COGNITIVE BEHAVIORAL THERAPY

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COGNITIVE BEHAVIORAL THERAPY

• Ann Olincy, M.D.
• Associate Professor of Psychiatry

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Uses of Cognitive Behavioral Therapy (CBT)

• Any disorder with distortions in thinking or
  dysfunctional behavior
• Anxiety disorders
• Post traumatic stress disorder
• Panic disorder
• Obsessive/compulsive disorder
• Depression
• Schizophrenia
• Personality disorders

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First Step Learning

• Begin with education about the illness
• Symptoms
• Causes
• Heredity
• Childhood circumstances
• Stress
• Triggers
• Brain chemicals
• Medical conditions

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Second step Identify Things That Maintain The
Thoughts/Behaviors

• Avoidance
• Self talk-what you say in your mind
• Mistaken beliefs-thoughts about yourself and your
  life
• Withheld feelings-anger, frustration, sadness
• Lack of assertiveness

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Second step Identify Things That Maintain The
Thoughts/Behaviors

• Lack of self-nurturing skills
• Muscle tension
• Stimulants or other diet factors
• High stress lifestyle
• Lack of sense of purpose

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Third Step Identify Things That May Help In
Recovery

• Physical
• Medical (medications)
• Relaxation
• Nutrition/diet
• Emotional
• Express suppressed feelings
• Behavioral
• Confront the things you avoid

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Third Step Identify Things That May Help In
Recovery

• Mental
• Counter negative self-talk
• Interpersonal
• Build strong, supportive relationships
• Whole level
• Improve self esteem

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Third Step Identify Things That May Help In
Recovery

• Mental
• Counter negative self-talk
• Interpersonal
• Build strong, supportive relationships
• Whole level
• Improve self esteem

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Third Step Identify Things That May Help In
Recovery

• Existential/spiritual
• Find a broad purpose or direction in their life
  that gives a person meaning
• Take responsibility for your problems
• Examining motivations for illness and overcoming
  secondary gains
• Willingness to take risks
• Make a commitment to change

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Fourth Step Learn How to Cope

• Deflate the danger-face symptoms dont run from
  them
• Coping statements
• This feeling isnt comfortable but I can handle
  it.
• This isnt the worst thing that could happen.
• This will pass.
• These are just thoughts-not reality.
• Nothing serious is going to happen to me.

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Fourth Step Learn How to Cope

• Explore the antecedents and identify preliminary
  signs to preempt a full blown episode
• Do something that requires focused concentration
  to draw your attention from the uncomfortable
  feelings

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Fourth Step Learn How to Cope

• Express your emotions
• Practice thought stopping-shout stop it or if
  others are around, visualize a stop sign
• Relaxation

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Relaxation Benefits

• Decrease heart rate, respiratory rate, blood
  pressure, muscle tension, metabolic rate, oxygen
  consumption, analytical thinking
• Increase energy and productivity, concentration
  and memory

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Relaxation Benefits

• Decrease insomnia and fatigue
• Decrease psychosomatic disorders
• Increase self-confidence
• Increase availability of feelings

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Relaxation Techniques

• Abdominal breathing
• Progressive muscle relaxation
• Visualizing a peaceful scene
• Meditation
• Guided imagery
• Biofeedback
• Sensory deprivation
• Physical exercise

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Fifth Step Behaviors- Desensitization

• Imagery desensitization
• Unlearning the connection between emotion and
  particular situation
• Visualize yourself in the situation that is
  disturbing and then practice relaxation
• Hierarchical-pick the least disturbing that you
  can tolerate and work up to the most disturbing
  when these are conquered

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Desensitization

• Real-life desensitization
• Put yourself in a real situation that is
  disturbing and practice tolerating the feelings
• Set goals for recovery
• Use a support person at the beginning
• Be aware of elements that make you anxious

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Desensitization

• Real-life desensitization
• Be willing to take risks
• Be willing to tolerate discomfort
• Avoid flooding (overexposure with lack of control
  over your emotions)
• Plan for contingencies-things do go wrong

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Desensitization

• Real life
• Trust your own pace
• Reward yourself for small successes
• Use positive coping statements
• Expect and know how to handle setbacks
• Be prepared to experience strong emotions

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Sixth Step Cognitions-Self-talk

• Automatic and subtle
• One image or word contains scores of memories,
  thoughts, associations
• Can be irrational but sounds like the truth
• Are learned
• Perpetuates avoidance

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Types of Self-talk

• Worrier
• Imagines the worst case scenario, overestimates
  the bad, creates images of catastrophe
• What if
• Critic
• Points out flaws, limits,
• You stupid

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Types of Self-talk

• Victim
• Helpless, hopeless, something inherently wrong
• I cant
• Ill never be able to
• Perfectionist
• Efforts not good enough, intolerant of mistakes
  or setbacks
• I should
• I must

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Cognitive Distortions

• Filtering
• Focus on the negative aspect of a situation
• Worthless, hopeless, pointless, stupid, failure,
  dangerous, unfair
• Emotional reasoning
• Judge illogically only on basis of own feelings
• Should statements
• Should, must, have to

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Types Of Unrealistic Thinking-Cognitive
Distortions

• Overestimating odds of negative outcome
• Catastrophizing
• Terrible, insufferable, catastrophic
• Over generalizing
• One bad experience will repeat itself
• Never, always, all, every, none, no one, nobody,
  everyone, everything

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Mistaken Beliefs

• Im powerless
• Life is a struggle
• If I take a risk Ill fail
• I should always look and act good no matter how I
  feel
• If I worry enough this problem will get better

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Mistaken Beliefs

• I cant cope with difficult situations
• The outside world is dangerous
• My needs dont matter
• Im worthless
• Im unlovable

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Challenging Mistaken Beliefs

• What is the evidence for the belief?
• Is this invariably or always true?
• Does this look at the whole picture?
• Does this promote well-being?
• Did I choose this belief on my own?

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Positive Counterstatements

• The worrier
• So what
• The critic
• Im ok the way I am
• I accept and believe in myself
• The victim
• Its never too late to change
• The perfectionist
• Its ok to make mistakes

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Positive Counterstatements

• Write down and rehearse
• Examine the evidence
• What are the odds of this really happening?
• Is this always true?
• What is the worst that could happen?
• Am I looking at the whole picture?
• Am I fully objective?

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Daily Record of Dysfunctional Thoughts