COGNITIVE

BEHAVIORAL
THERAPY

PRESENTED BY:
Rakshatha J
3 WAVES IN
THERAPY

Psychoana CBT Humanisti

lysis c and
existential
INTRODUCTION
Aaron T Beck developed cognitive therapy
[CT] about the same time that Ellis was
developing REBT. They were not aware of
each other’s work and created their
approaches independently.
Beck’s CT was based on empirical research.
It emphasizes on education and prevention
but uses specific methods for specific
issues.
Specificity of CT allows therapists to link
assessments, conceptualization and
treatment strategies.
INTRODUCTION
He set out to create an evidence based
therapy for depression and he tested each
of his theoretical constructs with empirical
studies to determine how CT’s outcomes
vary from psychodynamic approaches.
His early studies say that patients with
symptoms of depression have a negative
bias in the interpretation of certain life
events leading to active processes of
cognitive distortions.
He mentioned that there maybe other
precipitating factors as well.
INTRODUCTION
He referred to the thinking pattern of a
depression patient to be NEGATIVE
COGNITIVE TRIAD [negative view about
self, world and future.]
Both REBT and CT/CBT are active, directive,
time-limited, present-centered, problem
oriented, collaborative, structured,
empirical.
INTRODUCTION

NEGATIVE COGNITIVE TRIAD

AARON TEMKIN BECK
PHILOSOPHY OF CBT

Thoughts
Solution-
determine Inductive
focused feelings and Method
therapy behavior
DIFFERENCE B/W CBT AND
REBT:
REBT CBT
REBT is highly CBT uses socratic

direct, persuasive, dialogue, posing open-

ended questions to
confrontational and
clients with the aim of
teaching role of the getting clients to
therapist is reflect on personal
emphasized. issues and arrive at
The therapist their own conclusions.
Helps clients identify
models rational
misconceptions and
thinking and helps are not taught.
clients to identify
and dispute their
THE CLIENT-THERAPIST
RELATIONSHIP
Establishes a trusting relationship and builds
rational self counseling skills in the client that helps
the client learn to think differently.
The counselor’s role is to listen, teach, and
encourage, while the client’s role is to express
concerns, learn, and implement that learning.
Beck believes effective therapists must combine
empathy and sensitivity with technical competence.
Therapists emphasizes on the client’s role in self-
discovery.
Home-works are often given to improve the effect
the therapy.
APPLICATIONS OF CBT:
Gained recognition as a therapy for treating
depression, bur extensive research has
been devoted to many other treatments as
well.
Strong empirical research and theoretical
framework.
Treats depression, anxiety, cannabis
dependence, hypochondriasis, body
dysmorphic disorders, eating disorders,
anger, schizophrenia, insomnia, chronic
pain, Personality disorders, substance
abuse.
COMPONENTS OF CBT
There are 2 critical components of CBT
1. Functional Analysis
Functional Analysis plays a critical role in helping the
client and counselor assess high risk situations
that are likely to lead to substance use and
providing insights into what may trigger or
stimulate the client’s substance use (e.g.,
interpersonal difficulties, opportunities to take
risks or feel euphoria not otherwise available in
the patient’s life, Later in treatment, functional
analysis of substance use episodes helps identify
those situations or states in which the individual
still has difficulty coping.
COMPONENTS OF CBT
2. Skills Training.
can be viewed as a highly individualized
training program to help the client unlearn
old habits associated with substance use
and learn or relearn healthier skills. In CBT,
the goal is to identify and reduce habits
associated with a drug using lifestyle by
substituting more enduring, positive
activities and rewards. The client learns to
recognize and cope with urges to use
substances. In addition, the skills can
improve interpersonal functioning, enhance
social supports, and help clients learn to
THEORETICAL ASSUMPTIONS:
People’s thought pattern are accessible to
introspect.
People’s beliefs have highly personal
meaning.
People discover these meanings
themselves rather than being taught or
having them interpreted by the therapist.
Beliefs play a major role in determining
what type of psychological distress we will
experience.
Empirically supported observation that
changes in beliefs lead to changes in
COGNITIVE MODEL
Based on 50 years research work Beck
proposed the GENERIC COGNITIVE MODEL.
This described the CT applications from
depression and anxiety treatments to
therapists for a wide variety of other
problems including psychosis and
substance use.
By linking psychological difficulties with
adaptive human responses, Beck believes
the generic cognitive model “has the
potential to be the only empirically
supported general theory of
psychopathology.”
COGNITIVE MODEL
It has a comprehensive framework for
understanding psychological distress.
Helps in understanding human cognition,
behavior, and emotion.
PRINCIPLES OF COGNITIVE MODEL
 Psychological distress can be thought of as an exaggeration
of normal adaptive human functioning.
 Faculty information processing is a prime cause of
exaggeration in adaptive emotional and behavioral
reactions.
 Insight focused with strong psycho-educational component
that emphasizes recognizing and changing unrealistic
thoughts and maladaptive beliefs.
 This helps clients learn practical skills that they can use to
make changes in thoughts, behaviors and emotions over
time.
 Focus on present problems.
 Focus of brief therapy- symptom relief, assisting clients in
resolving their most pressing problems, changing beliefs
and behaviors.
PRINCIPLE
S OF CBT
01 04

