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Cognitive Behavioral Therapy/Techniques

NURS 329 Psychiatric Mental Health Nursing

Objectives Describe the interaction between

thoughts, behaviors, and feelings. Describe the aims and 4-step process

of CBT Identify cognitive distortions Recognize treatment strategies used

in CBT

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Terms Cognitive behavioral therapy (CBT) is a

therapeutic approach that addresses the relationship among thoughts, feelings, behaviors, & physiology.

Cognitive distortions are inaccurate, irrational thoughts.

Cognitive restructuring is the examination & reframing of one’s interpretation of the meaning of an event.

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Psychologic Effects of Stress Research documents a relationship exists

between high stress levels, negative mood states, a person’s cognitive coping style & the importance of interventions that control these states in person’s with chronic diseases.

History of CBT Principles Introduced officially in 1979 by Aaron T.

Beck, but actually started as early as 1964 by Beck and principles were appearing in the 50’s and 60’s (desensitization and relaxation training)

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2 central tenets “cognitions have a controlling

influence on our emotions and behavior”

“how we act or behave can strongly affect our thought patterns and emotions”

(Wright, Basco, & Thase, 2006, p. 1)

Interacting Systems in Human Behavior

Aims of CBT Increasing a desired activity Reducing unwanted behavior Increasing pleasure Enhancing social skills

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The Process of CBT Cognitive restructuring to help

people experience a range of feelings when they are stuck in powerful negative mood states.

The health care provider acts as a guide in the process.

The client performs the intervention on themselves.

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CBT Process The process contains 4 Steps.

– Awareness– Automatic Thoughts– Cognitive Distortions/errors– Choosing Effective Coping

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Identifying Emotions The way we feel is very important. Positive

feelings promote health while negative feelings contribute to ill health.

Family & cultural influences determine how we deal with & express emotions.

Exaggerated emotions interfere with good problem solving & can require the need of someone to assist in processing these emotions to attain a good outcome.

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Automatic Thoughts

Automatic thoughts occur in response to a situation. – A.Beck talks about Automatic Thoughts – A.Beck part 2

Common characteristics of AT include:– Knee-jerk responses to perceived stressor.– Usually negative in content– Quick, fleeting, a kind of shorthand is involved– Usually these thoughts are not in our conscious

awareness– Often these thoughts are unrealistic, illogical, &

distorted.

What are some examples of automatic thoughts?

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Relationships Between Thoughts & Emotions

Cognitive restructuring (CR) allows the person to become aware of the emotions & automatic thoughts related to a particular emotion & its connection to stress.

When the person focuses on the underlying themes it allows them to reflect on the meaning and choose how they want to respond.

Through CR the person can learn to reduce the intensity, frequency & length of time these distortions are experienced.

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Relationship Between Thoughts & Emotions

The goal is to help the person become aware of the relationship between emotional themes to stress triggers & cognitive distortions.

Journal keeping that reflects on the thoughts & feelings related to stressful events is a valuable way to identify automatic thoughts & underlying emotions.

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Automatic Thoughts Stop, take a breath & Reflect. Ask:

– What is going on?– How do I feel?– What are my automatic thoughts? Do

they contain “shoulds, always, oughts, and nevers?”

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Cognitive Distortions 10 General Categories:

– All or Nothing (dichotomous) Thinking -all good or all bad

– Overgeneralization- never ending in nature– Mental filtering- awfulizing the situation– Disqualifying the positive- rejecting the positive– Jumping to conclusions- mind reading expected– Magnification- exaggerating the outcome– Emotional reasoning- assuming feelings reflect the

truth about the situation or person.– Should statements- monkey on the back– Labeling –name calling – Personalization- blaming oneself inappropriately for

the situation or the event.(Stuart, 2013, p. 564, Table 27.5)

Treatment Strategies Anxiety reduction

– Relaxation training– Biofeedback– Desensitization

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Treatment Strategies Cognitive Restructuring

– Monitoring thoughts and feelings– Questioning the evidence– Examining alternatives– Decatastrophizing– Reframing– Thought stopping

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A patient states “I am always the one getting into trouble”.– What type of cognitive distortion is this?– How could the nurse respond to this

statement?

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Treatment Strategies Learning new behavior

– Modeling– Shaping– Token economy– Social skills training– Aversive therapy– Contingency contracting

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Treatment Strategies When a person develops a large

number of positive coping skills, their perspective of a stressful situation shifts to viewing the event as a challenge rather than a stressor.

This sense of control diminishes the effects of stressful situations or persons.

Summary CBT is a form of psychotherapy and

is an EBP for many problems Techniques to apply in the context of

patient interactions Remember that thoughts, behaviors,

and feelings are influential on one another

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