Transcript Pg-CBT-Comparison Effectiveness Presentation

Pg-Certificate CBT-2017
Dr.Bashir Ahmad
(Course Director)
An overview of Psychotherapies
Moderators
Professor SM Sultan & Dr. Bashir Ahmad
6th January 2017
PSYCHOTHERAPY
Psychotherapy is the development of a
trusting relationship, which allows free
communication and leads to understanding,
integration and acceptance of self.
Schools of Psychotherapies
• Psychodynamic Therapies
• Behavioural Therapies
• Cognitive Behaviour Therapies
• Supportive Psychotherapy
• Inter personal
• Family therapy and couples therapy
1. Psychoanalysis
Founded by Sigmund Freud(1856-1939)
• The aim of psychoanalytic therapy is to release repressed emotions
and experiences, i.e., make the unconscious conscious.
• Treatment focuses on bringing the repressed conflict to
consciousness, where the patient can deal with it.
• Lengthy process (2-5 sessions per week for several years).
• Types: classic psychoanalysis, brief psychoanalysis, CAT.
In psychoanalytic therapy Freud would have a patient lie on a couch to relax,
and he would sit behind them taking notes while they told him about their
dreams and childhood memories.
Psychoanalytic concepts
Various techniques used for encouraging patients develop insights
into their behaviour and the meaning of symptoms. E.g.,
Ink blots
Slip of tongue
Free association
Dreams interpretation
Resistance
Transference and counter transference
2. Behaviour Therapies
• Psychologists in 1930s in London, began to use learning
principles to devise treatments for phobic disorders.
• In USA Skinner( 1953) proposed operant conditioning in the
treatment of psychiatric disorders.
• First clinical trial reported in 1978 on desensitization; several
trials have followed since resulting in strong evidence base
for the current use of behavioural methods.
• Types: Systematic desensitization, flooding
3. Cognitive Therapies
Aaron T Beck (1979) noted recurring themes in the thinking of
depressed patients and concluded that these themes were an
essential part of the disorder and had to be changed by
challenging them in specific ways.
This formed the basis for a cognitive approach in treating
psychological conditions.
Types: Rational Emotive Therapy (RET) by Albert Ellis
4. Cognitive Behaviour Therapies
• Cognitive approaches were integrated into behaviour
therapy to produce Cognitive Behaviour Therapy in the
current form .
• The strong evidence base, clearly defined procedures and
relatively brief treatment time have made CBT the preferred
psychological treatment for many disorders.
• Types: Classic CBT, REBT, DBT, Mindfulness Based CBT
Rational emotive behavior therapy (REBT)
• REBT is one form of cognitive behavior therapy and was first expounded
by Ellis in the mid-1950s.
• Rational emotive therapy, focuses on resolving emotional and
behavioral problems and enabling people to lead happier and more
fulfilling lives.
Cognitive analytic therapy (CAT)
• Cognitive Analytic Therapy (Anthony Ryle) is a collaborative program for
looking at the way a person thinks, feels and acts, and the events and
relationships that underlie these experiences (often from childhood or
earlier in life).
• it brings together ideas and understanding from different therapies into
one user-friendly and effective therapy.
• It is a distinctive integration of cognitive and analytic practice and its
collaborative nature, involving the patient actively in their treatment.
Dialectical Behavior Therapy (DBT)
• A cognitive behavioral treatment that was originally developed to treat
individuals diagnosed with borderline personality disorder and it is now
recognized as the gold standard psychological treatment for this population.
•
Research has shown that it is effective in treating a wide range of other
disorders such as substance dependence, depression, PTSD and eating
disorders.
DBT includes four sets of behavioral skills.
• Mindfulness , Distress Tolerance, Interpersonal Effectiveness, Emotion
Regulation:
Mindfulness-based cognitive therapy (MBCT)
A psychological therapy designed to aid in preventing the relapse of depression
•
MBCT uses traditional cognitive behavioral therapy methods and adds in newer
psychological strategies such as mindfulness and mindfulness meditation.
•
Cognitive methods include educating the participants about depression.
•
Mindfulness and mindfulness meditation, focus on becoming aware of all incoming
thoughts and feelings and accepting them, but not attaching or reacting to them.
•
This process is known as "Decentering" and aids in disengaging from self-criticism,
rumination, and dysphoric mood that can arise when reacting to negative thinking
pattern.
Effectiveness of CBT
What does the research say?
• Cognitive behavior therapy has been extensively tested since the first
outcome study was published in 1977 (Rush, Beck, Kovacs, & Hollon,
1977).
• At this point, more than 500 outcome studies have demonstrated the
efficacy of cognitive behavior therapy for a wide range of psychiatric
disorders, psychological problems, and medical problems with psychological components (see, e.g., Butler, Chapman, Forman, & Beck, 2005;
Chambless & Ollendick, 2001).
What does the research say?
•Studies have been conducted that demonstrate the effectiveness of
cognitive behavior therapy in community settings (see, e.g., Shadish, Matt,
Navarro & Philips, 2000; Simons et al., 2010; Stirman, Buchhofer, McLaulin,
Evans, & Beck, 2009).
•Other studies have found computer- assisted cognitive behavior therapy to
be effective (see, e.g., Khanna & Kendall, 2010; Wright et al., 2002). And
several researchers have demonstrated that there are neurobiological
changes associated with cognitive behavior therapy treatment for various
disorders (e.g., Goldapple et al., 2004)
Maudsley prescribing guidelines
• CBT+ Fluoxetine is first line treatment in Depression in
children and adolescents
• There is evidence for adults and children that adjunct
treatments and CBT can enhance treatment effects and
reduce depression relapse rates.
• CBT first line for Anxiety and moderate depression in
pregnancy
NICE guidelines
• Psychological intervention including CBT should be
considered as the first-line treatment for child and
adolescent depression
• Cognitive behavioural therapy and individual guided self‐help
are recommended as a first‐line treatment in recent‐onset
mild to moderate depression
• CBT is the First‐line treatment for social anxiety, OCD and
phobic anxiety disorders
Thank you