Cognitive behavior

therapy
Ummi Pratiwi Rimayanti

Behavior
Classical conditioning focuses on involuntary
behavior
Operant conditioning concerned with the
relationship between voluntary behavior and
environment
Increasing behavior: positive reinforcement,
negative reinforcement
Decreasing behavior: punishment, response
cost, extinction

Cognitive principle
Peoples emotional reactions & behavior are
influenced by cognitions
People react differently to similar events
Maladaptive responses arises from cognitive
distorsion

Cognitive distortion

Overgeneralization
Personalization
Dichotomous thinking
Catastrophizing
Selective abstraction
Arbitratry inference
Mind reading
Magnification/minimization
Perfectionism
Externalization of self-worth

Cognitive Behavior Therapy

A structured, short-term, presentoriented psychotherapy for
depression, directed toward solving
current problems and modifying
dysfunctional (inaccurate and/or
unhelpful) thinking and behavior
Based on a conceptualization, or
understanding, of individual patients

CBT basic principles

Based on formulation of patients problems and an individual
conceptualization of each patient in cognitive terms
requires a sound therapeutic alliance
emphasizes collaboration and active participation
goal oriented and problem focused
initially emphasizes the present
educative, aims to teach the patient to be her own therapist, and
emphasizes relapse prevention
aims to be time limited
Cognitive behavior therapy sessions are structured
teaches patients to identify, evaluate, and respond to their
dysfunctional thoughts and beliefs
Uses a variety of techniques to change thinking, mood, and
behavior

Interacting system in human behavior

Level of cognition

CBT & nursing process

CBT is patient centered
Educational & skill building rather than
curative
Empathy & therapeutic relationship
CBT emphasis on objective assessment
process, bases treatment strategies
on research evidence, values ongoing
evaluation

CBT Indication
Depressive disorder, dysthymic disorder,
panic disorder, social phobia, OCD, PTSD,
generalized anxiety disorder and bulimia
nervosa (Wright et al. 2002)
Bipolar disorder (Basco and Rush 1996,
Basco and Thase 1998, Lam et al. 2000,
2005b, Scott et al. 2003, and Zaretsky et al.
1999) and schizophrenia (Mueser 1998,
Kingdon and Turkington 1995, Sensky et al.
2000)

Cognitive behavioral assessment

Actions, thoughts, feeling

Identifying problem from the data
Defining problem behavior
Deciding how to measure the
problem behavior case spesific
standarized rating scale
Identifying enviromental variables

Initial questions

What is the problem?

Where does the problem occur?
When does the problem occur?
Who or what makes the problem
occur?
What is the feared consequence
related to the problem?

The ABCs of behavior

Antecedent: cue that occurs before
behavior
Behavior: what the person does or
does not say or do
Consequence: what kind of effect
(positive, negative, neutral) the
person thinks the behavior has

Treatment strategies
Effective for anxiety, affective, eating,
schizophrenic, substance abuse &
personality disorder
Aimed at increasing activity, reducing
unwanted behavior, increasing
pleasure, enhancing social skill

CBT strategies
Anxiety reducton

Cognitive
restructuring

Learning new behavior

Monitoring thoughts
and feelings
Questioning the
evidence
Examining
alternatives
Decatastrophizing
Reframing
Thought stopping

Relaxation training
Biofeedback
Systematic
desensitization
Interoceptive
exposure
Flooding
Vestibular
desensitization
training
Response prevention
Eye movement
desensitization

Modeling
Shaping
Token economy
Role playing
Social skill training
Aversive therapy
Contingency
contracting

Selection of CBT Treatment

should be based on the
appropriateness of cognitivebehavior therapy for the treatment
situation
acute phase CBT typically ranges
from 10 to 20 weekly treatment
sessions
conducted in a period of 36 months

Phases of Treatment
The initial phase: clinical assessment, case
formulation, establishment of a therapeutic
relationship, socialization of the patient to
therapy, psychoeducation, and introduction to
treatment procedures.
The middle stage: sequential application and
mastery of cognitive and behavioral treatment
strategies.
The final phase of therapy: preparation for
termination, relapse prevention.

Evaluation
integrated use of objective
assessment methods
administered before treatment and
repeated periodically
high residual levels of cognitive
symptoms most likely convey an
increased risk for relapse after
termination of treatment

Referrence
Beck, Judith. 2011. Cognitive behavior therapy:
basics and beyond. New York. The Guilford Press.
Friedman, et al. 2008. Cognitive and Behavioral
Therapies. New York. John Wiley & Sons
Rector, Neil. 2010. Cognitive-behavioural therapy :
an information guide. Toronto. CAMH publications
Westbrook, et al. 2011. An Introduction to
Cognitive Behaviour Therapy: Skills and
Applications. New York. SAGE Publications