Cognitive

Therapy

Dr. Jayesh Patidar www.drjayeshpatidar.blogspot.com

Introduction

Short-term structured therapy

Uses active, collaboration between the patient and the therapist to achieve the therapeutic goals.

Altering maladaptive thinking

concentrates on unconscious processes and past events

Verbal techniques and behavioral techniques

in depressive disorders (with or without) suicidal ideation

30/04/2015 www.drjayeshpatidar.blogspot.in 2

Classification

Techniques to interrupt cognitions

Techniques Used to counterbalance emotional effects of cognitions

Techniques intended to alter cognitions

Problem solving techniques

30/04/2015 www.drjayeshpatidar.blogspot.in 3

Techniques to interrupt

cognitions

In distraction, patient forcefully attends to

something other than the intrusive thoughts.

Distraction’s two common forms are:

First shouts aloud and after practice repeats silently

to himself

Mildly painful sensation is produced

30/04/2015 www.drjayeshpatidar.blogspot.in 4

Techniques used to

counterbalance emotional

effects of cognitions

A suitably chosen statement, produced by

a conscious effort to balance the intrusive

thought.

30/04/2015 www.drjayeshpatidar.blogspot.in 5

Techniques intended to

alter cognitions

By Beck and consists of three stages:

To:-

Identify maladaptive cognitions

Identify logical ‘errors’ allowing maladaptive cognitions

Persist and to challenge the underlying assumptions which generate maladaptive cognitions in the first place

30/04/2015 www.drjayeshpatidar.blogspot.in 6

Problem Solving

Techniques

Define the problem,

Divide it into manageable parts,

Think of alternative solutions,

Select the best solution,

Carry it out, and

Examine the result 30/04/2015 www.drjayeshpatidar.blogspot.in 7

Cognitive Therapy in

Psychiatric Disorders Obsessive Compulsive Disorder (OCD)

Major Depression

Anxiety Disorder

Eating Disorder

Schizophrenia

Phobias

Panic Disorders

Post-Traumatic Stress Disorder (PTSD)

Suicidal Behavior

Other Indications 30/04/2015 www.drjayeshpatidar.blogspot.in 8

Obsessive Compulsive

Disorder (OCD)

Challenging obsessional thoughts,

Thought stopping; and

Challenging negative automatic thoughts

30/04/2015 www.drjayeshpatidar.blogspot.in 9

Challenging obsessional

thoughts

Challenge the obsessional thoughts (i.e.

those thoughts concerned with harm,

aggression and contamination)

Techniques involve

Either self-instructional training (SIT)

Rational emotive therapy (RET) techniques.

30/04/2015 www.drjayeshpatidar.blogspot.in 10

Either self-instructional training (SIT)

Instructs patients to determine how anxious

they feel, to observe and record their

obsessioinal thoughts, and to replace their

thoughts by productive self-statements.

Rational emotive therapy (RET) techniques

- Focuses on challenging the belief in the

obsessional thoughts through rational

disputations.

30/04/2015 www.drjayeshpatidar.blogspot.in 11

Thought Stopping

Disrupting obsessions and thought

processes by using a cue word (i.e.

Stop).

30/04/2015 www.drjayeshpatidar.blogspot.in 12

Challenging Negative

Automatic thoughts

NATs were often precursors to disturbed

imagery.

30/04/2015 www.drjayeshpatidar.blogspot.in 13

Major Depression

Cognitive techniques are used to alter

cognitions and not merely to arrest or

counterbalance them.

These methods are used because

depressive thoughts are very difficult to

arrest and evoke a particularly strong

emotion reaction that is difficult to

counteract.

Cont.. 30/04/2015 www.drjayeshpatidar.blogspot.in 14

Specialized techniques

Scheduled Activity

Active scheduling of activities structures time and enables the patients to observe their own potential effectiveness.

Graded Task Assignment

Success in graded tasks changes patient’s self-concepts.

Masterly and pleasure Therapy

Patients keep records of all activities and designate each masterly experience with ‘M’ and each pleasure experience with a ‘P’, thus increasing their awareness of positive experiences. Cont… 30/04/2015 www.drjayeshpatidar.blogspot.in 15

Cognitive Reappraisal

Cognitive reappraisal involves the identification of maladaptive cognitions and attitudes.

