Cognitive behavior therapy

Ummi Pratiwi Rimayanti

Behavior

• Classical conditioning focuses on involuntary behavior

• Operant conditioning concerned with the relationship between voluntary behavior and environment

– Increasing behavior: positive reinforcement, negative reinforcement

– Decreasing behavior: punishment, response cost, extinction

Cognitive principle

• People’s emotional reactions & behavior are influenced by cognitions

• People react differently to similar events• Maladaptive responses arises from cognitive

distorsion

Cognitive distortion

• Overgeneralization

• Personalization

• Dichotomous thinking

• Catastrophizing

• Selective abstraction

• Arbitratry inference

• Mind reading

• Magnification/minimization

• Perfectionism

• Externalization of self-worth

Cognitive Behavior Therapy

• A structured, short-term, present-oriented psychotherapy for depression, directed toward solving current problems and modifying dysfunctional (inaccurate and/or unhelpful) thinking and behavior

• Based on a conceptualization, or understanding, of individual patients

CBT basic principles

• Based on formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms

• requires a sound therapeutic alliance• emphasizes collaboration and active participation• goal oriented and problem focused• initially emphasizes the present• educative, aims to teach the patient to be her own therapist, and

emphasizes relapse prevention• aims to be time limited• Cognitive behavior therapy sessions are structured• teaches patients to identify, evaluate, and respond to their

dysfunctional thoughts and beliefs• Uses a variety of techniques to change thinking, mood, and

behavior

Interacting system in human behavior

Level of cognition

CBT & nursing process

• CBT is patient centered

• Educational & skill building rather than curative

• Empathy & therapeutic relationship

• CBT emphasis on objective assessment process, bases treatment strategies

on research evidence, values ongoing evaluation

CBT Indication

• Depressive disorder, dysthymic disorder, panic disorder, social phobia, OCD, PTSD, generalized anxiety disorder and bulimia nervosa (Wright et al. 2002)

• Bipolar disorder (Basco and Rush 1996, Basco and Thase 1998, Lam et al. 2000, 2005b, Scott et al. 2003, and Zaretsky et al. 1999) and schizophrenia (Mueser 1998, Kingdon and Turkington 1995, Sensky et al. 2000)

Cognitive behavioral assessment

• Actions, thoughts, feeling

• Identifying problem from the data

• Defining problem behavior

• Deciding how to measure the problem behavior case spesific standarized rating scale

• Identifying enviromental variables

Initial questions

• What is the problem?

• Where does the problem occur?

• When does the problem occur?

• Who or what makes the problem occur?

• What is the feared consequence related to the problem?

The ABCs of behavior

• Antecedent: cue that occurs before behavior

• Behavior: what the person does or does not say or do

• Consequence: what kind of effect (positive, negative, neutral) the person thinks the behavior has

Treatment strategies

• Effective for anxiety, affective, eating, schizophrenic, substance abuse & personality disorder

• Aimed at increasing activity, reducing unwanted behavior, increasing pleasure, enhancing social skill

CBT strategies

Anxiety reducton Cognitive restructuring

Learning new behavior

• Relaxation training• Biofeedback• Systematic

desensitization• Interoceptive

exposure• Flooding• Vestibular

desensitization training

• Response prevention• Eye movement

desensitization

• Monitoring thoughts and feelings

• Questioning the evidence

• Examining alternatives

• Decatastrophizing• Reframing• Thought stopping

• Modeling• Shaping• Token economy• Role playing• Social skill training• Aversive therapy• Contingency

contracting

Selection of CBT Treatment

• should be based on the appropriateness of cognitive-behavior therapy for the treatment situation

• acute phase CBT typically ranges from 10 to 20 weekly treatment sessions

• conducted in a period of 3–6 months

Phases of Treatment

• The initial phase: clinical assessment, case formulation, establishment of a therapeutic relationship, socialization of the patient to therapy, psychoeducation, and introduction to treatment procedures.

• The middle stage: sequential application and mastery of cognitive and behavioral treatment strategies.

• The final phase of therapy: preparation for termination, relapse prevention.

Evaluation

• integrated use of objective assessment methods

• administered before treatment and repeated periodically

• high residual levels of cognitive symptoms most likely convey an increased risk for relapse after termination of treatment

Referrence

• Beck, Judith. 2011. Cognitive behavior therapy: basics and beyond. New York. The Guilford Press.

• Friedman, et al. 2008. Cognitive and Behavioral Therapies. New York. John Wiley & Sons

• Rector, Neil. 2010. Cognitive-behavioural therapy : an information guide. Toronto. CAMH publications

• Westbrook, et al. 2011. An Introduction to Cognitive Behaviour Therapy: Skills and Applications. New York. SAGE Publications