cousin and school friend. He has always had a small group of friends and been fairly quiet at school. But recently become very withdrawn. Not socialising with friends. Poor attendance at school. EARLY EXPERIENCES Parental separation, bereavement diagnosis of diabetes CORE BELIEFS The world is unfair Only bad things happen to me I’m not as good as others ASSUMPTIONS If people know I have diabetes they will think I’m weird. If people know I’m different they won’t like me. TRIGGER: Out with friends NATs: They think I’m weird. BEHAVIOUR Avoid talking to people Avoid doing blood tests FEELINGS Anxious, Self-conscious Increase heart rate, nervous stomach Intervention Challenging of negative automatic thoughts Behavioural experiments Challenging of beliefs and assumptions Case Study 2 Chronic Fatigue Syndrome and Depression 15 year old girl with a 2 year history of Chronic Fatigue Syndrome. Extreme fatigue, aching muscles, dizziness, concentration problems, sleep problems, low appetite. Low school attendance. No other activities. Using a wheelchair to get around. Mood had worsened recently. EARLY EXPERIENCES High Achieving Family Emphasis on doing things perfectly UNDERLYING ASSUMPTIONS / CORE BELIEFS I should do things perfectly If you can’t do things perfectly you’re worthless PRECIPITATING FACTORS Worsening physical symptoms Stress of GCSEs NEGATIVE THOUGHTS I’ll never get better; I can’t go on; If I try to do anything, I’ll make myself worse; I’m a burden to my family BEHAVIOUR Avoid people, don’t push myself, focus on symptoms FEELINGS Low mood, heavy heart, lonely Intervention Challenging of negative automatic thoughts Behavioural experiments Challenging of beliefs and assumptions