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Awareness of CBT

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carl willis

on 10 March 2016

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Transcript of Awareness of CBT

Awareness of Cognitive Behaviour Therapy
Carl Willis
- Domestics
- Plan for the day
- Group Contract
- Introductions
- Fear and Hopes exercise
Discuss in groups of three:

What is Cognitive Behaviour Therapy?
Cognitive Behaviour Therapy is a form of...


'Counselling provides a regular time and space for people to talk about their troubles and explore difficult feelings in an environment that is dependable, free from intrusion and confidential. A counsellor should respect your viewpoint while helping you to deal with specific problems, cope with crises, improve your relationships, or develop better ways of living.'

How many counselling models are there?
460 Models of Counselling

But there are three main branches...

In small groups of 3 or 4, do you know what
the main branches of counselling are?
Psychodynamic Branch (early 1900's)
Cognitive Behaviour Branch (1950's)
Humanistic Branch (1950's)

Sigmund Freud
Anna Freud
Melanie Klein
Carl Jung
Donald Winnicott
Main Aspects

Importance of the past/childhood
Defense Mechanisms
Importance of primary care givers
Focus on the Unconscious

More aloof and distant
More expert stance
3 - 5 times a week
Long term can last years

Object Relations
Attachment theory

Carl Rogers
Abraham Maslow
Fritz Perls
Main Aspects

Focus on present
Focus on whole person
Focus on client perspective

More equal
once per week
Core conditions



B Skinner
A Beck
A Ellis
Main Aspects

Challenging irrational thoughts
Setting goals
Miracle Question
Testing beliefs
Challenging behaviour

Once a week
More scientific
Focus on present and future

Cognitive Therapy
Behaviour Therapy
Solution Focused Therapy
Senior Lecturer Counselling (BAES)
History of Cognitive Behaviour Therapy

- Behaviourism
- Pavlov's dog (1849) classical conditioning
- Watson (1878) Little Albert experiment
- Conditioned responses could be made extinct

Thinking of Phobias....
- in pairs, think of the following phobias
dogs, the dark, spiders, public speaking, snakes
going out, being alone, blood, confined spaces

How might they have developed?
Behaviourism continued..

- Skinner (1904)
- Experiments on animals
- Behaviour will be repeated if there is a reward
- Behaviour will not be repeated if there is an unpleasant outcome
- Reinforcers - positive and negative

In pairs - when have you applied this with people in your life
Behaviourism today...

- Wolpe (1915) created behavioural methods to
relieve psychological problems
- progressive relaxation training
- systematic desensitisation
- less focus on introspection of other approaches
- focus on learning new behaviours
- focus on counter conditioning
- clients active participants in their therapy
Behaviourism continued.

- Basic aim of this type of counselling is to enable clients to execise more control over their behaviour

- inital assessment includes
- the problem/issue
- sequence of events following issue
- factors which may have caused issue
- client's actions
- how frequently issue occurs
- duration and intensity of the issue
- any factors which worsen or relieve the issue
- what effect does this have on work/social life
- who else is effected?
In pairs, think of an issue you have had and think of the questions with regard to this
Behavioural Methods

- systematic desensitisation
- homework task of worrying for a set time
- client self monitoring
- practising and planning behaviour
- assertiveness training
- social skills training
- reinforcement methods
- modelling
- focus on physical exercise and nutrition
- imagery and visualisation
- relaxation training
An invitation - I will now go through a guided relaxation exercise
People who benefit from behaviourism

- Lack of assertiveness
- Phobias
- Depression
- People with OCD
- People who suffer from stress

Weaknesses of behaviourism

- Sometimes issues are deep seated
- If underlying unsecurity is not addressed, it may come back
- Oversimplied and mechanistic view of people
Rational Emotive Behaviour Therapy

Albert Ellis (1913) believed that psychodynamics and behaviourism had much in common.

However, he felt that there was something missing.

He felt that much emotional disturbance comes from negative thinking (or cognition).