Sound
therapeutic Educative in
alliance and nature where
active teaching is
participation
02 the focus
Goal oriented 05
and solution-
focused Focuses on
03 the present

Time limited
and
structured
COGNITIVE BEHAVIORAL MODEL:
Cognitive behavioral therapy is a short
term, problem focused psycho-social
intervention.
“It is an active, directive, time limited,
structured approach, based on the
rationale that the individual’s affect and
behavior are largely determined by the way
in which he/she structures the world.
THE ADVANTAGES OF USING CBT
INCLUDE

 Structure that reduces the possibility that

sessions will become “chat sessions”, and
more therapeutic work may be
accomplished,
 An emphasis on getting better by learning
how to recognize and correct problematic
assumptions, the root cause of many
problems, and
 Clearly defined goals and methods that
can be evaluated using scientific methods.
HOT CROSS
BUN MODEL TRIGGER

THOUGHTS

BEHAVIOUR EMOTIONS

PHYSIOLOGY
 CENTRAL IDEA OF CBT:
I AM A
FAILURE

COGNITION

SAD,
LOSING JOB WORTHLES
S

EVENT EMOTION
IMPLICATIONS OF THE CBT MODEL:
It is not the events only that matter, but,
the meaning of those events of the person.
Same event can have different emotional
consequences as the interpretations are
different.
We can help people in reducing their
distress by helping them change cognitions
by helping them develop other
perspectives.
CHARACTERISTICS OF CBT:
Brief and time limited [5-20 sessions]
Pace is relatively brisk, more in “here and
now”.
Need good therapeutic relationship.
Collaborative effort with the client.
“Guided discovery” is the cornerstone.
Structured and directive.
Based on a formulation.
Problem-solving oriented.
Educational
COGNITIVE
MODEL OF
CBT
Situation Reactions
Autom
atic
Though
ts
Emo Beh Phys
tion avio iolo
al ral gical
LEVELS OF COGNITION:
ANT’S Or NAT’S [Automatic Negative
Thoughts or Negative Automatic Thoughts]
Dysfunctional Assumptions
Core beliefs
AUTOMATIC NEGATIVE
THOUGHTS (ANT)
• Automatic: Unconscious in nature. [few believe it to be
concious]
• Automatic stream of thoughts about an event.
• Superficial/Surface level thoughts
• When we pay attention to them we can easily make
sense of those.
• Questions, images, telegraphic speech.
• These are plausible, especially when emotions are
strong.
• Habitual in nature, and hence cannot be checked.
• They can be images as well.
• ANTs of concern: distressing, distorted, dysfunctional
(unhelpful)
DYSFUNCTIONAL ASSUMPTIONS:
Assumptions operate as rules that guide
our daily actions and expectations in life.
They are beliefs about oneself, the world
and their future. [this is the soil from which
the ANT’s come].
Not as obvious as ANT’s
They usually have conditional rules. [if…,
should…,must…,then….,otherwise….,kind
of….. Statement].
COGNITIVE DISTORTIONS:
When we think about things in negative
ways, we experience exaggerated or
distorted emotional and behavioral
reactions as well. Beck identifies these as
cognitive distortions.

