Transcript COGNITIVE BEHAVIOURAL THERAPY

COGNITIVE
BEHAVIOURAL
THERAPY
Psychoeducation
 from
RCT, educational materials
play a significant role in
improvement in depression
Robinson, Katon, Von Korff et al., 1997
Cognitive Behaviour
Therapy
 Dispute
about unique effect
Murphy, Carney et al., 1995
 May
reduce relapse
Fava, Grandi, Zielezny et al., 1996
 Therapist
competency is vital
Scott, Tacchi, Jones & Scott, 1997
 Meta-analysis
suggests effect size post-
treatment
Reinecke, Ryan & DuBois, 1998
CBT Assumptions
 Cognitive
activity affects behaviour
 Cognitive
contents & processes can be
monitored & changed
 Behavioural
(& emotional) change may be
affected through cognitive change
Dobson and Dozois, 2001
Other assumptions
 Processing
of information is active &
adaptive
 Individuals
derive meaning from their
experiences using information processing
 Belief
 New
systems are idiosyncratic
information is assimilated into existing
belief systems
Automatic Thoughts (Beck)

Specific, discrete essential words

Shorthand distilled format

Not a result of deliberation, reasoning, or
reflection - “Just happen”

Not sequential as in goal directed thinking or
problem solving

Autonomous – person does not need to make
any effort to generate & may have difficulty
“switching off”
Core Beliefs
 Learned
2
through childhood experiences
broad categories – helplessness and
‘unlovability’
 Core
dysfunctional beliefs latent during
low stress periods
 Reactivated
by negative experiences that
resemble conditions under which original
beliefs were formed
Cognitive Distortions

Overgeneralisation

Dichotomous thinking

Magnification

Personalisation

Disqualifying positives

Jumping to conclusions

Catastrophising

Emotional Reasoning

Shoulds & Oughts

Labels
Cognitive Triad
Negative view of self, the world, and the
future central to maintenance of
depression
Beck (1983) subsequently proposed that
individuals are particularly likely to
experience depression if there is a
congruence between negative life events
& depressogenic schemata
Research
High levels of depressive symptomatology in
children with pessimistic attributional styles and
presence of internal, stable, global negative style:

suggest causal role of attributional style in
development of depression


increase risks of depression in adolescence
predict future increases in depressive symptoms
among adolescents irrespective of negative life
events
Spence et al., 2002
Research

40% of adolescents who responded to CBT
relapsed within 6 months

Significant number of adolescents discontinue
treatment prematurely, do not comply or remain
depressed at end of intervention (approx 33%)

Younger children seem to better

Need to investigate involvement of family
Spence & Reinecke, 2004
Major CBT strategies
Behavioural activation:
Getting the person to do something
– Monitoring activities, pleasure, mastery
– Scheduling activities
– Graded task assignment
Cognitive activities
– Distraction techniques
– Time set aside for thinking
Major CBT strategies
C-B strategies
– Identifying negative thoughts
– Questioning negative thoughts
– Behavioural experiments
Preventative strategies
– Identifying assumptions
– Challenging assumptions
– Use of set-backs
– Preparing for future
Initial Interview
Assessment of current difficulties
Symptoms
Life problems, e.g., interpersonal,
medical, practical
Associated negative thoughts
Onset/development/context of depression
Hopelessness/suicidal thoughts/lack of
energy
Agreed problem list
Initial Interview
Goal definition – may change later but
helps correct unrealistic expectations,
provides a standard to monitor progress,
focuses attention on future.
Presentation/acceptance of treatment
rationale
Practical details – what is involved,
homework, between session tasks,
frequency
Initial Interview
Introduction to basic relationship between negative
thoughts & depression
Possibility of change
Beginning intervention
Specific:
» Select first target
» Agree appropriate homework, monitoring/reading
General:
» Give Client experience of CBT style (focus on specific
issues, active collaboration, homework)
Overall aims:
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Establish rapport
Elicit hope
Give pt preliminary understanding of model
Get working agreement to test it in practice
Subsequent sessions
Set agenda
Weekly items
Review events from last session
Feedback from client on last session
Homework review (emphasises self-help,
independent functioning)
Outcome?
Difficulties?
What has been learned?
Subsequent sessions
Major topic for session
Specific strategies (e.g., relaxation,
learning evaluate automatic thoughts
Specific problems (e.g., difficulties
that have arisen during week)
Long term problems
List in order of priority
Subsequent sessions
Homework assignments
Task
Should follow logically from session content
Needs to be clearly defined
Rationale
explicit e.g., to test the idea that I can’t do anything, a
no lose situation will learn something regardless
Predicted difficulties
Feedback from client
Understanding ( summarise main points
Reactions to session