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

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

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

4. 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

5. 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.

6. 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

7. 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?”

8. 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

9. 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

10. 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?”

11. 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

12. 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!

13. 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?”

14. 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?”

15. 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).

16. 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

17. 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

18. 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

19. Any Questions?