10/12/2014

Cognitive Behaviour Therapy

Why CBT?    

Nice Guidelines Treatment of choice for depression, anxiety disorders, OCD, PTSD. Behaviour problems/parenting/anger management Multiple trials showing efficacy

CBT with younger children 

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CBT  

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With younger children the therapist is likely to be more active. Integration of behavioural and cognitive techniques ( more emphasis on behavioural techniques with younger children) Therapy sessions made fun by using play based, imagery and visual, art and creative techniques. More likely to integrate work around social skills and inter personal problem solving alongside pure CBT i.e. work on cognitive deficiencies as well as cognitive distortions.

Structure of each session      

Check in Homework review Agenda setting Session content Homework setting Check out

Can describe NATs, emotion, behaviour and see the link between them but are not often able to question the evidence and will not be able to think hypothetically. Must be fun-often frame interventions as a game. Work with their interest and agenda. Externalise the problem. Make him think he is your best/ favourite/ most thoughtful/bravest etc patient.

Measuring success     

Aims of therapy agreed with child and parents and made explicit Target aims /measures at impairment as well as symptoms. As far as possible make aims observable and measurable. Problem list complied collaboratively Use child, parent, and therapist rating scales if available.

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10/12/2014

Treatment Plan  

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8-12 weekly sessions First phase- psycho-education and socialization into the model, developing a collaborative, theraputic, relationship. Second phase-cognitive re-attribution, questioning the evidence,linking cognitions, behaviour and emotion. Third phase-extending the behavioural experiments, exposure and response prevention, abandoning safety and escape behaviours. Fourth phase-relapse prevention.

Ways of eliciting relevant NATs          

Worst consequences scenario Re-counting of specific episodes Affect shifts Dysfunctional thought records Exposure tasks Role Play Manipulation of safety behaviours Symptom Induction Ask about imagery Audio/video feedback

Behavioural Experiments    

P-prepare E-expose T-test S-summarise

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