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Cognitive behavior

Ummi Pratiwi Rimayanti

response cost. extinction .Behavior • Classical conditioning focuses on involuntary behavior • Operant conditioning concerned with the relationship between voluntary behavior and environment – Increasing behavior: positive reinforcement. negative reinforcement – Decreasing behavior: punishment.

Cognitive principle • People’s emotional reactions & behavior are influenced by cognitions • People react differently to similar events • Maladaptive responses arises from cognitive distorsion .

Cognitive distortion • • • • • • • • • • Overgeneralization Personalization Dichotomous thinking Catastrophizing Selective abstraction Arbitratry inference Mind reading Magnification/minimization Perfectionism Externalization of self-worth .

or understanding. of individual patients . presentoriented psychotherapy for depression. directed toward solving current problems and modifying dysfunctional (inaccurate and/or unhelpful) thinking and behavior • Based on a conceptualization.Cognitive Behavior Therapy • A structured. short-term.

evaluate. and emphasizes relapse prevention • aims to be time limited • Cognitive behavior therapy sessions are structured • teaches patients to identify. mood. and behavior . aims to teach the patient to be her own therapist.CBT basic principles • Based on   formulation of patients’ problems and an individual conceptualization of   each patient in cognitive terms • requires a sound therapeutic alliance • emphasizes collaboration and active participation • goal oriented and problem focused • initially emphasizes the present • educative. and respond to their dysfunctional thoughts and beliefs • Uses a variety of techniques to change thinking.

Interacting system in human behavior .

Level of cognition .

CBT & nursing process • CBT is patient centered • Educational & skill building rather than curative • Empathy & therapeutic relationship • CBT emphasis on objective assessment process. values ongoing evaluation . bases treatment strategies on research evidence.

2000) . 2003. generalized anxiety disorder and bulimia nervosa (Wright et al. PTSD. 1999) and schizophrenia (Mueser 1998. and Zaretsky et al. Kingdon and Turkington 1995. 2005b. Lam et al.CBT Indication • Depressive disorder. Scott et al. Sensky et al. Basco and Thase 1998. OCD. panic disorder. 2000. 2002) • Bipolar disorder (Basco and Rush 1996. dysthymic disorder. social phobia.

feeling Identifying problem from the data Defining problem behavior Deciding how to measure the problem behavior  case spesific standarized rating scale • Identifying enviromental variables .Cognitive behavioral assessment • • • • Actions. thoughts.

Initial questions • • • • What is the problem? Where does the problem occur? When does the problem occur? Who or what makes the problem occur? • What is the feared consequence related to the problem? .

negative.The ABCs of behavior • Antecedent: cue that occurs before behavior • Behavior: what the person does or does not say or do • Consequence: what kind of effect (positive. neutral) the person thinks the behavior has .

substance abuse & personality disorder • Aimed at increasing activity. eating. increasing pleasure.Treatment strategies • Effective for anxiety. schizophrenic. enhancing social skill . reducing unwanted behavior. affective.

CBT strategies Anxiety reducton Cognitive restructuring Learning new behavior • • • • Monitoring thoughts and feelings • Questioning the evidence • Examining alternatives • Decatastrophizing • Reframing • Thought stopping • • • • • • • • • • • • Relaxation training Biofeedback Systematic desensitization Interoceptive exposure Flooding Vestibular desensitization training Response prevention Eye movement desensitization Modeling Shaping Token economy Role playing Social skill training Aversive therapy Contingency contracting .

Selection of CBT Treatment • should be based on the appropriateness of cognitivebehavior therapy for the treatment situation • acute phase CBT typically ranges from 10 to 20 weekly treatment sessions • conducted in a period of 3–6 months .

socialization of the patient to therapy. • The final phase of therapy: preparation for termination. establishment of a therapeutic relationship. • The middle stage: sequential application and mastery of cognitive and behavioral treatment strategies. and introduction to treatment procedures. psychoeducation. .Phases of Treatment • The initial phase: clinical assessment. relapse prevention. case formulation.

Evaluation • integrated use of objective assessment methods • administered before treatment and repeated periodically • high residual levels of cognitive symptoms most likely convey an increased risk for relapse after termination of treatment .

New York. 2010. John Wiley & Sons • Rector. The Guilford Press. Neil. New York. et al. • Friedman. 2011. CAMH publications • Westbrook. Cognitive-behavioural therapy : an information guide. An Introduction to Cognitive Behaviour Therapy: Skills and Applications. Cognitive and Behavioral Therapies. SAGE Publications . Judith. et al. 2008. Toronto. Cognitive behavior therapy: basics and beyond. 2011.Referrence • Beck. New York.