Cognitive therapy

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
30/04/2015 www.drjayeshpatidar.blogspot.in 2

Classification
 Techniques to interrupt cognitions
 Techniques Used to counterbalance
emotional effects of cognitions
 Techniques intended to alter cognitions
 Problem solving techniques

Techniques to interrupt
cognitions
 In distraction, patient forcefully attends to
something other than the intrusive thoughts.
 Distraction’s two common forms are:
 First shouts aloud and after practice repeats silently
to himself
 Mildly painful sensation is produced

Techniques used to
counterbalance emotional
effects of cognitions
 A suitably chosen statement, produced by
a conscious effort to balance the intrusive
thought.

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

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

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 Indications30/04/2015 www.drjayeshpatidar.blogspot.in 8

Obsessive Compulsive
Disorder (OCD)
 Challenging obsessional thoughts,
 Thought stopping; and
 Challenging negative automatic thoughts

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.

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.

Thought Stopping
 Disrupting obsessions and thought
processes by using a cue word (i.e.
Stop).

Challenging Negative
Automatic thoughts
 NATs were often precursors to disturbed
imagery.

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 patient’s
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…

 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.

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…

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.

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.

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)

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 person’s
irrational ideals about the stimulus.

Panic Disorders
 The therapy is focused on the tendency
of the patient to make catastrophic
misinterpretation about bodily sensations
or mental experiences.

Post-Traumatic Stress
Disorder (PTSD)
Several cognitive behavioral techniques
 Desensitization to the trauma,
 Cognitive restructuring,
 Problem solving approach, and
 Stress inoculation training.

Suicidal Behavior
 The therapist concentrates on the patient’s
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.

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

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.

SUMMARY

CONCLUSON

THANK
YOU

Cognitive therapy

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Cognitive therapy