COGNITIVE BEHAVIOURAL THERAPY

1. COGNITIVE BEHAVIOURAL THERAPY INTRODUCTION

2. CBT INTRODUCTION • Concept • History • Basic concepts

3. Concept • COGNITIVE-thoughts, beliefs • BEHAVIOURAL-behavioural modification to influence link between problem, thought and behaviour • THERAPY-structured approach used to overcome disorder

4. WHY USE CBT • Highlights how irrational thoughts influence feelings and behaviour • Helps us change to achieve our life goals • Evidence based • NICE Recommended.

5. HISTORY OF CBT • PAVLOV-emotional responses can be conditioned. Dogs given food when bell rung. After repetition, dogs salivate in response to bell alone. • LAW OF EFFECT-if a behaviour is consistently rewarded, it is likely to recur • Positive reinforcement eg praise • Negative reinforcement eg not being told off.

6. HISTORY OF CBT 2. • BECK 1960s • Link between self talk and feelings • Described negative internal dialogue as automatic thoughts or hot thoughts, to describe thoughts laden with negative emotions • People not always aware, but if they learn to identify them, they can change them

7. HISTORY OF CBT 3 • BECK THEORY • It is not a particular situation or event that directly causes us problem feelings but the meaning we attach to the situation-our “self talk” • Originates in childhood experiences which become core beliefs or rules for living • Sometimes they are helpful and sometimes they are not.

8. BASIC PREMISE OF CBT • Our thoughts produce our feelings • What you think about a situation triggers certain feelings –mental and physical • There is no such thing as a negative or positive event-our reaction is caused by the meaning we attach to the event, whether consciously or unconsciously.

9. TYPES OF PROBLEMS • Practical problems • Obstacles that prevent us reaching our goals eg bank problem means no money in the account • It is real, no matter how we react to it • Emotional problems • Our reaction to a perceived problem • Eg how we feel about the bank problem • Imagined problems • We think a practical problem exists when it does not • Eg bank can solve problem immediately

10. NEGATIVE THINKING • A pattern of negative thinking produces a problem cycle of emotions • The way to break the cycle is to • recognise that the negative thoughts are not inevitable, correct or natural • Recognise negative thought patterns • Set up new habits

11. MAKING THE THOUGHT AND FEELING LINK • ABC MODEL • ACTIVATING EVENT • BELIEFS • CONSEQUENCES

12. ABC Model • Activating event • What you are AWARE of –situation , event, problem • may be present or in future, or in memory • Beliefs • Automatic negative, toxic beliefs and thoughts, which include your unconscious rules, values, principles for self, others and world. Self talk determines the meaning you attach to the event. • Consequences • Emotions, physical feelings, actions and behaviour

13. Beliefs • They are often hidden, and unconscious because we have had them so long • Known as automatic or reflex thoughts • Automatic negative thoughts can be useful • Eg useful to brake automatically if obstacle in front • But can be irrational and destructive • Eg if neighbour frowns, it means he is going to hurt me.

14. THOUGHTS • Internal memory of a past event • Internal image of a future event • Your rule about how you “should “ appear and behave. • May happen in a ten thousandth of a second..so we may not be aware , and think the feeling directly followed the event , rather than the intervening thought.

15. Beliefs and thoughts • Our thoughts arise from our beliefs • Beliefs determine the meaning we ascribe to an event • A belief about yourself can trigger an onslaught of automatic thoughts when you encounter an event/situation • Negative thoughts are habitual, automatic, but we may think of them as facts

16. Beliefs tend to • Be about you and how you view your identity • Eg I am a lazy person • Be about other people eg he doesn’t like me • Stop you from taking action eg I cant show my emotions • Make you take action eg I need to be nice to people or they wont like me

17. Beliefs and facts • Are very different • A belief is an opinion you hold about yourself, or other people ,or the world • It may be supported by evidence, but that doesn’t make it true • To change your irrational beliefs you must first identify them • Ask yourself, in order to have this reaction to the event, what would I have to believe.

