Cognitive Behavioural Therapy
Behaviour therapy
- developed in 1950's
- Joseph Wolpe
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Cognitive therapy
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Rational Emotive Behaviour Therapy
- Related to cognitive therapy
- Albert Ellis
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Lang's three systems model of emotion
Cognitions
- Thoughts
- Beliefs
- Attitudes
- images
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Autonomic / Physiological symptoms
- palpitations
- sweating
- dizziness
- nausea
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Behaviour
- Escape from threatening situations
- withdrawn or inactive depressed patient
- constant checking by obsessional patients
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Behaviour Therapy
- Detailed analysis of problem behaviour
- Antecedents
- how did the behaviour become established
- Consequences
- why is the behaviour being continued
Cognitive Therapy
- Focussed on meaning of antecedents
- "Men are disturbed not by things but by the views which they take of
them" - Epictetus
- Patients with emotional disorders tend to have distorted or biased
information processing that leads to vicious circles of emotion
- Formulation emphasises how core beliefs of patient drive negative thinking
and self-defeating behaviours
- strategy is to identify and challenge beliefs in behavioural experiments
- Developed by Beck, 1976
- Aim is to help patients modify ways of thinking about life situations and
depressive symptoms
- Negative intrusive thoughts
- Assumptions that render ordinary situations stressful
- Errors of logic that allow assumptions to persist despite evidence to
contrary
- ? less effective in severe depression esp. melancholic illness
- ? lower relapse rates
- Features
- Patient as partner
- Attention to provoking and maintaining factors
- Treatment as experiment
- Homework assignments
- Highly structured sessions
- Monitoring of progress
- Treatment manuals
- Techniques used to change cognitions
- Distraction
- Neutralising
- Challenging
- Reassessing
Cognitive Behavioural Therapy
Nature of the beast
- Problem orientated and focused on specific goals
- analysis of predisposing factors, precipitating factors and
perpetuating factors
- tends to target perpetuating factors
- emphasis on problems here and now
- therapy tends to brief and time limited (Avg 15 sessions, longer with
personality disorders)
- 1 shared, evolving formulation of the problem
- "Good enough" therapeutic relationship
- "Homework" tasks between sessions
- Patients encouraged to collaborate and actively participate
- Therapist is active and explicit
- Uses an educational model, patient is learning new skills
- at the end of therapy patients are taught relapse prevention so become
their own therapist
- theories and models of psychopathology derive models which can be
empirically tested. Randomised controlled trials can be evaluated
- Emphasises Socratic style of questioning during therapy to "guide
discovery"
- Sessions Structured with agenda
Application
- Treatment of phobias
- Graded self exposure
- habituation to stimulus
- Response prevention
- in obsessive-compulsive disorders
- body dysmorphic disorders
- Sex therapy
- Tics habit
- Chronic schizophrenia, learning disabilities
- Cognitive therapy
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