Introduction to CBT therapy Cognitive Behavioral Therapy Physical

Introduction to CBT therapy Cognitive Behavioral Therapy

Physical and Emotional Symptoms Poor coping skills, Poor self esteem , Distorted thinking patterns Nature and Nurture 2

Story Walking through the woods alone at night – you suddenly hear some crackling branches nearby – you turn around and see a large hungry black bear!!! Reaction You begin to shiver, your knees start knocking together, you feel frightened, your heart starts pounding, your vision becomes blurred, you feel you are going to pass out. Story Sitting on your porch on a bright sunny day, a bumblebee flies onto the porch and you see it from a distance. Reaction You begin to shiver, your knees start knocking together, you feel frightened, your heart starts pounding, your vision becomes blurred, you feel you are going to pass out. 3

THE PROBLEM: SIMILAR TO A FALSE ALARM LIKELIHOOD SEVERITY -THIS TRIGGERS VERY UNCOMFORTABLE PHYSICAL AND EMOTIONAL SYMPTOMS 4

The relationship between obsessions and compulsions Understand the cycle • The obsession hits • Obsessions bring along an overload of worry and anxiety • The obsessions drain your body’s energy • You are dying for any kind of relief • There is a force within you pushing you to do something that it perceives as immediate relief. • This relief is only temporary and the cycle begins once again.

Obsessions repetitive, negative thoughts, images, or impulses Relief Distress distress subsides temporarily anxiety, fear, disgust, shame Compulsions repetitive thoughts, images, or actions

CBT – Goals • CBT helps the person – understand the disorder – develop strategies to identify problem situations – Learn how to resist giving in to the obsessive thoughts and compulsive behaviors. – Manage the resulting anxiety by training the person to use strategies that help them work with their anxiety in a more effective and less disruptive way.

Cognitive therapy – thoughts and feelings are interconnected Having made a mistake at work, a person may believe, "I'm useless and can't do anything right at work. " Strongly believing this, in turn, tends to worsen his mood. The problem may be worsened further if the individual reacts by avoiding activities and then behaviorally confirming his negative belief to himself. As a result, an adaptive response and further constructive consequence becomes unlikely, which reinforces the original belief of being "useless. ”

Cognitive therapy – thoughts and feelings are interconnected

Behavior therapy ERP • Exposure • Response • Prevention אדם לפי פעל נ ותיו פעול

ERP – affects cognition 1) Your negative assumption will not allow you to figure out the truth. 2) The more you avoid something the less you know about it. 3) Facing the fears, will uncover the fallacy of the fear. The fear just melts on its own!

Habituation We get used to everything sooner or later.

Habituation - definition Habituation, is the tendency to become familiar with a stimulus after repeated exposure to it. A person who moves to a house on a busy street may initially be disturbed every time a loud vehicle drives by. After living in the house for some time, however, the person will no longer notice, let alone be disturbed, by the street noise. The person becomes habituated to it and the original response disappears.

Habituation - Normal Habituation is very useful. Our environment is full of sights and sounds, we would waste a tremendous amount of time and energy if we paid attention to every stimulus each time we encountered it. Habituation allows us to ignore repetitive, unimportant stimuli. Habituation occurs in nearly all organisms, from human beings to animals with very simple nervous systems.

Some simple examples that demonstrate this 1) The noise of the train rumbling by. 2) The cat in the lap. 3) Cold water in the pool

Facts about the safety and sequence of exposure and habituation 1) 2) 3) 4) 5) 6) 7) Anxiety is not dangerous and although uncomfortable there is no physical or psychological concern. Anxiety is transient and passes away. Avoidance strengthens fear. Exposure weakens fear. Habituation is natural and automatic. Exposure is necessary for habituation. Anxiety in anticipation of exposure may be a higher than anxiety during actual exposure.

Face the FEARS don’t Fight the FEARS xie ow gd oin g ty g An A ty e i nx up g oin n

R. I. D. E. R ename thought I nsists that you are in charge D efy – do the opposite E njoy – your success

Why is it, that so many people suffer from anxiety for years, even decades, and they do not seem to habituate?

There is another easy option – it is a coasting down easy ride, but…

If you never fully face the fears, and rather choose to use the easy escape which supplies temporary relief. You will never learn the false and conniving foolishness of these fears. You will never habituate!!!!

Important facts about habituation 1)You cannot habituate before reaching the peak of your anxiety. 2)Distraction may feel good but it won’t allow for habituation to take place. 3)Any reassurance that eases the anxiety will hinder the ability to habituate. (face it to its fullest) 4)The longer the exposure, the more solid the habituation (at least 45 minutes, an hour or more is better) 5)The closer and more frequent the exposures, the more effective the habituation.

Progression of the process Initial goals are specific to 1 or 2 behaviors; however, as the person becomes successful in coping with these situations, generalization usually occurs to other symptoms that have not been targeted directly. Usually, the person reports an overall reduction in obsessive thoughts, general anxiety, and the need to perform certain actions.

It is very important that sessions not be ended when anxiety levels are at their peak or rising. The habituation model relies on extensive contact with fear situations that allow for significant decrease in anxiety over time.

Troubleshooting – 4 mistakes 1) The exposure task does not include the relevant anxiety provoking cues. 2) The person is engaging in some subtle form of avoidance such as an attempt to self distract (ex. daydreaming) 3) The exposure is not continued long enough (it is better to do fewer exposures of sufficient length than to do many short exposures during which habituation does not occur) 4) The exposure was not done repeatedly enough times.