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10 Basic Principles of CBT

Cognitive Behavior Therapy: CBT - Therapy and Therapists: An excerpt from the first chapter of Cognitive Behavior Therapy: Basics & Beyond (2nd Edition, 2011): The basic principles of ...

 

  1. #1
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    10 Basic Principles of CBT

    An excerpt from the first chapter of Cognitive Behavior Therapy: Basics & Beyond (2nd Edition, 2011):

    The basic principles of cognitive behavior therapy are as follows:

    Principle No. 1. Cognitive behavior therapy is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms.


    I consider Sally’s difficulties in three time frames. From the beginning, I identify her current thinking that contributes to her feelings of sadness ("I’m a failure, I can’t do anything right, I’ll never be happy"), and her problematic behaviors (isolating herself, spending a great deal of unproductive time in her room, avoiding asking for help). These problematic behaviors both flow from and in turn reinforce Sally’s dysfunctional thinking. Second, I identify precipitating factors that influenced Sally’s perceptions at the onset of her depression (e.g., being away from home for the first time and struggling in her studies contributed to her belief that she was incompetent). Third, I hypothesize about key developmental events and her enduring patterns of interpreting these events that may have predisposed her to depression (e.g., Sally has had a lifelong tendency to attribute personal strengths and achievement to luck, but views her weaknesses as a reflection of her "true" self)...

    Principle No. 2. Cognitive behavior therapy requires a sound therapeutic alliance.

    Sally, like many patients with uncomplicated depression and anxiety disorders, has little difficulty trusting and working with me. I strive to demonstrate all the basic ingredients necessary in a counseling situation: warmth, empathy, caring, genuine regard, and competence. I show my regard for Sally by making empathic statements, listening closely and carefully, and accurately summarizing her thoughts and feelings. I point out her small and larger successes and maintain a realistically optimistic and upbeat outlook. I also ask Sally for feedback at the end of each session to ensure that she feels understood and positive about the session...

    Principle No. 3. Cognitive behavior therapy emphasizes collaboration and active participation.

    I encourage Sally to view therapy as teamwork; together we decide what to work on each session, how often we should meet, and what Sally can do between sessions for therapy homework. At first, I am more active in suggesting a direction for therapy sessions and in summarizing what we’ve discussed during a session. As Sally becomes less depressed and more socialized into treatment, I encourage her to become increasingly active in the therapy session: deciding which problems to talk about, identifying the distortions in her thinking, summarizing important points, and devising homework assignments.

    Principle No. 4. Cognitive behavior therapy is goal oriented and problem focused.

    I ask Sally in our first session to enumerate her problems and set specific goals so both she and I have a shared understanding of what she is working toward. For example, Sally mentions in the evaluation session that she feels isolated. With my guidance, Sally states a goal in behavioral terms: to initiate new friendships and spend more time with current friends. Later, when discussing how to improve her day-to-day routine, I help her evaluate and respond to thoughts that interfere with her goal, such as: My friends won’t want to hang out with me. I’m too tired to go out with them. First, I help Sally evaluate the validity of her thoughts through an examination of the evidence. Then Sally is willing to test the thoughts more directly through behavioral experiments in which she initiates plans with friends. Once she recognizes and corrects the distortion in her thinking, Sally is able to benefit from straightforward problem solving to decrease her isolation.

    Principle No. 5. Cognitive behavior therapy initially emphasizes the present.

    The treatment of most patients involves a strong focus on current problems and on specific situations that are distressing to them...Therapy starts with an examination of here-and-now problems, regardless of diagnosis. Attention shifts to the past in two circumstances. One, when patients express a strong preference to do so, and a failure to do so could endanger the therapeutic alliance. Two, when patients get "stuck" in their dysfunctional thinking, and an understanding of the childhood roots of their beliefs can potentially help them modify their rigid ideas. ("Well, no wonder you still believe you’re incompetent. Can you see how almost any child— who had the same experiences as you—would grow up believing she was incompetent, and yet it might not be true, or certainly not completely true?")

    Principle No. 6. Cognitive behavior therapy is educative, aims to teach the patient to be her own therapist, and emphasizes relapse prevention.

    In our first session I educate Sally about the nature and course of her disorder, about the process of cognitive behavior therapy, and about the cognitive model (i.e., how her thoughts influence her emotions and behavior). I not only help Sally set goals, identify and evaluate thoughts and beliefs, and plan behavioral change, but I also teach her how to do so. At each session I ensure that Sally takes home therapy notes— important ideas she has learned—so she can benefit from her new understanding in the ensuing weeks and after treatment ends.

    Principle No. 7. Cognitive behavior therapy aims to be time limited.

    Many straightforward patients with depression and anxiety disorders are treated for six to 14 sessions. Therapists’ goals are to provide symptom relief, facilitate a remission of the disorder, help patients resolve their most pressing problems, and teach them skills to avoid relapse. Sally initially has weekly therapy sessions. (Had her depression been more severe or had she been suicidal, I may have arranged more frequent sessions.) After 2 months, we collaboratively decide to experiment with biweekly sessions, then with monthly sessions. Even after termination, we plan periodic "booster" sessions every 3 months for a year.

    Not all patients make enough progress in just a few months, however. Some patients require 1 or 2 years of therapy (or possibly longer) to modify very rigid dysfunctional beliefs and patterns of behavior that contribute to their chronic distress. Other patients with severe mental illness may need periodic treatment for a very long time to maintain stabilization.

    Principle No. 8. Cognitive behavior therapy sessions are structured.

    No matter what the diagnosis or stage of treatment, following a certain structure in each session maximizes efficiency and effectiveness. This structure includes an introductory part (doing a mood check, briefly reviewing the week, collaboratively setting an agenda for the session), a middle part (reviewing homework, discussing problems on the agenda, setting new homework, summarizing), and a final part (eliciting feedback). Following this format makes the process of therapy more understandable to patients and increases the likelihood that they will be able to do self-therapy after termination.

