Cognitive Behaviour Therapy

Overview of Cognitive Behaviour Therapy:

It combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).

• An agoraphobic may exposed to their feared stimulus (e.g. busy supermarket).
• This might be beneficial alone, by reducing avoidance, but it will also trigger physical symptoms (palpitations) and associated negative automatic thoughts (e.g. ‘I’m having a heart attack’).
• These can used as the basis for simple cognitive interventions, using a dysfunctional thought record, which can help the patient to regain control over their anxious thoughts.
• This increase in self- perception of control makes further exposure easier.
• Behavioural experiments can prescribed that test out the beliefs that patients have about how their body and the world around them work (e.g. running up and down stairs to increase heart rate and give ‘palpitations’, and to thereby demonstrate a benign cause of ‘palpitations’).

Therapy of CBT

• CBT therapists can help the patient to analyse the varied forms of avoidance in their life, which are maintain by their beliefs about their vulnerabilities (in this case cardiac).
• Avoidance includes over avoidance, such as avoiding busy shops, and also covert avoidance, which includes safety behaviours.
• These are personal ways of reducing the sense of threat, such as always carrying a mobile phone in case of the need to summon assistance, or hanging on very tightly to a supermarket trolley to avoid the risk of collapse.
• CBT requires special training, and generalists need know only the principles of the treatments and the main reasons for referral.
• There are, however, some simpler procedures that can be used by non-specialists, such as relaxation, graded exposure, and anxiety management. [1]

CBT MODEL 

If your negative interpretation of situations goes unchallenged, then these patterns in your thoughts, feelings and behaviour can become part of a continuous cycle:

Cognitive Behavioural Therapy

Principles of CBT

• The general approach to CBT is that the therapist helps patients first to become aware of, and then to modify, their maladaptive thinking and behaviour.
• The treatment is collaborative, and the patient is treated as an active and expert partner in care.
• Patients practise new ways of thinking and behaving between the sessions of treatment; this is call homework.
• Written instructions are often used to supplement the explanations give by the therapist during treatment sessions, because it is important that they understand the procedures clearly and are well motivated to carry them out.
• Symptoms, cognitions, and associated behaviours monitore by recording them in a diary or dysfunctional thought record,

in which are noted the occurrence of

(i) Symptoms,

(ii) Thoughts and events that precede and possibly provoke the symptoms, and

(iii) Thoughts and events that follow and possibly reinforce the symptoms.

• Treatment takes the form of a graded series of tasks and activities such that patients gain confidence in dealing with less severe problems before attempting more severe ones.
• Tasks and activities present as experiments in which the achievement of a goal is a success, while on achievement is not a failure but an opportunity to learn more by analysing constructively what went wrong.
• This format helps to avoid discouragement and maintain motivation.
• Behavioural experiments can use to test out a patient’s predictions (invariably negative, due to active cognitive biases) of what will happen in a particular circumstance. [1]

CBT For common problems 

1. CBT for Anxiety Management:

The components of anxiety management are;

(i) Assessment of the problem,

(ii) Relaxation,

(iii) Techniques for changing anxiety-provoking cognitions, and

(iv) Exposure.

Anxiety management is a time-limited, focused intervention.

However, when delivered face to face, one to one, it still demands a significant amount of a healthcare professional’s time, with a resulting impact on feasibility and cost.

The First Step:

Generally, It is applicable to most patients, is bibliotherapy, with the recommendation or provision of self-help materials including a booklet or book and relaxation tape or CD.

The Second Step:

In brief, This is applicable to some patients, might be group anxiety management.

The Final Step:

For a few patients who have not been helped by steps one and/or two, is individual anxiety management.

2. Cognitive behaviour therapy for panic disorder:

Patients with panic disorder are convince that some of the physical symptoms are not caused by anxiety but are the first indications of a serious physical illness (often that palpitations signal an impending heart attack).

This conviction causes further anxiety so that a cycle of mounting anxiety is set up.

The treatment includes the general components listed above under anxiety management, with the following additional features:

• The therapist explains that physical symptoms are part of the normal response to stress, and that fear of these symptoms sets up a vicious circle of anxiety.
• Patients record the fearful thoughts that precede and accompany their panic attacks. Patients who cannot identify their thoughts during naturally occurring panic attacks can often do so if panic-like symptoms are induced by voluntary hyperventilation.
• The therapist demonstrates that fearful cognitions can induce anxiety, by asking patients to remember and dwell on these cognitions and observe the effect.
• Patients attempt to think in the new way when they experience symptoms, and they observe the effect of this change on the severity of the panic attacks.

By repeating this sequence many times they gradually gain control of the panic attacks.

3. Therapy for depressive disorder:

The three kinds of cognitive abnormality in depressive disorder are deal with as follows;

Intrusive thoughts i.e.:

• They are usually of a self-depreciating kind (e.g. ‘I am a failure’).
• When they are weak such thoughts can counteract by distraction, using the methods describe above, but when they are strong they are difficult to control.

Logical errors i.e.:

• It distort the way in which experiences interpreted, and maintain the intrusive thoughts.
• The therapist helps the patient to recognize these irrational ways of thinking and change them into more realistic thoughts.

Maladaptive assumptions i.e.:

• They often about social acceptability; for example, the assumption that only good-looking and successful people are liked by others.
• The patient help to examine how ideas of this kind influence the ways in which they think about themselves and other people. [1]

Cognitive Behaviour Therapy Approach

The cognitive-behavioural approach in everyday clinical practice:

Although formal CBT is a complex procedure that requires special training, three features of the cognitive behavioural approach are useful in everyday clinical practice.

1. Recording thoughts i.e.:

• It occur when symptoms are experience, via a diary.
• There is no fix design for a diary/dysfunctional thought record—the professional and patient can design one together that will work for that patient’s particular circumstances.
• However, standard templates are widely available.

2.Abnormal behaviours and events i.e.:

That precede and follow them (the ABC approach—e.g.Antecedents, Behaviours, Consequences).

3. Asking patients to monitor and record their progress i.e.:

Both as a way of judging the success of treatment and as a way of increasing their collaboration with treatment. [1]

CBT Schedule 

A typical cognitive therapy schedule consists of about 15 visits over a three-month period.

Some important techniques in CBT are:

i. Cognitive techniques such as recognising and correcting negative automatic thoughts, teaching reattribution techniques, increasing objectivity in perspectives, identifying and testing maladaptive assumptions, and decentering,

ii. Behavioural techniques such as activity scheduling, homework assignments, graded task assignment, behavioural rehearsal, role playing, and diversion techniques, and

iii. Teaching problem-solving skills.

iv. Mindfulness, originally a Buddhist technique, can also combined with CBT. [2]

Homoeopathic Treatment

Terminology

References 

1. Psychiatry, Fourth Edition- Oxford Medical Publications – SRG- by Geddes, Jonathan Price, Rebecca McKnight / Ch 14.
2. A Short Textbook of Psychiatry by Niraj Ahuja / Ch 19.
3. Comparative Efficacy of Homoeopathy, Cognitive Behavior Therapy and Placebo on Depression.
4. The Role of Homeopathic Remedies in Cognitive Neuropsychology.
5. Management of Depression Through CBT and Homoeopathy.