1. ALL OR NOTHING
It refers to thinking in extremes. Things are
perceived to be either good or bad, right or
wrong.
 COGNITIVE DISTORTIONS:
2. SHOULD STATEMENTS
Tendency to make unreasonable demands on self and others.

3. OVERGENERALIZATION
Draw a general conclusion on the basis of small evidence.

4. MENTAL FILTER
Focusing on negative events while rejecting the positive.

5. MAXIMIZATION AND MINIMIZATION

Magnify imperfections and minimize good points.

6. CATASTROPHIZING
Making big statements on the basis of something small.
 COGNITIVE DISTORTIONS:
7. PERSONALIZATION
Taking blame for everything that goes wrong in your life.

8. LABELING
Labeling oneself or other based on errors and mistakes. Making a
negative view of oneself or others.

9. JUMPING TO CONCLUSIONS

A) MIND READING
Arbitrarily concluding that someone is reacting negatively to you.

B) FORTUNE TELLING
Anticipation of things turning out negatively and conviction of
your prediction being a fact.
 COGNITIVE DISTORTIONS:
10. EMOTIONAL REASONING
You reason from how you feel. “I feel like an idiot, so I really must be
one.”

11. ALL OR NONE THINKING

You look at things in absolute black or white categories.

12. DISCOUNTING THE POSITIVES

You insist that your accomplishments or positive qualities “don’t count”.

13. ARBITRARY INFERENCES

Conclusions drawn without supporting evidence. Thinking about worst
scenario.

14. SELECTIVE ABSTRACTION

Forming conclusions based on an isolated detail of an event while
ignoring other information.
 COGNITIVE DISTORTIONS:
15. UNFAIR COMPARISONS
You interpret events in terms of standards that are
unrealistic— for example, you focus primarily on others
who do better than you and find yourself inferior in the
comparison.

16. REGRET ORIENTATION

You focus on the idea that you could have done better in
the past, rather on what you can do better now.

17. WHAT IF?

You keep asking a series of questions about “What if”
something happens and fail to be satisfied with any of
the answers.
 COGNITIVE DISTORTIONS:
18. INABILITY TO DISCONFIRM:
You reject any evidence or arguments that might contradict
your negative thoughts.

19. JUDGMENT FOCUS:

You view yourself, others and events in terms of evaluations
of good bad or superior inferior, rather than simply
describing, accepting, or understanding. You are continually
measuring yourself and others according to arbitrary
standards, finding that you and others fall short. You are
focused on the judgments of others as well as your own
judgments of yourself.

20. EMOTIONAL REASONING

You let your feelings guide your interpretation of reality.
CORE BELIEFS:
• Core Beliefs are our ideas about self, others and the
world.
• They start forming since childhood.
• These are absolute truths for the person.
• They can be true or just an idea.
• They are: fundamental, global, rigid and over-generalized.
• Core Beliefs influence people’s perceptions about the
situation and events.
• Arise from ANTs.
• These are absolute statements.
• Difficult to identify and tackle in short term therapies.
• More predominant and important in personality disorders.
 3
CATEGORIES
OF CBs
HELPLESS UNLOVABLE WORTHLESS

I am: I am: I am:

