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Cognitive Behavioral Therapy:an overviewAmber Hammontree, LPCClinical TrainerGeorgia Families 360 GAPEC-1204-16March 20161
Learning objectives Understand the basic concepts of cognitivebehavioral therapy (CBT) Identify the symptoms/disorders that CBT is used totreat Understand evidence-based treatment Discuss the strengths and limitations of CBT as atreatment model2
What is cognitive behavioral therapy? Cognitive behavioral therapy (CBT) combines principals ofboth cognitive and behavioral therapies. Cognitive therapy emphasizes the role of thinking in “how wefeel and act.” Therapy focuses on:― Identifying negative patterns of thinking― How to change these unhealthy thoughts to healthier beliefsHealthy thoughts will then lead to more desirable reactions andoutcomes.3
What is cognitivebehavioral therapy? (cont.) Behavioral therapy focuses on replacing damaging habitswith pro-social behaviors through skill building. This is doneby:― Focusing on decreasing the connections between stimuli (people,situations or events) and negative reactions to them.― Learning and applying new skills to improve reactions.Additional approaches to CBTRational Emotive Behavior Therapy (REBT)Rational Living Therapy (RLT)Trauma Focused Cognitive Behavioral Therapy (TF-CBT)Dialectic Behavior Therapy (DBT)4
Basic principles of CBTCBT focuses on exploring the relationship between thoughts,feelings and behaviors.What we think affects how weact and feel.ThoughtWhat we feelaffects what wethink and do.FeelingsBehaviorWhat we do affectshow we think and feel.5
CBT terminology CBT views behavior as either "adaptive" or"maladaptive", "learned" vs "unlearned", and"rational" vs "irrational." Behavior that is rational meets these three criteria:̶ It is based on fact̶ It helps us achieve our goals̶ It helps us feel how we want to feel Behavior that does not meet these criteria is notrational.6
CBT fundamentals CBT believes that maladaptive thought patterns arecreated from faulty perceptions about others, theworld and themselves. Individuals interact with the world through theirpersonal view. If the individual’s view is incorrect ortheir reasoning is lacking, then emotions andbehavior may become disordered. CBT emphasizes the importance of individualslearning how to identify and change irrationalthought patterns that have a influenced theirbehavior.7
CBT fundamentals (cont.) This healthier thinking can lead to feeling better andreacting better even if people, situations or events donot change. CBT is generally a short-term treatment option thathas been shown to effectively help individualsovercome a wide variety of maladaptive behaviors/disorders. While other forms of therapy can take months oryears to resolve issues, CBT can achieve results in ashorter periods of time (a few weeks to a fewmonths).8
CBT fundamentals (cont.) Changes with CBT tend to occur faster due to directteaching by the therapist and routine homework for theindividual to complete outside of the therapy setting. The purpose of homework is to practice healthy ways ofthinking and reacting to people, situations or events. Homework assignments may make use of chartingthoughts/feelings/behavior to reinforce healthy ways ofthinking or practicing calming techniques such asrelaxation, visual imagery and affirmations.9
CBT fundamentals (cont.)It is important to understand that there are factors thataffect the length of CBT. These include: The condition of the individual at the start of treatmentThe number of symptoms and their severityThe individual’s motivation to succeedThe individual’s expectations10
Assessment In order to overcome maladaptive and irrational thoughts and behaviors, atherapist begins helping the individual identify the problematic beliefs andbehaviors. This is known as a functional assessment. A functional assessment is the process of uncovering unhealthy patternsof thought and how they impact self-destructive behaviors and beliefs.Example of a functional assessmentA n te ce d e n itsB e h a v io rsS h o rt-T e rmLo n g -T e rim{W h a t h a p p e n e d{W h a t d fd y o u d o )C o n se q u e n ce sC o n se q u e n ce s{W h a t w a s th e re su lt 1{W h a t w e re th e lastin gse co n d a n d X h o u rre su lts?)b e fo re ? )fo llo w in g th eb e h av io r? )1 to ld m y fo ste r m o m1 y e lle d b a ck a t h e r1 fe lt b e tte rfo rft/ly fo ste r m o m w o n 'tsta n d in g u p fo r m y se lftru st m e w h e n 1 te II h e rh o m e w o rk . 1 d id n 't d oa n d th e n 1 sta rte d toso m e th in g .m y h o m e w o rk an d sh efe e lb a d a b o u ty e llin gfo u n d o u t a n d ye lle d ata t h e r te llin g h e r a lie .th a t 1 d td n 'th a v e a n ym e.1 fe lt b a d fo r y e llin g a t1 cu t m y a rm w ith a p a ir1 fe lt at p e ace b e ca u se1 n o w h a ve m o re sca rsm y fo ste r m o m a n do f scisso rsfe lt a re le ase o fo n m y a rm . 1 h a ve tote llin g a liefru stra tio n .h id e m y a rm fro m m yfo ste r m o m so 1 w o n 'tg e t in to tro u b le .11
