C OGNITIVE B EHAVIOURAL T HERAPY

1. COGNITIVE BEHAVIOURALTHERAPY

2. Psychoeducation • from RCT, educational materials play a significant role in improvement in depression Robinson, Katon, Von Korff et al., 1997

3. Cognitive Behaviour Therapy • Dispute about unique effect Murphy, Carney et al., 1995 • May reduce relapse Fava, Grandi, Zielezny et al., 1996 • Therapist competency is vital Scott, Tacchi, Jones & Scott, 1997 • Meta-analysis suggests effect size post-treatment Reinecke, Ryan & DuBois, 1998

4. CBT Assumptions • Cognitive activity affects behaviour • Cognitive contents & processes can be monitored & changed • Behavioural (& emotional) change may be affected through cognitive change Dobson and Dozois, 2001

5. Other assumptions • Processing of information is active & adaptive • Individuals derive meaning from their experiences using information processing • Belief systems are idiosyncratic • New information is assimilated into existing belief systems

6. Automatic Thoughts (Beck) • Specific, discrete essential words • Shorthand distilled format • Not a result of deliberation, reasoning, or reflection - “Just happen” • Not sequential as in goal directed thinking or problem solving • Autonomous – person does not need to make any effort to generate & may have difficulty “switching off”

7. Core Beliefs • Learned through childhood experiences • 2 broad categories – helplessness and ‘unlovability’ • Core dysfunctional beliefs latent during low stress periods • Reactivated by negative experiences that resemble conditions under which original beliefs were formed

8. Cognitive Distortions • Overgeneralisation • Dichotomous thinking • Magnification • Personalisation • Disqualifying positives • Jumping to conclusions • Catastrophising • Emotional Reasoning • Shoulds & Oughts • Labels

9. Cognitive Triad • Negative view of self, the world, and the future central to maintenance of depression • Beck (1983) subsequently proposed that individuals are particularly likely to experience depression if there is a congruence between negative life events & depressogenic schemata

10. Research High levels of depressive symptomatology in children with pessimistic attributional styles and presence of internal, stable, global negative style: • suggest causal role of attributional style in development of depression • increase risks of depression in adolescence • predict future increases in depressive symptoms among adolescents irrespective of negative life events Spence et al., 2002

11. Research • 40% of adolescents who responded to CBT relapsed within 6 months • Significant number of adolescents discontinue treatment prematurely, do not comply or remain depressed at end of intervention (approx 33%) • Younger children seem to better • Need to investigate involvement of family Spence & Reinecke, 2004

12. Major CBT strategies • Behavioural activation: • Getting the person to do something • Monitoring activities, pleasure, mastery • Scheduling activities • Graded task assignment • Cognitive activities • Distraction techniques • Time set aside for thinking

13. Major CBT strategies • C-B strategies • Identifying negative thoughts • Questioning negative thoughts • Behavioural experiments • Preventative strategies • Identifying assumptions • Challenging assumptions • Use of set-backs • Preparing for future

14. Initial Interview • Assessment of current difficulties • Symptoms • Life problems, e.g., interpersonal, medical, practical • Associated negative thoughts • Onset/development/context of depression • Hopelessness/suicidal thoughts/lack of energy • Agreed problem list

15. Initial Interview • Goal definition – may change later but helps correct unrealistic expectations, provides a standard to monitor progress, focuses attention on future. • Presentation/acceptance of treatment rationale • Practical details – what is involved, homework, between session tasks, frequency

16. Initial Interview • Introduction to basic relationship between negative thoughts & depression • Possibility of change • Beginning intervention • Specific: • Select first target • Agree appropriate homework, monitoring/reading • General: • Give Client experience of CBT style (focus on specific issues, active collaboration, homework) • Overall aims: • Establish rapport • Elicit hope • Give pt preliminary understanding of model • Get working agreement to test it in practice

17. Subsequent sessions • Set agenda • Weekly items • Review events from last session • Feedback from client on last session • Homework review (emphasises self-help, independent functioning) • Outcome? • Difficulties? • What has been learned?

18. Subsequent sessions • Major topic for session • Specific strategies (e.g., relaxation, learning evaluate automatic thoughts • Specific problems (e.g., difficulties that have arisen during week) • Long term problems • List in order of priority

19. Subsequent sessions • Homework assignments • Task • Should follow logically from session content • Needs to be clearly defined • Rationale • explicit e.g., to test the idea that I can’t do anything, a no lose situation will learn something regardless • Predicted difficulties • Feedback from client • Understanding ( summarise main points • Reactions to session