• Incompetent • Unlovable • Worthless

• Ineffective • Unlikeable • Bad
• Cannot do • Undesirable • Waste
anything right • Unattractive • Immoral
• Powerless • Unwanted • Dangerous
• Helpless • Uncared • Undeserving
• Weak • Bad
• Vulnerable/ • Rejected
victim • Abandoned
• Needy • Bound to be
• Trapped alone
• Out of control • Not good
• Failure enough
• Defective
PUTTING IT ALL TOGETHER:
An example for all the above discussed topics:

CORE BELIEF: “I AM UNLOVABLE”

DYSFUNCTIONAL
ASSUMPTIONS/COGNITIVE
DISTORTION: “EVERYONE MUST LIKE
ME, IF SOMEONE DOESN’T THEN I AM
UNLOVABLE BY EVERYONE.”

ANT: “PEOPLE AVOID ME, NO ONE

SPEAKS TO ME.”
ATTITUDES, RULES,
ASSUMPTIONS
• Attitude: view point
• Eg. Mistakes are terrible

• Rules: commands or demands that direct

our behaviour.
• Eg. I must do everything perfectly

• Assumptions: Conditional in nature. They

are in ‘if’ and ‘then’ format.
• Eg. If I do everything perfectly then it is
okay, if not then I am a loser/failure.
TECHNIQUES:
COGNITIVE
RESTRUCTURING
Cognitive restructuring is the therapeutic
process of identifying and challenging
negative and irrational thoughts.
Although everyone has some cognitive
distortions, but they start to become a
problem when they start to become a
problem when they are too frequent or too
intense.
In such cases, they can contribute to
problems such as depression or anxiety.
COGNITIVE
RESTRUCTURING
 This involves taking a hard look at negative thought
patterns.
 Perhaps you tend to over-generalize, assume the worst
will happen, or place far too much importance on minor
details. Thinking this way can affect what you do and it
can even become a self-fulfilling prophecy.
 Your therapist will ask about your thought process in
certain situations so you can identify negative patterns.
Once you’re aware of them, you can learn how to reframe
those thoughts so they’re more positive and productive.
 For example: “I blew the report because I’m totally
useless” can become “That report wasn’t my best work,
but I’m a valuable employee and I contribute in many
ways.”
COGNITIVE
RESTRUCTURING
SOCRATIC QUESTIONING
• Ask for evidences
• Is there any other way of looking at the
situation?
• Worst, Best, Realistic
(Decatastrophising)
• What happens when I believe in this AT?
What could be the effect of changed
thinking?
• What would you suggest your friend or
close family member if they were in this
place?
TYPES OF COGNITIVE
RESTRUCTURING
Socratic questioning
Decatastrophizing
Theory A v/s theory B
Double standards method
Survey method
Shades of grey
Define the terms
Probability estimation
Semantics focus
Fact or opinion
GOAL SETTING
Help the client set goals both short term,
middle term and long term.
End goals and mean goals are to be set as
well.
SMART goals
S- Specific
M- Measurable
A- Attainable
R- Relevant
T- Time limited
RELAXATION TRAINING
The relaxation response puts the body at
rest, andcounteracts many symptoms of
the fight-or-flightresponse.
Deep breathing (also known as
diaphragmatic/ belly/ abdominal breathing)
is one of the most versatile andeasy-to-use
relaxation skills.
When taking deep breaths, our bodies are
better ableto exchange carbon dioxide for
oxygen, which resultsin a slower heart rate,
lower blood pressure, and,consequently, a
feeling of relaxation.
RELAXATION TRAINING
Progressive mind body relaxation
Belly breathing
Relax in a jiffy
Brief scanning relaxation
Differential relaxation
Mini practices
GRADED EXPOSURE:
Graded - overcoming a fear is best
achieved bygradually confronting the fear.
Prolonged - exposure must be for a long
enoughtime to allow the levels of anxiety to
[Link] need to last until the levels
of anxietyhave reduced by around 50%.
 Repeated an exposure task needs to
berepeated around 4 or 5 times a week.
Without distraction when doing exposure it
isimportant that people can experience
someanxiety and see that it can reduce.
COUNTERING NEGATIVE
THOUGHTS
The client is asked to come up with a
rational counter statement for each of the
thoughts that are negative in nature or are
disturbing to them.
NEGATIVE THOUGHTS RATIONAL COUNTER STATEMENT

