COGNITIVE BEHAVIOR THERAPY

By Diana and Bela

WHAT IS COGNITIVE BEHAVIORAL THERAPY? HISTORY

•Three main types of cognitive therapy: Albert Ellis’s rational-emotive behavior therapy, Aaron Beck’s cognitive therapy and cognitive-behavioral therapy

•CBT is a combination of cognitive and behavioral therapy. Where cognitive therapy focuses on reducing self-defeating thoughts and behavioral therapy focuses on changing behavior.

•Two stages of CBT: functional analysis and focusing on the actual behavior.

•CBT is used for some anxiety disorders, personality disorders, mood disorders, eating disorders, substance abuse, sleep disorders, schizophrenia and depression

WHAT IS CBT?

RESEARCH/EVIDENCE

•“When we change our habitual patterns of thinking, we are also making physical changes in the brain”

•Research suggests that depression is most likely caused by life influences and only 16% is genetic.

•Psychotherapy especially CBT is as effective as antidepressant medications.

•Patients treated with psychotherapy remained undepressed and less likely to relapse.

HOW TO EMBARK ON A COGNITIVE BEHAVIORAL THERAPY JOURNEY There are several ways to initiate Cognitive Behavior Therapy.

1. Self-Help Purchase books, audiotapes, and exercise workbooks to begin your own self help journey.

2. Workshops There are many lectures and workshops available nation wide. Dr. Burns offers workshops year round. http://www.FeelingGood.com

3. Therapist You may visit a therapist who will provide exercises and homework to help you achieve your goals. This therapy takes much less time then other therapies such as psychoanalysis. The average for CBT is 16 visits with your therapist.

GETTING STARTED: YOUR THOUGHTS AND YOUR FEELINGS

*Your thoughts create your feelings*

1. Sadness or Depression: Thoughts of loss.

2. Guilt or Shame: Believing you hurt someone or that you failed to live up to your own moral standards.

3. Anger or Resentment: You feel that someone is trying to take advantage of you.

4. Frustration: Life falls short of your expectations.

5. Anxiety or Panic: You believe you are in danger because you think something bad is about to happen.

YOUR THOUGHTS AND YOUR FEELINGS 6. Inferiority: You compare yourself to others and conclude that

you are not as good as they are.

7. Loneliness: You tell yourself that you are bound to feel unhappy because you are alone and aren’t getting enough love and attention from others.

8. Hopelessness: You feel convinced that your problems will go on forever and things will never improve.

10 FORMS OF DISTORTED THINKING1. All or nothing thinking: You see things in black and white categories.

2. Overgeneralization: You see a single, negative event as a never ending pattern of defeat. Use words such as “always” and “never”.

3. Mental filter: You pick out a single negative detail and dwell on it exclusively, darkening your vision of all reality.

4. Discounting the positive: You reject positive experiences by insisting they “don’t’ count”.

5. Jumping to conclusions: You interpret things negatively when there are no facts to support your conclusion. Mind reading: Without checking it out you arbitrarily conclude that someone is reacting negatively to you. Fortune-telling: You predict that things will turn out badly.

10 FORMS OF DISTORTED THINKING6. Magnification: You exaggerate the importance of your problems

and shortcomings, or you minimize the importance of your desirable qualities.

7. Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are.

8. “Should” statements: You tell yourself that things should be the way you hoped or expected them to be.

9. Labeling: An extreme form of All or nothing thinking. “I made a mistake=I’m a loser”.

10.Personalization and blame: You hold yourself or blame another person personally responsible for an event that isn’t entirely under control.

10 WAYS TO UNTWIST YOUR THINKING1. Identify the distortions.

2. Examine the evidence.

3. Use the double-standard method.

4. Use the experimental technique.

5. Think in shades of grey.

6. Use the survey method.

7. Define the terms.

8. Use the semantic method.

10 WAYS TO UNTWIST YOUR THINKING9. Use re-attribution.

10.Perform a cost benefit analysis.

Use the following examples to help you untwist your distorted thinking!!

