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  1. General CBT Assumptions:
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  3. Cognitive therapy: foundations, conceptual models, applications and research

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CBT: An Overview

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General CBT Assumptions:

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Two systems of reasoning. Cambridge: Cambridge University Press. Smits, J. Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, — Stanovich, K. Who is rational?

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Studies of individual differences in reasoning. Mahwah, NJ: Erlbaum. Individual differences in reasoning: Implications for the rationality debate. Radical constructivism. Karen structures her session with Kathy in the following way:. Assess Kathy's mood and review her view of recent events. Collaboratively set an agenda for the meeting, making sure that discussion of psychotherapy and medication options are a component.

Review results of Kathy's medical evaluation. Discuss Kathy's issues and views as identified on the agenda. Introduce or review specific skills to address her cognitions and behaviors. Formulate a homework task and identify any factors that may interfere with homework completion. Help Kathy summarize the main points of today's meeting and conclusion. Discuss her thoughts and feelings about the session.

Karen uses a Socratic dialogue technique to talk with Kathy. The goal of her questions is to understand the meaning Kathy is attaching to her experiences and the way she understands herself as an individual. Karen does this by gently and persistently evaluating experiences and Kathy's interpretations that support her beliefs and attitudes as well as examining the advantages and disadvantages of maintaining those views.

Specific questions Karen might ask include:. Examining Kathy's thoughts and allowing her to develop an alternative plan gives her control over her behavioral choices. This increases the possibility that Kathy will "own" the plan and act upon it in between sessions. Karen and Kathy evaluate progress on the plan homework in the following session. Depending upon the results of the homework, Karen and Kathy will modify the plan or move on to the next issue. Karen uses this same method of questioning to evaluate Kathy's negative thought processes and faulty conclusions.

Karen: "You said that your life will never be normal again. What do you mean by normal? Kathy: "I am so deformed and I don't have any energy and I don't care about anything anymore! Karen: "Which is more troubling to you — feeling deformed, no energy, or not caring about anything? Kathy: "If I have to choose, I would say feeling deformed. Karen: "Okay. Let's start with that feeling. Tell me more about feeling deformed. Kathy: "My right breast is rebuilt — but I don't have a nipple and I have this huge scar across my chest!

It is so ugly! Karen: "What choices have you discussed with your surgeon about replacing your nipple? Kathy: "He said there were more surgeries I could have to build one, or I could have a tattoo of a nipple put on it. Karen: "Which of these options is more appealing to you? She is giving Kathy limited choices in a positive direction. Kathy: "I think a tattoo — the other surgery really sounds painful.

Karen: "Would the tattoo make you feel more or less deformed? Karen: "What have you investigated about this possibility? Kathy: "I haven't started that yet. Karen: "Where will you start investigating this possibility? Kathy: "Well, my daughter got a tattoo last month — I can ask her where she went. She is going to laugh when I ask her about a tattoo parlor! Karen: "You'll have to let me know how that goes! Then end result of the session with Kathy is that Kathy now has a homework assignment that will shift her image of "deformed" toward a more positive possibility.

CBT is a process of engaging an individual in a collaborative manner in order to examine the way the individual constructs and understands the world around them cognitions , and to evaluate the processes by which the individual acts on those cognitions behaviors. The role of the APN is to act as a coach, mentor, or guide through the process, provide the necessary skills training, and design appropriate experiments with high likelihood for success in collaboration with the patient. There has been a rapid increase in the numbers of psychiatric nurses who obtain advanced degrees and develop independent practices.

The APN specializes in holistic assessment, prevention, and treatment approaches in a variety of settings. The approaches become more complicated as psychiatric medication, physical complications, and psychological conditions collide. APNs need specialized and empirically tested evidence to guide their practices. CBT has been proven to integrate well in nursing practice and meets the scientific standard for effective techniques and interventions that are empirically based.

As a result, CBT is the ideal vehicle for the APN to use to guide counseling and education interactions with individuals. Cognitive Technique. Downward Arrow. The individual is helped to uncover underlying assumptions in logic and sequence through careful questioning by the therapist, who asks, "If this is true, then what happens? Idiosyncratic Meaning. The therapist assists the client to clarify statements and terms used so that both the therapist and the patient have a clear understanding of perceived reality.

