1. Cognitive Model
Denise Hashempour

2. Rationale
An individual is not a passive recipient of stimuli. They are actively engaged in interpreting events in terms of their own unique set of values, beliefs, expectations and attitudes i.e cognitions
These cognitions influence the picture the person has of their world past, present and future

3. Cont..
Changes in the clients affective state are directly due to the way they make sense of events around them. It is not the external reality that causes the problems but the way in which the person interprets the reality.
Cognitive Therapy enables the individual to become aware of and correct their unhelpful thinking patterns. Leading to Clinical improvement

4. Automatic Negative Thoughts
These are thoughts or images which are present in specific situations. This can be when an individual is anxious, depressed etc
E.g Someone who is concerned about what somebody thinks of them (social evaluation) may have an automatic negative thought such as “ They don’t think I’m interesting”

5. Dysfunctional assumptions
These are more general beliefs which a person holds about the world and themselves. This cam lead them to interpret situations in often negative and dysfunctional ways. These not only lead to negative thoughts but also faulty cognitive processing. These could be the thinking styles we adopt such as :-
Arbitrary influence – Drawing conclusions in absence of specific evidence.
Overgeneralisation – Making sweeping statements based on one single event.
Dichotomous thinking – Black and white thinking
Etc etc

6. The Cognitive Model EARLY LIFE EXPERIENCES
FORMATION OF DYSFUNCTIONAL ASSUMPTIONS CRITICAL INCIDENT/ACTIVATING EVENT
ASSUMPTIONS TRIGGERED
AUTOMATIC NEGATIVE THOUGHTS
SYMPTOMS FORM
BEHAVIOURAL AFFECTIVE PHYSIOLOGICAL

7. Collaborative empiricism
The therapist is seen as the expert collaborator assisting the client in identifying and altering dysfunctional thoughts. And attitudes.
Things are not done to the client, but with them. The client is informed throughout of the purpose and nature of each stage of intervention and encouraged to judge the therapy by it’s results, rather than just trust in the therapist.
The therapist is not an expert on the accuracy of the client’s view of the world.

8. Initial Interview Aim To screen out inappropriate referrals
Establish a therapeutic alliance
Instil hope
Present the model
Get agreement to try it - collaborative

9. Fact
Knowledge of CBT and perceived benefits of treatment is associated with improved outcomes

10. What is the problem ? Symptoms Impact on life
Related negative thoughts
How did the problem develop
Agree a problem list
What is the client doing that may be maintaining the problem.

11. Goals
Write a list of realistic goals. SMART Specific, measurable, achievable, realistic, targeted. Discuss and agree the goals with client

12. Cognitive Therapy Orientation to Model Cover practical arrangements
Beck’s CBT Model briefly
Installation of hope, the possibility of change

13. Start Therapy
Specifically select the first issue and agree an inter session task.
Generally introduce client to the style of the approach and the use of appropriate language

14. Approaches in Therapy
To identify. Challenge and test faulty thinking patterns, to enable the client to change dysfunctional thoughts and behaviours
Assessment
Education
Self Monitoring
Activity scheduling
Behavioural experiments
Guided discovery
Socratic questioning
Homework
Exposure therapy
Inference chaining

15. Subsequent sessions Agree topics to be discussed
What has happened since last session, feedback on last session, Homework review.
Session topics, Strategies, specific problems, manageable chunks of long term problems
Homework, What it is , rationale, identify anticipated difficulties and discuss
Session review, What has been learnt, encourage client to summarise. Any misunderstandings, correct any errors