CBT

Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane
Cognitive behavioural therapy (CBT)

Introduction
Developed by Beck in the 1960s
Treatment is based on the idea that disorder is caused not by events, but by the view that
people take of events
It is a short-term, collaborative therapy, focused on current problems, whose goals are
symptom relief and development of new skills
Rationale
Behaviours and emotions are determined by the persons cognitions
Some pathological emotions are as a result of cognitive errors
While underlying emotions are not amenable to examination and behavioural change, the
cognitions are
If the person can be helped to understand the connection between cognitive errors and
distressing emotions, they can try methods of change
CBT aims to change the way you feel by changing the way you think
How illness is viewed: in some personality types and in mental illness there are errors in
the perception of risk, logical errors and errors in the processing of information (i.e.
cognitive distortions). These distortions relate to (1). self, (2). the world, (3) the future. =
Becks cognitive triad
Examples of negative core beliefs (i.e. cognitive distortions)
Such cognitive distortions arise from early traumatic experiences and childhood learning
and show 4 basic types of error:
o Arbitrary inference: always drawing the worst conclusions from a situation
o Selective abstraction: focusing on the worst aspects of a situation
o Over-generalisation: drawing general conclusions about personal worth from one
example
o Minimization and magnification: performance is underestimated and errors are
overestimated
Cognitive errors thus lead to dysphoria and maladaptive behaviour
Biological inheritance affects early learning, the two contributing to the development of core beliefs
(B1), for example: To be an acceptable human being, a woman must have a happy home and family.
An activating event (A) in the present e.g. an argument in the family triggers the core belief (B 1),
generating current thinking (B2) e.g. "I am failing to keep my family happy" which in turn creates
emotions and behaviours (C) in this case, low mood and neglecting self-care to meet the needs of
other family members.
This low mood and self-neglect compound the

problem, further lowering of mood. There may
also be ongoing activating events of a negative
nature (e.g. family strife). This combination
creates the possibility that the low mood may
eventually develop into a clinical depression
Techniques
The therapist is very active in CBT
The patient and therapist are viewed as
working together in a therapeutic
alliance to explore the problem and
solutions (collaborative empiricism)
1
Anxious temperament stress at work
Lack of peer friendships loose job
Triggering factor
Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane- dad shouting
CBT is a goal orientated therapy in which the therapist assists the patient to:
o Monitor cognitions Feelings
- anxiety
o Identify and challenge cognitive errors and negative automatic thoughts
o Understand maladaptive schema
o Explore with the therapist strategies to challenge and change cognitions and examine
Thoughts Physical effects
the resultant symptomatic effects
I will vomit abdominal pain
Behavioural techniques:
Everyone will Nausea
laugh at me
o Activity and pleasant event scheduling
o Graded task assignments
o Exposure and response prevention
o Distraction
Behaviours
o Relaxation training - avoidance
o Assertiveness
o Social skills training
Cognitive techniques:
o Psychoeducation
o Including reading assignments (e.g. Coping with Depression)
o Identifying automatic thoughts and cognitive errors
o Socratic questioning (e.g. if that were true, what would it mean.and what would
that mean.etc?)
o Role play
o Imagery
o Diary (for thoughts)
o Examining the evidence (e.g. lets suppose that is true what happens then?)
o Examining advantages and disadvantages
o Thought reversal
o Generating rational alternatives
o Coping cards which identify a specific situation/problem and detail a coping strategy
Phases of treatment
Approx 12-20 sessions
Initial assessment followed by 6-20 hour long sessions
Clinical attention is primarily focused on events in the here and now
Each session generally proceeds as follows:
o Deal with emergencies
o Jointly set agenda
o Review homework task
o Feedback
o Focus on specific items guided by current problems
o Suggestion of cognitive or behavioural techniques to challenge automatic
thoughts/core schema
o Give homework
Indications
CBT is an active treatment requiring patient understanding and collaboration. Patients
should therefore be motivated and be able to link thoughts and emotions
Mild to moderate depression (as least as effective as pharmacotherapy)
Eating disorders (anorexia nervosa and bulimia nervosa)
Anxiety disorders
In selected patients, may have a role in personality disorders, substance misuse and in the
management of chronic psychotic symptoms

CBT

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Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

Cognitive behavioural therapy (CBT)

This low mood and self-neglect compound the

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