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CBT: COGNATIVE BEHAVIORIAL THERAPY. PRESENTED BY: OLUSOLA ILESANMI & JUSTINA OGRAJA. HISTORY OF CONGNITIVE BEHAVORIAL THERAPY.
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CBT: COGNATIVE BEHAVIORIAL THERAPY PRESENTED BY: OLUSOLA ILESANMI & JUSTINA OGRAJA
HISTORY OF CONGNITIVE BEHAVORIAL THERAPY Two of the earliest forms of Cognitive behavioral Therapy were Rational Emotive Behavior Therapy ( REBT ), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s. Beck found that depressed patients experienced streams of negative thoughts that seemed to arise spontaneously. He called these cognitions “automatic thoughts.” He found that the patients’ automatic thoughts fell into three categories. The patients had negative ideas about themselves, the world and/or the future.
cont... Dr. Beck began helping patients identify and evaluate these automatic thoughts. He found that by doing so, patients were able to think more realistically. As a result, they felt better emotionally and were able to behave more functionally. When patients changed their underlying beliefs about themselves, their world and other people, therapy resulted in long-lasting change. Dr. Beck called this approach “cognitive therapy.” It has also become known as “cognitive behavior therapy.”
cont... Beck called it cognitive therapy because of the importance it places on thinking. It’s now known as cognitive-behavioral therapy (CBT) because the therapy employs behavioral techniques as well.
WHAT IS CBT? Cognitive Behavioural Therapy is a type of talking therapy which involves identifying and challenging unhelpful thoughts and helping people learn how to modify their thinking patterns and behaviours, to improve the way they feel. CBT explores the relationship between feelings, thoughts, and behaviours. As such, it arose from two very distinct schools of psychology: behaviourism and cognitive therapy. Its roots can be traced to these two models and their subsequent merging.
Behavioural Therapy Roots Behavior: What we do affects how we feel and think. The individual, who deals with an upcoming exam by putting off his studies until the last minute, is likely to experience more distress on the day of the exam than an individual who has studied well in advance. CBT helps people to learn new behaviors and new ways of coping with events, often involving the learning of particular skills.
Cognitive Therapy Roots Beck contends that people with emotional difficulties tend to commit characteristic “logical error” that tilt objectively in the direction of self-destruction. Cognitive therapy perceives psychological problems as stemming from common place processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information and failing to distinguish between fantasy and reality. Thinking: Different people can think differently about the same event. The way in which we think about an event influences how we feel and how we act. A classic example is that when looking at a glass of water filled halfway, one person will see it half empty and feel discouraged and the other sees it half full and feels optimistic.
USES OF CBT • CBT has been applied to a broad range of psychological issues. Its use became more widespread in the 1990s and is now promoted by the NHS. As its popularity grows, the number of clinical trials into CBT is increasing and the evidence base is strengthening. • CBT has been shown as an effective way of treating a number of different mental health conditions and for treating a range of conditions.
Cont... In addition to depression or anxiety disorders, CBT can also help people with: • obsessive compulsive disorder (OCD) • panic disorder • post-traumatic stress disorder (PTSD) • phobias • eating disorders – such as anorexia and bulimia • sleep problems – such as insomnia • problems related to alcohol misuse CBT is also sometimes used to treat people with long-term health conditions, such as: • irritable bowel syndrome (IBS) • chronic fatigue syndrome (CFS) Although CBT can't cure the physical symptoms of these conditions, it can help people cope better with their symptoms.
