cognitive behaviour therapy (cbt) : preparing organisations for psychological change

Cognitive Behaviour Therapy (CBT): preparing organisations for psychological change

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Aims of This Discussion

• To understand how CBT can help organisations with well being, behaviour change and performance

• To reflect on workplace challenges, training needs, and research opportunities

Psychological theories & approaches in the workplace

• CBT (Beck, 1979) and MI (Miller & Rollnick, 1991; 2002) are psychological approaches, underpinned by evidence, that can help organisations and individuals overcome challenges related to physical, emotional, behavioural and situational factors.

• Issues within the workplace maybe; stress, resistance, burnout, presenteeism, absenteeism, sickness ill health, counter-productive work behaviours, physical ill health, poor mental health and so on.

WHAT IS THE AIM OF CBT?

• To increase self-awareness

• To encourage a better self-understanding

• To help us recognize the ‘negative traps’ or ‘vicious cycles’ we get caught in

• To improve self-control by developing more appropriate cognitive and behavioural skills

Cognitive Behaviour Therapy

CBT is ‘a process and identifying and re-evaluating self defeating thinking so that a person is persuaded to engage in more effective ways of thinking, feeling, and behaving’. • A therapy using a mixture of cognitive

(thought processing) and behavioural techniques to look at the links between a person’s environment, thoughts, feelings and behaviours and the impact of these on their health and functioning

• Cognitive techniques address thoughts and thought patterns which may be ‘unhelpful’ and may trigger and/or increase anxiety

• Behavioural techniques address behaviours which may be used by a person to reduce their anxiety or avoid it altogether

Cognitive Behavior Therapy

Basic Tenets

– The main theories are Cognitive Behavior Therapy, Rational Emotive Behavior Therapy and Cognitive Behavior Modification.

– The way individuals structure and interpret experiences, determines their moods and behaviors.

– Changing conceptualizations lies at the heart of cognitive behavioral therapy.

– Combines both cognitive and behavioral approaches.

“Copyright © Allyn & Bacon 2004”


Basic Tenets

– Cognitive therapy rests upon the belief that what one thinks determines how one feels.

– The therapist is supportive and empathic and uses experiments and empirical processes along with a collaborative alliance with the client, to explore thinking and alternatives.

– Cognitive therapy has been used with a variety of disorders and problems (e.g. anxiety, phobias, depression).


Situation

THOUGHTS

PHYSICAL REACTIONS FEELINGS

BEHAVIOURS

Overly negative

Self-critical

Thinking things are going to go wrong

Thinking there is danger

Imagining people will judge you harshly

Imagining that you will look foolish

Unpleasant

Anxious

Angry

Depressed

Heart pounding

Feeling hot

Sweaty

Shakiness

Headache

Stomach ache/cramps

Nausea

Avoid situations

Run away from situations (escape)

Give up

Don’t try to go places or do things

Cognitive Behavioral Therapy is based on the observation that cognition, emotion,

and behavior are reciprocally related.

Cognition

Behavior Emotion

EMOTIONS

Emotion

• James-Lange Theory of Emotion

– Action or response precedes emotion

– I run, therefore I must be afraid.

• Canon-Bard Theory of Emotion

– Emotion precedes action.

– I am afraid, therefore I run.

Singer-Schacter Theory of Emotion

Emotion #3

Emotion cannot be accessed directly, but it can be elicited in therapy.

Experiences that are accompanied by the arousal of strong emotion have more powerful effects on cognitive and behavioral patterns.

Memory (learning) is mood congruent. A recurrence of mood triggers recall of learning. A reminder of learning situation triggers the original mood.

Emotional Symptoms

• Emotional excess – Overreactions or unpredictable

emotions – Excessive or overly extravagant

expression of emotion – Emotionally labile

• Emotional insufficiency – Difficulty in displaying emotion – Difficulty in “reading” emotion

in others – Difficulty in verbal expression of

emotion – Lack of self-control, poor

frustration tolerance

• Judgment is the emotionally (socially) relevant use of knowledge.

• Judgment takes place in the frontal cortex.

Behavior

Classical Conditioning The repeated pairing of a

stimulus with a (formerly) neutral response, resulting in the stimulus coming to trigger the neutral response. (Pavlovian) Aversion therapy Desensitization Flooding Stimulus control

Alters antecedent conditions to affect behavior

Behavior #2

• Operant Conditioning – Modifies “voluntary behavior”

• Positive Reinforcement: a behavior is followed by a reward. Increases behavioral frequency.

