Cognitive Behavioral Therapy (CBT) Overview

Overview of CBT Part 1

• CBT is designed to help people identify negative thought patterns and change them into positive ones
• CBT treatment focuses on reframing the thinking process
• Cognitive behavioral therapy utilizes five problem-solving steps which include
  • Recognizing the problem
  • Creating a list of potential solutions
  • Evaluating the strengths and weaknesses of each solution
  • Choosing a solution to apply
  • Implementing the solution

Types of CBT

• Cognitive Therapy is one of the earliest therapies to be considered CBT
• Cognitive Therapy focuses on identifying and changing unhelpful or distorted thinking patterns
• Cognitive Therapy uses collaborative elements like agenda setting and homework assignments to correct cognitive distortions, thinking errors, and maladaptive behaviors
• Rational Emotive Behavior Therapy (REBT) involves identifying irrational beliefs, challenging these beliefs, and changing maladaptive thought patterns
• Albert Ellis created REBT based on the idea that each person holds a unique set of basic assumptions influencing their actions, reactions, and perspectives
• In Acceptance and Commitment Therapy (ACT), people's thoughts and feelings are affected by events, their environment, and the people around them
• ACT focuses on increasing tolerance for emotional pain to promote a fulfilling and meaningful life, helping people get "unstuck" from emotions to pursue value-consistent actions
• In Acceptance and commitment therapy, the focus is on changing the relationship to unwanted thoughts/feelings, freeing client from their grip
• Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan and is based on CBT, highlighting validation or acceptance over fighting uncomfortable thoughts, feelings, and behaviors
• DBT encourages change through a mindful and present stance, originally designed to treat individuals with Borderline Personality Disorder (BPD), and is a commonly utilized treatment intervention
• DBT is beneficial for anyone experiencing extreme, unpredictable, negative emotions
• DBT includes strategies for accepting and changing unwanted thoughts/feelings, and managing relationships/conflict
• Cognitive processing therapy treats traumas
• Cognitive processing therapy focuses on changing the way you see traumas so that they don't negatively affect your life
• Cognitive processing therapy is helpful in treating post-traumatic stress disorder (PTSD) and will be covered in session 5
• Motivational Interviewing (MI) is an evidence-based approach that is directive and goal-directed and recognizes varying levels of client commitment
• Motivational Interviewing facilitates internal motivation for behavior change while resolving any ambivalence toward change
• Motivational Interviewing can be utilized to help people overcome substance use problems, explore, and enhance motivation for changing almost any behavior
• Mindfulness-Based Stress Reduction (MBSR) utilizes mindfulness meditation to manage stress and related symptoms
• MBSR is primarily used in anxiety-related disorders and chronic pain
• Mindfulness-Based Cognitive Therapy (MBCT) is fairly new and rides on the crest of Mindfulness-Based Cognitive Therapy (MBCT)
• Essential element of MBCT is mindfulness
• The focus of MBCT is on the way a person reacts to their thoughts
• Those with stress, anxiety, or chronic pain can benefit from MCBT
• In MCBT, the goal is to help people make healthy choices each day and improve life moment-to-moment
• Exposure therapy treats OCD, PTSD, and phobias
• In exposure therapy, a person and their therapist identify anxiety triggers and learn relaxation techniques to manage anxiety
• In a controlled, safe environment, the person confronts triggers while implementing relaxation techniques
• Some can encounter distressing memories at once or via exposure therapy flooding, but others need time
• A therapist will help ease someone into the exposure process