COUNTERING NEGATIVE
I got into trouble at work. I made a mistake at work,
They’llTHOUGHTS
probably want to fire but everyone does that from
me soon because I can’t do time to time. I usually get a
any of my job right. lot of positive feedback
about the work. I’ll be
careful not to make the
same mistake next time.
My husband was angry
yesterday and he yelled at
me for not feeding the dog.
I’m so irresponsible.

How will I ever get a date?

Everyone else seems like
more fun than me.
 DYSFUNCTIONAL THOUGHT
RECORD
DATE & SITUATION AUTOMATI EMOTIONS COGNITIVE ALTERNATI OUTCOME
TIME C DISTORTIO VE
THOUGHTS N THOUGHT

WHEN 1. WHAT DESCRIBE WHAT NAME WHAT IS NOW RE-

DID THE WAS THE THE FEELINGS THE A MORE RATE
THOUGHT CONTEXT THOUGHT CAME TO DISTORTI ADAPTIVE HOW
OCCUR? ? AND RATE YOU AT ON ALTERNAT MUCH
2. WHAT IT OUT THAT IVE? YOU
WAS OF 100% TIME? BELIEVE
HAPPENIN RATE IT THE
G? OUT OF ORIGINAL
100% STATEME
NT
SITUATION AUTOMATIC REACTIONS ALTERNATE OUTCOME
THOUGHT THOUGHTS THOUGHTS
RECORD SHEET
1. What 1. What 1. What 1. (optional) 1. How much
actual thought(s) emotion(s) What do you
event of and/or (sad, cognitive believe
stream of image(s) anxious, distortion each
thoughts, went angry, etc) did you automatic
or through did you feel make? thought?
daydreams, your mind? at the 2. 2. Use 2. 2. What
or 2. 2. How time? questions emotion(s)
recollection much did 2. 2. How at bottom do you feel
led to the you believe intense (0- to compose now? How
unpleasant each one 100) was a response intense (0-
emotion? at the the to the 100) is the
2. 2. What (if time? emotion? automatic emotion?
any) thought(s) 3. What will
distressing 3. 3. How you do? (or
physical much do did you
sensations you believe do?)
did you each
have? response?
WAYS TO UNTWIST
THINKING
IDENTIFY THE DISTORTION:
Write down your negative thoughts so you
can see which of the cognitive distortions
you're involved in. This will make it easier
to think about the problem in a more
positive and realistic way.
EXAMINE THE EVIDENCE
Instead of assuming that your negative
thought is true, examinethe actual
evidence for it. For example, if you feel that
you neverdo anything right, you could list
several things you have donesuccessfully.
WAYS TO UNTWIST
THINKING
THE DOUBLE-STANDARD METHOD:
Instead of putting yourself down in a harsh,
condemning way, talk to yourself in the same
compassionate way you would talk to a friend with
a similar problem.

