Everything CBT can do to help

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How Can CBT help?


What is Depression?

  • sad mood
  • loss of interest in pleasure
  • hopelessness
  • helplessness
  • lack of self-worth
  • excessive guilt
  • feeling like a burden to others
  • sleeping too much or not enough
  • significant appetite changes
  • reduction in sexual interest
  • low energy and fatigue
  • irritability
  • lasts two weeks or longer
  • most of the day, most days
  • longer periods last years (this could be dysthymia)

Cognitive-Behavioral Treatment for Depression

  • daily routines
  • increased pleasurable activities
  • learning how thinking affects your mood
  • logging your moods, including times of joy
  • changing depressive thinking patterns
  • increasing realistic views of the world
  • building supportive relationships


What is Anxiety?

  • Fearful ideas of dread
  • Fear of fear
  • Coping through escape or avoidance
  • Inability to handle fear
  • Catastrophic ideas about the future
  • Uncontrollable worrisome ideas
  • A sense of feeling anxiety
  • increases in heart rate and breathing
  • Upset stomach, diarrhea or constipation
  • Flushing in the face
  • Hands and feet feel cold or numb
  • Muscle tension
  • In panic, belief you’re having a heart attack or are going crazy

Kinds of Anxiety

  • Phobias: a fear of a specific thing or situation
  • Social Anxiety: fears that you’ll fail socially and embarrass yourself
  • Panic: Anxiety attacks with racing heart and shortness of breath, lasting about 30-45 minutes
  • Obsessive-compulsiveness: Intrusive thoughts (I’m covered in germs) and rituals to decrease the anxiety from the thoughts
  • Generalized Anxiety: Chronic worrying that’s hard to control that creates stress and physical complaints

Cognitive-behavioral Treatment of Anxiety

  • Exposure to the source of the anxiety
  • Learning new safety beliefs
  • Methods to test anxiety-based thoughts to see if they are realistic
  • Mindfulness and relaxation to handle physical reactions of anxiety
  • Prevention of escape, avoidance, or rituals

Read more about Depression and Anxiety

Post-traumatic Stress Disorder

What is PTSD?

  • Anxiety in response to severe, traumatizing situation
  • Often fears of escaping death or horrific outcomes
  • Avoidance of reminders of the trauma event
  • Thoughts or dreams about the trauma that intrude into your mind
  • Feelings as if it’s happening again
  • Strong emotional and physical reactions when reminded of the trauma
  • Flashbacks that can seem like movies of the trauma
  • Frequently losing track of time during flashbacks
  • Numbed out feelings that can seem like depression
  • Loss of interest in life’s joy
  • A feeling life the future offers nothing, or not being able to think of a future

What are examples of traumatizing situations?

  • Motor vehicle accidents
  • Combat situations while in the military
  • Rape and other assaults
  • Domestic abuse
  • Childhood abuse
  • Victimization by stalking or other terror-inducing situations
  • Witnessing events that are deadly, horrific, or extremely harmful

What is CBT of PTSD?

  • Some form of exposure to the memories or traumatic environments
  • Redesigning the meaning of the trauma event
  • Building safety beliefs to replace danger beliefs
  • Creating a new “story line” about the world and personal competency
  • Names of some treatments include Direct Exposure Therapy, Cognitive Processing Therapy, Narrative Story Telling Therapy.


What do relationship problems look like?

  • Chronic patterns of unresolved arguments
  • Feeling stuck when arguing
  • Defensiveness, criticism, stonewalling or contempt feelings
  • Feeling isolated from the other person
  • A shift to believing the other person has a flawed personality
  • Belief that there is no hope for improvement
  • Emotional and/or sexual affairs

What is CBT of relationship problems?

  • Rebuilding trust and love
    • Creating ways to learn that your partner “has your back”
    • Accepting or tolerating your partner’s flaws and painful feelings
    • Talking to your partner about your fears and feelings
    • Creating a safe place to be vulnerable with each other
  • Working to know the “real” person who is your partner
  • Softening your approach to raising problems
  • Discovering the hidden meaning your partner holds about seemingly little things
  • Finding the dreams you and your partner have when a conflict happens
  • Learning to have regular times to share with each other about the relationship
  • Taking responsibility when you own part of the problem
  • Saying what you want, not what you don’t want

Read more about relationship issues. 


What are disruptive behaviors in childhood?

  • Usually first recognized in pre-school or elementary school
  • If not treated, can become far more obvious in the teenage years
  • Defiance of adults
  • Willful disregard of rules
  • Loud interruptions
  • Verbal or physical aggression
  • Co-existing learning problems and/or attention deficit hyperactivity disorder

What is CBT for disruptive behaviors?

  • Targets both parenting child behaviors
  • Incorporates behavior analysis
  • Parents learn how to
    • Reward with attention
    • Reward with a points system
    • Replace unwanted behaviors with their positive opposite
    • Attend to children when they mind the parents
    • Model positive new behaviors
    • Use practice strategies with children
    • Use time-out from reinforcement
    • Use point systems
  • CCBT uses the Kazdin Parent Management Training model

Read more about Positive Behavioral Parenting


What is unhealthy anger?

  • There is normal and unhealthy anger
  • Unhealthy anger includes
    • Hurting others with words or physical actions
    • Out of control rages
    • Excessive over-reactions
    • Inability to walk away
    • Blaming others
    • Difficulty in remembering the anger outburst

CBT for anger

  • Identification of underlying depression or anxiety
  • Calming the physical side of anger
    • Relaxation Therapy
    • Mindfulness strategies
  • Changing ideas that contribute to the anger
  • Modifying beliefs that support being angry


What is autism?

