Pg-Certificate CBT-2017 Dr.Bashir Ahmad (Course Director)

An overview of Psychotherapies Moderators Professor SM Sultan & Dr. Bashir Ahmad 6th January 2017

pSYCHOTHERAPY Psychotherapy is the development of a trusting relationship, which allows free communication and leads to understanding, integration and acceptance of self.

Schools of Psychotherapies Psychodynamic Therapies Behavioural Therapies Cognitive Behaviour Therapies Supportive Psychotherapy Inter personal Family therapy and couples therapy

1. Psychoanalysis Founded by Sigmund Freud(1856-1939) The aim of psychoanalytic therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. Treatment focuses on bringing the repressed conflict to consciousness, where the patient can deal with it. Lengthy process (2-5 sessions per week for several years). Types: classic psychoanalysis, brief psychoanalysis, CAT.

In psychoanalytic therapy Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories.

Psychoanalytic concepts Various techniques used for encouraging patients develop insights into their behaviour and the meaning of symptoms. E.g., Ink blots Slip of tongue Free association Dreams interpretation Resistance Transference and counter transference

2. Behaviour Therapies Psychologists in 1930s in London, began to use learning principles to devise treatments for phobic disorders. In USA Skinner( 1953) proposed operant conditioning in the treatment of psychiatric disorders. First clinical trial reported in 1978 on desensitization; several trials have followed since resulting in strong evidence base for the current use of behavioural methods. Types: Systematic desensitization, flooding

3. Cognitive Therapies Aaron T Beck (1979) noted recurring themes in the thinking of depressed patients and concluded that these themes were an essential part of the disorder and had to be changed by challenging them in specific ways. This formed the basis for a cognitive approach in treating psychological conditions. Types: Rational Emotive Therapy (RET) by Albert Ellis

4. Cognitive Behaviour Therapies Cognitive approaches were integrated into behaviour therapy to produce Cognitive Behaviour Therapy in the current form . The strong evidence base, clearly defined procedures and relatively brief treatment time have made CBT the preferred psychological treatment for many disorders. Types: Classic CBT, REBT, DBT, Mindfulness Based CBT

Rational emotive behavior therapy (REBT) REBT is one form of cognitive behavior therapy  and was first expounded by Ellis in the mid-1950s. Rational emotive therapy, focuses on resolving  emotional and behavioral problems and enabling people to lead happier and more fulfilling lives.

Cognitive analytic therapy (CAT) Cognitive Analytic Therapy (Anthony Ryle) is a collaborative program for looking at the way a person thinks, feels and acts, and the events and relationships that underlie these experiences (often from childhood or earlier in life). it brings together ideas and understanding from different therapies into one user-friendly and effective therapy. It is a distinctive integration of cognitive and analytic practice and its collaborative nature, involving the patient actively in their treatment.

Dialectical Behavior Therapy (DBT) A cognitive behavioral treatment that was originally developed to treat individuals diagnosed with borderline personality disorder and it is now recognized as the gold standard psychological treatment for this population. Research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, PTSD and eating disorders. DBT includes four sets of behavioral skills. Mindfulness , Distress Tolerance, Interpersonal Effectiveness, Emotion Regulation:

Mindfulness-based cognitive therapy (MBCT) A  psychological therapy designed to aid in preventing the relapse of depression MBCT uses traditional cognitive behavioral therapy  methods and adds in newer psychological strategies such as mindfulness and mindfulness meditation. Cognitive methods include educating the participants about depression.  Mindfulness and mindfulness meditation, focus on becoming aware of all incoming thoughts and feelings and accepting them, but not attaching or reacting to them.  This process is known as "Decentering" and aids in disengaging from self-criticism, rumination, and dysphoric mood that can arise when reacting to negative thinking pattern.

Effectiveness of CBT

What does the research say? Cognitive behavior therapy has been extensively tested since the first outcome study was published in 1977 (Rush, Beck, Kovacs, & Hollon, 1977). At this point, more than 500 outcome studies have demonstrated the efficacy of cognitive behavior therapy for a wide range of psychiatric disorders, psychological problems, and medical problems with psycho- logical components (see, e.g., Butler, Chapman, Forman, & Beck, 2005; Chambless & Ollendick, 2001).

What does the research say? Studies have been conducted that demonstrate the effectiveness of cognitive behavior therapy in community settings (see, e.g., Shadish, Matt, Navarro & Philips, 2000; Simons et al., 2010; Stirman, Buchhofer, McLaulin, Evans, & Beck, 2009). Other studies have found computer- assisted cognitive behavior therapy to be effective (see, e.g., Khanna & Kendall, 2010; Wright et al., 2002). And several researchers have demonstrated that there are neurobiological changes associated with cognitive behavior therapy treatment for various disorders (e.g., Goldapple et al., 2004)

Maudsley prescribing guidelines CBT+ Fluoxetine is first line treatment in Depression in children and adolescents There is evidence for adults and children that adjunct treatments and CBT can enhance treatment effects and reduce depression relapse rates. CBT first line for Anxiety and moderate depression in pregnancy

NICE guidelines Psychological intervention including CBT should be considered as the first-line treatment for child and adolescent depression Cognitive behavioural therapy and individual guided self‐help are recommended as a first‐line treatment in recent‐onset mild to moderate depression CBT is the First‐line treatment for social anxiety, OCD and phobic anxiety disorders

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