THE EXPERIMENTAL METHOD:

Do an experiment to test the validity of your negative
[Link] example, if, during the episode of
panic, you become terrifiedthat you're about to die
of a heart attack, you could jog or run upand down
several flights of stairs. This will prove that your
heartis healthy and strong.
WAYS TO UNTWIST
THINKING
DEFINE TERMS:
When you label yourself "inferior" or "a fool” or “a
loser," ask,“ What is the definition of a 'fool?" You
will feel better when you see that there is no such
thing as a "fool" or a "loser.“

SEMANTIC METHOD:
Simply substitute language that is less colorful and
emotionally loaded. This method is helpful for
“should statements.” Instead of telling yourself “I
shouldn't have made that mistake," you can say,
"It would be better if I hadn't made that mistake."
WAYS TO UNTWIST
THINKING
RE-ATTRIBUTION:
Instead of automatically assuming that you
are "bad" and blaming yourself entirely for
a problem, think about the many factors
that may have contributed to it. Focus on
solving the problem instead of using up all
your energy blaming yourself and feeling
guilty.
WAYS TO UNTWIST
THINKING
COST-BENEFIT ANALYSIS:
List the advantages and disadvantages of a
feeling (like getting angry when your plane
is late), a negative thought (like "No matter
how hard I try, I always screw up"), or a
behavior pattern(like overeating and lying
around in bed when you're depressed).You
can also use the Cost-Benefit Analysis to
modify a self-defeating belief such as, “I
must always try to be perfect."
GUIDED DISCOVERY

In guided discovery, the therapist will

acquaint themselves with your viewpoint.
Then they’ll ask questions designed to
challenge your beliefs and broaden your
thinking.
You might be asked to give evidence that
supports your assumptions, as well as
evidence that does not.
In the process, you’ll learn to see things
from other perspectives, especially ones
that you may not have considered before.
This can help you choose a more helpful
path.
ACTIVITY SCHEDULING AND BEHAVIOR ACTIVATION
If there’s an activity you tend to put off or
avoid due to fear or anxiety, getting it on
your calendar can help. Once the burden of
decision is gone, you may be more likely to
follow through.
Activity scheduling can help establish good
habits and provide ample opportunity to put
what you’ve learned into practice.
RELAXATION AND STRESS
REDUCTION TECHNIQUES
In CBT, you may be taught some
progressive relaxation techniques, such as:
deep breathing exercises
muscle relaxation
imagery
You’ll learn practical skills to help lower
stress and increase your sense of control.
This can be helpful in dealing with phobias,
social anxieties, and other stressors.
ROLE PLAYING

Role playing can help you work through different

behaviors in potentially difficult situations.
Playing out possible scenarios can lessen fear
and can be used for:
improving problem solving skills
gaining familiarity and confidence in certain
situations
practicing social skills
assertiveness training
improving communication skills
SUCCESSIVE APPROXIMATION

This involves taking tasks that seem

overwhelming and breaking them into
smaller, more achievable steps. Each
successive step builds upon the previous
steps so you gain confidence as you go, bit
by bit.
JOURNALING