DAILY MOOD LOG

COST BENEFIT ANALYSIS

o Attitude

o Emotion

o Behavior

o Self-Esteem

VERTICAL ARROW TECHNIQUEExample

PLEASURE PREDICTING SHEETShopping addiction example

COMMON SELF DEFEATING ATTITUDES AND FEARS1. It would be terrible to be rejected, abandoned, or alone. I must have

love and approval before I can feel good about myself.

2. If someone criticizes me, it means there’s something wrong with me.

3. I must always please people and live up to everyone’s expectations.

4. Other people are to blame for my problems.

5. I am basically defective and inferior to other people.

6. The world should always be the way I want it to be.

7. Other people should always meet my expectations.

8. If I worry or feel about a situation, it will somehow make things better. It’s not really safe to feel happy and optimistic.

10 COMMON SELF DEFEATING ATTITUDES AND FEARS9. I’m hopeless and bound to feel depressed forever because the

problems in my life are impossible to solve.

10.I must always try to be perfect. There are several kinds of perfectionism that can make you unhappy:

Moralistic

Performance

Emotional

Romantic

Relationship

COMMON SELF DEFEATING ATTITUDES AND FEARS

Sexual

Appearance

Pinpoint your silent assumptions by using the “Vertical Arrow Technique”

Evaluate the consequences of the assumption using the “Cost Benefit Analysis”.

Test your belief using the “Feared Fantasy Technique”.

CBT HEALING TECHNIQUES

Self-defense: Make a list of your negative thoughts. Stand in the mirror and read your thoughts out loud using first person. Lastly defend your self critical thoughts using the second person. Use the same compassionate manner you would counsel a dear friend having a similar problem.

Acceptance Paradox: Instead of defending yourself, find some truth in the thought and agree with it. This is to be done with inner peace, self esteem, and a little humor.

The Acceptance Paradox is the more powerful healing technique

4 STEPS TO HAPPINESS

1. Identify the upsetting situation. Describe the event or problem. Use who, what, where, why, and how.

2. Record your negative feelings. Use feeling words like sad, angry, anxious, guilty, frustrated, and hopeless. Rate each feeling on scale 0 (least) to 100 (the most).

3. Use the triple column technique. Write automatic thoughts in one column and rate how much you believe them from 0-100. Identify distortions in middle column. Substitute rational responses in last column and rate how much you believe them from 0-100. Remember, rational responses put the lie to the automatic thought.

4. Outcome. Indicate how much you now believe each automatic thought between 0-100. Then rate how much better you feel.

*Use the Daily Mood Log to apply these steps*

DAILY MOOD LOG

Example

TROUBLESHOOTING GUIDE

If you still feel upset after you fill out a Daily Mood Log, use this troubleshooting guide.

5 SECRETS OF INTIMATE COMMUNICATION1. The disarming technique. Find some truth in what the other

person is saying.

2. Empathy. Put yourself in the other person’s shoes.

3. Inquiry. Ask gentle, probing questions to learn what the other is thinking and feeling.

4. Use “I feel” statements. Avoid “you” statements.

5. Stroking. Re-assure the other that you care and appreciate them.

COST BENEFIT ANALYSIS

Let’s practice together!

REFERENCES

Burns, D.D. (1999). Feeling good the new mood therapy (Rev. Ed.). New York, NY: Avon Books

Burns, D.D. (1999) The feeling good handbook (Rev. Ed.). New York, NY: Penguin Group.

Burns, D.D. (1993) Ten days to self-esteem. New York, NY: HarperCollins.

Stuart-Shor, E.M., Wells-Federman, C.L., & Seibold, E. (2013) Cognitive Behavioral Therapy. In B.Dossey & L. Keegan Holistic Nursing: A handbook for practice (6th Ed.) (pp.221-246), Burlington, MA: Jones & Bartlett Learning

REFERENCES

Retrieved from http://psychology.about.com/od/psychotherapy/a/cbt.htm  by Kendra Cherry

Retrieved from https://www.youtube.com/watch?v=VcKEJLb52mk

Retrieved fromhttp://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm   (Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., July 2012

King, Laura A.(2008), The science of psychology: an appreciative view (pp.581-587). (1st .ED). New York, NY: McGraw-Hill