Alternative Therapy

By encouraging alternative explanations for negative experiences, patients are helped to recognize their biases. By considering alternative ways of handling psychological and situational problems, patients find solutions to the problems previously considered insoluble.

Cognitive Rehearsal

By imagining that they are carrying out an activity, patients report obstacles and conflicts that are then discussed.

Homework Assignments

Assignments are given are each session to counteract the depressive symptoms. Patients keep records of the negative cognitions in one column and of the rational responses in another. 30/04/2015 www.drjayeshpatidar.blogspot.in 16

Anxiety Disorder

Cognitive techniques used include Distraction

Thought stopping,

Counterbalance emotional effects.

Most anxiety disorders have prominent physical symptoms, which are an accompaniment of high arousal, cognitive techniques are generally combined with relaxation training.

Cont…

30/04/2015 www.drjayeshpatidar.blogspot.in 17

Anxiety management Training

First phase

Taught both to relax and to increase anxiety by imagining in a vivid way and he learns how to change quickly from provoking anxiety to reducing it.

Second Phase

The patient is helped to identify further situations that arouse anxiety, to imagine them, and to terminate the resulting anxiety by relaxing.

Third Phase

The patient focuses on the sensations associated with anxiety with act as stimuli for further anxiety.

30/04/2015 www.drjayeshpatidar.blogspot.in 18

Eating Disorder

Patients with eating disorders have

maladaptive assumptions

The evaluation of cognitive therapy for bulimia

nervosa, thought uncontrolled, has shown that

the treatment is both acceptable and effective.

30/04/2015 www.drjayeshpatidar.blogspot.in 19

Schizophrenia

Many cognitive – behavioral techniques

Technique of reality testing (Hole et al 1979),

Belief modification techniques (Walts et al 1983),

Intensive cognitive therapy (Perris 1988),

Improving coping abilities (Fowler and Morley 1090), and

Cognitive behavioral techniques (Kington and Turbington – 1991, 1994)

30/04/2015 www.drjayeshpatidar.blogspot.in 20

Phobia

Effectives as systematic desensitization

The change in the behavior following cognitive

therapy with these patients seems to follow a

cognitive change of reattribution of anxiety

from the phobic stimulus itself to the person’s

irrational ideals about the stimulus.

30/04/2015 www.drjayeshpatidar.blogspot.in 21

Panic Disorders

The therapy is focused on the tendency

of the patient to make catastrophic

misinterpretation about bodily sensations

or mental experiences.

30/04/2015 www.drjayeshpatidar.blogspot.in 22

Post-Traumatic Stress

Disorder (PTSD)

Several cognitive behavioral techniques

Desensitization to the trauma,

Cognitive restructuring,

Problem solving approach, and

Stress inoculation training.

30/04/2015 www.drjayeshpatidar.blogspot.in 23

Suicidal Behavior

The therapist concentrates on the patient’s

misery and hopelessness.

A major emphasis is given to problem solving

techniques such as define the problem,

generating alternatives to solve the problem,

and implementing the solution.

30/04/2015 www.drjayeshpatidar.blogspot.in 24

Other Indications

Cognitive therapies have also been used in the treatment

Dissociative (and conversion) disorders and

Paranoid disorders

Solving real life problems

Including marital problems,

Substance abuse, and

Stress disorders

30/04/2015 www.drjayeshpatidar.blogspot.in 25

Limitation

Cognitive therapy is contraindicated

Patients with poor reality testing (e.g. with psychotic features),

Impaired reasoning and retention abilities, and

Borderline or other severe personality disorders. 30/04/2015 www.drjayeshpatidar.blogspot.in 26

SUMMARY

30/04/2015 www.drjayeshpatidar.blogspot.in 27

CONCLUSON

30/04/2015 www.drjayeshpatidar.blogspot.in 28

30/04/2015 www.drjayeshpatidar.blogspot.in 29

THANK

YOU 30/04/2015 www.drjayeshpatidar.blogspot.in 30