• Negative Reinforcement: a behavior is followed by the removal of an aversive stimulus. Increases behavioral frequency.

• Positive Punishment: a behavior is followed by an aversive stimulus. Decreases behavioral frequency.

• Negative Punishment: a behavior is followed by the removal of a favorable stimulus.

Behavior #3

• Operant conditioning = instrumental learning (Skinnerian)

– Extinction

– Differential Reinforcement of Other Behavior (DRO)

– Avoidance learning (E.g., electric shock to reduce arousal in presence of child pornography)

Behavior #4

• A behavior that is rewarded every time is acquired or learned quickly.

• Fading the reward schedule to intermittent makes the behavior less vulnerable to instances of non-reward. The behavior persists for a relatively long period of time, even if not rewarded.

Effectiveness of consequences depends on:

• Immediacy

• Consistency (reinforcement schedule)

• Potency (cost-benefit ratio)

• Satiation (felt need for the stimulus or response)

The Premack Principle

• A desirable or often-engaged in behavior or situation can serve as a reinforcer for another (new) behavior.

• Example: If you always brush your teeth and need to develop a habit of taking medicine, pair the medicine routine with the teeth-brushing routine.

Social Conditioning

Complex social behavior increases and decreases in frequency in response to social reinforcement and social “response cost” or punishment.

Example: A pat on the back or a thank you from the boss reinforces excellent work habits better than an increase in salary.

Behavioral Difficulties

• Behavioral excess • Behavioral insufficiency • Lack of skill (lack of “know-

how”) • Restricted range of coping

strategies (“know-what”) • Behavioral inconsistency

(“know-when”) • Insufficient stimulus control

(difficulty with initiating or maintaining behavior)

• Insufficient contingency control (failure to reward self)

Behavioral Difficulties #2

• Disorders of Executive Control

– Planning – Organization – Time Management – Task Management – Delay of Gratification / Poor

Impulse Control (inhibition of behavior)

– Goal Directedness (initiation of behavior)

Cognition

• Human cognition tends to be categorical and hierarchical. (We sort and categorize.) This is biologically determined – it’s how the brain works.

• Sorting and categorizing makes learning possible, through a process of assimilation and accommodation.

• Categorizing and comparing allows us to arrive at efficient rules for sorting the vast amount of information that confronts us every waking moment.

Cognition #2

• Early-acquired cognitive rules form basic schema that tell us what information is important for survival:

– what data to actively seek, – what data is relevant and noteworthy, and

– what can be safely ignored

Cognitive Schema

Early acquired schema (probably prior to age 8 or so) form our basic assumptions about ourselves and the world and the relationship between those two. They form our Core Beliefs or Basic Beliefs.

Schema tend to be partial

constructs, usually operating outside our awareness. They tend to be fragmentary, visceral, iconic vs. verbal. They are presumed true, unquestioned.

Characteristics of Basic Schema

• They are absolutes. • They are unquestioningly taken as

Truths. • They are consistent across time and

situation. • They function below the level of

awareness. • They tend to be non-verbal, visceral &

iconic. • They tend to be partial constructs. • They are highly resistant to change. • They are evident only indirectly in

patterns of cognition, emotion, & behavior.

Cognitive Schema may be…

Compelling

Non-Compelling

Active Latent

Self-Schema • Beliefs about Self are acquired

from: – Stories told about the child

within his/her hearing – Stories told directly to the child

about themselves – Reflections of and reactions to

the child’s behavior by significant others

– Stories erroneously adopted (false memories)

• Events that happened to others • Events in books or on television

– Personal experience • Interpretations of early life

events • Experiences of success and

failure

Characteristics of

Cognitive-Behavioral Therapies:

1. Thoughts cause Feelings and Behaviors.

2. Brief and Time-Limited.

3. Emphasis placed on current behavior.

4. CBT is a collaborative effort between the therapist and the client.

Client role - define goals, express concerns, learn & implement learning

Therapist role - help client define goals, listen, teach, encourage.

5. Teaches the benefit of remaining calm or at least neutral when faced with difficult situations. (If you are upset by your problems, you now have 2 problems: 1) the problem, and 2) your upsetness.

