Discussing the basics of cognitive behavior therapy in very short

1. Basics of Cognitive Behavior Therapy
Dr. Ahsan Aziz Sarkar
MD-2 & FCPS-2 Trainee
Assistant Registrar, NIMH

2. Cognitive Behavior Therapy
It is a structured, short term, present oriented
psychotherapy directed towards solving current
problems and modifying dysfunctional thinking
and behavior.

3. Theory underlying CBT
Dysfunctional thinking (which also influences
mood and behavior) is common to all
psychological disorders.
When people learn to evaluate their thinking in
realistic and adaptive way they experience
improvement.
CBT works at a deeper level of cognition to bring
long lasting changes.

4. Theory Underlying CBT
Core beliefs
Intermediate beliefs (rules, attitude, assumption)
Situation
Automatic thoughts
Reaction (emotional, physiological, behavioral)

5. Theory Underlying CBT
I am incompetent
I should give up if the challenge seems great
Reading a new text
This is too hard
Discouragement, heaviness in body, watching TV

6. Application of CBT
Depression
Anxiety Disorder
OCD
ADHD
Eating Disorder
Personality Disorder
Substance Use Disorder

7. Application of CBT
Couple Problem
Family Problem
Pathological Gambling
Complicated Grief
Anger and Hostility

8. Principles of CBT
Sound Therapeutic Relationships
Collaboration and active participation of
patient
Goal oriented and problem focused
Initially emphasizes the present
Educative
Time limited
Structured

9. CBT Structure
Usually 6-14 sessions
Initially weekly sessions, later biweekly or
monthly
Sometimes 2-5 years, booster session
Before beginning CBT patient’s evaluation
and assessment, problem conceptualization
are done.

10. Structure of Sessions
Initial part:
 Mood check
 Set the agenda
 Obtain an update
 Review homework
 Prioritize the agenda
Middle Part:
 Work on specific problem and teach CBT skills

11. Structures of Sessions
End part
 Summarization of the session
 New homework
 Elicit Feedback

12. Identifying Automatic thoughts
Automatic thoughts coexists with a more manifest
stream of thoughts, arise spontaneously, quite
brief, not based on reflection or deliberation.
What was going through your mind?
Emotion, detailed description, visualization, role
play, suggesting opposite thoughts, meaning of the
situation

13. Identifying intermediate and core beliefs
May actually articulate belief as automatic
thought
Downward arrow technique
Half assumption by therapists
Common theme among automatic thoughts
Directly asking the patient
Belief questionnaire

14. Thinking Errors
All or none thinking/polarized/dichotomous
Catastrophizing
Disqualifying the positive
Emotional reasoning
Labeling
Magnification/minimization
Mental filter/selective abstraction

15. Thinking Errors
Mind reading
Overgeneralization
Personalization
Should and must statement
Tunnel vision

16. Modifying belief
Socratic Questioning
Examining advantages and disadvantages
Behavioral Experiments to test belief
Cognitive Continuum to modify belief

17. Modifying belief
Intellectual-emotional role play
Using other people as reference point
Acting “as if”
Using self-disclosure

18. Modifying belief
Using extreme contrasts
Using stories, movies, metaphors
Historical tests of the belief
Restructuring early memories

19. Additional cognitive and behavioral
techniques
Problem solving and skills training
Making decision
Refocusing/distraction
Relaxation (progressive muscle relaxation,
imagery, controlled breathing)

20. Additional cognitive and behavioral
techniques
Mindfulness
Exposure
Role playing
Self comparison and credit lists

21. Homework Assignment
Behavioral activation/activity scheduling
Monitoring, evaluating and responding to
automatic thoughts
Problem solving
Behavioral skills or experiments
Bibliotherapy

22. Termination of therapy
Responding to concern about tapering and
termination of therapy
Reviewing what has been learned
Self-therapy session
Booster session

23. Reference
 Cognitive Behavior Therapy: Basics and
Beyond by Judith Beck (2nd ed.)
 Shorter Oxford Textbook of Psychiatry (6th
ed.)
 Kaplan and Sadock’s Synopsis of Psychiatry
(11th ed.)
 Oxford Handbook of Psychiatry (3rd ed.)

24. Thank You