Cognitive Behavioural Therapy

All enquiries are welcomed at:

Tel: 01933 650875

Mobile: 07920 462541

Agreed therapy plans may include a single or combined therapies.

Dr Nightingale is trained in a number of psychotherapies and psychoanalytical techniques including:

Cognitive Behaviour Therapy (CBT)

The initial consultation will last approximately one to two hours

Cognitive Behavioural Therapy

Cognitive Therapists assess thoughts, moods, behaviours, biology and environment in understanding the origin of client problems.

The five areas are interconnected with each part influencing the others.

Cognitive Behavioural Therapy places particular emphasis on identifying and evaluating thoughts and on behavioural change.

Cognitive Behavioural Therapists do not necessarily believe that thoughts cause all problems. However, thoughts play a powerful role in maintaining dysfunctional moods and behaviours regardless of their origins.

Emotional states, whatever their origin, carry characteristic patterns of thinking.

Anxiety carries thoughts of Danger and Vulnerability

Anger carries thoughts of Violation and Unfairness

Paranoia carries thoughts of Abuse, Intrusion, Persecution and Frustration

Therapeutic change is expedited by identification and evaluation of these thoughts.

While cognitive therapy seeks to relieve distress it does not set out to change the personality completely. Learning how to navigate the squalls of life in our own battered vessel is often a more realistic objective than trying to rebuild it to someone else’s specification as an ocean liner.

Stirling Moorey, Handbook of Individual Therapy

Aaron Beck (1921-1994) trained as Freudian, gained interest in depression and cognitive therapy.

Looked at how and what people think and decided that depression is a distortion of the thinking.

People think and then the feelings follow.

The aim of the therapy is to modify faulty or unproductive thinking (distorted cognition)

Outcome survey in 1977 showed better results than drugs.

When people are encouraged to think differently their feelings change.

Reality is tested to see how the conclusions are true.

Limitations

People need to be reasonably intelligent but the therapy sometimes does not appeal to very intelligent people.

Not useful for deeply disturbed people.

Very specific problem orientated therapy. Not useful for personal growth.

Not thought to be useful for people with serious interpersonal or relationship difficulties.

Cognitive Model

Psychological disturbance is seen as a result of some malfunction in interpreting and evaluating experience.

Aim

Overall aim is to teach clients to monitor thought processes and reality test them.

A positive therapist-client relationship is essential.

As well as other therapeutic qualities such as warmth, empathy, genuineness, etc.

CBT addsCollaboration (Active state of working together as a team towards agreed goals). This when linked withGuided Discovery enables the client to analyse the situation and they can then come to their own conclusions.

Guided discovery generally consists of:

A series of questions to uncover relevant information outside the client’s current awareness.

Accurate listening and reflection by the therapist.

Summarising the information discovered.

Synthesising questions that ask the client to apply the new information discussed to his/her own belief.

Padeski 1993

Automatic Thoughts

A Schemata is an absolutist core belief about self, others and the world. They can be positive or negative. (eg. People can’t be trusted, I cannot be wrong.)

Schemata have been described as the screens or filters that process and code stimuli.

Beck et Al 1979)

{Exercise: Investigate the effect of schemas and underlying thoughts on yourselves}

The three levels of thought and interconnected Schema lead to underlying assumptions and these determine the type of automatic thoughts that occur.(eg. I am a poor conversationalist- No one will talk to me- I wont have any fun at the party)

Some texts only refer to two levels Automatic Thoughts and Schema but eliciting the underlying assumption can be useful.

Three Main Goals

To relieve symptoms and resolve problems.

To help client to develop coping strategies.

To help client to modify underlying cognitive structures (beliefs and attitudes) in order to prevent relapse.A learning exercise in which client learns then practices new skills.

Overall Strategies of CBT

Clarify the problem.

Overall.

Describe the feelings.

Find the automatic negative thought.

What is the underlying assumption (belief, attitude, value, etc. developed in early life).

Generate an alternative thought (Therapist and Client collaborate on this)..

Reality test (Homework to test new thought).

Report back.

Collaboration

Allows input from the person who knows most about the problem.

Encourages use of self-help techniques.

Encourages client to take control of session and reduces conflict.

Typical Questions to uncover goals and explore dreams and desires

.If you were given three wishes what would you change?

If you went to bed tonight and all your problems were solved by magic. How would you know when you woke up?

What do you want most out of life?

Have you had treatment before? What did you gain from it?

If you became a super hero for a day what would you do?

Who is your favourite character from a book or film? What is special about them?

Methods to modify negative thinking

Reality testing

Client is taught to question the evidence for the automatic thought.

Looking for Alternatives

Client is asked for alternative explanations or solutions until as many as possible are found. These usually are negative at start then more positive and constructive thoughts emerge. It removes the "blinkered" view that often accompany emotional crisis.

Reattribution

Involves reattributing the cause of, or responsibility for an event.

Decatastrophising