An Introduction to CBT techniques

Part One
What we’ll cover
1 What is CBT? What are its principles? What is the evidence that it’s
effective?

2 What does CBT have to offer?

3 How do you incorporate CBT techniques into your practice if you’re not a
CBT practitioner? (Think, Act, Be)

4 Challenges to CBT/myth busting

What we’ll cover in Part One
1 What is CBT? What are its principles? What is the evidence that it’s
effective?

2 What does CBT have to offer?

 What are your
prejudices about
CBT?
 McGrath et al. (1990):
75% of patients with
phobias respond to
systematic desensitisation.
 “Cognitive therapy seeks to
alleviate psychological
stresses by correcting faulty
conceptions and self-signals.
By correcting erroneous
beliefs we can lower
excessive reactions.”
Aaron T. Beck
 Emotional reasoning - taking one’s
emotions as evidence of truth.

“Should” statements reflect our (often

unreasonable) standards.

Labeling and mislabeling - “I am

hopeless” or “I am stupid”.
 “The central shift is from a focus on what you
think and feel to how do you relate to what you
think and feel. Specifically, the new emphasis
is on learning to step back from what you are
thinking, notice it, and open up to what you are
experiencing. These steps keep us from doing
the damage to ourselves that efforts to avoid or
control our thoughts or feelings inflict,
allowing us to focus our energies on taking the
positive actions that can alleviate our
suffering.”

Steven C. Hayes
The CBT Triangle
 Thoughts vs feelings – is it that simple?
• No, they’re both useful information.
• Feelings came first. Thoughts are based on
experience. But they can be as faulty as gut
feelings and intuition.
• Thinking and feeling work together. They’re not
in competition, as in Plato’s chariot rider.
• Neuroplasticity - emotional regulation is a skill
like any other. CBT - intervention is based on
challenging old ways of thinking about, and
reacting to, emotionally charged situations.
 Thoughts vs feelings – is it that simple?
• No, they’re both useful information.
• Feelings came first. Thoughts are based on
experience. But they can be as faulty as gut
feelings and intuition.
• Thinking and feeling work together. They’re not
in competition, as in Plato’s chariot rider.
• Neuroplasticity - emotional regulation is a skill
like any other. CBT - intervention is based on
challenging old ways of thinking about, and
reacting to, emotionally charged situations.
 “The use of the two different terms,
cognitive neuroscience and affective
neuroscience, may be doing a disservice to
our understanding of the processing that
actually goes on. The new idea making its
way into the field is that emotion itself is a
kind of information.”
Matthew Scult, Duke University psychology and neuroscience
Principles of CBT 1
Goals based.
• Got to be tight, realistic, measurable
where possible (even if these are self-
reported measures).
• Outcome measures and output measures.
E.g. want to feel better vs. want to
exercise more.
• Tie goals to values. Why do you want to
change? What’s the positive motivation
to change? Often mutually reinforcing -
getting more exercise and sleeping better
helps you be a better partner.
Principles of CBT 2
Active immediately. Focus on the everyday
from day one - your sleep, your exercise, your
diet, your use of substances.

Skills based, to prevent relapse. Focused on

strengths as well as problems.

Structured. Focus on practice since last session;

focusing on week ahead and when and how to
apply the skills.

Time limited; hope-based.

Lovely. But does it
work?
Research base
•
269 meta-analytic studies and reviewed of
those a representative sample of 106 meta-
analyses examining CBT.
•
The strongest support exists for CBT of
anxiety disorders, somatoform disorders,
bulimia, anger control problems, and
general stress.

• In general, the evidence-base of CBT is

very strong. However, additional research
is needed to examine the efficacy of CBT
for randomized-controlled studies.
How do you feel at the end of Part One?

Open to how you’ll put CBT into

practice with your clients? Still sceptical?

Did the focus on the principles of CBT

make you reflect on how you already
implement some CBT techniques in your
practice – e.g. hope, goals focus?
What We’ll Cover in Part
Two

3 How do you incorporate CBT techniques into your practice if you’re not a
CBT practitioner? (Think, Act, Be)

4 Challenges to CBT/myth busting

An Introduction to CBT Techniques

Part Two
Course summary
1 What is CBT? What are its principles? What is the evidence that it’s
effective?

2 What does CBT have to offer?

3 How do you incorporate CBT techniques into your practice if you’re not a
CBT practitioner? (Think, Act, Be)

4 Challenges to CBT/myth busting

What We’ll Cover in Part
Two

3 How do you incorporate CBT techniques into your practice if you’re not a
CBT practitioner? (Think, Act, Be)

4 Challenges to CBT/myth busting

Challenging Negative
Thoughts
 Emotional reasoning - taking one’s
emotions as evidence of truth.

“Should” statements reflect our (often

unreasonable) standards.

Labeling and mislabeling - “I am

hopeless” or “I am stupid”.
The Magic Dial technique
Challenging negative thoughts - tools
Thought journal – record the thought. Stand outside the
thought.

• Is there an event that caused a feeling, that led to a

behaviour?
• What was the thought that shaped the interpretation of
that event, that shaped the feeling?
• The downward arrow technique to get to the root
thought/belief. “Which means that….”
I believe I’m too anxious to speak at this event.

I will embarrass myself if I try. My legs will wobble. My voice will crack.

My boss will think I’m terrible at my job.

I will lose my job.

If I lose my job, I’ll lose my home and,

possibly, my family.
Challenging negative thoughts - tools
Breaking the pattern. What’s the evidence? What are the errors in
thinking?

