CBT

Theoretical Frame work

The cognitive model theorizes that disturbances in ones mood and behavior arise from dysfunctional thinking. Therefore, it is not the particular situation, but rather how the patient perceives the situation, that leads to a change in the patients mood. These situation-specic words and images that enter ones mind are called automatic thoughts. C T aims to help patients identify, challenge, and then modify these automatic thoughts in order to improve mood and behavior. !nderlying automatic thoughts are more global, generalized ideas about oneself, called core beliefs. These beliefs develop in childhood, and can be positive "e.g., #$ am likeable%& or negative "e.g., #$ am unworthy%&. These beliefs may e'tend to other people and the world. Core beliefs generally belong to one of two categories( helpless core beliefs and unlovable core beliefs. etween automatic thoughts and core beliefs are intermediate beliefs, a set of rules, attitudes, and assumptions that aim to reduce the negative impact of the core belief , but which may not be e'plicitly discussed in treatment. Typically, therapy begins with a focus on identifying and modifying automatic thoughts) later, the same is done for the underlying core belief.

INDICATIONS
mild to moderate ma*or depressive disorder and as ad*unct therapy along with medications for severe ma*or depressive disorders panic disorder, generalized an'iety disorder, bulimia nervosa, substance use disorders, and schizophrenia. +ther indications for which it has been e'plored include personality disorders, somatoform disorders, obsessive-compulsive disorder, posttraumatic stress disorder, and smoking cessation. ,atients who are ideal for C T are psychologically minded and are able to recognize their emotions and become aware of distorted thought patterns. -actors that suggest C T alone is not indicated include evidence of coe'isting schizophrenia, dementia, or substance-related disorders) medical illness or medication likely causing depression) poor reality resting) history of manic episode or family member with bipolar $ disorder) little evidence of cognitive distortions) and absence of precipitating environmental stresses.

Treatment structure
C T is a problem-oriented, short-term treatment that typically lasts between . and /0 sessions for uncomplicated cases, though more comple' or treatment-resistant cases may take longer. The focus is on the here and now, but a longitudinal perspective is used to develop a more complete understanding of the patient and his difficulties. The rst step in C T is a comprehensive history and mental status e'amination leading to a multia'ial diagnosis. The patient is educated about his illness and about the cognitive model. ecause this treatment may be new or different for the patient, it is important to understand his e'pectations about therapy and to socialize him into cognitive therapy.

C T is highly structured, and sessions often begin with a brief update and check on mood symptoms "and medications, if prescribed&. This is typically followed by #bridging% from the previous session) that is, reviewing the patients understanding and any pertinent issues. Then, an agenda is set, in which both patient and therapist identify important issues to address in the session. 1omework is a key element of C T and allows the patient to practice the techni2ues that have been learned in session throughout the week. $f completed, homework is reviewed in session. $f not completed, reasons for not completing it are e'plored and homework may be completed in session. -inally, sessions end with feedback3summary.

therapeutic Strategies
C T, as previously noted, has three components( didactic aspects, cognitive techni2ues, and behavioral techni2ues. 4idactic strategies are used to educate the patient about his illness and the treatment process. The ultimate goal in C T is for the patient to become his own therapist. +ne of the principles of C T is that when patients suffer from illnesses such as depression or an'iety, they are more likely to commit cognitive errors that lead to changes in mood and behavior. 5 list of common errors is included in Table 61./.7. ,atients can be taught to observe their thoughts, to recognize errors, and to replace dysfunctional thoughts with more realistic appraisals. This process is known as cognitive restructuring. Commonly used methods include 8ocratic 2uestioning, the keeping of thought records, e'amining the evidence, and cognitive rehearsal. ehavioral strategies are also used in C T. +ne e'ample is behavioral activation, in which patients are helped to choose one or two manageable activities that might change the way they feel and to develop a plan for carrying them out. ,atients rate activities on the sense of mastery and pleasure that they provide. +ther techni2ues include graded e'posure to feared situations, breaking down large tasks into smaller, more achievable ones, the scheduling of pleasant activities, and rela'ation training. 9,+:T5;T ,+$;T8 T+ :<9<9 <: C T was developed by 5aron T. eck to treat = patients with depression and an'iety disorders. $t has also been shown to be useful in the treat-ment of bulimia nervosa, substance abuse, and schizophrenia, among others.C T may be used as monotherapy in mild = to moderate ma*or depression, when antide-pressants have not been effective due to poor response or side effects, or when other psychotherapies have failed.The cognitive model, on which C T is based, = theorizes that problems with mood and behavior arise from dysfunctional automatic thoughts, which in turn are based on negative core beliefs about the self, others, and the world.C T uses a set of didactic, cognitive, and behav-= ioral strategies to help patients e'amine their thoughts, detect distortions, and replace them with more adaptive and realistic ones.The treatment is problem oriented and time = limited with structured sessions and emphasis on the here and now.1omework is a key element of C T that = allows patients to practice skills in real world situations.5n ultimate goal of C T is for patients to gain = the tools they need to act as their own therapists once treatment is complete.

T5 >< 61./.7 Cognitive <rrors 7. 5ll-or-nothing thinking( viewing a situation in black-and-white terms /. Catastrophizing( predicting negative outcomes without considering other, more likely, possibilities 6. 4iscounting the positive( telling oneself that positive e'periences or 2ualities do not count ?. <motional reasoning( assuming something is true because it #feels% true, despite evidence to the contrary .. >abeling( using 'ed, global labels for self or others without considering more reasonable alternatives @. 9agni cation3minimization( magnifying the negative and minimizing the positive when e'amining self, others, or a situation A. 9ental lter( focusing e'cessively on one negative detail instead of on the whole picture B. 9ind reading( assuming you know what others are thinking without considering other possibilities C. +vergeneralization( making sweeping conclusions that go beyond the current situation 70. ,ersonalization( believing other peoples behavior is a direct reDection on you without considering other e'planations 77. #8hould% and #must% statements( you have 'ed e'pectations of how you and others should behave and overestimate how bad it is if these are not met7/. Tunnel vision( you only see the negative aspects in a situation.