Module 4: Contemporary Therapeutic Interventions
COGNITIVE BEHAVIOR
THERAPY (CBT)
MSC (SEM-3) (C) Janvi Parekh (2024) NMIMS UNIVERSITY
COGNITIVE MODEL
Aim: To relieve symptoms of psychological
distress through the direct modi ication of
the dysfunctional ideation that accompanies
them
Goals:
• Remove biases & distortions in thinking;
• Cognitive distortions challenged, tested,
discussed
• Remove automatic thoughts
• Changing cognitive schemas
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ASSUMPTIONS
People’s emotions, behaviours, and physiology are in luenced by their perception of
events. The situation itself does not directly determine how they feel or what they do; their
emotional response is mediated by their perception of the situation.
The way you think about events in luences how you feel & behave.
Only you can change your thinking, and that will change the way you feel & behave.
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THERAPEUTIC ALLIANCE
1. Emotional bond & partnership
2. Cognitive consensus on goals & tasks
Rupture
A. Confrontation Rupture (Client expressed anger/frustration: questioning tasks/roles/rationale/
outcome of therapy)
B. Withdrawal Rupture (Minimal responding, discounting contribution, rationalising/shifting topic)
Recognise rupture: Subtle misunderstandings, withdrawal in therapy, disagreement, therapist’s
reactions
Rupture Management: Acknowledgment of client’s feelings, Discuss perspectives, Exploration
of parallel situations outside therapy, Consensus, Alternate ways of relating
SESSION STRUCTURE
Assess Mood (Subjective + Objective)
Setting Agenda
Bridge from last session
Follow-up homework (Review & reinforce
progress)
Work on Agenda Items (Discuss & Introduce
speci ic skill/module)
Setting Homework
Session Summary
Client Feedback (Thoughts & Feelings about the
session)
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KEY CONCEPTS
ABC MODEL
NATs/ANTs: Unreasonable
conclusions & meanings drawn
from experiences; extremely
quick after an event; short,
speci ic, can be words/images
COGNITIVE TRIAD
NEGATIVE TRIAD
COGNITIVE ERRORS/
DISTORTIONS
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CASE FORMULATION
Cognitive Factors (eg. Negative triad, distortions, low self-esteem,
etc.)
Affective Factors (eg. Mood luctuations, crying spells, etc.)
Environmental/Social (eg. Limited social support, Poor family
environment, etc.)
Strengths/Protective Factors (eg. Motivation, Early intervention,
etc.)
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GOAL SETTING
LESS/REDUCE, not STOP
SMART goals
General Goals:
• Learn coping skills
• Healthy thinking ways
• Alternate ways of behaving
• Promote ways of ‘solving’ life problems (eg. building con idence to start business)
• Reduce emotional disturbance
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BEHAVIORAL INTERVENTIONS
Self-Monitoring (Dysfunctional Thought Record; Thought Sampling)
Situation Exposure Hierarchies
Systematic Desensitisation (Always paired with breathing/relaxation)
Exposure Response Prevention (ERP; OCD- compulsive behaviour, in-vivo; in-vitro)
Skills Training (Assertiveness, Communication, Social)
Contingency Management (Reinforcement, Reward System)
Behaviour Contracting (Suicide)
Activity Scheduling
Role Play
Breathing & Relaxation (Diaphragmatic, Deep, Progressive Muscle Relaxation)
COGNITIVE INTERVENTIONS
• Guided Discovery/Socratic Dialogue (explore problems and help draw conclusions. Eg, What is the
evidence for this thought? Against it? What would be the worst + best thing about….; What is most
likely to happen?)
• 3 Question Techniques: Inquiring & revising negative thinking/beliefs to bring more objective
thinking (1. What is the evidence for the belief? 2. How else can you interpret the situation? 3. If it is
true, what are the implications?)
• Downward Arrow
• Challenging Absolutes (Always, never, no-one, all the time)
• Play the script until the end (Examine worst case scenario)
• Thought-Stopping (provided for HW)
COGNITIVE INTERVENTIONS
Decatastrophizing (What-if?)
Thought Challenging: Step 1: Attending Thoughts (how strongly do you believe 0 to 100), Step 2: Looking for
evidence, Step 3: Alternative Thought (mainly used for NATs)
Reframing: Embrace thoughts are not facts, identify limiting beliefs, get clear image on how limiting beliefs hold
you back, reframe, what new T-F-B stem from reframed belief, practice
Paradoxical Intervention: Suggesting a thought that is opposite to client’s thoughts or beliefs
Cognitive Restructuring (Calm Yourself > Identify situation > Analyse mood > Identify NATs > Objective
Supportive Evidence > Objective Contradictory Evidence > Fair & Balanced Thoughts > Monitor Present Mood))
Worry Time
Worry Tree
Cost-Bene it Analysis
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CONTRAINDICATIONS
Severe Mental Illness & Personality Disorders (eg. ASPD)
Organic brain conditions
Intellectual Disability/Limited Cognitive Abilities
Lack of Motivation in Client
Active Suicidality & Substance Abuse
H/O Seizures
BOOKS & RESOURCES
https://www.researchgate.net/publication/281571945_Guided_Discovery_with_Socratic_Questioning
https://padesky.com/wp-content/uploads/2012/11/socquest.pdf
CBT Aaron Beck
CBT Basics & Beyond_Judith Beck
CBT Keith Hawton
Worksheets for CBT (freely available online)
Youtube videos & demos
Course: Beck Institute, Team CBT