He believed that language is key and important.

For example, a man is made redundant, discuss in pairs how the man is likely to feel
'Men are not disturbed by things but by the views they take of them' (Epictetus, 55 A.D.)
Activating Event
Something happens
Beliefs about what happened
These can be rational or irrational
Emotional and behavioural
Rational Emotive Behaviour Therapy

- Ellis believed that people are largely responsible for their negative feelings
- Irrational thinking is seen as a cause of disturbance
- Clients are encouraged to think rationally
- He believes clients often subscribe to irrational beliefs.
ABC model of personality
Irrational Beliefs

- I should always be loved and approved of by everyone
- In order to be worthwhile, I have to be good at everything
- Bad people, including myself, should be punished
- If things are not the way I want them to be, it's a disaster
- I have no real control over my problems which are caused by external factors
- I need to keep reminding myself of the awful things that may happen
- It's easier to avoid problems than face them
- I always need someone stronger to take care of me
- I can't change my behaviour because of my awful past
- I should always become emotionally engaged in other people's problems
(Adapted from Ellis 1962)
In pairs, discuss any of these you have had throughout the course of your life
Irrational thinking continued..

- Ellis believed that clients often overuse the words 'should and must'
- Clients believe that people 'should' treat them a certain way
- Clients believe that they 'must' be good at certain things
- Clients believe they 'should have' done better
- Clients are encouraged to change the language they use to say 'want', 'choose' or 'I would prefer'
- These should/must words can make people feel unnecessarily burdened, sad and angry
'Musts and Shoulds'

I should do the washing up

I would like to do the washing up as I don't want my kitchen to look at mess

I must go to work now

It's better for me to go to work now as I don't want to get the sack

I should have called my mum yesterday

I wish I had called my mum yesterday
In Pairs, when do you use should, and when could you change it
How clients are helped

- Clients are taught the ABC model
- Clients are encouraged to change their must/should thinking
- Clients are encouraged to identify their own irrational beliefs
- Clients are encouraged to monitor and record their progress
- Clients may be given homework tasks
- Role-play might also be used
- Semantic correction might be used
e.g. 'client: my wife always lets me down
Counsellor: always lets you down?
client: well, not always but quite often
Who benefits from this approach?

- Clients who are unassertive
- Clients with depression or anxiety


- Little focus on the past so unresolved childhood trauma may not be addressed
- Although approach can bring fast results, results may not be permanent
- Therapy is directive and may threaten people who may feel controlled by the approach
- Sometimes therapists do not show enough empathy to clients and they feel patronised
Cognitive Therapy

Beck (1979) believed that clients distress themselves by making 'common errors' in their thinking. These thoughts often happen automatically and are often referred to as NATS or negative automatic thoughts.
- All or Nothing thinking
- Overgeneralising
- Discounting the positives
- Jumping to Conclusions
- Mind reading
- Fortunetelling
- Magnifying/minimising
- Making 'should' statements
- Emotional Reasoning
- Labelling
- Inappropriate Blaming
In pairs, discuss which of these thinking errors, you are most likely to engage in
Cognitive Therapy

Beck believed that clients often have core beliefs about themselves

He believed that events could trigger these painful beliefs

He also believed that therapists could help clients identify these core beliefs and change them

I am helpless I am weak
I am inadequate I am defective
I am a failure I am powerless
I am unlovable I am not good enough
I am unlikeable I don't belong

In pairs, discuss if you think you know someone who may have these ore beliefs (don't mention names)
Cognitive Therapy

Beck also believed that if clients had certain core beliefs they may behave in certain ways to protect themselves from these beliefs. These are known as compensatory strategies

Someone who thinks they are weak may seek to control everything

Someone who thinks they are unlikeable may avoid confrontation

Someone who thinks they are inadequate or defective may strive for perfection

Someone who thinks they are unloveable may seek love and intimacy at any cost

CBT often holds that clients create self-fulfilling prophecies - a viscious cycle

