1. Cognitive Behaviour Therapy (CBT) For Anxiety And Depression

2. CBT History In the 1960’s Aaron Beck developed the approach Cognitive Therapy which became known as effective treatment for Depression. He found that Depressed patients experienced “automatic negative thoughts” about themselves the world and the future. By helping patients to evaluate these thoughts and think more realistically they felt better emotionally and overall functioning improved.

3. CBT Today NICE Guidelines recommend CBT in the treatment of Anxiety Depression Panic Disorder and O.C.D. ( initially in 2004). IAPT ( Improving Access To Psychological Therapies introduced 2007) Luton Wellbeing Service. Offering face to face, telephone, structured groups and CCBT. Intensity of treatment and number of sessions dependent on severity.

4. How does CBT work CBT can help to manage your problems by Changing the way you THINK and BEHAVE Initially developed from Rational Emotive Therapy ( R.E.T.) by Albert Ellis 1950’s. “It is not events that shape our lives but our perception of them”

5. CBT Model (3 Areas Model)

6. Application of the model  Usually focuses on the ‘here and now’  Requires an effective therapeutic alliance  Collaborative- relies on a shared view of the client’s difficulties  Identifies personal, time-limited therapy goals and strategies, which are monitored and evaluated  Treatments are empowering: development of specific psychological and practical skills

7. How it works  Acquisition and use of such skills seen as a main goal: skills practiced between sessions as ‘homework’  Client attributes improvement in their difficulties to their own efforts in treatment  Works on Individual, couples, families, groups  Across genders, race, culture, ability and sexual preference  May be used alone or in conjunction with medication  cognitive restructuring and behavioural experiments or exposure

8. CBT Model for Depression.

9. CBT model for Anxiety

10. CBT Evidence Based  Anxiety disorders (GAD; panic; phobias; OCD; body dysmorphic disorder; post traumatic stress disorder; health anxiety; social phobia)  Depression  Eating disorders  Chronic pain  Anger problems  Insomnia  Chronic fatigue syndrome Also effective in following mental health conditions with growing evidence Psychosis; schizophrenia; bipolar affective disorder; personality disorders

11. Tools of CBT Cognitive Restructuring’ – targeting unhelpful thinking styles 5 Area approach/ ABC model Thought Diary

12. Thought Dairy

13. 5 Area Model

14. Cognitive Restructuring Common 'unhelpful' thinking styles: All or nothing Negative focus Personalising Catastrophising Mind reading Jumping to conclusions Fixed rules: shoulds, musts & oughts Typical thinking styles present in depression and anxiety

15. CBT for Depression Behavioural Activation Keep a baseline activity diary Identify types of activity: Routine, Essential, Pleasurable Create an activity hierarchy (least difficult → most difficult) Plan activities using SMART goals Implement activities and keep a record Review progress

16. CBT for Anxiety Graded Exposure Create a hierarchy of feared situations (least difficult → most difficult) Start with the first step & practice exposure using SMART principles - Regular, Repeated, Prolonged, Without distraction. Rate anxiety levels before, during & after exposure exercise Move up to the next step when anxiety levels have reduced by approx. 50%

17. Example Graded Exposure Heirarchy 1.To walk to the end of the street with James when quiet20% 2.To walk to the end of the street alone when quiet35% 3.To travel on the bus into town at a quiet time with James50% 4.To travel on the bus into town at a quiet time alone65% 5.To travel on the bus into town at a busy time with James75% 6.To travel on the bus into town alone at a busy time100%

18. In SUMMARY Evidence Based Therapy Recommended by NICE guidelines Time limited intervention Can be used in conjunction with medication Available locally on NHS cCBT for self-help clients Perhaps not for everyone