  • Typically seen by ages 24 to 36 months
  • Usually delayed development of speech
  • Disinterest in others or affection
  • Pre-occupation with certain objects
  • Excessive difficulty changing from one activity to another
  • Repetitive behaviors (e.g., flapping hands, rocking back and forth)
  • Echoing what others say
  • Elevated scores on the M-CHAT (https://www.m-chat.org/mchat.php)

How is Autism identified?

  • Direct observations
  • Structured interview, including a history, such as the ADI-R
  • Sometimes with formalize play ADOS
  • Coordinated assessments with the primary care physician, psychologist, and other health providers

Competently delivered of applied behavior analysis

  • ABPP Board Certified in Cognitive and Behavioral Psychology with education and training in ABA
  • BCBA-D board certified psychologist
  • BCBA board certified behavior analysts
  • Masters trained ABA providers under the supervision of a competent health services provider such as a psychologist
  • Health Service Providers (psychologists, pediatricians, etc.) who can demonstrate knowledge, skills and attitudes in ABA

ABA has been shown to

  • Build language skills
  • Improve social skills
  • Decrease self-stimulatory behaviors
  • Reduce or eliminate self-injurious behaviors
  • Reduce or eliminate aggressive behaviors
  • Improve behaviors in the community (stores, restaurants, etc.)

ABA includes

  • Providing consultations to the family and other service providers AAP resources on Autism
  • Coordinating with the child’s treatment team/educational team
  • Coordinating with the medical home’s primary care physician
  • Analyzing the function of behaviors
  • Relying on behavioral functions to design the learning of healthier behaviors

Read more about applied behavior analysis services for autism and PDD NOS


What are developmental or intellectual disabilities?

  • Usually start early in life or at birth
  • Sometimes associated with syndromes like Adrenoleukodystrophy
  • Typical symptoms may include
    • Speech development delays
    • Delays in motor development like walking or crawling
    • Lower than average mental abilities
    • Difficulties in learning social behaviors and social rules
    • Difficulties learning pre-kindergarten or academics skills

How may developmental or intellectual disabilities identified?

  • Mental abilities testing
  • Academic achievement testing
  • Assessment of adaptive behaviors
  • Interviews with parents, teachers, and others who know the individual well
  • Rating forms

What are interventions for developmental or intellectual disabilities?

  • Application of behavioral strategies to instruction/teaching like Direct Instruction
  • Use of behavior modification and ABA
    • Use rewards systems
    • Implement attention as a reward
    • Improve social skills
    • Develop or improve toileting skills
    • Teach every day skills like tying shoes or job performance skills
    • Replace problem behaviors with skills that are appropriate
    • Behaviorally based academic interventions
    • Direct Instruction (Nat. Institute for Direct Instruction)
    • Instructional reliance on rewards and modeling
    • Hierarchical instructional design
    • Repeated reading to increase fluency and comprehension (Research on Repeated Reading)
    • Study skills like the SQ3R (Univ. of Vermont on SQ3R)

Read more about Learning, Educational, and Disability Issues


What is addiction and substance abuse

  • Excessive use of substances like illegal drugs or alcohol
  • Inability to stop using
  • Disruptive impact of drugs or alcohol on everyday life and relationships
  • Drug or alcohol based damage no health

What is a behaviorally based treatment for addictions and abuse?

  • Strategies for thinking about changing and deciding to change
  • Controlling patient’s exposure to triggers of substance use
  • Coordination with primary care physician
  • Defining abuse as a problem to manage
  • Development of skills to live life without substance use
  • Identifying and managing the urges to use substances
  • Building new habits that are stronger than the substance use habits
  • Creating social skills to build healthy, non-using social supports
  • Support for involvement with other programs like 12 Steps
  • Treatment of co-existing mental health problems

Read more about addictions, alcohol and substance abuse. 

Attention Deficit/Hyperactivity Disorder (ADHD)

What is ADHD?

Three forms

  1. Mostly impulsive/overactive type
    •   Poor control of impulses, especially regarding things they like
    •  Failing to wait for things to be explained
    •  Talking a lot
    •  Trouble stopping things they like to do
    •  Hard time waiting or being patient
    •  Poor planning and high-risk actions
  2. Mostly inattentive type
    • Hard time directing attention to less interesting tasks
    • Described often as daydreaming or not listening
    • Trouble staying with a task they don’t find interesting
    • Easily distracted when things they find interesting happen
    • Often forgetful
    • Poor strategies to organize tasks if not interested in them
  3. Combined impulsive and inattentive type

How is ADHD diagnosed at CCBT?

  • Primarily use Barkley’s model, (http://www.russellbarkley.org)
  • Barkley’s behavioral rating scales
  • Structured interviews to assess behaviors, attention, and co-existing disorders
  • Rating forms to assess executive functions and daily life functioning
  • Achenbach rating forms (https://www.aseba.org)
  • Pediatricians and Family Physicians often use a screener
  • Vanderbilt rating form
  • Similar approach to diagnosis in adulthood

What is CBT of ADHD?

  • Training in organizational skills
  • Self-monitoring of and skills to manage attention
  • Self-control of impulsivity/ Stop-Think-Do (Sample Treatment)
  • Parent management training
  • Usually in conjunction with medical management if moderate or severe ADHD
  • In adults, addition treatment of procrastination


What is CCBT’s approach to school consultations?

  • Functional Behavior Assessments (FBAs)
  • Creation of behavioral plans to increase positive behaviors
  • Use of planned ignoring
  • Designing of effective prompting
  • Development of attention and point-based reward systems
  • Effective redirection
  • Systemic rule-governed behavior plans

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