CBT – WEEK 1
BECK CHAPTER 1 – INTRODUCTION TO CBT
WHAT IS CBT?
Based on cognitive formulation: the maladaptive beliefs, behavioral strategies & maintain factors that characterize a
specific disorder
Understanding op individual clients & their specific underlying beliefs & patterns of behavior
CBT THEORETICAL MODEL
= dysfunctional thinking (which influences mood & behavior) is common to all psychological disturbances
If clients learn to evaluate their thinking in a more realistic & adaptive way, they experience a decrease in
negative emotion & maladaptive behavior
Examine validity of thoughts & conclude overgeneralization of thoughts
Focus less on cognitions in past but rather the ones that will interfere with steps to achieve goal
Automatic thoughts Intermediate beliefs (underlying Core beliefs about self, others & the
“I’m too tired to do anything” assumptions) world
Most superficial “If I try to initiate relationships, I’ll get “I’m helpless”
Thought leads to a rejected” “Other people will hurt me”
particular reaction “the word is dangerous”
Deepest level
CBT works on all three levels: modifying automatic thoughts & underlying dysfunctional beliefs produce enduring
change
“I cannot do anything” after CBT:
1. I’m not good at this specific task
2. I can do a lot of things well (positive automatic thoughts)
3. I can learn what I need & I have strengths & weaknesses like everyone else (intermediate & core belief)
CT-R AN ADAPTATION OF TRADITIONAL CBT
= recovery-oriented approach that maintains theoretical foundation of the cognitive model but adds an additional emphasis
on the cognitive formulation of client’s adaptive beliefs & behavioral strategies & factors that maintain a positive mood
Emphasizes client’s strengths, personal qualities, skills and resources
Cultivates positive cognitions & memories (e.g. family)
Time orientation:
CBT = talk about problems that arose in the past week & CT-R = focus on clients aspirations for the future, values &
use CBT to address them seps they can take toward goals
BECK CHAPTER 2 – OVERVIEW OF TREATMENT
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization
= conceptualize patients’ difficulties in three-time frames:
current cognition that are obstacles to his aspirations & behavioral obstacles that serve to maintain the
depression
precipitating factors that influenced perceptions at onset of depression (e.g. work, wife…)
Developmental events & enduring patterns of interpretation of these events
2. CBT requires a sound therapeutic relationship
= clients vary on the degree to which they are able to develop good therapeutic alliance
Ask for reaction to treatment plan
Make collaborative decision about treatment & provide rationales for intervention
Use self-disclosure
Elicit feedback at the end of the session
,3. CBT continually monitors client progress
Use weekly symptom checklists + verbal & written feedback from client after sessions
Measure clients general functioning, progress toward goals, sense of satisfaction & well-being
4. CBT is culturally adapted & tailors’ treatment to the individual
Therapist should educate himself about client’s characteristics & anticipate how differences might be
relevant for treatment
5. CBT emphasizes the positive
Cultivate positive mood & thinking + inspire hope (help to attend positive)
6. CBT stresses collaboration & active participation
Therapy is seen as teamwork in which both therapist & clients are active
As patients becomes less depressed he takes a more active role
7. CBT is aspirational, value based & goal oriented
8. CBT initially emphasizes the present
Normally focus on the skills they need to improve their mood
Shift to past if:
- Clients expresses desire to do so
- Work directed on presented produces insufficient change
- Important to judge where dysfunctional ideas & coping strategies originate
9. CBT is educative
Educate about the course of the disorder, process of CBT, structure of sessions & cognitive model
Psychoeducation presenting ongoing & refined conceptualization & ask for feeback
Use diagrams & teach to become their own therapist
10. CBT is time sensitive
Different patients require different duration of treatment
11. CBT sessions are structured
Use standard format in every session
Reestablish therapeutic alliance, review action plan, collect data, discuss issues or goals, action plan,
summarize session
12. CBT uses guided discovery & teaches clients to respond to
dysfunctional cognitions
Use socratic questioning to help client to identify
dysfunction thinking & evaluate validity of thoughts
Goal: cognitive restructuring = process of assessing &
responding to maladaptive thinking
13. CBT includes action plans (therapy homework)
Practicing behavioral skills learned in session
(therapy notes help client to remember)
14. CBT uses a variety of techniques to change thinking, mood & behavior
CBT adapts strategies from many psychotherapeutic modalities
, BECK CHAPTER 4 – THERAPEUTIC RELATIONSHIP
Stay alert for clients emotional reactions (facial
expressions, body language etc.)
Address issue right at the moment (you are looking
upset, how are you feeling right now?)
Positively reinforce (its good you told me that)
1. Collaborate with clients
2. Tailor therapeutic relationship to the individual
3. Using self-disclosure
4. Repair ruptures
5. Help clients to generalize to other relationships
6. Manage own negative reactions toward clients
THE EVALUATION SESSION
Objectives for evaluation sessions
Collect information
Determine whether you will be an appropriate therapist
Whether adjunctive treatment (e.g. medication) is needed
Initiate therapeutic alliance
Educate client about CBT
Set up easy action plan
What to do before the session
Request relevant reports
Let patient fill out questionnaires & self-reports
Recent medical check up
Structure of the evalution session
Together decide if family member or friend should participate
Set agenda & convey expectations
Psychosocial assessment
Set broad goals
Relate diagnosis with treatment plan & educate about CBT
BECK CHAPTER 1 – INTRODUCTION TO CBT
WHAT IS CBT?
