039- Cognitive Behavioral Therapy Skills

 
 
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Cognitive Behavioral Therapy Skills
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs

Continuing Education (CE) credits can be earned for this presentation at  https://www.allceus.com/member/cart/index/product/id/520/c/

Objectives
~Define Cognitive Behavioral Therapy and its basic principles
~Identify factors impacting people’s choice of behaviors
~Explore causes and impact of thinking errors
~Identify common thinking errors and their relationship to cognitive distortions

Why I Care/How It Impacts Recovery
~The way people perceive the world and interpret events leads to behavioral reactions
~A person who perceives the world as hostile, unsafe and unpredictable will tend to be more hypervigilant (until they exhaust the stress response system)
~A person who perceives the world as generally good and believes they have the ability to deal with challenges as they arise will be able to “allow” their stress response system to function normally.

Factors Affecting Rational Behavior
~Stress
~Negative emotions
~Physical
~Pain
~Illness
~Sleep deprivation
~Poor Nutrition
~Intoxication (Alcohol, Barbiturates, Street Drugs)
~Environmental
~The introduction of a new or unique situation
~Exposure to un-preferable situations
Factors Affecting Rational Behavior
~Stress
~Social
~Peers or family who convey irrational thoughts as necessary standards for social acceptance.
~“Nobody wants to associate with “those” people”
~Lack of supportive peers to buffer stress

A Note About Irrationality
~The origins of most beliefs were rational and helpful given:
~The information the person had at the time
~The cognitive development (ability to process that information)
~“Irrationality” or unhelpfulness of thoughts comes when those beliefs are:
~Perpetuated without examination
~Continue to be held despite causing harm to the person

Sometimes it is more productive for clients to think of these thoughts as “unhelpful” instead of “irrational.”
Basic Principles
~In cognitive therapy, clients learn to:
~Distinguish between thoughts and feelings.
~Become aware of the ways in which thoughts can influence feelings in ways that sometimes are not helpful.
~Learn about thoughts that seem to occur automatically, without even realizing how they may affect emotions.
~Constructively evaluate whether these “automatic” thoughts and assumptions are accurate, or perhaps biased.
~Evaluate whether the current reactions are helpful and a good use of energy, or unhelpful and a waste of energy that could be used to move toward those people and things impotent to the person.
~Develop the skills to notice, interrupt, and correct these biased thoughts independently.

Causes of Thinking Errors
~Information-processing shortcuts
~Using outdated, dichotomous schemas
~Mental noise
~The brain's limited information processing capacity
~Age
~Crisis
Causes of Thinking Errors
~Emotional motivations
~I feel bad, therefore it must be bad
~Moral Motivations
~It was the right thing to do
~Social influence
~Everyone is doing it
Impact of Thinking Errors (Fight or Flee)
~Emotional upset
~Depression
~Anxiety
~Behavioral
~Withdrawal
~Addictions
~Sleep problems/changes
~Eating changes

~Physical
~Stress-related illnesses
~Headaches
~GI Distress
~Social
~Irritability/impatience
~Withdrawal

Thinking Errors
~Emotional Reasoning –Feelings are not facts
~Learn to effectively identify feelings and separate facts
~I am terrified
~About what are you terrified?
~What is the evidence that you are in danger now?
~In what ways is this similar to other situations?
~How have you dealt with those situations?
~Develop distress tolerance skills
~Develop emotional regulation skills

Thinking Errors
~Cognitive Bias/Negativity/Mental Filter– Focus on the negatives and worry about the future
~Questions
~What is the benefit to focusing on the negative?
~What are the positives to this situation?
~What are all the facts?
~Coin toss activity
~Disqualifying or minimizing the positive
~Questions
~Would you minimize this if it was your best friend’s experience?
~What is scary about accepting the positive?
~Sometimes we disqualify the positive because it fails to meet someone else’s standards, might that be true here?

Thinking Errors
~Egocentrism– My perspective is the only perspective
~Question: What are some alternate perspectives
~Personalization/Mindreading
~Questions
~What are some alternate explanations for the event that did not involve you
~How often is it really about you?
~Magnification
~All-or-Nothing
~Availability Heuristic

Thinking Errors
~Magnification
~Questions
~Are you confusing high and low probability outcomes?
~How much will this matter 6 months from now?
~What have you done in the past to tolerate events like these?
~All-or-Nothing
~Questions
~Love vs Hate
~Perfection vs. Failure
~All good intentions vs. All bad intentions
~Availability Heuristic: Remembering what is most prominent in your mind
~Questions
~What are the facts

Thinking Errors
~Availability Heuristic: Remembering what is most prominent due to (frequency, intensity or duration) in your mind
~Questions
~What are the facts
~How often does it really happen
~How long has it been since you have seen that behavior
~The good times are amazing, but how frequent are they compared with the bad times?

Thinking Errors
~Belief in a just world/fallacy of fairness
~Question:  Identify 4 good people who have had bad things happen.
~Attributional Errors (Labeling yourself not a behavior)
~Global vs. Specific
~I am stupid vs. I do not have good math skills
~Stable
~I am (and always will be stupid) vs. I can learn math skills
~Internal
~It is about me as a person vs. It is about a skill/skill deficit

Questions for Clients
Belief = Thought/Fact + Personal Interpretation
~What are the facts for and against my belief
~Is the belief based on facts or feelings?
~Does the belief focus on one aspect, or the whole situation?
~Does the belief seem to use any thinking errors?
~What are alternate explanations?
~What would you tell your child/best friend if they had this belief?
~What do you want someone to tell you about this belief?
~How is this belief
~Moving you toward what and who is important to you?
~Moving you away from what or who is important to you?

Irrational Thoughts (Beliefs)
~How do these thoughts impact clients’ emotions, health, relationships & perceptions of the world?
~How may have this been helpful in the past?
~Dealing with irrational (unhelpful) thoughts
~Is this thought bringing you/the client closer to those people and things important?
~Are there examples of the statement not being true?
~How can the statement be made less Global, Stable, Internal?
Irrational Thoughts (Beliefs)
~Thoughts
~Mistakes are never acceptable.  If I make one, it means that I am incompetent.
~When somebody disagrees with me, it is a personal attack against me.
~If someone criticizes or rejects me there must be something wrong with me
~To feel good about myself, others must approve of me.
~To be content in life, I must be liked by all people.
~My true value as an individual depends on what others think of me.

Irrational Thoughts (Beliefs)
~Thoughts
~Nothing ever turns out the way you want it to.
~I won’t try anything new unless I know I will be good at it
~I am in total control. Anything bad that happens is my fault.
~If I feel happy about life something will go wrong
~The past repeats itself.  If it was true then, it’s true now.
~It’s not my fault my life didn’t go the way I wanted.
~If I am not in an intimate relationship, I am totally alone.
~There is no grey area.

Summary
~Thoughts impact behaviors and emotional and physical reactions
~Emotional and physical reactions impact thoughts and interpretations of events
~Irrational thinking patterns are often caused by cognitive distortions
~Cognitive distortions are schemas which were formed based on faulty, inaccurate or immature knowledge or understanding
~By identifying the thoughts (hecklers) that are maintaining unhappiness, the person can choose whether to accept the thoughts or change them.