This technique is a way to gather about

one’s moods and thoughts. A CBT journal
can include the time of the mood or
thought, the source of it, the extent or
intensity, and how we reacted, among
other factors.
This technique can help us to identify our
thought patterns and emotional tendencies,
describe them, and change, adapt, or cope
with them (Utley & Garza, 2011).
EXPOSURE AND RESPONSE PREVENTION
This technique is specifically effective for
those who suffer from obsessive-
compulsive disorder(OCD; Abramowitz,
1996). You can practice this technique by
exposing yourself to whatever it is that
normally elicits a compulsive behavior, but
doing your best to refrain from the
behavior.
You can combine journaling with this
technique, or use journaling to understand
how this technique makes you feel.
INTEROCEPTIVE EXPOSURE
Interoceptive Exposure is intended to treat
panic and anxiety. It involves exposure to
feared bodily sensations in order to elicit
the response (Arntz, 2002). Doing so
activates any unhelpful beliefs associated
with the sensations, maintains the
sensations without distraction or
avoidance, and allows new learning about
the sensations to take place.
It is intended to help the sufferer see that
symptoms of panic are not dangerous,
although they may be uncomfortable.
NIGHTMARE EXPOSURE AND
RE-SCRIPTING
Nightmare exposure and rescripting are
intended specifically for those suffering
from nightmares. This technique is similar
to interoceptive exposure, in that the
nightmare is elicited, which brings up the
relevant emotion (Pruiksma, Cranston,
Rhudy, Micol, & Davis, 2018).
Once the emotion has arisen, the client and
therapist work together to identify the
desired emotion and develop a new image
to accompany the desired emotion.
PLAY THE SCRIPT UNTIL THE END
This technique is especially useful for those
suffering from fear and anxiety. In this
technique, the individual who is vulnerable
to crippling fear or anxiety conducts a sort
of thought experiment in which they
imagine the outcome of the worst-case
scenario.
Letting this scenario play out can help the
individual to recognize that even if
everything he or she fears comes to pass,
the outcome will still be manageable
(Chankapa, 2018).
BEHAVIORAL
EXPERIMENTS
the most powerful means to cognitive
change and changing beliefs in CBT
(AdrianWells, 1997, David Clark, 1989)
Targets: Core beliefs/DA's/ ANT'S.
 Can be
1. Active: Real situations, Role play
2. Observational: Internet, Surveys
BEHAVIORAL EXPERIMENTS
Behavioral experiments are typically used
for anxiety disorders that
involve catastrophic thinking.
Before embarking on a task that normally
makes you anxious, you’ll be asked to
predict what will happen. Later, you’ll talk
about whether the prediction came true.
Over time, you may start to see that the
predicted catastrophe is actually not very
likely to happen. You’ll likely start with
lower-anxiety tasks and build up from
there.
ABC MONITORING
A [ACTIVATING EVENT]
B [BELIEF]
C [CONSEQUENCE]

Post this the information is put in the CBT

model.
ALTERNATE THOUGHT
Works best when the client has the
cognitive distortion of LABELING.
Examples: 1. I’m inadequate ----- I have
skills and talents
2. I’m worthless---- I have been a worthwhile
person on many occasions and to many
people.
Statements that are alternate to the
original thought, helpful and balancing in
nature are used.
ASSIGNING NEW MEANINGS TO
OLD EVENTS
 OLD MEANING  NEW MEANING
1. My parents may not have
1. I must not be as been aware of ignoring me.
important to my My brother was very
commanding and needs lot
parents as my of attention. My sister had
brother and sister. problems and it is pretty
understandable that my
parents devoted much of
their attention towards her.
It may have been more of a
case of circumstances that
I ended up overlooked
rather than a true
reflection of my importance
to my parents.
GROUND RULES FOR
THERAPY
COME ON TIME
COME EVERY WEEK
DO THE HOMEWORK
TELL ME IF YOU ARE UNHAPPY
COME BACK
 HOW TO BEGIN FOLLOW-UP
SESSIONS?
Review of past week(s)
• What positive things have happened? What do
deserve credit for?
• What problems came up? What did I do? If the
problem recurs, what, if anything, should I do
differently?

Review of homework
• Did I do what I had planned? If not, what got in
the way (practical problems, automatic thoughts),
and what can I do about that next time?
• What should I continue to do this week? Rating
scales Follow-up sessions...
 HOW TO BEGIN FOLLOW-UP
SESSIONS?
 Current problematic issues/situations
Am I viewing this problem realistically, or have I been
overreacting? Is there another way of viewing this? What
should I do?

 Prediction of future problems

What problems may come up in the next few days or weeks,
and what should I do about them?

 Set new homework

What homework would be helpful for the current problems?
Should I consider: Thought Records/Scheduling activities/
Practicing relaxation?