    Principle No. 9. Cognitive behavior therapy teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.

    Patients can have many dozens or even hundreds of automatic thoughts a day that affect their mood, behavior, and/or physiology (the last is especially pertinent to anxiety). Therapists help patients identify key cognitions and adopt more realistic, adaptive perspectives, which leads patients to feel better emotionally, behave more functionally, and/or decrease their physiological arousal. They do so through the process of guided discovery, using questioning (often labeled or mislabeled as "Socratic questioning") to evaluate their thinking (rather than persuasion, debate, or lecturing). Therapists also create experiences, called behavioral experiments, for patients to directly test their thinking (e.g., "If I even look at a picture of a spider, I’ll get so anxious I won’t be able to think"). In these ways, therapists engage in collaborative empiricism. Therapists do not generally know in advance to what degree a patient’s automatic thought is valid or invalid, but together they test the patient’s thinking to develop more helpful and accurate responses...

    Principle No. 10. Cognitive behavior therapy uses a variety of techniques to change thinking, mood, and behavior.

    Although cognitive strategies such as Socratic questioning and guided discovery are central to cognitive behavior therapy, behavioral and problem-solving techniques are essential, as are techniques from other orientations that are implemented within a cognitive framework. For example, I used Gestalt-inspired techniques to help Sally understand how experiences with her family contributed to the development of her belief that she was incompetent. I use psychodynamically inspired techniques with some Axis II patients who apply their distorted ideas about people to the therapeutic relationship...

    The emphasis in treatment also depends on the patient’s particular disorder(s). Cognitive behavior therapy for panic disorder involves testing the patient’s catastrophic misinterpretations (usually life- or sanity-threatening erroneous predictions) of bodily or mental sensations. Anorexia requires a modification of beliefs about personal worth and control. Substance abuse treatment focuses on negative beliefs about the self and facilitating or permission-granting beliefs about substance use.
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  2. 2 members thanked Daniel for this post:

    David Baxter (July 5th, 2011),Turtle (July 6th, 2011)

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  4. #2
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    Re: 10 Basic Principles of CBT

    Can CBT be used for people who do not have mental illness, but who want help to change the way they feel about and handle a complicated, difficult, and long-time ongoing situation? I am asking this because someone asked me if CBT could help them change the way they feel and react to help relieve the stress and pressure she has in the situation, which is one she can't walk away from. I told her I didn't know so I said I would try to find out. I told her it has helped me, but then I have depression and anxiety, so maybe that's different?
    Thanks,
    B

  5. #3

    Re: 10 Basic Principles of CBT

    It would almost always open up new possibilities and options for most people in a challenging situation, or present some new coping tools. So with that in mind I'd be inclined to say yes.
    David Baxter and Bumblebean like this.

  6. 2 members thanked MHealthJo for this post:

    Bumblebean (May 18th, 2014),David Baxter (May 18th, 2014)

  7. #4
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    Re: 10 Basic Principles of CBT

    Quote Originally Posted by MHealthJo View Post
    It would almost always open up new possibilities and options for most people in a challenging situation, or present some new coping tools. So with that in mind I'd be inclined to say yes.
    Thanks MHealthJo, that was kind of what she and I were thinking, to find tools that would help her.



    BB

  8. #5

    Re: 10 Basic Principles of CBT

    Yes, definitely. These are tools that can help anybody deal more effectively with life, other people, and their own reactions.
    Bumblebean likes this.

  9. Members who thanked David Baxter for this post:

    Bumblebean (May 19th, 2014)

  10. #6
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    Re: 10 Basic Principles of CBT

    Thank you, David. My friend has been holding off, but now is feeling way more comfortable with the idea of making an appointment. She has decided she wants to see a private therapist, which I guess would make more sense than going to her local mental health office. Private therapy isn't the kind of thing that's in my budget, so I have no experience to share with her, and this is probably a really silly question, but is there anything she should ask or be looking for on her first visit that would help her know if it's going to be a good match? She said the info she got on the person she wants to see was that she could expect quick result, and maybe for people without mental health problems that's the way it works, so is that a fair expectation?

    I think I ask way too many questions, but as you can likely tell I care about my friend and want her to have good results and a good experience. Over all the years I've been with mental health services I have a couple of times talked to psychiatrists who were not a good match for me - not to say it's their fault, we just didn't click - and it was like sandpaper on my brain, and especially since she'll be paying a lot for the sessions and if it doesn't go well she might back off and not try someone else, I'm trying to find out everything I can in advance to give her confidence as well as info. Anyway, I definitely talk way too much, so I'll just say thanks and leave it there. I really appreciate the help in helping my friend.

    BB

  11. #7

    Re: 10 Basic Principles of CBT

    Recommendations of friends who know you, or a family doctor who knows you, can help, but it may require a bit of trial and error sometimes to find the right match.
    Bumblebean likes this.

  12. Members who thanked David Baxter for this post:

    Bumblebean (May 21st, 2014)

  13. #8
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    Re: 10 Basic Principles of CBT

    Thank you again David. I think she does know a couple of people who talked about this therapist and were happy with the results. I guess she'll know soon enough if it's a good match, and if it doesn't work out, she might hold off a bit, but likely will try again after a bit.

    BB
    David Baxter likes this.

  14. #9
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    Re: 10 Basic Principles of CBT

    I just got a call from my friend and I'm very glad to be able to say that the appointment went really well. She's feeling a little bit overwhelmed, but in a good way.

    Thanks again



    BB
    Turtle and David Baxter like this.
    The way to do is to be - Lao Tzu

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