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
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Classification

Techniques to interrupt cognitions

Techniques Used to counterbalance

emotional effects of cognitions

Techniques intended to alter cognitions

Problem solving techniques

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

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

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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
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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
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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 Indications

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Obsessive Compulsive
Disorder (OCD)

Challenging obsessional thoughts,

Thought stopping; and

Challenging negative automatic thoughts

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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.
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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.

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

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

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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..14
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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 patients
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
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 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.
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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
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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.
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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.

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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)
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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 persons
irrational ideals about the stimulus.

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

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Post-Traumatic Stress
Disorder (PTSD)
Several cognitive behavioral techniques

Desensitization to the trauma,

Cognitive restructuring,
Problem solving approach, and
Stress inoculation training.

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Suicidal Behavior
The therapist concentrates on the patients
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.

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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
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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.
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SUMMARY
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CONCLUSON
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THANK
YOU
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