While Cognitive Behavior Therapy is a text to train psychiatry practitioners, many of the techniques can be applicable to daily life. Even if you aren’t formally diagnosed with a mental health disorder, you likely face situations that evoke more negative emotions than you’d like—nervousness talking to your boss, road rage, anxiety in social situations, stress that you won’t get everything done, or fear of failure in trying something new.
This summary focuses on the key CBT interventions to change your dysfunctional automatic thoughts and behaviors. These are generally applicable for all readers, not just those aiming to practice CBT for patients.
When you feel dysphoria (negative emotion), think the cardinal question: “What was just going through my head?” Articulate the thought explicitly.
Evaluate the thought with these questions:
Patterns of cognitive distortions: These put a label to common ways that people distort reality in self-defeating ways.
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The cognitive model proposes that dysfunctional thinking is common to all psychological disturbances. In this way, mental illnesses such as depression and anxiety may be considered thinking disorders. The patient has automatic dysfunctional self-talk that influences behavior negatively; the behavior is then interpreted in a negatively biased way, leading to worse thinking. This reinforces itself into a vicious cycle.
The negative thinking extends to the core of a patient’s beliefs about herself, the world, and other people, as well as intermediate levels of attitudes, rules, and assumptions the patient holds.
It’s not just the situation itself that makes a person feel a certain way, but also how they construe it, what lens they use to view it.
Automatic thoughts can arise for all people. Think about what automatic thoughts you have and how they affect your emotion.
Think about the last time you felt an automatic negative emotion in response to a situation. What was the situation? What were you feeling?
Cognitive Behavioral Therapy (CBT) is directed toward solving current problems and modifying dysfunctional thinking and behavior. Changing the underlying belief system leads to enduring behavior change.
CBT encourages the patient to:
The cardinal question of CBT: “What was just going through my mind?”
CBT treatment has 6 characteristics.
1) CBT is Collaborative
Each CBT session consists of a regular structure. Here we’ll go over the structure for three types of sessions:
The session structures will refer to tasks such as problem-solving, identifying beliefs, and assigning homework. We’ll cover those items in the next chapters.
The goal in the evaluation session is to start building a cognitive conceptualization of the patient. Treatment and problem-solving should NOT be done until the first therapy session.
Prepare by gathering all the notes available, including previous psychiatry work.
Invite a family member or friend to attend, but start the meeting alone with the patient and discuss when to bring the other person in on the session.
**Set the agenda and convey expectations for the...
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A key part of treating mood disorders is identifying the patient’s automatic thoughts and guiding the patient to evaluate them and overcome them. This is done by:
We’ll cover each component in a dedicated section.
The key question of identifying automatic thoughts is: “What is going through your mind right now?”
To elicit the automatic thought, try a range of techniques:
Reflect on automatic thoughts you have and how they might be improved.
Think about a time in the past day or so where you felt a negative emotion about yourself (like self-doubt, anxiety, or sadness). What was going through your mind just then?
After the first session, you can begin building a cognitive conceptualization of the patient, linking the whole pathway of
As you develop your understanding of this, share them merely as hypotheses. Avoid making the patient feel categorized or put in a box.
We’ll discuss investigating both intermediate beliefs and core beliefs.
Given the same core belief, people may have different intermediate beliefs.
How to identify intermediate beliefs:
Homework gives the patient opportunities to practice new behaviors and thinking. Patients who regularly complete homework show better progress.
Explain the rationale of homework, often in terms of improving patient affect or in proven efficacy.
Sessions should typically begin with review of homework completion, outcomes from doing homework, and appropriateness of tasks for future homework.
Set homework collaboratively. Get patient buy-in for homework assignment.
Lean toward making homework assignments easy and able to be completed than too hard. Aim for 90-100% likelihood of completion.
Make homework no-lose—even if the patient doesn’t complete homework, she’ll discover thoughts that prevent her from making progress.
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CBT is customized to the patient, and different techniques may have different efficacy between patients. Here are more techniques mentioned in the book to draw upon:
CBT is intended to be fixed in duration, teaching the patient to be her own therapist. Make this known to the patient at the beginning, to prepare for the expectation.
To help ease the transition, help the patient attribute positive changes to herself, not to the therapist or external causes.
As sessions near the end, patients should anticipate setbacks and anticipate how they will respond.