Cognitive Behaviour Therapy: CBT Dr Laura Bocci Clinical

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Cognitive Behaviour TherapyCBT

• Dr Laura Bocci
• Clinical Psychologist
• GRIP

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Aims of CBT

• To reduce stress/distress
• To increase coping
• To improve quality of daily life
• To increase understanding and find an explanation
  of symptoms which makes sense to the client
  is helpful to them.

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Ethos of CBT

• People are not distressed by events. What
  distresses them is the meaning that they
  construct around the event.
• CBT takes a here now symptom focus.
• CBT focuses on what is distressing for the
  person.
• Normalising psychotic experiences are on a
  continuum with ordinary experiences.
• Takes a collaborative approach.

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Components of CBT

• Education.
• Constructing a personal understanding of
  difficulties from a biological, social and
  psychological perspective.
• Coping strategy enhancement.
• Challenging beliefs.
• Relapse prevention.

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Coping enhancement

• Develop an individualised coping strategy for
  each distressing symptom.
• Involves detailed assessment of symptoms
  working each distressing symptom in turn.
• Helps to underline strengths of a person in
  attempting to cope.
• Develops awareness of what might trigger the
  distress and the persons ability to deal with
  distress.

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Understanding challenging beliefs
Situation / activating event (A)
BELIEFS (B)
Thoughts/ interpretation
Consequence (C) mood/behaviour
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ABCs
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Challenging beliefs

• Help people to come up with alternative
  explanations what might be the consequences if
  the alternative beliefs are true?
• Test out the alternatives.
• Challenging what might be maintaining the beliefs
  (e.g. avoiding situations).

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Generating alternatives
How might you test these out?
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Testing it out
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Relapse prevention

• Relapse prevention crisis contingency
  planning
• Identify relapse signatures
• Risk times and situations
• Medication issues
• Self help action plan
• Make it clear at what point professionals are
  involved

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When do we think that CBT might be a helpful
approach to use?

• When a persons mental health difficulties have
  settled, but they continue to experience symptoms
  of psychosis.
• They are willing to engage with it and to talk
  about what they are thinking/experiencing.
• Their experiences causing them distress or
  disability.
• When some kind of change is wanted by them.
• Able (or at least willing) to consider
  alternative explanations.

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CBT is not just about delusions hallucinations

• CBT strategies are also used to work with
• low mood
• low motivation
• Anxiety (esp panic attacks social anxiety)
• Withdrawal social isolation
• CBT psychotherapy might be helpful working with
• trauma
• other difficulties accompanying psychosis, e.g.
  anger management difficulties, low self esteem

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Finally..

• CBT wont cure psychosis
• Can reduce demoralisation
• Provide more helpful coping strategies
• Help to reduce the risk of relapse
• Help to reduce the distress of psychosis
• Help to reduce the disability associated with
  psychosis