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Cognitive Behaviour Therapy (CBT) - its application to Depression & Low Self-esteem. Frank McDonald Consultation-Liaison Psychologist The Townsville Hospital for JCU Med School Year 5 Mental Health Rotation www.fmcdonald.com. Overview. What is CBT? Suitable Conditions for CBT
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The Townsville Hospital for JCU Med School Year 5 Mental Health Rotation
Any significant mental health problem involves on-going interactions amongst
genes, current biological state
Confronting fear of heights consolidates new ideas about fear
Substance abuse (including alcohol)
Phobias (eg Social Phobia)
Generalised anxiety disorder
Posttraumatic stress disorder
Somatoform & factitious disorders
Some sleep disorders
Marital, family and parenting problems
Health-related behavioursCBT empirically supported for
In these diagnostic groups CBT has increasingly become the treatment of choice or a significant adjunct to pharmacological management
e.g. “I can’t face the day. Why get up? There’s nothing to live for!”
It does not usually address normal sadness or distress associated with unpleasant situations e.g. anxiety while awaiting cancer test results
Rather, stages of therapy reflect objectives: i) to help pts see relationship between thinking & feeling thru identifying specific ANT’s & then
ii) to help pts consider possibility of alternative ways of seeing situation. Simply inviting them. There are numerous ways to achieve this goal‘How to’: Managing ANT’s
iii) Pts then to identify changes in mood or distress levels & to record simultaneously what specific images & thoughts they were aware of & new ratings of endorsement of original beliefs after reflecting on new perspectives (see diary example below)
May well positively effect deeper levels of maladaptive thinking/assumptions (schemas & core beliefs) without direct attention to these . . .
. . . or maybe not‘How to’: Managing ANT’s
Clinically depressed 25 y.o. with low self-esteem presents for CBT after rejection by work colleague saying “I don’t know how to interact successfully with people.” “Life is such a struggle, I’ve run out of fight. I can’t face another day.” “People don’t care about me. They are trying to destroy me. I’ll never get better.”
(These are her ANT’s - that stream spontaneously into her consciousness unbidden but which seem very real & plausible. These emerge early in Cognitive Therapy as you ask pt to identify thoughts associated with her feelings of low self-esteem & depression.)Case study formulation
Italicized headings above are drawn from Aaron T. Beck’s Cognitive Therapy approach to case conceptualisation
Formation of core beliefs about self, others, world & life in general
Formation of schema & basic assumptions
Automatic Negative Thoughts
Armed with formulation based on above, you can more fully engage in Cognitive Therapy following steps outlined in slides 8 (Preparatory steps) & 15 – 17 (Managing ANT’s)
(Remember - these are unconditional, absolutist core beliefs developing from early experiences)
Q & A