Cognitive Behavioural Approaches to Mental Health

Sophie Kennish –

MSc Occupational Therapy Student, UEA

Session outline

Icebreaker What does CBT mean? What are thoughts CBT triangle Actions / Behaviours The CBT process What CBT is (and isn’t!)

ACTIVITY!

Does CBT work? CBT in Norwich Bibliotherapy and CCBT Pros and Cons of CBT Some other alternatives Homework Discussion, role of

MHFA / Associate

ANYTHING ELSE YOU’D LIKE TO COVER?

Icebreaker

1. Your MIDDLE name (if you have one)

2. One thought you’ve had today (positive, negative or neutral)

3. One thing you’ve done this week to promote your positive mental wellbeing

4. Any experience / knowledge of CBT

The powerpoint isn’t going to work!

Cognitive Behavioural

Behavioural = ActingCognitive = Thinking

Example Thoughts

I’m uselessI’ll never achieve anything

I’ll never get betterIt’s all my fault

It’s going to go wrongThey hate me

Why does this always happen to me?

Thoughts about youThoughts about others

Questions

CBT Triangle

Some actions / behaviours

Self Harming Phoning a friend Going on a walk Going to work Drinking alcohol Hiding under the

duvet Taking/not taking

medication

What is the CBT process?

CBT involves three stages: Identifying / acknowledging and writing down

thoughts Classifying these thoughts Modifying these thoughts

Also involves some understanding of our ‘core beliefs’

What was I just thinking about which made me so depressed?

What CBT is…

Hard, and requires a lot of effort and time, including homework!

Something that’s ‘taught’ rather than ‘given’

Realistic thinking; NOT “positive thinking”Shorter term than traditional therapies

What CBT isn’t…

Let’s try out some CBT

Two groups Handout – thought identification Cards with example thoughts written on them

Match up the thought to the thought type using the worksheet – 15 minutes (don’t worry if you don’t manage them all)

If you find this easy (you won’t!), try thinking of alternative, more helpful thoughts to the ones on the cards

NB – Not all of them fit into neat little boxes!

Does CBT work? (Here’s the science…)

Yes! “Low-intensity psychosocial interventions” are effective for people with mild-moderate depression and anxiety

Recommended by NICE guidelines ‘Best Practice’ - Based on high quality data

As effective as Prozac? Group exercise

programmes are also effective!

CBT in Norwich

IAPT Service – “Improving Access to Psychological therapies” – Short term low level CBT for mild-moderate anxiety, depression Referral from GP or health professional iapt.norwich@nhs.net, 01603 421 688

Local Counsellors may be trained in CBT approaches - BABCP (British Association of Behavioural and Cognitive Psychotherapy)

Private practices – Psychologists - £££! Long waiting lists! Group CBT

Bibliotherapy

CBT self help approaches Gilbert Overcoming Depression : a

Self-help Guide Using Cognitive Behavioural Techniques

Padesky & Greenberger Mind Over Mood: Change How You Feel By Changing the Way You Think

Books on prescription, available at the city libraries

CCBT- The future?

Some websites offer computerised CBT ‘courses’ http://www.beatingtheblues.co.uk/patients/ http://www.livinglifetothefull.com/ - This one is

free if you sign up! http://www.themindgym.com/ No human contact (if you don’t want any)

Pros and Cons of CBT

It’s quick, and doesn’t involve dredging up the past. This means it’s cheap (for the NHS) and (quite) easily accessible (for patients).

It can work really effectively if people are able to put the effort in

Effective with people with mild-moderate depression, also for use in anger management, relationships, other mental health problems

Some people need longer term therapies, but are given CBT as this is what the NHS can afford

It can be seen as a bit of a ‘cure-all’, without consideration to the complexity of people’s lives

It focuses so much on the thoughts rather than the ‘doing’

Alternatives to CBT

Other talking therapies such as counselling

Medication Graded exposure /

“flooding” Occupational Therapy –

‘doing’ rather than ‘thinking’.

Exercise Five Ways to Wellbeing A combination of different

interventions

Homework!

Try to become more aware of your thoughts by jotting them down, even if they sound ridiculous. Try to connect them with a certain situation, feeling or behaviour.

Try to rationalise thoughts by working out why they’re ‘faulty’ and providing alternative ‘helpful’ thoughts

Try some ‘thought experiments’; doing something that you’ve been dwelling on for a while. Is it as bad as you imagined?

Perhaps next time we can feedback on how we found this

Discussion

What do you think about CBT?As a MHFA, how would you use what

you’ve learnt today to support?Can this approach be applied to people

with other mental health problems (Bipolar Disorder, Schizophrenia)?

Thanks for listening!

Time for a tea break!

Please fill in the evaluation forms (be as nasty as you like, so I can improve!)