18. Feelings • Distinguish between unproductive and productive feelings • Unproductive feelings (negative, uncomfortable, toxic) lead to ineffective behaviour • Learned and can be controlled

19. Symptom stress • Not just situation /event that can cause negative emotions • Some people feel bad about the fact that they feel bad • Afraid of being anxious • Depressed about being depressed • Anxious about being afraid • Depressed about having a problem • Afraid they will always have problems

20. EXAMPLE OF A NEGATIVE ABC PATTERN • activating event/what you are aware of • Boyfriend tells you he wants to end relationship because he has found someone else • Beliefs-meaning you give situation and automatic thoughts-this proves I am unlovable and other people are better than me • Physical reaction-you feel sick and cry.

21. GROUP EXERCISE • Take 5 minutes to produce example of negative ABC pattern in workplace

22. POSITIVE ABC PATTERN • Activating event • Boyfriend tells you he wants to end it because he has found someone else • Beliefs-meaning you give the situation- • My boyfriend does not appreciate me, we are very different, • this is just proof of incompatibility, • it is good we are both moving on, • it will free me up to meet someone else with whom I can have a better relationship • Consequence-calmness with some sense of loss or relief.

23. GROUP EXERCISE • Take 5 minutes to produce example of positive ABC pattern

24. Identifying faulty thinking • Faulty thinking causes us to interpret memories and thoughts about future in a negative way, resulting in negative emotions

25. All or nothing thinking • Viewing things in black and white terms, or everything or nothing, instead of seeing a middle way. • Eg our relationship is totally spoilt now • She is fat • I am not perfect • It’s a complete waste of time trying to give up smoking • Men are all untrustworthy • There is no point me saving money-I am rubbish at saving

26. Problems with all or nothing thinking • Interferes with goals • More likely to give up after a setback • May interpret a single piece of evidence as an ongoing pattern • Perfectionism invites failure..very few things in real life are able to be 100% • May interpret minscule shortfall as failure

27. Examples of all or nothing thinking • You want to lose weight, you set a goal to lose 10kg, but after 3 days of sticking to diet you eat slice of cake…with all or nothing thinking, you think diet is now totally ruined and give up. If you accept middle way of thinking, “it was just slice of cake” , you carry on afterwards with diet.

28. How to challenge all or nothing thinking • Allow for a middle ground in your thinking • Accept idea of failure as feedback rather than as total end • Instead of either/or, how about both/and • as well “can’t” , use “yet”. • Stop being a perfectionist • Recognise the 80/20 rule…if you achieve 80% you are doing very well.

29. Examples of all or nothing thinking • Class to give examples

30. Overgeneralisation • Make sweeping judgment and interpret single event as never ending pattern • Language clues • Always • Never • Everybody • Nobody • The world • All • none

31. LISTEN TO YOUR LANGUAGE • I NEVER meet people I like • I ALWAYS draw the short straw • I ALWAYS get sacked eventually • My friends ALWAYS end up rejecting me • I will ALWAYS be lonely • EVERYONE is better than me at everything • ALL people who live in towns take drugs • She NEVER hears what I am saying.

32. Problems with overgeneralisation • Suggests a situation is inflexible or final –it disempowers you by implying you don’t have the ability to change anything • Overgeneralisation causes prejudice • eg all young people are badly behaved

33. HOW TO CHALLENGE OVERGENERALISATIONS • Be specific in your descriptions • Be open minded • Question the words that overgeneralise • Eg never-has there been a time when she heard you

34. Examples of overgeneralisation • Class to give examples of over generalisation

35. MENTAL FILTERING • Singling out and focussing on the negative aspects of the experience. • Means by which we unconsciously filter information from the world to make it fit with a preconceived notion.

36. EXAMPLES OF MENTAL FILTERING • You think “I am stupid”. You ignore any evidence that counteracts this idea even though there are many examples of things you do to a high standard • You think “ My life is all terrible” Yet if asked to list the positive and negative aspects of your life you can come up with more positives than negatives • A separating couple think “My partner is a horrible mean person. They never used to be like this. Why did they change.” they ignore all the good things about the person they once fell in love with.

