Course leader: Ext:

Session 1 Concepts theories and models underpinning CBT practice Process of therapy Session 2 Assessment, formulation and measurement. Overview of cognitive behavioral techniques Socratic technique Session 3 Cognitive behaviour approach to understanding and treating anxiety problems Session4 Cognitive behaviour approach to understanding and treating depression Session 5 Session 6 CBT approaches to understanding and treating psychosis Third wave of CBT

 To complete the course and receive the award students must successfully complete a 2500 word essay based on a case study which will be provided. The essay will focus on the student’s ability to present a cognitive behavioural formulation of the information presented in the case study, identifying maintaining factors and suitable targets for CBT work. The student will be asked to identify treatment strategies based on this formulation with reference to the evidence base for supporting these potential interventions.  The assignment should include the following:  A brief explanation of CBT and its main principles.  Discuss the role of formulation within CBT work and its strengths/weaknesses.  Provide a description of your formulation of the case study (provided) with clear identification and explanation of maintaining factors.  Identify from the formulation possible targets for CBT work.  Provide a rationale for and description of possible treatment strategies for these identified targets with reference to the theory and evidence base underpinning these selected strategies.  Brief consideration of potential obstacles or limitations to the success of these strategies. 

► ► What is your current understanding of CBT and its core characteristics?

Cheryl Jordan

“Man is not affected by events but by the views he takes of them” ( Epictetus) “There is nothing good or bad but thinking makes it so” ( Hamlet, Shakespeare)

 Cognitive principle Emotional reactions are strongly influenced by cognitions

Behavioural principle What we do is crucial in maintaining or in changing psychological states

The continuum principle Emotional problems arise from exaggerated versions of Normal process

 Here and now Focus on what’s happening in the present and what processes are maintaining it.

 Interacting systems

 Characteristic cognitions in different problems  Depression: negatively biased views themes of loss and failure  Anxiety: Overestimation of threat  Anger ?

 Collaborative  Structured and active engagement  Time limited  Empirical in approach  Problem orientated  Guided discovery  Behavioural methods  In vivo work  Summaries and feedback

 Albert Ellis   considered as the second most influential psychotherapist in history ( USA,Canada) Carl RogersCarl Rogers ranked first Sigmund FreudSigmund Freud was ranked third

A Activating event Rational belief Flexible Self/other accepting High frustration tolerance Irrational Belief Rigid Self/other downing Low frustration tolerance Consequences healthy negative emotion helpful behaviour Adaptive Cognitions Consequences Unhealthy negative emotions Unhelpful behaviour Biased cognitions

A Rational belief I prefer to pass but it is possible I may not, if I do it proves I am a fallible Human and I can tolerate it Irrational Belief I want to pass therefore this must happen, If i don’t it’s Proof I am a total failure I can’t stand it Consequences concerned Focus on task at hand Giving it my best Consequences anxiety Procrastinate I going to fail, I’ ll never cope Completing assignment

 Please read the chapter  Fit the information given into the ABC model

A No current partner Rational belief I would prefer to be in a relationship, I can accept myself if i am not. Irrational Belief I want to be in a relationship, therefore I absolutely should be. The fact I am not is proof I am defective. Consequences Sad Seek out reinforcements Consequences Depression no one wants me There is something wrong with me Think about past failed relationships withdraw

 Watch the clip  Keep the ABC model in mind, see if you can identify the problem......

Cognitive consequences Behaviour ( action Tendencies) Un/healthy negative emotion

 Think of the last time you felt angry about something.  Can you remember what you felt most angry about? went through your mind?  What did you do or feel like doing?

Cognitive consequences Behaviour ( action Tendencies) Un/healthy negative emotion Overestimates Extent to which other person acted Deliberately. See’s malicious intent in action of other Self right other wrong Unable to see others point of view Plots to exact revenge Hit, shout, sulk, kick the cat, Recruits allies against others

 Trained as a psychoanalytic analyst at the Philadelphia Psychoanalytic Institute. (1921-….)

Early Experience Core Beliefs Rules and Assumptions Critical Incident Emotionthinking Behaviour physiology Self, world, others If ……. Then…….. I must………

Early Experience Core Beliefs Rules and Assumptions Critical Incident Emotionthinking Behaviour Somatics I am not as lovable as other people I should be in a relationship if not then ………… Relationship not working out Seeing others in relationships depression What am I doing wrong Think about past Relationships, no one wants me. Withdraw ruminates Low energy

Core Schema Assumptions Negative automatic thoughts

Informational Processing Styles

Trigger: critical incident Thoughts Mood Behaviour Physical

 Have a look at the film clip and map the information to the model.  What event triggered her reaction?  What negative automatic thoughts is this lady experiencing? How is this effecting her mood?  Behaviour?

 Survey by Wright and Davis(1994), found that clients wanted their therapists to:  Offer physically safe, private, confidential setting free from distractions  Be respectful  Treat concerns seriously  Prioritise client interests over own  Be competent  Share information  Permit client to make own choices  Be flexible not assume the client fits a theory  Review progress  Pace, not rush or keep changing appointments

What works in Therapy? – Traditional view Adapted from Lambert (1992)

 How would you define each of these?

 Consider what you think about the basic principles of CBT. Do they make sense to you?  What do you think of the theory underpinning CBT? does it make sense ? Does it fit with your experience?

1) Therapeutic relationship: engage and facilitate collaborative working process 2) Comprehensive assessment: Detailed picture of problem within context of person’s life experiences and history 3) Problems & Goals: agree on a ‘CB’ definition of problem set goals 4)Clinical Ratings: baseline ratings symptoms distress disability progress evaluated set time frame and target 5) Formulation; Develop shared understanding of problem and it’s maintenance.

6) Treatment rationale: explanations of how and why CBT could work with the problem 7) Interventions: aims reduce symptoms, increase coping 8) Evaluation: Of interventions for effectiveness 9) Relapse prevention: Maintain gains prevent relapse 10) Discharge. 11) Follow-up: further reflection on practice learnt. Set new long term goals

 Phobic disorders  Anxiety disorders (GAD panic disorder)  Obsessive compulsive disorder  Mild-moderate depression  Post-traumatic stress disorder  Eating disorder  Substance abuse (alcohol, cocaine)  Sexual dysfunction  Habit & impulse control disorders  Psychosis

 Bipolar disorders  Delusional disorders  Personality disorders  Severe depression  Depression and anxiety associated with long term chronic health problems

 Observe your own experience and/or those of the clients you work. If you or they are upset about something See if you can identify what they/you are upset about, what patterns of thinking, feeling and behaving are occurring?

 Branch R, Dryden W 2008, The cognitive behaviour counselling Primer. Athenoeum Press, UK.  Dryden W, steps to positive living. Sage. London  Hawton K, Salkovskis P, Kirk J, Clark D, 1993, Cognitive behaviour therapy for psychiatric Problems. Oxford University Press.Oxford.  Beck A T, The current state of Cognitive Behaviour Therapy.Archive of Gen Psy 2005;