Assessment (cont.)During the assessment phase, the therapist may useother assessment methods, such as: Self-report symptom inventories: Beck DepressionInventory, Beck Anxiety Inventory, State-Trait AnxietyInventory Problem lists: The therapist will ask the individual toidentify 5 to 10 difficulties from the patient.12
Assessment (cont.)Example of a problem listProblemFeelings ofFrequencyOccurs 4 out of 7 daysworthlessnessSeverityImpactVery intense whenHighly distressing;present. Sometimesinfluences school workinvolves self-harmingand social/ relationshipsand suicidal thoughtsSocially IsolatedStay at home 6 out of 7Severe isolationHighly distressing;daysLimited social contacts;socially debilitating,stopped cheerleadingestrangedfrom peers/friendsFatigueOccurs dailyModerateto severeDecreased activity level,Impacts ability to focusfalls asleep in class,at school and whileinability to stay on taskcompleting homeworkand completeassignments.13
Treatment strategies Following the assessment phase, the therapist will teach theindividual how to identify distorted cognitions, how todiscriminate between their own thoughts and reality, learnabout how thinking influences their feelings and how tomonitor their own thoughts. The therapist will work with the individual by challengingmaladaptive thoughts and beliefs, teaching, modeling/roleplaying positive coping skills (i.e., problem solving,communication skills, relaxation skills, identifying alternativeactivities).14
Evolution of CBT Due to the increased focus on trauma and the use of traumasensitive treatment, a new form of CBT was developed. The goal of TF-CBT is to help address the biopsychosocialneeds of individuals who have suffered trauma. TF-CBT combines trauma-sensitive interventions withcognitive behavioral therapy. Additional information on TF-CBT will be presented in aseparate training.15
What is an evidence-based treatment? Evidence based interventions (EBIs) are treatments thathave been proven effective through outcomeevaluations. EBIs are treatments that are likely to be effective inaltering target behavior if executed in the manner inwhich it was designed/researched. EBIs are only useful for a specified range of problems,which means that the treatment provider must pair thecorrect treatment to the right situation.16
CBT as evidence-based interventionCBT is effective for a variety of conditions: Mood DisordersAnxietyAddictions/dependence (substance abuse, gambling)Attention Deficient Hyperactivity DisorderConduct disorders/oppositional defiant disorderLow self-esteemGrief and loss17
Examples of CBT use A 14 year-old male who has been struggling withcannabis abuse has frequent anger outbursts and isnoncompliant with simple requests. A 17 year-old female who is suffering fromdepression and low self-esteem participates in selfharm activities (cutting). She had a two prior suicideattempts.18
Examples where CBT would not beappropriate A 4-year old male who has been diagnosed with anexpressive language disorder and has frequent angeroutbursts and difficulty self soothing A 12-year old female who has a below average IQand struggles with processing information becomesfrustrated and bangs her head against the wall andscratches herself19
Strengths of CBT CBT is instructive and structured (teaches/skills building) CBT is a short-term treatment option CBT emphasize getting better rather than feeling better(correcting the underlying behavior creates long-term results) CBT is cross-cultural (based on universal laws of humanbehavior) and uses client focused goals CBT can be researched (techniques are clearly defined)20
Limitations of CBT CBT may not be effective for individuals with more complexmental health issues or those with learning difficulties becausethe client needs to have the capacity to bring change tothemselves. CBT can be used with children, adolescents and adults, but tendsto work best with older children and teens. CBT has a narrow focus and ignores important issues like family,personal history and wider emotional problems. Attending regular CBT sessions and carrying out extra workbetween sessions can be time consuming. CBT focuses on the “here and now” so it may not address thepossible underlying causes of mental health conditions.21
Resources National Alliance on Mental erapy The Anxiety e-behavioral-therapy Mayo 4 The American Institute for Cognitive aspx22
Questions23
Cognitive Behavioral Therapy, Amerigroup, Georigia Families 360, Basic principles of CBT, CBT terminology, CBT fundamentals, Assessment, Treatment strategies, Evolution of CBT, evidence-based treatment, CBT as evidence-based intervention, CBT use, Strengths of CBT, Limitations of CBT,
