CBT, APPLIED RELAXATION, & ERP

By-VIJIT AGARWAL4th PHARM.D

COGNITIVE BEHAVIOURAL THERAPY (CBT)

The cognitive behavioural therapy involves 4 sequential steps.

1. Identifying how the patient is thinking and the beliefs about self, world and the future that underlie those thoughts.

2. Evaluate the accuracy of those cognitions through examination of their logic, probability and past evidence.

3. Generating alternatives, more accurate interpretations, predictions, and ways of believing.

4. Using these perspectives (whenever anxiety and worry are detected), to support them.

Two additional methods to give the therapy are as follows…

1. Tell the patient to make a ‘worry

outcome diary’ and any time they notice themselves in worrying, writing down the worry and what they are afraid of might happen.

At the end of each day they can review the prior entries and identify whether the outcome relevant to the particular worry has actually occurred or not.

With this technique the patient can self identify that the worry outcome was turned out well, and they cope up better then they expected with the small number of bad things.

2. Patient are learning to spend more time in present rather then in their minds and the future.

They are encouraged to give more positive values to their present moments.

Patient can overcome their anxiety and worry by some of the following ways… Do different kinds

of relaxation exercises like meditation

Avoid alcohol and caffeine

Listen to slow music and,

Make yourself calm.

Better results

Applied Relaxation

It is the best and one of the proven stress management technique and it was developed by Swedish Physician L.G. Ost.

Guidelines for Practice:- Allow yourself sufficient time in a quite

space to practice. Don’t rush yourself. Each new stage will help you relax more

quickly and more deeply.These stages includes …

Stages Include…1. Progressive muscle

relaxation2. Release only relaxation 3. Que-control relaxation4. Rapid relaxation5. Applied relaxation

1. Progressive muscle relaxation

It will help you to recognize the difference between tension and relaxation in each of the major muscle group.

It helps you to drain the tension from your muscles.

2. Release only relaxation It cuts off the tensing step in

progressive muscle relaxation. This means you can cut the time by half.

Give yourself 1 - 2 weeks to practice. Your goal should be relax your entire

body in less than 10 minutes.

3. Que-control relaxation

It will further reduces the time you need to relax.

In this stage you will focus on your breathing.

Give yourself 1 – 2 weeks time to practice.

Your goal should be to relax your entire body in about 7 minutes.

4. Rapid relaxation It will reduce the time to relax, less than

1 minute. Give yourself 1 – 2 weeks time to

practice. Your goal should be to relax your entire

body in about 3 minutes.

5. Applied relaxation The final stage of applied relaxation training

involves relaxing quickly in the face of anxiety provoking situations.

If your breath speeds up, muscles tense up, or if you feel your heart rate is increasing, begin these 3 steps…

1. Take 2 or 3 deep, even breaths2. Think these calming words to yourself as you continue to breath deeply BREATH IN…….RELAX BREATH IN…….RELAX3. Scan your body for tension and concentrate on relaxing the muscle

Patient can be asked that how he/she feels before and after relaxing for better treatment with the help of a simple exercise…

Keep Yourself Calm

Exposure and response Prevention It is one of the most popular and

effective form of behaviour therapy for OCD.

ERP involves exposing you to anxiety that is provoked by your obscession and preventing the patient to use the rituals, to reduce anxiety.

Eg - Exposure Response Prevention Therapy exposes a patient to their drug or alcohol triggers but prevents them from getting high.

ERP makes patient to confront their worst fear: accidental exposure to substance abuse triggers.

Example of Obscession Repetitive thoughts (e.g., feeling

contaminated after touching an object, doubting whether the stove was turned off)

Repetitive images (e.g., recurrent sexually explicit pictures)

Compulsions Repetitive activities (e.g., hand washing,

checking, ordering, need to ask, need to confess)

Repetitive mental acts (e.g., counting, repeating words silently, praying)

Screening questions

Do you have repetitive thoughts that make you anxious and that you cannot get rid of?

Do you check things excessively? Do you feel the need to wash your

hands frequently? Do you keep things exceptionally clean?

Relaxation, Craving Rating, and Pulse A typical ERP session starts with about 5

minutes of relaxation exercises. After relaxing, the patient is asked to rate

their craving level before being exposed to their triggering stimuli. They use a 10 point scale to do this where 10 represents a desire to use immediately.

The patient’s pulse is also measured (pulse rate generally increases as a patient’s craving level rises).

Once a patient has completed the first level of stimulus exposure he proceeds to the next level and repeats all of the steps.

An ERP therapy session continues until the patient has completed all of the stimulus exposure levels, or the session has to be stopped because of over stimulation.

The typical user requires at least 30 ERP sessions to complete the entire stimulus hierarchy without experiencing any significant levels of craving.

Thank you…