Cognitive Behavioral Therapy/Techniques NURS 329 Psychiatric Mental Health Nursing

Objectives Describe the interaction between thoughts, behaviors, and feelings. Describe the aims and 4-step process of CBT Identify cognitive distortions Recognize treatment strategies used in CBT

Terms Cognitive behavioral therapy (CBT) is a therapeutic approach that addresses the relationship among thoughts, feelings, behaviors, & physiology. Cognitive distortions are inaccurate, irrational thoughts. Cognitive restructuring is the examination & reframing of one’s interpretation of the meaning of an event.

Psychologic Effects of Stress Research documents a relationship exists between high stress levels, negative mood states, a person’s cognitive coping style & the importance of interventions that control these states in person’s with chronic diseases.

History of CBT Principles Introduced officially in 1979 by Aaron T. Beck, but actually started as early as 1964 by Beck and principles were appearing in the 50’s and 60’s (desensitization and relaxation training)

2 central tenets “cognitions have a controlling influence on our emotions and behavior” “how we act or behave can strongly affect our thought patterns and emotions” (Wright, Basco, & Thase, 2006, p. 1)

Interacting Systems in Human Behavior

Aims of CBT Increasing a desired activity Reducing unwanted behavior Increasing pleasure Enhancing social skills

The Process of CBT Cognitive restructuring to help people experience a range of feelings when they are stuck in powerful negative mood states. The health care provider acts as a guide in the process. The client performs the intervention on themselves.

CBT Process The process contains 4 Steps. Awareness Automatic Thoughts Cognitive Distortions/errors Choosing Effective Coping

Identifying Emotions The way we feel is very important. Positive feelings promote health while negative feelings contribute to ill health. Family & cultural influences determine how we deal with & express emotions. Exaggerated emotions interfere with good problem solving & can require the need of someone to assist in processing these emotions to attain a good outcome.

Automatic Thoughts Automatic thoughts occur in response to a situation. A.Beck talks about Automatic Thoughts A.Beck part 2 Common characteristics of AT include: Knee-jerk responses to perceived stressor. Usually negative in content Quick, fleeting, a kind of shorthand is involved Usually these thoughts are not in our conscious awareness Often these thoughts are unrealistic, illogical, & distorted.

What are some examples of automatic thoughts?

Relationships Between Thoughts & Emotions Cognitive restructuring (CR) allows the person to become aware of the emotions & automatic thoughts related to a particular emotion & its connection to stress. When the person focuses on the underlying themes it allows them to reflect on the meaning and choose how they want to respond. Through CR the person can learn to reduce the intensity, frequency & length of time these distortions are experienced.

Relationship Between Thoughts & Emotions The goal is to help the person become aware of the relationship between emotional themes to stress triggers & cognitive distortions. Journal keeping that reflects on the thoughts & feelings related to stressful events is a valuable way to identify automatic thoughts & underlying emotions.

Automatic Thoughts Stop, take a breath & Reflect. Ask: What is going on? How do I feel? What are my automatic thoughts? Do they contain “shoulds, always, oughts, and nevers?”

Cognitive Distortions 10 General Categories: All or Nothing (dichotomous) Thinking -all good or all bad Overgeneralization- never ending in nature Mental filtering- awfulizing the situation Disqualifying the positive- rejecting the positive Jumping to conclusions- mind reading expected Magnification- exaggerating the outcome Emotional reasoning- assuming feelings reflect the truth about the situation or person. Should statements- monkey on the back Labeling –name calling Personalization- blaming oneself inappropriately for the situation or the event. (Halter, 2019, p. 420, Table 29.1)

Treatment Strategies Anxiety reduction Relaxation training Biofeedback Desensitization

Treatment Strategies Cognitive Restructuring Monitoring thoughts and feelings Questioning the evidence Examining alternatives Decatastrophizing Reframing Thought stopping

A patient states “I am always the one getting into trouble”. What type of cognitive distortion is this? How could the nurse respond to this statement?

Treatment Strategies Learning new behavior Modeling Shaping Token economy Social skills training Aversive therapy Contingency contracting

Treatment Strategies When a person develops a large number of positive coping skills, their perspective of a stressful situation shifts to viewing the event as a challenge rather than a stressor. This sense of control diminishes the effects of stressful situations or persons. Developing positive coping skills is a significant piece of treatment, as people need to replace the strategies with more effective, healthy ones.

Summary CBT is a form of psychotherapy and is an EBP for many problems Techniques to apply in the context of patient interactions Remember that thoughts, behaviors, and feelings are influential on one another