Based on cognitive formulation: the maladaptive beliefs, behavioral strategies & maintain factors that characterize a
specific disorder
Understanding op individual clients & their specific underlying beliefs & patterns of behavior
CBT THEORETICAL MODEL
= dysfunctional thinking (which influences mood & behavior) is common to all psychological disturbances
If clients learn to evaluate their thinking in a more realistic & adaptive way, they experience a decrease in
negative emotion & maladaptive behavior
Examine validity of thoughts & conclude overgeneralization of thoughts
Focus less on cognitions in past but rather the ones that will interfere with steps to achieve goal
Automatic thoughts Intermediate beliefs (underlying Core beliefs about self, others & the
“I’m too tired to do anything” assumptions) world
Most superficial “If I try to initiate relationships, I’ll get “I’m helpless”
Thought leads to a rejected” “Other people will hurt me”
particular reaction “the word is dangerous”
Deepest level
CBT works on all three levels: modifying automatic thoughts & underlying dysfunctional beliefs produce enduring
change
“I cannot do anything” after CBT:
1. I’m not good at this specific task
2. I can do a lot of things well (positive automatic thoughts)
3. I can learn what I need & I have strengths & weaknesses like everyone else (intermediate & core belief)
CT-R AN ADAPTATION OF TRADITIONAL CBT
= recovery-oriented approach that maintains theoretical foundation of the cognitive model but adds an additional emphasis
on the cognitive formulation of client’s adaptive beliefs & behavioral strategies & factors that maintain a positive mood
Emphasizes client’s strengths, personal qualities, skills and resources
Cultivates positive cognitions & memories (e.g. family)
Time orientation:
CBT = talk about problems that arose in the past week & CT-R = focus on clients aspirations for the future, values &
use CBT to address them seps they can take toward goals
BECK CHAPTER 2 – OVERVIEW OF TREATMENT
1. CBT treatment plans are based on an ever-evolving cognitive conceptualization
= conceptualize patients’ difficulties in three-time frames:
current cognition that are obstacles to his aspirations & behavioral obstacles that serve to maintain the
depression
precipitating factors that influenced perceptions at onset of depression (e.g. work, wife…)
Developmental events & enduring patterns of interpretation of these events
2. CBT requires a sound therapeutic relationship
= clients vary on the degree to which they are able to develop good therapeutic alliance
Ask for reaction to treatment plan
Make collaborative decision about treatment & provide rationales for intervention
Use self-disclosure
Elicit feedback at the end of the session
,3. CBT continually monitors client progress
Use weekly symptom checklists + verbal & written feedback from client after sessions
Measure clients general functioning, progress toward goals, sense of satisfaction & well-being
4. CBT is culturally adapted & tailors’ treatment to the individual
Therapist should educate himself about client’s characteristics & anticipate how differences might be
relevant for treatment
5. CBT emphasizes the positive
Cultivate positive mood & thinking + inspire hope (help to attend positive)
6. CBT stresses collaboration & active participation
Therapy is seen as teamwork in which both therapist & clients are active
As patients becomes less depressed he takes a more active role
7. CBT is aspirational, value based & goal oriented
8. CBT initially emphasizes the present
Normally focus on the skills they need to improve their mood
Shift to past if:
- Clients expresses desire to do so
- Work directed on presented produces insufficient change
- Important to judge where dysfunctional ideas & coping strategies originate
9. CBT is educative
Educate about the course of the disorder, process of CBT, structure of sessions & cognitive model
Psychoeducation presenting ongoing & refined conceptualization & ask for feeback
Use diagrams & teach to become their own therapist
10. CBT is time sensitive
Different patients require different duration of treatment
11. CBT sessions are structured
Use standard format in every session
Reestablish therapeutic alliance, review action plan, collect data, discuss issues or goals, action plan,
summarize session
12. CBT uses guided discovery & teaches clients to respond to
dysfunctional cognitions
Use socratic questioning to help client to identify
dysfunction thinking & evaluate validity of thoughts
Goal: cognitive restructuring = process of assessing &
responding to maladaptive thinking
13. CBT includes action plans (therapy homework)
Practicing behavioral skills learned in session
(therapy notes help client to remember)
14. CBT uses a variety of techniques to change thinking, mood & behavior
CBT adapts strategies from many psychotherapeutic modalities
, BECK CHAPTER 4 – THERAPEUTIC RELATIONSHIP
Stay alert for clients emotional reactions (facial
expressions, body language etc.)
Address issue right at the moment (you are looking
upset, how are you feeling right now?)
Positively reinforce (its good you told me that)
1. Collaborate with clients
2. Tailor therapeutic relationship to the individual
3. Using self-disclosure
4. Repair ruptures
5. Help clients to generalize to other relationships
6. Manage own negative reactions toward clients
THE EVALUATION SESSION
Objectives for evaluation sessions
Collect information
Determine whether you will be an appropriate therapist
Whether adjunctive treatment (e.g. medication) is needed
Initiate therapeutic alliance
Educate client about CBT
Set up easy action plan
What to do before the session
Request relevant reports
Let patient fill out questionnaires & self-reports
Recent medical check up
Structure of the evalution session
Together decide if family member or friend should participate
Set agenda & convey expectations
Psychosocial assessment
Set broad goals
Relate diagnosis with treatment plan & educate about CBT
