MEDI7111 Lecture Notes - Lecture 4: Emotional Reasoning, Socratic Questioning, Cognitive Dissonance
CBT
CBT is one of the most effective treatments for conditions where depression or anxiety is
the main problem, with many studies finding it is equally as effective as medication. There is
evidence for the effectiveness of CBT in treating virtually all mental illness, so long as the
illness doesn’t interfere with the person’s cognition/reality (limited use in florid psychosis).
Broad Goals of CBT
Enhance problem solving capacity
oCoping with stressful events & problem relationships
Modify patient’s perspective of self
oImprove self-esteem, challenge negative beliefs about self
Assist in regulation of distressing affective states
oRelaxation, breathing techniques, mindfulness
In order to achieve successful outcomes in CBT, the patient must be have a strong
therapeutic alliance, be ready to make the changes and have the social supports in place to
make changes.
The Process
CBT is an active, directive, time-limited and structured approach based on an underlying
theoretical rationale than an individual’s affect and behaviour are largely determined by the
way in which he/she structures their view of the world.
The goal of therapy is to find solutions to patients’ problems using cognitive and
behavioural strategies to prevent (or at least attenuate) future episodes of mental illness,
with the expectation that patients will develop independent self-help skills. However the
immediate target is symptom relief.
Initial sessions will work to establish rapport, instil hope, provide a preliminary
understanding of the model, and engage the patient in a “contract” to return for the next
session and to set activities for them to do at home.
Behavioural Therapy
Often the first changes that will be encouraged are behavioural changes (e.g. scheduling
pleasurable activities, learning a new skill, scheduling their day to give purpose etc.) which
often give relief to the negative affect and improve self-esteem/motivation. These changes
often don’t have to be big to have a big effect, this is where graded task assignment comes in
(e.g. if walking to the corner of the street is too much how about walking halfway?).
Cognitive Therapy
Thought help to define the moods we experience, how we behave, what we choose to
do/not to do and the quality of our performance. Negative/anxious thoughts are able to
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