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Cognitive
Therapy
Dr. Jayesh Patidar www.drjayeshpatidar.blogspot.com
Introduction
Short-term structured therapy
Uses active, collaboration between the patient and the therapist to achieve the therapeutic goals.
Altering maladaptive thinking
concentrates on unconscious processes and past events
Verbal techniques and behavioral techniques
in depressive disorders (with or without) suicidal ideation
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Classification
Techniques to interrupt cognitions
Techniques Used to counterbalance emotional effects of cognitions
Techniques intended to alter cognitions
Problem solving techniques 30/04/2015 www.drjayeshpatidar.blogspot.in 3
Techniques to interrupt
cognitions
In distraction, patient forcefully attends to something other than the intrusive thoughts.
Distractions two common forms are:
First shouts aloud and after practice repeats silently to himself
Mildly painful sensation is produced
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Techniques used to
counterbalance emotional
effects of cognitions
A suitably chosen statement, produced by a conscious effort to balance the intrusive
thought.
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Techniques intended to
alter cognitions
By Beck and consists of three stages:
To:-
Identify maladaptive cognitions
Identify logical errors allowing maladaptive cognitions
Persist and to challenge the underlying assumptions which generate maladaptive cognitions in the first place
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Problem Solving
Techniques
Define the problem,
Divide it into manageable parts,
Think of alternative solutions,
Select the best solution,
Carry it out, and
Examine the result 30/04/2015 www.drjayeshpatidar.blogspot.in 7
Cognitive Therapy in
Psychiatric Disorders Obsessive Compulsive Disorder (OCD)
Major Depression
Anxiety Disorder
Eating Disorder
Schizophrenia
Phobias
Panic Disorders
Post-Traumatic Stress Disorder (PTSD)
Suicidal Behavior
Other Indications 30/04/2015 www.drjayeshpatidar.blogspot.in 8
Obsessive Compulsive
Disorder (OCD)
Challenging obsessional thoughts,
Thought stopping; and
Challenging negative automatic thoughts
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Challenging obsessional
thoughts
Challenge the obsessional thoughts (i.e. those thoughts concerned with harm,
aggression and contamination)
Techniques involve
Either self-instructional training (SIT)
Rational emotive therapy (RET) techniques.
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Either self-instructional training (SIT)
Instructs patients to determine how anxious they feel, to observe and record their
obsessioinal thoughts, and to replace their
thoughts by productive self-statements.
Rational emotive therapy (RET) techniques
- Focuses on challenging the belief in the
obsessional thoughts through rational
disputations.
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Thought Stopping
Disrupting obsessions and thought processes by using a cue word (i.e.
Stop).
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Challenging Negative
Automatic thoughts
NATs were often precursors to disturbed imagery.
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Major Depression
Cognitive techniques are used to alter cognitions and not merely to arrest or
counterbalance them.
These methods are used because depressive thoughts are very difficult to
arrest and evoke a particularly strong
emotion reaction that is difficult to
counteract.
Cont.. 30/04/2015 www.drjayeshpatidar.blogspot.in 14
Specialized techniques
Scheduled Activity Active scheduling of activities structures time
and enables the patients to observe their own potential effectiveness.
Graded Task Assignment Success in graded tasks changes patients
self-concepts.
Masterly and pleasure Therapy Patients keep records of all activities and
designate each masterly experience with M and each pleasure experience with a P, thus increasing their awareness of positive experiences. Cont 30/04/2015 www.drjayeshpatidar.blogspot.in 15
Cognitive Reappraisal Cognitive reappraisal involves the identification of
maladaptive cognitions and attitudes.
Alternative Therapy By encouraging alternative explanations for negative
experiences, patients are helped to recognize their biases. By considering alternative ways of handling psychological and situational problems, patients find solutions to the problems previously considered insoluble.
Cognitive Rehearsal By imagining that they are carrying out an activity,
patients report obstacles and conflicts that are then discussed.
Homework Assignments Assignments are given are each session to
counteract the depressive symptoms. Patients keep records of the negative cognitions in one column and of the rational responses in another. 30/04/2015 www.drjayeshpatidar.blogspot.in 16
Anxiety Disorder
Cognitive techniques used include Distraction Thought stopping, Counterbalance emotional effects.
Most anxiety disorders have prominent physical symptoms, which are an accompaniment of high arousal, cognitive techniques are generally combined with relaxation training.
Cont
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Anxiety management Training
First phase
Taught both to relax and to increase anxiety by imagining in a vivid way and he learns how to change quickly from provoking anxiety to reducing it.
Second Phase
The patient is helped to identify further situations that arouse anxiety, to imagine them, and to terminate the resulting anxiety by relaxing.
Third Phase
The patient focuses on the sensations associated with anxiety with act as stimuli for further anxiety.
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Eating Disorder
Patients with eating disorders have maladaptive assumptions
The evaluation of cognitive therapy for bulimia nervosa, thought uncontrolled, has shown that
the treatment is both acceptable and effective.
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Schizophrenia
Many cognitive behavioral techniques
Technique of reality testing (Hole et al 1979),
Belief modification techniques (Walts et al 1983),
Intensive cognitive therapy (Perris 1988),
Improving coping abilities (Fowler and Morley 1090), and
Cognitive behavioral techniques (Kington and Turbington 1991, 1994)
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Phobia
Effectives as systematic desensitization
The change in the behavior following cognitive therapy with these patients seems to follow a
cognitive change of reattribution of anxiety
from the phobic stimulus itself to the persons irrational ideals about the stimulus.
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Panic Disorders
The therapy is focused on the tendency of the patient to make catastrophic
misinterpretation about bodily sensations
or mental experiences.
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Post-Traumatic Stress
Disorder (PTSD)
Several cognitive behavioral techniques
Desensitization to the trauma,
Cognitive restructuring,
Problem solving approach, and
Stress inoculation training.
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Suicidal Behavior
The therapist concentrates on the patients misery and hopelessness.
A major emphasis is given to problem solving techniques such as define the problem,
generating alternatives to solve the problem,
and implementing the solution.
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Other Indications
Cognitive therapies have also been used in the treatment
Dissociative (and conversion) disorders and
Paranoid disorders
Solving real life problems
Including marital problems,
Substance abuse, and
Stress disorders 30/04/2015 www.drjayeshpatidar.blogspot.in 25
Limitation
Cognitive therapy is contraindicated
Patients with poor reality testing (e.g. with psychotic features),
Impaired reasoning and retention abilities, and
Borderline or other severe personality disorders. 30/04/2015 www.drjayeshpatidar.blogspot.in 26
SUMMARY
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CONCLUSON
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THANK
YOU 30/04/2015 www.drjayeshpatidar.blogspot.in 30