37. PROBLEMS WITH MENTAL FILTERING • Being blinkered eg being in love-just see the good things, then later see the rest and think person has changed but it is just that they have stopped filtering • Disqualifying the positive-so focussed on the negative that you don’t see the positive • Leaping to conclusions-coming to conclusion too quickly

38. HOW TO CHALLENGE MENTAL FILTERING • Pay attention to sweeping statements • Hunt for contradictory evidence-could you be wrong, look at all aspects • Propose a new belief-you don’t have to believe it yet, but allow it as a possibility and look for evidence to support it, then reconsider your beliefs

39. MIND READING • We presume we can read what another person is thinking and then we act on our assumption • We tend to project on to others our own way of thinking • We project what we most fear • No room for doubt, instead of thinking that the person may think this, we think they definitely think this.

40. EXAMPLES OF MIND READING • woman goes on blind date-she has been on several before but it is his first. She talks all time while he is quiet . She assumes he is not interested because she talked too much. In fact he is interested but shy. He thinks she will follow up with him if she is interested. • Man called to meeting with boss. When he begins talking he notices boss frown…he thinks boss disapproves, but in fact boss is worrying that his parking meter is running out. • Woman bumps into old school friend..he says he will call but doesn’t, so next time she sees him she ignores him. In fact, he had a family crisis and forgot.

41. PROBLEMS WITH MIND READING • You cant read another persons mind • Jumping to conclusions, and acting on asssumption of what others are thinking • Reading minds is a waste of time-respond to how they act, rather than how they might be thinking

42. HOW TO CHALLENGE MIND READING • Challenge your negative assumptions • Communicate rather than leap to a conclusion-if you don’t like the way someone is behaving, instead of assuming you know the reasons, talk to them. Find out why instead of guessing. • Think of possible alternative reasons

43. FORTUNE TELLING • You leap to conclusions by thinking you know what is going to happen • Eg you are asked on a skiing trip. You predict you would be bad at skiiing, so refuse, and then bemoan fact you don’t do interesting things.

44. PROBLEMS WITH FORTUNE TELLING • Predicting the future can lead to a self fulfilling prophecy • Eg if you are convinced a girlfriend is about to end a relationship, you start to behave differently, so she gets unhappy and does in fact end the relationship • Eg you think you will fail maths exam so you don’t bother to revise properly • Negative fortune telling stops you taking action

45. HOW TO CHALLENGE FORTUNE TELLING • Avoid leaping to conclusions • You don’t own a crystal ball. Recognise that you predictions might be true but that isnt the same as definitely true, which in turn means they might be wrong • Your future can be different from your past • Take account of all the evidence • Go outside your comfort zone

46. CATASTROPHISING • You take a smallish situation and blow it out of all proportion so you imagine all sorts of dreadful things happening • Magnify importance of problems you have caused or achievements of others • Minimise the importance of your achievements

47. EXAMPLES OF CATASTROPHISING • You spill something on our clothes just before you go to a party and assume everyone will mock you • Your girlfriend fails to turn up for a date, and you assume it is her way of telling you the relationship is over or perhaps she has been run over • You magnify a personal shortcoming. “I’ve put on 3kg, I am fat, I cant meet my friends” • You minimise a positive attribute.

48. PROBLEMS WITH CATASTROPHISING • You assume the worst possible result • The smallest disagreement becomes the end of the relationship • A mistake becomes a great failure • A shortcoming becomes your whole identity

49. HOW TO CHALLENGE CATASTROPHISING • Get some perspective-what does it matter? • What resources do you have to change attitude eg people, personal qualities , to prevent it escalating and becoming self fulfilling prophecy • Do your personal shortcomings really affect the bigger picture • Experiment • Remember you have learned and changed before –you can do it again

50. EMOTIONAL REASONING • You assume your negative emotions reflect the way things are • This can set up a negative cycle of escalating negativity or possimism • Eg you are tired, and you think your colleagues are being very unhelpful, when in fact they are same as usual, and it is just your fatigue which is making you think they are unhelpful