6. Based on "rational thought." - Fact not assumptions.

7. CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits.

8. Based on assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting.

9. Homework is a central feature of CBT.

Three assumptions

1. Cognitive activity impacts behavior.

2. Cognitive activity can be monitored and changed.

3. A desired change in behavior can be accomplished through changing cognitions.

Symptoms

Physical

Feelings Thoughts

Behavioural

Negative

automatic

thoughts

Incidents

Past

experience

in workplace

CBT and self defeating thinking in the workplace

Core beliefs

Underlying

assumptions or

life rules


Strategies for Helping Clients

Beck’s cognitive psychotherapy

– The goals are to correct faulty information processing and help clients modify their assumptions that maintain their maladaptive behaviors and emotions.

Collaborative Empiricism: Therapist and client are co-investigators.

Guided Discovery: Guided by the therapist, the client engages in experiments that result in more adaptive ways of thinking.




Relaxation Training and Relaxation

Therapy

– A person cannot be in a state of complete physical relaxation while at the same time be emotionally anxious.

– Works well for stress, anxiety, physiological problems, workplace pressures, and coping with modern lifestyles.



Strategies for Helping Clients Mental and Emotive Imagery

– Mental Imagery is a process through which a person focuses on vivid mental pictures of experiences or events—past, present or future.

– Emotive Imagery: It is a procedure where the client imagines the emotional sensations and feelings of an actual situation or behavior.




– Cognitive Modeling: Identification of what maladaptive or bad thoughts or emotions the client wishes to be rid of and then the therapist models with self-talk that the client will incorporate.

– Covert Modeling: A client imagines engaging in the desired behaviors he or she wants to learn or adopt.

– Thought Stopping: Interruption of unwanted thoughts when they occur by shouting “stop” whenever the unwanted thought pops into consciousness.




– Cognitive Restructuring:

Replacement of negative, maladaptive thoughts with positive, adaptive ones.

– Reframing: To modify or restructure a person’s view or perception regarding a problem or behavior.

– Stress Inoculation: A process of teaching clients both cognitive and physical skills for autonomously coping with future stressful and distressing situations.




– Meditation and Relaxation: Helps the client concentrate on some internal or external stimulus that serves to focus the client’s attention away from aversive stimuli.

– Biofeedback: Uses technology to communicate to a client what his or her own body is doing and then allows that person to use mental processes to control bodily functions.

– Neurolinguistic programming: Using the client’s sensory language to fully experience the client’s inner world (e.g. I see that (visual); I feel that (kinesthetic) ; I hear that auditory).




– Eye Movement Desensitization Reprocessing (EMDR):

Used primarily to treat traumatic memories.

The client imagines the scene, is aware of the negative statement regarding that scene (along with noxious feelings), and then follows the therapist’s finger with his or her eyes.

Then the client erases the image from his or her mind.

This is continued over a series of steps until hopefully the painful image and noxious feelings and memories are removed.


Cognitive Behavior Therapy Advantages of Cognitive Behavior

Therapy

– It has established human thought processes as data or events that can be studied.

– It validated a number of relaxation techniques.

– It has enhanced the rational therapies such as Rational Emotive Behavior Therapy.

– Uses the systematic scientist-practitioner model.



Disadvantages of Cognitive Behavior Therapy

– It has been harshly judged by feminists, multiculturalists and ecologists because it mirrors masculine and Euro-American worldviews and does not adequately take culture into consideration.

– It requires a lot of training and skill.

– The therapist needs to not only understand cognitive techniques but also have a vast understanding of behavioral and learning theories.

– The therapist needs to have strong discipline and there is less tolerance for error.



Cognitive Behavior Therapy with Diverse Populations

– It matches problems to treatments without regard for race or cultural considerations.

– It can be used effectively if culture and the client’s worldview is take into consideration.

– Therapy is a collaboration and depends upon trust between counselor and client and this can work well with culturally diverse clients.


WHAT CAN DO?

COGNITIVE • Identify negative thoughts and

thinking patterns which make you feel unpleasant using a thought diary (Appendix A)

• Label the type of ‘thinking error’ (Appendix B)

• Develop balanced thinking by looking for evidence for and against the thoughts and finding new evidence you might otherwise miss

• Learn new skills i.e. distraction, positive self-talk, problem-solving skills

BEHAVIOURAL • Activity monitoring – link activity,

thoughts and feelings

• Become more active – this leaves you less time to worry or listen to your negative thoughts

• Increase pleasant activities

• Break tasks into small achievable steps

• Face your fears – try to break negative cycles by dropping avoidance, escape and safety behaviours

How understanding theory and practice may help you and your organisation

• Help identify and achieve health and work goals

In particular

Dealing with change and resistance

Modification of health and worked related beliefs

Solution focused approach to development of action plans

Training needs of yourself and your workforce

Applying consultancy for your organisational needs

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