Fundamentals of Cognitive Behavioural Therapy

Question 1

What is CBT?

Answer 1

Talking therapy
Time-limited, not helpful to offer more than 16 sessions
Brief - 50-60 minute sessions
Structured
Collaborative
Problem orientated
Used to treat a range of different mental health difficulties

Question 2

How many sessions do you usually have?

Answer 2

Time limited - 12-16 sessions

Question 3

Why use CBT?

Answer 3

NICE guidelines (national institute for health and care excellence) 
Developed on the best evidence and research we have to ensure clinicians give the best therapy for the people they are treating 

Lots of evidence so know it is effective

Question 4

What do NICE recommend that CBT should be used for?

Answer 4

Generalised anxiety
OCD
Panic disorder
Social phobia
Specific phobias
Post-traumatic stress disorder
Depression
Psychosis

Question 5

What are the principles of CBT? Kennerly and Kirk, 2007

Answer 5

Cognitions - thoughts/beliefs
Affect - emotional states
Physiology - bodily stress
Behaviour - what we do

Question 6

Why do some people make the wrong interpretations?

Answer 6

Someone doesn’t wave to you on the street - a anxious person, will think they are being ignored, heart will race and they will ignore the person next time. However, if you think they didnt see you, you will have a completely different approach

Question 7

What is the cognitive model?

Answer 7

The meaning people attach to events influences different emotional responses to that event

Different people attach different meanings to the same events

Question 8

What is a panic attack?

Answer 8

Different to panic disorder

Period of intense fear or discomfort, in which four or more symptoms developed abruptly and reached a peak within 10 minutes

Question 9

What are the symptoms of a panic attack?

Answer 9

Palpitations
Sweating
Shaking
Shortness of breath
Feeling of choking
Nausea or abdominal distress
Feeling dizzy or faint
Fear of losing control
Fear of dying
Praesthesias (numbness)

Question 10

What is panic disorder?

Answer 10

Recurrent and unexpected panic attacks - come randomly
More than one panic attack has been followed by 1 month or more of 1 or more of:
concern about attacks
worry about implications and consequences of attacks
change in behaviour related to the attacks - so worried about when next is coming
when in middle of attack, feel like it will never stop

Question 11

What does the Cognitive Model of panic disorder believe? Clarke

Answer 11

We experience panic attacks when we interpret normal bodily sensations as being dangerous - catastrophic misinterpretation

It Is the meaning we attach to the bodily sensation that makes them seem important - if heart is racing, people think its dangerous (about to have a hear attack)

Question 12

What is catastrophic misinterpretation?

Answer 12

When we interpret normal bodily sensations as being dangerous

Question 13

What is the panic formulation?

Answer 13

Believes there is:
Trigger - slight physical sensation, memory of previous panic attack. This causes an emotional response - which heightens awareness of physical sensations - impacting thoughts and beliefs about the situation - leading to a safety behaviour

Question 14

Why is the attentional spotlight important?

Answer 14

Often our attentional spotlight is focussing too much on one thing with an anxiety disorder - for example, they would start counting their heart beat, making it seem a lot worse

Question 15

What is an example of panic formulation?

Answer 15

Trigger - burning face and heart racing
Feelings - anxiety and fear
Physical sensations - breathless/light headed
Thoughts - I am going to die
Safety behaviour - sit down/monitor heart

Question 16

What is the treatment for panic disorder?

Answer 16

Treated differently depending on severity
Step 2 - treatment mild to moderate panic disorder (few panic attacks)
NICE recommend facilitated or non facilitated self-help - speak to PWP over the phone or look at CBT program delivered on a computer and see how your symptoms are - if no better, step 3

Step 3 - treatment moderate to severe panic disorder
CBT 7-14 hours from a psychologist
or an antidepressant if the disorder is long standing or the person has not benefitted from or has declined psychological intervention

Question 17

What is a key role of the CBT therapists?

Answer 17

Help clients identify:
the thoughts that have a negative impact on the way they feel and behave
the behaviours that affect their thoughts and feelings

Question 18

What are the key stages of CBT?

Answer 18

Psychoeducation
Cognitive techniques
Behavioural techniques
Relapse prevention - ensure people are prepared for the end of therapy

Question 19

What is psychoeducation?

Answer 19

Giving information about symptoms helps to normalise people’s experiences - focus on normalising the symptoms

Aims at correcting unhelpful beliefs

Sharing formulation diagram - in first or second session, draw out the formulation diagram so it is meaningful to them, ensure they have understood why they are having particular experiences

Question 20

What is the aim of cognitive techniques?

Answer 20

Help to loosen conviction in the beliefs so that behavioural work can be done
elicit evidence for the belief
examine that evidence
elicit evidence against the belief

Question 21

What is the theory A theory B technique?

Answer 21

Used to contrast threat belief with alternative belief
Theory A problem (believe it will actually happen)
I am going to have a heart attack
Evidence?
If it is true, what shall I do? go Hospital
If it is true, what does life look life? Panicking all the time

Theory B problem (always a problem with worrying)
I worry I am going to have a heart attack
Evidence? I thought I was having one many times but never had
If theory is true, what do I need to do? Stop avoiding places that trigger panic attacks

Need to challenge beliefs so that people have different thoughts

Question 22

What is the C in CBT?

Answer 22

Need to do the cognitive work first - make people believe that is is worry that is the problem

Question 23

What is the B in CBT?

Answer 23

Behavioural experiments

Question 24

What are behavioural experiments?

Answer 24

Planned experimental activities based on experimentation or observation
Their design is derived from a cognitive formulation of the problem
Behavioural experiment record sheet

Question 25

What is a behavioural experiment record sheet?

Answer 25

Look at cognition being targeted (feel unwell, going to have a heart attack), experiment (go to park and have a run), prediction (I might have a heart attack), outcome (I ran for longer than I thought), what I learned (when I feel that way, it is not a sign of a heart attack)

Question 26

What are the aims of behavioural experiments?

Answer 26

Test the validity of the patient’s existing beliefs about themselves, others and the world
Construct and test new more adaptive beliefs
Contribute to the development and verification of the cognitive formulation

Question 27

What do safety behaviours do?

Answer 27

They decrease anxiety short term, but maintain it long term

Question 28

What is the overall structure of CBT?

Answer 28

Time limited
Starts with formulation
Cognitive and behavioural work in the middle
Therapy blueprint (record of their learning) at the end - used to reinforce therapy gains at the end of therapy and as a relapse prevention technique

Question 29

What is therapy blueprint and why is it good?

Answer 29

It is a record of their learning at the end - used to reinforce therapy gains and the end of therapy

It is good in case someone is going to have a relapse - can look at what helped them before

Question 30

What is the session structure of a CBT session within the session?

Answer 30

Starts with an agenda- set collaboratively
Assessment of mood
Discussion of homework
Session topics for discussion
Planning of next homework
Feedback on how client has experienced the session

Question 31

What is socratic questioning / guided discovery?

Answer 31

A method used in CBT which is part of the collaborative and empowering approach that CBT advocates
A good socratic question is one that: your client can work out an answer to, the answer reveals new perspectives

Question 32

What are examples of socratic questions?

Answer 32

What is going through our mind, how much do you believe it?
What supports/contradicts this?
How would someone else see this?
What evidence is there to support this?
Can the problem situation be changed?
What can be done differently?