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OrientationtoCBT

(Cognitivebehaviortherapy)

2003JohnWinstonBush,PhD.Allrightsreserved.

Inthebeginning
Therewaspsychoanalysis(invariousflavors) Andtherewasclientcentered(Rogerian)therapy Andverylittleelse Note:Nearlyallofitwasbasedonclinical experience,personalhunch,andintuitionnot muchsciencebehindit

2003JohnWinstonBush,PhD.Allrightsreserved.

Butthen...
About50yearsago,psychologistsand psychiatristsbeganlookingtoscientific studiesofhumanbehaviorforideasabout howtodotherapy Theresulttoday:Cognitivebehaviortherapy (CBT)hasbecomethepreferredtreatmentfor mostemotionalandbehavioralproblems

2003JohnWinstonBush,PhD.Allrightsreserved.

BasicCBTstrategies
(inorderofappearance) Behaviortherapy(1950s) Desensitization Behaviormodification Behavioralactivation Cognitivetherapy(1960s) Rationalemotivetherapy Beckscognitivetherapy Newerapproaches(1990s) Mindfulnessmeditation Acceptanceandcommitmenttherapy
2003JohnWinstonBush,PhD.Allrightsreserved.

Examples

2003JohnWinstonBush,PhD.Allrightsreserved.

Desensitization
Typicalgoal:Toreducefeelingsofanxiety, angerorotheremotionthatiscausing needlesstrouble Typicalmethod:Elicitthefeelingwhileina relaxedstate

2003JohnWinstonBush,PhD.Allrightsreserved.

Behaviormodification
Typicalgoal:Toreplaceahabitual, unwantedbehaviorwithamoredesirableone Typicalmethod:Identifyelicitingcues; specifynewbehavior;thenrewardprogress towardgoalwithoutwaitingtofullyachieveit

2003JohnWinstonBush,PhD.Allrightsreserved.

Behavioralactivation
Typicalgoal:Toovercomedepressionby restoringcontactwiththenormalrewardsof theeverydayworld Typicalmethod:Identifyactivitieswith potentialforpleasureormastery;initiateor increaseparticipationinthem

2003JohnWinstonBush,PhD.Allrightsreserved.

Rationalemotivetherapy
Typicalgoal:Tothinkandactmore rationally Typicalmethod:Identifyirrational beliefsandassumptionsthatare causingormaintainingaproblem,and worktowardscorrectingthem
2003JohnWinstonBush,PhD.Allrightsreserved.

Beckscognitivetherapy
Typicalgoal:Sameasinrational emotivetherapy Typicalmethod:Identifyparticular typesofcognitiveerrorsandworkon correctingthem
2003JohnWinstonBush,PhD.Allrightsreserved.

Mindfulnessmeditation
Typicalgoal:Tobelessdisturbedbyevents, thoughts,memories,mentalimages, fantasiesandbodilysensations Typicalmethod:Developknackofjust observingthoughts,memories,images, fantasiesandsensationsastheyoccur, withoutclingingtothemorrejectingthem (acceptance)
2003JohnWinstonBush,PhD.Allrightsreserved.

Acceptanceand commitmenttherapy
Typicalgoal:Sameasinmindfulness meditation,butincontextofcommitmentto personalvalues Typicalmethod:Identifypersonalvalues;use varioustacticstoreducedominationofthoughts, memories,mentalimagesandemotionsthat restrictcontactwithongoingexperienceand interferewithlivingbythosevalues
2003JohnWinstonBush,PhD.Allrightsreserved.

DiagnosisinCBT

2003JohnWinstonBush,PhD.Allrightsreserved.

Orthodox(medicalized)diagnosis:

Assignpersonorproblemtooneormore broadcategoriesbasedonsymptomsand complaints Identifyexactlywhatevents,thoughts, emotions,moodsandactionsarecausing trouble Findoutunderwhatspecificcircumstances theyoccur,andwhattheconsequencesare (bothimmediateanddelayed)


2003JohnWinstonBush,PhD.Allrightsreserved.

CBT(behavioranalytic)diagnosis:

Nothardtoseehowthis makestherapymore focusedandeffective,isit?

2003JohnWinstonBush,PhD.Allrightsreserved.

Howtobegin

2003JohnWinstonBush,PhD.Allrightsreserved.

First:Tellyourstoryin whateverwayisnaturalto you

2003JohnWinstonBush,PhD.Allrightsreserved.

Next:Reviewwiththerapist whatseemtobethemain problems,usingthis framework....

2003JohnWinstonBush,PhD.Allrightsreserved.

Content:Whathappens?Whenit happens,whatdoyouthink, remember,imagine,feel,ordo? Context1(obvious):Whendoesit happen?Where?Withwhom(if anyone)?Withwhatconsequences? Context2(notsoobvious):How doesitrelatetoyourideasabouthow thingsareoroughttobe?

2003JohnWinstonBush,PhD.Allrightsreserved.

Thenwhat?
Workwiththerapistonidentifyingthingsyou candothatarelikelytodiminishtheproblem eitherbychangingthesituationor acceptingit Tryyourbesttodotheagreedthings Keeptrackofhowwell(orbadly)theyseem tobeworking Ifnecessary,reviseplanandtryagain
2003JohnWinstonBush,PhD.Allrightsreserved.

Feelingbetteralready? Good.

2003JohnWinstonBush,PhD.Allrightsreserved.

Nowbeginsthehardwork. Andtheadventure.

2003JohnWinstonBush,PhD.Allrightsreserved.