COGNITIVE BEHAVIOURAL THERAPY

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COGNITIVE BEHAVIOURALTHERAPY
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Psychoeducation

• from RCT, educational materials play a
  significant role in improvement in depression
• Robinson, Katon, Von Korff et al., 1997

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Cognitive Behaviour Therapy

• Dispute about unique effect
• Murphy, Carney et al., 1995
• May reduce relapse
• Fava, Grandi, Zielezny et al., 1996
• Therapist competency is vital
• Scott, Tacchi, Jones Scott, 1997
• Meta-analysis suggests effect size post-treatment
• Reinecke, Ryan DuBois, 1998

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CBT Assumptions

• Cognitive activity affects behaviour
• Cognitive contents processes can be monitored
  changed
• Behavioural ( emotional) change may be affected
  through cognitive change
• Dobson and Dozois, 2001

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Other assumptions

• Processing of information is active adaptive
• Individuals derive meaning from their experiences
  using information processing
• Belief systems are idiosyncratic
• New information is assimilated into existing
  belief systems

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Automatic Thoughts (Beck)

• Specific, discrete essential words
• Shorthand distilled format
• Not a result of deliberation, reasoning, or
  reflection - Just happen
• Not sequential as in goal directed thinking or
  problem solving
• Autonomous person does not need to make any
  effort to generate may have difficulty
  switching off

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Core Beliefs

• Learned through childhood experiences
• 2 broad categories helplessness and
  unlovability
• Core dysfunctional beliefs latent during low
  stress periods
• Reactivated by negative experiences that resemble
  conditions under which original beliefs were
  formed

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Cognitive Distortions

• Overgeneralisation
• Dichotomous thinking
• Magnification
• Personalisation
• Disqualifying positives
• Jumping to conclusions
• Catastrophising
• Emotional Reasoning
• Shoulds Oughts
• Labels

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Cognitive Triad

• Negative view of self, the world, and the future
  central to maintenance of depression
• Beck (1983) subsequently proposed that
  individuals are particularly likely to experience
  depression if there is a congruence between
  negative life events depressogenic schemata

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Research

• High levels of depressive symptomatology in
  children with pessimistic attributional styles
  and presence of internal, stable, global negative
  style
• suggest causal role of attributional style in
  development of depression
• increase risks of depression in adolescence
• predict future increases in depressive symptoms
  among adolescents irrespective of negative life
  events
• Spence et al., 2002

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Research

• 40 of adolescents who responded to CBT relapsed
  within 6 months
• Significant number of adolescents discontinue
  treatment prematurely, do not comply or remain
  depressed at end of intervention (approx 33)
• Younger children seem to better
• Need to investigate involvement of family
• Spence Reinecke, 2004

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Major CBT strategies

• Behavioural activation
• Getting the person to do something
• Monitoring activities, pleasure, mastery
• Scheduling activities
• Graded task assignment
• Cognitive activities
• Distraction techniques
• Time set aside for thinking

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Major CBT strategies

• C-B strategies
• Identifying negative thoughts
• Questioning negative thoughts
• Behavioural experiments
• Preventative strategies
• Identifying assumptions
• Challenging assumptions
• Use of set-backs
• Preparing for future

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Initial Interview

• Assessment of current difficulties
• Symptoms
• Life problems, e.g., interpersonal, medical,
  practical
• Associated negative thoughts
• Onset/development/context of depression
• Hopelessness/suicidal thoughts/lack of energy
• Agreed problem list

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Initial Interview

• Goal definition may change later but helps
  correct unrealistic expectations, provides a
  standard to monitor progress, focuses attention
  on future.
• Presentation/acceptance of treatment rationale
• Practical details what is involved, homework,
  between session tasks, frequency

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Initial Interview

• Introduction to basic relationship between
  negative thoughts depression
• Possibility of change
• Beginning intervention
• Specific
• Select first target
• Agree appropriate homework, monitoring/reading
• General
• Give Client experience of CBT style (focus on
  specific issues, active collaboration, homework)
• Overall aims
• Establish rapport
• Elicit hope
• Give pt preliminary understanding of model
• Get working agreement to test it in practice

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Subsequent sessions

• Set agenda
• Weekly items
• Review events from last session
• Feedback from client on last session
• Homework review (emphasises self-help,
  independent functioning)
• Outcome?
• Difficulties?
• What has been learned?

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Subsequent sessions

• Major topic for session
• Specific strategies (e.g., relaxation, learning
  evaluate automatic thoughts
• Specific problems (e.g., difficulties that have
  arisen during week)
• Long term problems
• List in order of priority

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Subsequent sessions

• Homework assignments
• Task
• Should follow logically from session content
• Needs to be clearly defined
• Rationale
• explicit e.g., to test the idea that I cant do
  anything, a no lose situation will learn
  something regardless
• Predicted difficulties
• Feedback from client
• Understanding ( summarise main points
• Reactions to session