 Schedule the next appointment

STRUCTURE AND FORMAT OF
CBT SESSIONS
CBT focuses on a great deal of work in each session
(ie. review practice exercises, debrief any problems
that have occurred, skills training, feedback on skills
training, in session practice, and plans for the next
session) that a “20/20/20 Rule” be applied by the
counselor to the flow of the session.
First 20 minutes
• Assess substance abuse, craving, and high risk
situations since last session,
• Listen for/elicit patient’s concerns, and
• Review and discuss the homework practice
exercise
STRUCTURE AND FORMAT OF
CBT SESSIONS
Second 20 minutes
• Introduce and discuss the session topic,
and
• Relate the session topic to the client’s
current concerns
Third 20 minutes
• Explore the client’s understanding of and
reactions to the topic,
• Assign a practice exercise for the next
week, and
• Review plans for the week and anticipate
potential high risk situations.
CBT FOR DEPRESSION
CBT FOR DEPRESSION
Negative triad
Beck’s cognitive model for depression:
‘persons susceptibility to depression develop
inaccurate and unhelpful core beliefs about
themselves, others, and the old as a result of
learning.’
These beliefs can be dormant for extended
periods of time and are activated by life events
that carry specific meaning for that person.
Core beliefs that render someone susceptible to
depression are broadly categorized into beliefs
about being unlovable, worthless and helpless.
CBT FOR DEPRESSION
Beck’s cognitive model for depression:
ESSENCE OF THERAPY: In CBT, patients are
taught cognitive and behavioral skills so
they can develop more accurate and
helpful beliefs and eventually become their
own therapists.
Typically delivered over 8-16 sessions.
COGNITIVE THEMES IN
DEPRESSION
LOSS: actual and perceived
Hopelessness
Helplessness
Negative view of self
Negative view of world
Negative view of future.
THERAPY PLAN FOR CBT
[DEPRESSION]
Initially work on how THOUGHTS influence
mood. [Monitor ANT’s and Modify ANT’s]
Then focus on daily activities that affect
mood.
Later address how interaction with others
affect the mood.
Use behavioral experiments.
Mood thermometer check
Cause and effect dynamics check
CBT FOR ANXIETY
DISORDERS
CBT FOR ANXIETY
DISORDERS
Look at mind body connection.
CLARK’S CBT MODEL FOR ANXIETY
DISORDERS:
Catastrophic misinterpretation of bodily
sensations.
The sensations are perceived as indication
of an impending disaster.
Maintained by selective attention to bodily
cues and safety behaviours.
Safety behaviours are usually excess and
avoidant in nature.
CBT FOR PANIC DISORDERS
 ANTECEDENT OR TRIGGER

PERCEIVED THOUGHT

CATASTROPH ANXIETY
IC
THOUGHTS
AND PHYSICAL
EMOTIONAL SYMPTOMS
DISTURBANC
ES
CBT FOR PANIC
DISORDERS
Assessment of the current problem.
Develop a basic information.
Assess the ANT’s
Check safety behaviours
Daily record of situations that might trigger
the anxiety.
Self reporting
Behavioral experiments
CBT FOR SPECIFIC PHOBIA
CBT FOR SPECIFIC PHOBIA
Make a list of situations, places or objects
that the client fears.
Build a fear ladder.
Facing fears through exposure.
Exposures should be planned, prolonged
and repeated.
Learning relaxation.
Practice repeatedly.
CBT FOR SUBSTANCE USE
 CBT FOR SUBSTANCE USE
The primary objectives of CBT are to:
1. Foster motivation for abstinence.
 CBT methods such as functional analysis, which
clarifies what the client stands to lose or gain
by using substances, can enhance the client’s
motivation to stop use.
2. Teach coping skills.
 This is the core of CBT to help clients
recognize the high risk situations in which
they are most likely to use substances and to
develop other, more effective, means to cope.
CBT FOR SUBSTANCE USE
3. Change reinforces.
 CBT focuses on identifying and reducing habits
associated with drug use by substituting positive
activities and rewards.
4. Foster management of painful feelings.
 CBT skills help the client recognize and cope with
urges to use substances and learn to tolerate other
strong feelings such as depression and anger.
5. Improve interpersonal relationships and social
supports.
 CBT trains the client in interpersonal skills and
strategies to help them increase their support
networks and build healthy relationships.