Things I CAN control Things I CANNOT control

THRIVE /FLOURISH STRESS

STRESSAdverse Event

DESTABILIZED

ALMOST NORMAL EMOTIONALLY OVERWHELMED

Re-Integrate

• Therapy

• Activity

• Support structure

• Fun

• Think clearly

• Recurring and relapsing • Very common in depression and anxiety estimates of a lifetime

experience of 25% (women) and 12% (men).• Less than 30% seek active treatment, less than 10% see a psychiatrist.• Only those with heart disease spend more time in bed• One in five is the common estimate

Persistence of emotional crises

1) Target symptoms clearly

2) Explain CBT collaborative model

3) Outline strategies and skills needed for change

4) Design and apply behavioural and cognitive tasks

5) Discuss relapse prevention

6) Provide follow-up plan - regular and crisis

• Active collaborative approach with specified goals and strategies. Focus can shift across thinking, affective, motivational and behavioural strategies as needed

• Provision of structured interventions for faulty thinking, disregulated affect and behaviours.

• Treatment both of explicit symptoms and implicit causal links.

• Mindfulness has added new dimensions to appraisals, explicit values and present moment thinking

• Cognitive Therapy was first developed to treat depression. The cognitive triad (deprivation, helplessness and hopelessness)

• A current experience of rejection links with other rejection and negative experiences to form a core belief about being a worthless, rejectable person

• Functioning impaired by wrong appraisals, over-reactive affect and social isolation. High concordance of depression with social anxiety disorder

Cognitive Model of Depression (Beck model)

• Distortions in thinking underpin emotional distress & crisis.

• The way we think forms the emotional response - adaptive or maladaptive.

• Appraisals cluster to form behavioural, affective and motivational schema that are enacted habitually.

• Core beliefs, assumptions, automatic thoughts, compensatory mechanisms.

• Cognitive bias focusing on the negative and disregarding other evidence.

Examples:• all or nothing thinking (eg. “If I don’t get this contract then I’m a total failure”), • overgeneralization (“I’m always miserable at the weekends”), • discounting the positive (“nothing went right today”), • jumping to conclusions (“Other mothers never find it difficult to keep their children

happy”), • catastrophising (“Even if I do win the lottery my ticket won’t be valid”), • global judgements (“I got that wrong so I must be useless”), • personalization (“ it’s all my fault”)

Thinking Errors

Assumptions or schemata

Self-value ..I’m bad, worthless, useless

Body image…I’m ugly, unattractive

Self-control ….I’m out of control

Weakness….I’m weak-willed.

Incompetence….I can’t do this

Frustration with self….I can’t stand being me

Self-blame ..if something goes wrong, it will be my fault

Negative Core beliefs

Taking another perspective

• CBT tries to normalise the experience of psychological symptoms - the persistence, intensity, frequency and impact leads to disturbed thinking, feeling and behaving.

• If another thought about this like you do, they would be having similar experiences of distress.

• What does it say about me that I feel like this right now?

• What does it say about the context of my life - behavioural, emotional, relationships, thinking style?

• What does it say about my future?

• If a friend shared their thoughts about this very matter, what would you advise them?

Behavioural activation

• Recent study from Duke University reports that a thirty-minute walk or jog three times a week was as effective as a medication regime and the combined exercise/medication.

• Useful for as many as 30% of depressed patients do not respond to medication or cannot cope with side effects.

• Use careful planning of behavioural tasks to reinforce efforts at change – 75% rule.

• Reinforce changes to schedule – counter-condition new schedules

• Use of cue cards, review sheets

CBT IN VERSEONE SHIP SAILS EAST, ANOTHER SAILS WEST

BOTH WITH THE SAME BREEZES BLOWING

‘TIS THE SET OF THE SAILS NOT THE FORCE OF THE GALES

THAT TAKES THEM WHERE THEY’RE GOING(Anon)

The fault dear Brutus lies not in our stars but in ourselves … Julius Caesar Act 1

People are not disturbed by things, but by the views that they take of themEpictetus , Encheridion