In pairs, do you know of someone or a child who engages in this behaviour? (Don't mention names)
Cognitive Therapy

Clients are encouraged to write thought journals

You have been provided with a blank thought journal. Please look at this now

They are encouraged to think of an upsetting event and then record the emotions that followed with the percentages

They are then encouraged to write the automatic thoughts that accompanied the thoughts with percentages

They are then asked to identify any thinking errors

Once they identify thinking errors, they are asked to provide more rational thoughts and then record the effects these have on their emotions - usually once they challenge their negative thinking - their negotive emotions become less
Please look at the case study you
have been provided with

In pairs, look at the case study and
thought journal and try to identify
any thinking errors
There is a case study in your pack -
look at this thought journal and first
identify any distorted thoughts.

In groups of 3, try to write alternative
more rational thoughts

Discuss what these rational thoughts might
have on the client?
Find the blank thought journal you have been given

Think of a situation that you found a little distressing

Write down the emotions and thoughts that
ocurred during the event

Once completed, try to identify if there were
any thinking errors, if so, what other thoughts
could you change them to?
Challenging automatic thoughts..

What is the evidence?
What might happen?
What is the worst that could happen?
Can you survive it?
What would you tell a friend if the
situation was happening to them?
What is the best way forward?
Solution-Focused Therapy

- A very new approach
- Focuses on solutions not problems
- Therapist often normalises the client's
- Positive change is amplified and acknowleged
- Therapists use the 'miracle question'

In pairs, discuss a problem you might have,
and imagine that you went to bed and during the night a miracle occurred and your problem was gone,
how would you know the problem was solved and what would have changed?
We have looked at the Cognitive Behavioural branch:

Behaviour therapy
Cognitive therapy
Rational Emotive Behaviour therapy
Solution focused therapy

A Cognitive Behaviour Therapist may use
tools and techniques from all the above models

173 million pounds a year is being spent on
providing NHS patients with Cognitive Behaviour Therapy

Most counsellors in the country are known as integrative therapists which means they use tools and techniques from different branches, i.e. Humanistic and Cognitive Behavioural


Hough, M (2010) Counselling Skills and Theory, Norfolk:Hodder Education

Diploma in Cognitive Behavioural Therapy (2000) Glasgow: Institute of Counselling


Who else uses CBT techniques?

Mental Health Nurses
Social Workers

Cognitive Therapy has shown to be effective with the following:

People with depression/anxiety
Eating disorders
People with alcoholism
People with OCD
Clusters of thinking errors

All-or-nothing thinking, emotional reasoning, overgeneralising, magnifying/minimising, labelling, fortune telling.

All or nothing thinking, inappropriate blaming, emotional reasoning, making 'should' statements, discounting the positives, overgeneralising, magnifying, jumping to conclusions, mind-reading, fortune telling

All or nothing thinking, inappropriate blaming, emotional reasoning, making 'should' statement, overgeneralising, jumping to conclusions, mind reading.

All or nothing thinking, emotional reasoning, making
'should' statements, magnifying, mind-reading

All or nothing thinking, inappropriate blaming, mind-reading, fortune telling, jumping to conclusions

All or nothing thinking, emotional reasoning, making 'should' statements, discounting the positives, overgeneralising, magnifying, jumping to conclusions, mind reading, fortune telling

New Trends - Mindfulness

- originates in Buddhist meditation
- CBT has tended to challenge negative thinking with more rational thoughts
- Mindfulness doesn't challenge thoughts
- it accepts thoughts without judgment
- tries to take a dispassionate objective stance
- in some ways tries to spend time each day not engaged in thinking
- clients are encouraged either on their own or groups to engage in mindfulness
- The mind is like an uncontrolled yapping dog
For the next 3 minutes, let's sit in silence, as an experiment. Try to think of nothing but if thoughts come, accept them, be aware of them, don't try to fight them - act as a curious observer
Awareness of CBT week 2

Cognitive Therapy
Full transcript