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University of Dhamar
Definition of CBT
Cognitive Therapy is a system of psychotherapy that attempts
to reduce excessive emotional reactions and self-defeating
behaviours, by modifying the faulty or erroneous thinking
and maladaptive beliefs that underlie these reactions
• * Focused form of psychotherapy based on a model
suggesting that psychiatric/psychological disorders involve
dysfunctional thinking
• The way an individual feels and behaves in influenced by
the way s/he structures his experiences
• Modifying dysfunctional thinking provides improvements
in symptoms and modifying dysfunctional beliefs that
underlie dysfunctional thinking leads to more durable
improvement
• Therapy is driven by a cognitive conceptualization and uses
Environment
Body
Psych:
Cognition
Emotions
Behaviou
r
COGNITIVE FUNCTION
• Cognitive distortions:
Errors in interpretation that involve faulty
content of thoughts and can be associated with
changes in mood and behavior
• Cognitive deficits:
Information processing operations that are
missing or working poorly
Cognitive distortions
• Jumping to conclusion without supporting evidence (arbitrary
inference)
• Holding unrealistic EXPECTATIONS for a given situation
– Expecting self, others or situation to be perfect
– Pessimism: expecting things to always go wrong
– Dichotomous thinking (“black and white” or “all or nothing” thinking)
– Emotional reasoning
• Distorting the MAGNITUDE of a situation:
– Selective abstraction
– Catastrophizing, Magnifying
– Overgeneralizing
– Labelling--You identify with your shortcomings.
• Making the wrong ATTRIBUTION for a situation:
– Assuming the wrong intent for another person’s actions
– Assuming the wrong locus of control in a given event
– Personalization (Excess responsibility) or blaming others
Cognitive Deficits
• INPUT:
– Problems with sensory perception
– Inability to filter out irrelevant stimuli
– Problems attending to relevant stimuli
• PROCESSING:
Cognitive
Model Core Beliefs &
Assumptions
Beck (1979)
Critical Incident
Negative Automatic
Thoughts (NATS)
Behaviour Feelings
Physical symptoms
CBT of SZP
• SZP is:
- Frequently associated with impairments of cognition,
emotion, volition, behavior, somatic, educational and socio-
economic functioning
- Prodromal, Acute, Residual and Remission phases,
- Comorbidity: Anxiety disorders, depressive disorders,
substance abuse
- Biologically determined and psychotherapy was thought to
has no benefit and could be harmful
- NICE (2002) - ‘Psychological interventions should play a
key role in the treatment of schizophrenia. The best
evidence is for CBT and Family Intervention (FI)’
- Currently, NICE Guidelines (2003) recommended CBT as a
treatment modality for SZP - based on rigorous meta-
analysis of ‘high-quality’ RCTs (20)
Clinical Model
• Diathesis-Stress Model
(Vulnerability-Stress)
• Vulnerability (predisposing factors):
4) Biological factors: hereditary, constitutional or acquired
5) Psychological factors: constitutional or acquired eg:
cognitive deficits or maladaptive schemas
6) Social factors
* Stress: Precipitating factors (physical, psychological, social)
• Symptoms are normal responses to abnormal situations
• Psychotic symptoms are the extremes in a continuum of
psychological experience
* Maintaining factors (physical, psychological, social)
Clinical Model
Bio-psycho- Cognitive
social Trigger Emotional Anomalous
vulnerability Bio- Changes experience
psychosocial
Stressor
DON’T PANIC
It can be done !