Cognitive Behavioral Therapy Techniques

• Cognitive Restructuring or Reframing is a technique that helps people identify thought patterns responsible for ineffective behavior and negative emotions to reframe them into a more positive perspective
• By recognizing that negative thought patterns aren't balanced, such as placing too much importance on minor details or over-generalizing, clients are freed to consider a different point of view that focuses on the positive
• Guided Discovery is a technique where a therapist gets familiar with a client's viewpoint and then asks questions to broaden their thinking and challenge their beliefs
• During Guided Discovery providing evidence of their assumptions might be done, as well as evidence that doesn't support their beliefs, with the goal of helping them see things from a different perspective
• Graded Exposure Therapy a technique also called exposure therapy helps clients to slowly and systematically face what they fear
• With guided graded exposure, you as the therapist incrementally expose your client to increasing levels of the thing that provokes fear or anxiety while sharing guidance on how to cope with the trigger(s) in the moment
• Skills Training equips clients with practical skills to help them achieve various goals
• Skills Training may include communication training, assertiveness training, and social skills training, often using modeling, role-playing, and direct instruction
• Mindfulness is a helpful skill that leverages Buddhist teachings allowing clients disengage from negative thoughts/feelings and redirect attention to the present moment
• Activity Scheduling and Behavior activation helps identify and schedule positive and helpful behaviors and increases the likelihood that clients will take action on them
• Scheduling those activities that people avoid can help them follow through, and is helpful for procrastinators who don't engage with rewarding activities
• Behavioral experiments help a client predict what will happen when starting a task that causes anxiety
• The therapist then discusses with them whether their prediction came true
• Over a series of behavioral experiments, people will often see that the catastrophe they were anxious of, did not come to pass
• Roleplaying allows a reduction fear, due to the fact clients get to practice scenarios in situations they may encounter
• In the setting of scenarios during Roleplaying, it can help identify automatic thoughts, create new responses, practice them and modify core beliefs, improve communication, problem solving boost social skills
• Pie Technique uses a pie chart to help clients visualize their ideas and goals, this exercise teaches gaol-setting and accountability

Pros of CBT

• Is as effective as medication to treat some mental health disorders
• Does not take much time to complete compared to other forms of talking therapy
• Focuses on different formats, depending on the issues presenting themselves
• Different therapy session types and tools are available
• The skills learned offer useful real-world skills
• It is a collaborative effort
• Medication can work along side it
• Usefull regardless of age
• It retrains thoughts and changes behaviours
• prepares you for real-life situations
• Can be one on on or in group therapy

Cons of CBT

• Relies on will of the patient
• Takes a lot of time to complete CBT, with the work between sessions
• Is not useful for individuals with specific learning difficulties
• People with complex mental health needs may not benefit from CBT
• Can make you feel more anxious and stressed before it can make you feel better
• Addresses current issues only instead of addressing some underlying causes
• It focuses on the individual capacity to change

9 Steps Case Conceptualization

• Problem List: Listing 5-8 items with a short description of each problem a client presents, affect component, quantifying each problem as possible for duration, frequency, intensity, and pervasiveness of the symptoms
  • Usually, need to inquire about the psychological, medical, leisure, social/interpersonal, occupational, legal, and financial areas impaired with the patient
• Core Release involves the patient's hypothetical beliefs, schemas, or view about themselve, sustaining the patient problems
  • Therapists want to know in these cases what the client is thinking and how the client interprests others thinking of them
• Consideration of Other Etiological Factors involves gathering factors that contribute to the development of the problem and disorder
• Precieitant and Activating Situations: involves antecedets that automatically activate the problematic core beliefs, psychological symtoms and recent situations
  • It can also include activating vents, which are small events that arrise before negative symtoms
• Working Hypothesis is the core beliefs, as they relate to the problem at hand, how symtoms exist in the manner they do
• Origins of Core Beliefs involves the therapists analyzing the history of how the client acquired their belifs
• Treatment plan is the means in which goals form through intervention that best target symtoms and the remediation of learning the client can use
• Strengths of Treaments includes strong qualities and strengths. Although the patient may have a certain amount of negative beliefs, still they may have multiple opportunities to realize what strengths that they have
• Predicted Weaknesses/Limitations of Treatment Involve obstacles that impede the patient to a good outcome, such as culture, habits, envirnomental or financial