Explaining cbt

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The thought – feeling connection

• The way you think affects the way you feel (and behave)

• One of the aims of CBT is to replace rigid, unrealistic and unhelpful thoughts and beliefs with flexible, realistic and helpful alternatives

Rob Willson, Rhena Branch (2006) Cognitive Behavioural Therapy for Dummies, England: John Wiley & Sons.

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Digging deeper into our thoughts

Core beliefs – central ideas about the self“I am incompetent”

Intermediate beliefs – assumptions, attitudes, rules“If I don’t understand things perfectly I am dumb”

Automatic thoughts“This training is too hard, I’llnever understand it”

Judith Beck (1995) Cognitive Therapy: Basics and Beyond, New York: The Guilford Press, p16.

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Activating Event

- Situation

- Trigger

Consequences

- Feelings

- Behaviours

Beliefs- Thoughts

- Assumptions

- Interpretations

Your underlying beliefs can influence your interpretation of an event and the thoughts that follow, which results in a set of feelings and behaviours…

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Same situation – different thoughts and behaviours

• You receive an average mark on an assignment– Person 1: “This mark proves I am a failure” (feels

devastated, withdraws from subject)– Person 2: “Yes! I passed a tough assignment” (feels

excited, jumps for joy)– Person 3: “I will try something a little different on the

next assignment” (feels motivated, starts reading for the next assignment straight away)

• A friend passes you on the street without noticing you– Person 1: “My friend obviously doesn’t like me anymore”

(feels humiliated, doesn’t contact her friend again)– Person 2: “My friend is so distracted she must be in love”

(feels amused, laughs it off)– Person 3: “My friend might be stressed and distracted” (feels

concerned, calls her friend to see if she is ok)

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Use Helpful Metaphors

• Snow skiing– Skiing down the mountain in the same path in the deep

groves from your previous runs– Takes a while to develop new grooves to ski in– Link to learning new thinking patterns and behaviour

• The “Depression Gargoyle” – Sitting on your shoulder, the weight of the stone brings

you down– Whispering in your ear - negative self talk– The Gargoyle wants you to blame yourself, and think

you are worthless– When you are depressed, the messages from the

Gargoyle will seem true– Provides an emotional symbol to help identify self-

critical thoughts

Michael Otto (2000) Stories and Metaphors in Cognitive-Behavior Therapy, in Cognitive and Behavioural Practice, 7(2), pp166-172.

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Getting “buy in”

Acceptance of the CBT rationale is associated with positive treatment

outcomes

“What do you think about the idea that your thoughts play an important role in determining your mood/anxiety/behavior?What do you think about the idea of changing your thoughts and behavior as a way of working on your mood/anxiety?What are some possible downsides to these ideas?What do you think about the idea of having weekly homework related to your problem/situation?”Michael Addis, Kelly Carpenter (2000) The treatment rationale

in Cognitive Behavioral Therapy: Psychological mechanisms and clinical guidelines, in Cognitive Behavioural Practice, 7(2), pp151.

Explaining CBT role play

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Types of Unhelpful Thinking (slide 1)

Dichotomous thinking(Black and white thinking)

Thinking in extremes, often in terms of failures or successes

Mind reading Assuming you know what other people are thinking - often assuming people are thinking negative thoughts about you

Catastrophising (magnification)

Predicting the future as catastrophic, blown out of proportion

Mental filtering Focusing on weaknesses, ignoring strengths

Grant Blashki et al (2003) Cognitive behavioural strategies for general practice, Australian Family Physician, 32(1), pp910-917.

Lambert Maguire (2002) Clinical Social Work – Beyond Generalist Practice with Individuals, Groups and Families, Chapter 9: Cognitive Interventions, USE: Brooks / Cole.

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Types of Unhelpful Thinking (slide 2)

Self blame(personalisation)

Automatically blaming yourself when things are going badly

Over generalising(global labelling)

Sweeping and amplified statements used to describe yourself or others

Blaming Externalising the reason for your behaviour, not taking responsibility

Questions with no answers Unhelpful negative questions with no answers(why me?)

Examples of unhelpful thinking

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Any questions?