Cognitive-Behavioral Therapy November 11, 2004 Cognitive-Behavioral Therapy Tips & Techniques Gerri Hynes, B.Sc., M.A. Copyright 2004 G. Hynes Consulting

Agenda CBT origin and description (5 Minutes) Components of CBT (20 Minutes) Intervention Techniques (45 Minutes) Fostering hope (5 Minutes) Q & A

“The thing that upsets people is not what happens, but what they think it means” -Epictetus (55AD ~ 135AD)

CBT’s Origin Behavioral Therapy (1950’s) Cognitive Therapy (1960’s) Systematic Desensitization Behavior Modification Cognitive Therapy (1960’s) Beck’s Cognitive Therapy Ellis’ Rational Emotive Therapy

What is CBT? Based on the theory that our thoughts (cognitions) influence our feelings which lead to our actions/choices (behaviors) Cognitive: Change our thoughts and our actions/reactions will change also. Behavior: Weaken the connection between event and our knee-jerk reaction to the event.

Characteristics of CBT Faster and more effective than other forms of therapy - average number of session 16-20 - effective with most psychiatric disorders Emphasizes the Therapeutic Relationship - rapport builds trust, which permits room for challenge and change Facilitates Collaboration - Therapist listens, teaches and encourages - Client speaks, learns and implements

Characteristics of CBT (con’d) Based on Stoic Philosophy Teaches the benefits of staying calm in the face of undesirable situations. “Being upset in the event of a problem gives us two problems, the problem and our negative reaction.” -- Epictetus Utilizes the Socratic Method - Ask questions and encourages client to ask themselves questions like “Where is the proof or evidence which supports this belief?”

Characteristics of CBT (con’d) Structured and Directive Specific agenda for each session Specific techniques taught each session Instructions not on “what” to do, rather “how” to do. Programming/Reprogramming Model Most emotions and behaviors are learned therefore able to be unlearned Helping the client to understand how and why they do what they do, can lead to long term results in change

Characteristics of CBT (con’d) Experimental/Inductive Approach Look at thoughts as hypotheses to be questioned and tested Based on facts not assumptions Homework is key to progress One hour session per week is not enough for change to occur Reading and activity assignments are necessary for full integration of skills

Characteristics of CBT (con’d) Construction - istic Emphasis is on construction of new beliefs, not deconstruction of problem beliefs and behaviors. Example: “I’m always letting people down” Response: “What would you like to be doing instead?” rather than “How do you let people down?”

CBT Interventions Identify Cognitive Distortions Thought substitution Use Checklist (see handout) to identify CD’s Try a “should” bank Thought substitution Replace positive/realistic thoughts for old one (see Frame of Mind Chart handout) Write down what is bothering client Re-write thought more positively Find a new, more rational, thought

Frame of Mind Chart Negative Belief Positive Thought Integrated New Thought I can’t go back to work now, I’ve lost all of my skills. I’ve been off work for 1 year, anyone would feel nervous. It’s normal to fear the unknown. All I have to do is to try. I don’t have to be perfect on my first day back. I can ask for help getting my skills back!

CBT Interventions Experimental Technique Double Standard Technique Test validity and evidence of negative thought Example: “When you say that you were a terrible employee, do you mean that you’ve never done a good job?” Double Standard Technique Ask “what advice would you give your best friend if s/he had same problem?”

CBT Interventions (con’d) Socratic Method Questions that lead to discovery of inconsistency of negative beliefs. Example: “When you say you are a failure, do you mean you fail at everything or just some things?” The “What-if” Technique “What’s the worst thing that could happen?” “Could you live/survive this if it did happen?”

CBT Interventions (con’d) Thought Record (See Mind over Mood) Identify Irrational Beliefs and rate on scale of 0-5 Then identify evidence that belief is not true Assist client to come up with more plausible explanation (see Mind over Mood).

Insurer wrote me a letter telling me my benefits are ending. Angry 85% Situation (The 5 W’s) Moods (Rate each mood 0-100%) Automatic Thoughts (Circle hot thought) Evidence Supporting* Insurer wrote me a letter telling me my benefits are ending. Angry 85% Afraid 95% Hurt 80% How dare they! How will I manage? They don’t believe me! They just are concerned about money! I’m barely surviving now. I’m going without to feed the kids. I have no partner to help. **mood check

Evidence That Does Not Support Alternative Balanced Thoughts November 11, 2004 Evidence That Does Not Support Alternative Balanced Thoughts Rate Mood Now I have survived! I am better than I was. I now have the support of a voc. counsellor who can help me. If I go back to work, I’ll be better off financially. I can look for other jobs better when I’m employed. It will be nice to see everyone. Hopeful 85% Anxious 75% Inspired 75% Copyright 2004 G. Hynes Consulting

Hope = Motivation As long as we have hope, we have direction, the energy to move, and the map to move by. We have a hundred alternatives, a thousand paths and an infinity of dreams. Hopeful, we are halfway to where we want to go; hopeless, we are lost forever." -Chinese Proverb

Any Questions?