Change the script - is there a potential positive that isn’t

patronising and is based in evidence?.

Notice the impact of the new thought/belief on

behaviours/actions.
How might you construct
a thought journal to
work through with a
client?
Mindfulness in everyday life (ACT,
MBSR)
• Attention is your life. Make sure you’re using
your attention well.

• Taking shower. Eating. Having sex. Properly

paying attention when you’re talking to your
partner.

• Doesn’t this go against being goal-based? No.

You can’t multi-task. If you’re planning for a
future goal, concentrate on that planning.
Accepting things as they are makes it more likely
your plans will be realistic and evidence-based.
Think (C), Act (B), Be
(M).
Simple, but not easy.
Procrastination
Principles of CBT 1
Goals based.
• Got to be tight, realistic, measurable
where possible (even if these are self-
reported measures).
• Outcome measures and output measures.
E.g. want to feel better vs. want to
exercise more.
• Tie goals to values. Why do you want to
change? What’s the positive motivation
to change? Often mutually reinforcing -
getting more exercise and sleeping better
helps you be a better partner.
Principles of CBT 2
Active immediately. Focus on the everyday
from day one - your sleep, your exercise, your
diet, your use of substances.

Skills based, to prevent relapse. Focused on

strengths as well as problems.

Structured. Focus on practice since last session;

focusing on week ahead and when and how to
apply the skills.

Time limited; hope-based.

Think, Act, Be
Benefits of procrastinating.
- “I get to avoid the feeling of not being good enough at my work. I get to
avoid the feeling of trying and failing.”

Self-compassion.
- “I understand why I would want to avoid the feeling of not being good
enough, or of failing – it’d be horrible!”

Benefits of not procrastinating

- “I get to feel competent at my job. I get to feel self-respect.”

Doesn’t need to be perfect.

- “No-one needs me to deliver something perfect.”
Think, Act, Be
Get started!
- “I get to avoid the feeling of not being good enough.”

Plan.
- “I know what I need to do and when.”

Set reminders.
- “Even if I forget, my phone will remind me.”

Work in bursts. (Pomodoro method)

- “I’ll use the time I have now to do what I can.”

Reward yourself.
- “I did what I said I would do. Time for that TV show I love…”
Think, Act, Be
Accept it’s not going to be perfect. Or fun.
- “I’m not doing this for it to be fun. It’ll be what it’ll be.”

Re-settle if you get distracted.

- “Argh. I’m on my emails. That’s OK. It happens. Time to re-focus.”

Don’t pursue the negative thoughts. Let them be.

- “There’s a part of me that wants to sabotage this project. That’s OK – it’ll
come up from time to time. Let’s get back to work.”
Social anxiety
Think, Act, Be
Benefits of social anxiety
- “I get to avoid the feeling of not being shy/introverted/anxious/saying
something stupid.”

Self-compassion.
- “I understand why I would want to avoid that feeling.”

Benefits of challenging social anxiety

- “I get to spend time with people I care about. I get to meet new people, and
have exciting new experiences.”

Doesn’t need to be perfect.

- “Even if I feel anxious, I might still have fun.”
Think, Act, Be
Get started!
- “Which friend do I most want to see next? Which new bar can we meet in, one
that I really want to go to?.”

Plan.
- “Where and when? How will I manage my anxiety before, during and after?”

Reward yourself.
- “Brilliant. I’m proud of myself. Now for a quiet night in to recuperate.”

Repeat. Repeat. Repeat.

- “I have to get another date in the diary, or I’ll not go through with it again.”
Think, Act, Be
Accept it’s not going to be perfect. Or fun.
- “There will be moments when I’m feeling anxious. When that happens, I’ll
remind myself I’m with friends, and I’ll focus my attention on what they’re
saying/wearing.”

Re-settle if you get distracted.

- “OK. I need some air. But I’m not going home. I just need a moment to settle.
When I go back in, I’ll focus on what my friends are talking about.”

Don’t pursue the negative thoughts. Let them be.

- “There’s a part of me that is going to keep telling me “you said something
stupid”. That’s just one part of me, which wins too often. There’s another part of
me that wants to have some fun.”
Criticisms of CBT
• Just a sticking plaster. Not the solution to
everything. Some treatments work for
specific things. e.g. ERP for OCD.
Attachment-based therapy for personality
disorders or issues around intimacy.

• Doing research on longer term therapy is

hard (RCTs/active comparator). Shedler
(2010, 2015) - positive change and patient
growth continue to develop beyond well
termination.
Principles of effective therapy
1. Foster hope.

2. Build a strong, reciprocal relationship with the client.

3. Help clients step back and take a more self-reflective approach.

4. Encourage corrective emotional, cognitive and behavioural experiences.

5. Cultivate ongoing reality testing – linking new experiences with consequences.

Recap
1. Think, Act, Be (T.A.B.).
2. Start with goals.
3. Break goals down into achievable steps, with staged difficulty.
4. Challenge beliefs/thoughts underneath any hurdle. Thought
journals. Downward arrow techniques. Magic dial. Untwist your
thinking.
5. Set up the environment to help.
6. Encourage, celebrate, reward - cultivate new skills, especially
around mindfulness and being present – and relaxation skills.
7. Consider as part of the wider evidence base on the principles of
effective therapy.
Head to lcap.co.uk/courses to check out our training
courses on:

Addiction

Principles of Change in Therapy

What Makes A Good Therapist?

Single Session Therapy

Neuroscience
Thank you.
Attachment