The Cognitive Behavior Therapy Workshop Nuts & Bolts for Beginners and Seasoned APNs Kathleen McCoy DNSc APRN, PMHNP-BC, PMHCNS-BC, FNP-BC, FAANP Pamela Lusk DNP PMHNP-BC FAANP Ruth Milstein DNP PMHNP-BC LPC Disclosure: Dr. McCoy is a consultant with Otsuka Treatment team for Schizophrenia 1
CBT Basic Assumptions Relationship between client and therapist is collaborative Psychological distress is a function of disturbances in cognitive processes Focus is on changing cognitions to produce desired changes in affect and behavior Focus is present-centered and time-focused Therapist is active and directive Courtesy Cynthia Handrup and Kathleen McCoy 2
Basic Concept of Cognitive Therapy Psychological problems stem from common disturbances on cognitive process: Faulty thinking Making incorrect inferences Failing to distinguish between fantasy and reality 3
Triad for Automatic Thoughts Thoughts Feelings Behavior 4
Some Applications of CBT Depression PTSD Substance Abuse, Smoking cessation Medication Adherence Anxiety, Panic Disorder, PTSD Eating Disorders Sleep Disorders, Insomnia OCD, Phobias Anger Management Symptom management in long-term medical conditions, IBS, Arthritis, Diabetes, Cancer * 5
Research Supporting Effectiveness of CBT Most researched psychotherapy to date Comparative Outcome Studies conducted evaluating the effectiveness of: CBT vs. psychotropic medication CBT vs. supportive psychotherapy CBT vs. psychodynamic psychotherapy 6
Limitations of CBT Psychotic Disorders Patient unstable or in severe emotional distress Non-cooperative patient Those unwilling or without insight Patients with Borderline Personality Disorder 7
Major Contributions Historic Psychoanalytic foundation (!) context: Techniques used in non-cbt psychotherapy Gestalt Dream work etc Decrease use of addictive medications (sleeping pills, benzodiazepines) in the treatment of insomnia and anxiety disorder 8
Automatic thoughts Cognitive distortions Faulty assumptions and misconceptions Individuals in emotional distress tend to commit characteristic logical errors or assumptions Examine cognitive errors commonly leading to faulty assumptions and misconceptions 9
Arbitrary Inferences Conclusions without supporting and relevant evidence Catastrophizing Negative assumptions: presuming the very worst outcome for any situation Concretization: All or nothing thinking: looking at things in absolute, black and white categories Assumong that endpoints will turn out badly 10
Selective Abstraction Forming conclusions based on an isolated detail of an event The significance larger context is missed The only significant information is failure/ deprivation Measure of personal worth by errors/ weaknesses, not positive attributes/successes 11
Overgeneralization Extreme beliefs based on single event with generalization to every event and situation, regardless of difference A negative event seen as a permanent pattern of defeat 12
Magnification and Minimization Perceiving a case or situation in a greater or lesser light than it truly deserves Blowing situations out of proportion or shrinks importance 13
Personalization Relates external events to themselves, even without a basis for the connection Blaming oneself for anything not entirely responsible for Blaming others for things they are not responsible (projection) 14
Labeling and Mislabeling Portraying one s identity on the basis of imperfections/mistakes and allowing ones identity to be formed by such Identifying with one s shortcomings only Extreme form of all or nothing thinking Can also apply labels to others 15
Dichotomous Thinking Categorizing experiences in either-or extremes Polarized thinking, events labeled in black or white terms Identifying one s shortcomings, without room for human error/frailty or a mistake 16
The cure: a question What the evidence for _(such a thought)? Asks patient to be a detective; examine automatic thoughts using a Socratic-type dialogue, gathering data on assumptions they make, and forming alternative interpretations 17
Examples of Automatic Thoughts I made a mistake, therefore I m a failure I will fail and this will be unbearable I ll be so upset, I will not be able to work 18
More Examples I did not get into the graduate program at. I ll never get into a program I passed the course, but I got lucky I m a failure, because she is more successful than I am 19
More Examples What if I have a heart attack? The reason we have marital problems is because my husband is totally unreasonable I ve blown my diet; I ll never lose weight 20
Basic Concept of Cognitive Therapy Great deal of research evidence in support of CBT Comparative Outcome Studies conducted evaluating the effectiveness of: CBT vs. psychotropic medication CBT vs. supportive psychotherapy CBT vs. psychodynamic psychotherapy 21
Thank you Kathleen, Pam and Ruth 22