Labeling of Distortions. The individual is helped to identify automatic thoughts that are "dysfunctional or irrational. Questioning the Evidence. The individual is helped to question the facts related to their cognitions and conclusions. This procedure investigates whether information is based on facts or assumptions. Examining Options and Alternatives. This technique involves the development of all possible alternative explanations in order to learn the skills in generating options rather than "only one way" thinking.

In individuals with the habit of accepting all or most of the blame for outcomes, this is an excellent technique for redistribution of responsibility.

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This is also helpful for individuals with personality disorders that place the blame squarely on the shoulders of others for most outcomes. Catastrophic thinking is one of the hallmarks of anxious individuals. These individuals tend to focus on the most negative possible outcome of any given situation. Decatastrophizing allows for balance and realistic focusing by examining the "worst possible outcome" and developing a plan of action.

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Advantages and Disadvantages. For individuals who appear to be stuck between 2 options, examination of the advantages and disadvantages of certain situations helps them to develop alternative perspectives. This breaks the "all-or-nothing" mindset and permits a more balanced view of the situation. Paradox or Exaggeration. This type of technique should only be used by the very skilled therapist; otherwise, the patient may view this technique as sarcasm or belittling.

When used appropriately, the therapist takes an issue to the extreme to help the person see the absurdity of their sometimes overinflated viewpoints. Turning Adversity to Advantage. This technique is akin to "making lemonade out of lemons. For example, being turned down for a job may open the individual up for more attractive possibilities that they had not investigated. Cognitive Rehearsal. Prior to making a behavioral change, it is sometimes less threatening to "practice" the new behavior through visualization and discussion.

For example, this would include practicing assertiveness in a mirror or "talking through" a confrontation out loud prior to actually following through with the conversation. Automatic Thought Records. The ATR is used as homework after introducing the process within the therapy session. The individual completes the columns identifying a troubling situation, resulting emotion, and thoughts associated with both.

The therapist and patient work on clarification and development of "rational" responses in order to debate or challenge the original reaction. Behavioral Technique. Assertiveness Training. Assertiveness training involves a combination of cognitive and behavioral practice. The therapist may model assertive behavior, assist the patient within the session with role-play, and finally develop in vivo experiments that increase in complexity over time until the new behavior is internalized.

Cognitive therapy: foundations, conceptual models, applications and research

Behavioral Rehearsal. The behavioral component usually follows the cognitive training component and again includes behavioral experiments to gather more evidence or to develop more effective responses and styles. Graded Task Assignments. This technique is used in a series of steps that become increasingly more complex or difficult as a means of overcoming fears or anxiety-producing threats.

Bibliotherapy : The cognitive behavioral therapist will often prescribe specific readings related to the individual's difficulties. Guided Relaxation and Meditation. Therapists often employ behavioral techniques aimed at reduction of autonomic nervous system responses to anxiety such as measured breathing, relaxation training, meditation, and other techniques. Social Skills Training. These skills are often taken for granted by many individuals. It is important for the therapist to review and instruct on behaviors that will improve the potential for successful social interactions.

Shame-Attacking Exercises. This technique was first introduced by Albert Ellis as a rational emotive therapy technique. Rational emotive therapists have the patient engage in behavioral experiments that emphasize their concern for what others think of them. The individual develops an experiment testing their hypothesis people think I smile funny when I walk and look at me weird and collects data between sessions.

Have a neutral observer collect the actual data. This helps them differentiate between "feeling" and "fact" to move past shame-based behaviors [see homework below]. The hallmark behavioral technique in CBT is the use of homework assignments. Activities are designed within the therapy session to be carried outside and practiced between sessions.

Cognitive Distortion. All-or-nothing dichotomous thinking. He either loves me or he doesn't. Mind reading this is not thought insertion which is psychotic and in the opposite direction. I am sure they all think I am stupid. Emotional reasoning. Cipla 24hr Mental Health Helpline Adcock Ingram Depression and Anxiety Helpline 70 80 Akeso Psychiatric Response Unit 24 Hour Teen Suicide Prevention Week 11 - 18 February.

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