Techniques of Cognitive Behavioural Therapy
Techniques of Cognitive Behavioural Therapy help clients examine and change thoughts and behaviours.
Validity testing - The therapist asks the client to defend his or her thoughts and beliefs.
Cognitive rehearsal - The client is asked to imagine a difficult situation from the past, and then works with the therapist to practice successful management of the problem.
Guided discovery - The therapist asks the client a series of questions designed to guide the client towards the discovery of his or her cognitive distortions.
Writing in a journal - Clients keep a detailed written diary of daily situations, the thoughts, emotions and the behaviours that accompany them. The therapist and client then review the journal together to discover maladaptive thought patterns and their impact behaviour.
Homework assignments – as reading books or articles appropriate to the therapy or behavioural applications of a newly learned strategy or coping mechanism to a situation to encourage self-discovery and reinforce insights made in therapy.
Modelling – Role-playing exercises and modelling the behaviour to act out appropriate reactions to different situations.
Systematic positive reinforcement – a reward system is set up for specify particular behaviours.
Extinction - Eradicating undesirable behaviour by deliberately withholding reinforcement.
Aversive conditioning - the principles of classical conditioning to reduce a behaviour that is difficult to change because of habitual or temporarily rewarding (development of associations with unpleasant feelings). Treatment of alcoholics - the administration of nausea to produce an aversion to the taste and smell of alcohol.
Counter-conditioning is systematic desensitization which counteracts the anxiety connected with a particular behaviour or situation by inducing a relaxed response to it instead – a maladaptive response is weakened by the strengthening of a response that is incompatible with it.
Systematic Desensitization: creation of an anxiety hierarchy (a graded list of anxiety-provoking items) and then proceeding to pair each item with the feeling of being deeply relaxed, learning to confront the real situation while remaining calm and relaxed.
Self-administered systematic desensitization. The training process allows the client to remain relaxed even when thinking about the anxiety-provoking situation. It’s effective treatment of mono-phobias.
Self-control techniques are based on operant conditioning principles, and on self-reward (Bandura):
* self-evaluation (achievements to be awarded are agreed);
* self-monitoring, the keeping of daily records of the problem behaviour and the circumstances, associations, stressful events, and mood states;
* self-reinforcement (a system of reward points/ award herself).
It’s used for clients have difficulties to control own behaviour, overeating, excessive smoking and aimed to increase clients' control over their own behaviour.
Relaxation techniques. The goal: a state of deep relaxation.
Biofeedback. The goal: a state of deep relaxation.
Exposure use for the treatment of phobic disorders; focus on reducing of anxiety and avoidance behaviour. There are two main ways of procedure: in imagination of the phobic situations, and in practice, in the actual situations.
Graded exposure. Exposure can be gradual way for phobias and OCD - desensitization (starting with situations that provoke little anxiety and progressing), intensive way from the start, or flooding. It might be alone or combined with cognitive procedures. Exposure in everyday practice is between desensitization and flooding. For progress it is necessary to stop client’s disengagement, as thinking of other things.
Exposure and response prevention (ERP) is a treatment for a variety of anxiety disorders, especially Obsessive Compulsive Disorder. It is an example of an Exposure Therapy, with the addition of Response Prevention. Exposure with response prevention is used for treatment of obsessional rituals, obsessional thoughts accompanying rituals (rituals are brought under control), obsessional thoughts without rituals (more difficult to treat). The steps: a therapist is explaining the rationale of treatment, client’s confidence that every task will be agreed in advance and agreeing targets for exposure with the client, short-term targets, then advanced target, with refraining the rituals (response prevention) for long enough, so the urge diminishes, encouraging the client to enter situations that provoke rituals and have previously been avoided (exposure). Response prevention generates substantial anxiety, and clients usually tolerate this if they know that it will decline. The clients are accompanied by the therapist while they strive to prevent the rituals. Sometimes the therapist reassures the client on the first few occasions by carrying out the exposure procedure himself, a procedure called “modelling”.
Mental exposure is habituation training, the clients stay on the obsessional thoughts for long periods or listen repeatedly to a tape-recording of the thoughts.
Social skills training for socially inadequate people is a part of rehabilitation programme for people with chronic mental disorder. The target is to improve through modelling, guided practice, role play and video-feedback. Social skills training is recommended for depression, social phobia, chronic mental illness, including social cognition enhancement training for schizophrenia. The program improves daily coping skills, optimize medication adherence self-control techniques.
Assertiveness training (Rimm and Masters) designed for people with difficulties in self-confidence/ self-assertion. The technique is a combination of coaching, modelling, and role reversal. It applies encouragement to practise appropriate verbal and non-verbal behaviour and to judge the level of self-assertion.
Anger management focuses on situations which provoke anger, with encouragement to discover the situations that lead to anger, discover and practise alternative ways of dealing with such situations, as delaying a response, taking anger can be brought under control.
Other techniques are contingency management, eye movement desensitization and reprocessing, dialectic behaviour therapy, cognitive–behavioural treatments for PTSD, for anxiety disorders, for depressive disorders (A. T. Beck), for personality disorder (A. T. Beck), for hypochondria.
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