Cognitive Behavioral Therapy PDF

Reaction , Behavior , Thought -sucratic Cognitive Behavioral Therapy Introduction The foundation on which cognitive therapy is established can be identified by the statement, “Men are disturbed not by things but by the views which they take...

Reaction , Behavior , Thought -sucratic Cognitive Behavioral Therapy Introduction The foundation on which cognitive therapy is established can be identified by the statement, “Men are disturbed not by things but by the views which they take of them.” Epictetus, 125 AD  Indications for Cognitive Therapy Depression Substance use disorders Panic disorder Personality disorders Generalized anxiety Schizophrenia disorder Couple’s problems Social phobia Bipolar disorder Obsessive-compulsive Illness anxiety disorder disorder Somatic symptom Posttraumatic stress disorder disorder Eating disorders Goals and Principles of Therapy The goal of cognitive therapy is for clients to learn to identify and alter the dysfunctional beliefs that predispose them to distort experiences. Cognitive therapy is highly structured and short-term, lasting 12 to 16 weeks. Goals and Principles of Therapy (cont.) Client has to do the Cognitive Therapy work not them Is based on an ever-evolving formulation of the client and his or her problems in cognitive terms Requires a sound therapeutic alliance Emphasizes collaboration and active participation Is goal oriented and problem focused Initially emphasizes the present Goals and Principles of Therapy (cont.) Cognitive Therapy (cont.) Is educative, aims to teach clients to be their own therapist, and emphasizes relapse prevention Aims to be time limited Uses structured therapy sessions Teaches clients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs Uses a variety of techniques to change thinking, mood, and behavior  know definitions Basic Concepts (cont.) Automatic thoughts Some examples are: – Arbitrary inference ( (cognitive errors) – Overgeneralization - thoughts that occur – Dichotomous thinking – Selective abstraction rapidly in response – Magnification Loading… to a situation and – – Minimization Catastrophic thinking without rational – Personalization analysis D  Basic Concepts (cont.) * - Conclusions without evidence Arbitrary inference Applies to all - Always – Never OvergeneralizationI – Everyone - Nobody - Either all or nothing – good or Dichotomous thinking bad Selective abstraction- Using selective evidence to support negative thoughts Magnification- Exaggerating significance of negative ‘evidence’  # Minimization - Ignoring the positive significance of events Catastrophic thinking - Awfulizing – consistent focus on ‘awful’ or worst- case possibilities Personalization- Making all outcomes about oneself, typically including one’s own lack of competence Basic Concepts (cont.) 1. A client diagnosed with severe depression states, “When I wasn’t invited to my niece’s wedding, it was obvious that the in-laws did not think I was good enough to be included.” The nurse understands that this automatic thought is an example of which common cognitive error? A. Arbitrary inference B. Overgeneralization (absolute thinking) C. Dichotomous thinking D. Personalization Basic Concepts (cont.) Schemas (core beliefs): Cognitive structures containing most fundamental beliefs and assumptions – develop early from personal experiences and identification with significant others Reinforced by further learning experiences and then influence formation of additional beliefs, values, attitudes Schemas may be adaptive or maladaptive, general or specific, and positive or negative Generally form around themes of helplessness and/or unlovability Strategies of Cognitive Therapy Didactic (Educational) Aspects Clients must be prepared to become their own therapist. The therapist provides information about cognitive therapy and provides assignments to reinforce learning. A full explanation about the correlation between distorted thinking and clients’own situation (anxiety, depression, etc) is discussed Strategies of Cognitive Therapy (cont.) Cognitive Strategies Recognizing Automatic Thoughts and Schemas – Socratic questioning - systematic, depth, abiding interest in assessing the truth or plausibility of things. – Imagery – Role play – Thought recording Strategies of Cognitive Therapy (cont.) Cognitive Strategies (cont.) Modifying Automatic Thoughts and Schemas – Generating options and alternatives – Questioning the evidence – Decatastrophizing – Reattribution – Daily recording of dysfunctional thoughts – Cognitive rehearsal Strategies of Cognitive Therapy (cont.) 1. A nurse is using decatastrophizing techniques to help a client modify automatic thoughts and schemas. Which nursing statement could be used in this process? A. “First you must decide if this negative thought is valid.” “Let’s really look at that thought pattern. What evidence made you come to that conclusion?” “When you start to have a negative thought, start visualizing a pleasant experience.” D. “Let’s explore some other possibilities related to this thinking.” Strategies of Cognitive Therapy (cont.) Correct answer: A – This nursing statement could be used during the technique of decatastrophizing. Decatastrophizing assists the client to examine the validity of a negative automatic thought. Even if some validity exists, the client is then encouraged to review ways to cope adaptively, moving beyond the current crisis situation.  Strategies of Cognitive Therapy (cont.) Behavioral Interventions Cognitions affect behavior – Behavior influences cognitions Procedures to help client learn more adaptive behavioral strategies that in turn positively affect cognitions. – Activity scheduling – Graded task assignments – Distraction – Behavioral interventions (relaxation, assertiveness, role modeling, social skills, contingency management) Strategies of Cognitive Therapy (cont.) Behavioral Interventions (cont.) – Distraction – Relaxation exercises – Assertiveness training – Role modeling – Social skills training – Thought-stopping techniques Role of the Nurse Cognitive therapy strategies and techniques are within the scope of nursing practice. These concepts are often not a part of basic nursing education. It is important for nurses to understand the basic concepts of cognitive therapy as the scope of nursing practice continues to expand.