ABC MODEL A useful way to illustrate the role of cognition is with the ‘ABC’ model. (originally developed by Albert Ellis, the ABC model has been adapted for more general CBT use). In this framework ‘A’ represents an event or experience, ‘B’ represents the beliefs about the A, and ‘C’ represents the emotions and behaviours that follow from those beliefs. Here is an example of an ‘emotional episode’, as experienced by a person prone to depression who tends to misinterpret the actions of other people:
cont... The ABC Model is one of the most famous cognitive behavioural therapy techniques for analysing your thoughts, behaviour and emotions. The Basis of CBT Cognitive behavioural therapy or CBT works on the assumption that your beliefs influence your emotions and your behaviour and that by identifying and addressing problematic thoughts you can help to change your behaviour and experiences for the better. The ABC Model of CBT The ABC Model asks you to record a sequence of events in terms of: A - Activating Event (also sometimes described as a 'Trigger') B - Beliefs (for example, the thoughts that occur to you when the Activating Event happens) C - Consequences - how you feel and behave when you have those Beliefs (consequences may be divided into two parts: your actions and your emotions)
cont... Activating event:Friend passed me in the street without acknowledging me. Beliefs about A: He’s ignoring me. He doesn’t like me. I’m unacceptable as a friend – so I must be worthless as a person. For me to be happy and feel worthwhile, people must like me. C. Consequence: Emotions: hurt, depressed. Behaviours: avoiding people generally.
ABC Model-Example In this particular example, the beliefs "She thinks I am not working hard enough" and "She is trying to catch me out" might be examples of what is sometimes called 'Mind Reading' - i.e. making assumptions about what other people are thinking. Your beliefs may be justified and accurate beliefs but they may not. It is important to clarify whether the situation and the evidence justifies your beliefs and then decide how you want to act once you have done that.
RATIONALE FOR CBT Negative emotions are elicited by cognitive processes developed through influences of learning and temperament. • Adverse life events elicit automatic processing, which is viewed as the causal factor • Cognitive triad: Negative automatic thoughts center around our understanding of: Ourselves, Others (the world) and Future • Focus on examination of cognitive beliefs and developing rational responses to negative automatic thoughts. • Distorted appraisals follow themes relevant to the specific psychiatric condition • Psychological disorders are characterized by a different psychological profile. • Depression: Negative view of self, others, and future. • Core beliefs associated with helplessness, failure, incompetence, and unlovability. • Anxiety: Overestimation of physical and psychological threats, Core beliefs linked with risk, dangerousness, and uncontrollability.
COGNITIVE SPECIFICITY NegativeTriad Associated with Depression: • Self “I am incompetent/unlovable” • Others “People do not care about me” • Future “The future is bleak”• Negative Triad Associated with Anxiety • Self “I am unable to protect myself” • Others “People will humiliate me” • Future “It’s a matter of time before I am embarrassed”
ASSUMPTION OF CBT Beck’s is based on the theoretical rationale that the way people feel and behave is determined by how they perceive and structure their experience. The theoretical assumptions of CBT are: • that people’s communication is accessible to introspections. • that clients’ beliefs have highly personal meanings • that these meanings can be discovered by the client rather than being taught or interpreted by the therapists.
What is dysfunctional thinking? Definition To describe a belief as ‘irrational’ is to say that: • It blocks a person from achieving their goals,creates extreme emotions that persist and which distress and immobilise, and leads to behaviours that harm oneself, others, and ones life in general. • It distorts reality (it is a misinterpretation of what ishappening and is not supported by the available evidence); • It contains illogical ways of evaluating oneself,others, and the world.
THE THREE LEVEL OF THINKING People view themselves and the world around them at three levels: (1) Inferences (2) Evaluations (3) Core beliefs Every individual has a set of general ‘core beliefs’– usually subconscious – that determines how they react to life. When an event triggers off a train of thought, what someone consciously thinks depends on the core beliefs they subconsciously apply to the event. The therapist’s main objective is to deal with the underlying, semi-permanent, general ‘core beliefs’ that are the continuing cause of the client’s unwanted reactions.
Cont... Guiding a person’s inferences and evaluations are their core beliefs. Core beliefs are the underlying, general assumptions and rules that guide how people react to events and circumstances in their lives.They are referred to in the CBT literature by various names: ‘schema’; ‘general rules’; ‘major beliefs’; underlying philosophy’, etc. REBT and CT both propose slightly different types of core belief. They will be refer to as (1) assumptions and (2) rules. Assumptions are a person’s beliefs about how the world is – how it works, what to watch out for,etc. They reflect the ‘inferential’ type of thinking Here are some example • My unhappiness is caused by things that are outside my control – so there is little I can do to feel any better • Events in my past are the cause of my problems and they continue to influence my feelings and behaviours now. • It is easier to avoid rather than face responsibilities.
Cont... Rules are more prescriptive – they go beyond describing what is to emphasise what should be. They are‘evaluative’ rather than inferential. Here are some examples: • I need love and approval from those significant to me – and I must avoid disapproval from any source. • To be worthwhile as a person I must achieve, succeed at whatever I do, and make no mistakes. • People should always do the right thing. When they behave obnoxiously, unfairly or selfishly,they must be blamed and punished. • Things must be the way I want them to be, otherwise life will be unbearable. • I must worry about things that could be dangerous,unpleasant or frightening – otherwise they might happen. • Because they are too much to bear, I must avoid life’s difficulties, unpleasantness, and responsibilities. • Everyone needs to depend on someone stronger than themselves. • I should become upset when other people have problems, and feel unhappy when they’re sad • I shouldn’t have to feel discomfort and pain – Ican’t stand them and must avoid them at all costs • Every problem should have an ideal solution and it’s intolerable when one can’t be found.
cont.... CT(cognitive therpy) focuses mainly on inferential-type thinking, helping the client to check out the reality of their beliefs, and has some sophisticated techniques to achieve this empirical aim. REBT (Rational Emotive Behaviour Therapy) emphasises dealing with evaluative-type thinking (in fact, in REBT, the client’s inferences are regarded as part of the ‘A’ rather than the ‘B’). When helping clients explore their thinking, REBT practitioners would tend to use strategies that examine the logic behind beliefs (rather than query their empirical validity). What REBT and CT do share, though, is an ultimate concern with underlying core beliefs.
CORE BELIEFS Core beliefs underline and produce automatic thoughts. The assumptions influence information processing and organize understanding about ourselves, others, and the future. These core beliefs remain dormant until activated by stress or negative life events. Categories of core beliefs (helpless, worthless, unlovable).
AUTOMATIC THOUGHTS Thoughts that automatically come to mind when a particular situation occurs is called automatic thought. It happen spontaneously in response to situation and do not arise from reasoning so there is no logical sequence.
Cont... • Over-generalisation: building up one thing about oneself or one’s circumstances and ending up thinking that it represents the whole situation. For example: ‘Everything’s going wrong’, ‘Because of this mistake, I’m a total failure’. Or, similarly, believing that something which has happened once or twice is happening all the time, or that it will be a never-ending pattern: ‘I’ll always be a failure’, ‘No-one will ever want to love me’, and the like. • Mind-reading: making guesses about what other people are thinking, such as: ‘She ignored me on purpose’, or ‘He’s mad with me’. • Fortune-telling: treating beliefs about the future as though they were actual realities rather than mere predictions, for example: ‘I’ll be depressed forever’, ‘Things can only get worse’.
INFERENTIAL DISTORTATION In everyday life, events and circumstances trigger off two levels of thinking: inferring and evaluating. At the first level, we make guesses or inferences about what is ‘going on’ – what we think has happened, is happening, or will be happening. Inferences are statements of ‘fact’ (or at least what we think are the facts – they can be true or false). Inferences that are irrational usually consist of ‘distortions of reality’ like the following: • Black and white thinking: seeing things in extremes, with no middle ground – good or bad, perfect versus useless, success or failure, right against wrong, moral versus immoral, and so on. Also known as all-or-nothing thinking. • Filtering: seeing all that is wrong with oneself or the world, while ignoring any positives.
Cont... • Personalising: assuming, without evidence, that one is responsible for things that happen: ‘I caused the team to fail’, ‘It must have been me that made her feel bad’, and so on.
The systematic errors in reasoning that lead to faulty assumptions and misconceptions which are termed as cognitive distortions. Arbitrary Inference: refers to making conclusions without supporting and relevant evidence. This includes “catastrophizing” or thinking of absolute worst scenario and outcomes for most situations. Selective abstraction: consists of forming conclusions based on an isolation detail of an event. In this process other information is ignored and the significance of total context is missed. Magnification and minimization: consist of perceiving a case or situation in a greater or lesser light than it truly deserves
Behavioral Therapy teaches the client the necessary skills to modify their behavior in a way that makes it adaptive rather than maladaptive. So the negative cognitions and emotions decrease as the patients learns that they can function in social situations.
