Cognitive Behavoural Therapy in Councilling Children

The treatment of children who are suffering from stress has been the most difficult medical practitioner. Therefore counseling is the best treatment of psychological stress. Psychological stress arises from frustration conflict and pressure. Frustration arises from one individual failing to accomplish some needs or desires of life. When such kind of frustration strikes a person he needs counseling which can be cognitive behavioral therapy or rational emotive or behavioral therapy.

Another cause of psychological stress is conflict, which arises when there is two or more incompatible needs or valued goals. Pressure is another cause of psychological stress, which arises from demands made on the individual either from within conscious or from without. however, social cultural which the individual may have added into her believed. If a person believes he must work perfectly, and meet deadlines this may be a source of stress of internal stress.

People acquire values, believes, perceptions, and attitudes from our associates, parents ,teachers and peers and a variety of experiences. The values, believes attitudes and experiences which are faulty make us afraid of criticism, uptight, rejection, aviances about approval and disapproval, and prone of feelings about guilty and obcessed with subsiding.

Introduction

Recognition, emotive behavioral therapy and cognitive behavioral therapy are theories that are fundamental for psychological stress management.

Rational Emotive Behavioral Therapy

Rational emotive behavioral therapy holds that people wish to live happily and continue to stay alive without interruption. People tend to live irrationally by creating themselves disturbances, which are ego, and discomfort disturbance, which is known as low frustration tolerance. Ego refers to demands made about other people’s behavior. The other tendency people have which is optimistically, this work towards changing person irrationalities.

According to Dryden (1996), elllis believes that human beings tend naturally to perpetuate their problems and have a strong innate tendency to cling to self-defeating, habitual patterns, thereby resisting basic change. They may, for example, continue to believe deep down in the A-C connection, rendoctrinate themselves with irrational believes or fail to act mean fully to counter them due to low frustration tolerance.

In PCC, incongruence between a person s self-concept (the way the persons sees him or herself) and his or her real, authentic self is at the root of psychological disturbance. The wider the gulf between the two, the more the incongruent he or she is.

A persons self-concept is heavily dependant on the attitudes towards him or her of significant others (parent, teachers, influential peers) as he or she grows up. From earliest infancy the person has an overwhelming need for the acceptance and approval for others and, if necessary, will deny or distort their own visceral experience and instincts in order to obtain them. The amount the person has to sacrifice their own unique way of being will depend on the congruence or psychological health of their significant others. If the person grows up in a tolerant and accepting

What Is Cognitive Behavioral Therapy? (Cbt)

Cognitive behavioral therapy is a process of teaching, coaching, and reinforcing positive behaviors. Cognition behavioral therapy helps people to identify cognitive patterns or thoughts and emotions that are linked with behaviors. Cognitive behavioral therapy is a psychological treatment that addresses the interactions between how we think, feel and behave. It is usually time-limited (approximately 10-20 sessions), focuses on current problems and follows a structured style of intervention.

The development and administration of Cognitive behavioral therapy have been closely guided by research. Evidence now supports the effectiveness of Cognitive behavioral therapy for many common mental disorders. For some disorders, carefully designed research has led international expert consensus panels to identify Cognitive behavioral therapy as the current treatment of choice.

Cognitive behavioral therapy is less like a single intervention and more like a family of treatments and practices. Practitioners of Cognitive behavioral therapy may emphasize different aspects of treatment (cognitive, emotional, or behavioral) based on the training of the practitioner. Nevertheless, the identified techniques of Cognitive behavioral therapy prove their family resemblance in a number of ways. All techniques and approaches to Cognitive behavioral therapy are practically applied.

What gets used (that is, which technique for which problem) is what has been proven effective and the techniques themselves derive from science (for example, the behavioral experiments used to help people overcome feared objects or situations). Cognitive behavioral therapy has been studied and effectively implemented with persons who have multiple and complex needs, and who may be receiving additional forms of treatment, or have had no success with other kinds of treatment.

Thinking

Different people can think differently about the same event. The way in which we think about an event influences how we feel and how we act. A classic example is that when looking at a glass of water filled halfway, one person will see it half empty and feel discouraged and the other sees it half full and feels optimistic. People do not have to continue to think differently about their experiences in the same way for their entire lives. By identifying dysfunctional thoughts and by learning to think differently about their experiences, and in turn, behave differently.

Most of the time people believe things about themselves and the people around them because they have good evidence for their beliefs. However, people are often very selective in the evidence that they focus on (or what they believe to be fact). A depressed individual may remember the person who ignored her in a conversation but not remember the person who found her interesting. Therefore, she may conclude, l is boring person. Cognitive-behavioral practitioners help people understand how, by selecting particular evidence to focus on, they can end up forming believes that are cognitive distortions. The individual may not even be aware that they have formed these

The Use Recognitive Emotive Behavioral Therapy

The psychiatrist, Aaron T. Beck, developed cognitive therapy in the 1960s to treat depression. Up until that time, most psychotherapy for depression had its origins in the psychodynamic approach inspired by the work of Sigmund Freud. The first controlled outcome study cognitive behavior therapy (cognitive behavioral therapy) for depression was conducted in 1977 and since then a great deal of research into the effectiveness of cognitive behavioral therapy, across a range of treatment settings and populations has been conducted.

Cognition behavioral therapy, as applied to depression, relies on all the key principles of cognition behavioural therapy, in that it is collaborative, present oriented, and problem focused. Typically, the treatment involves;

1. Helping the person in treatment to establish daily activities to provide structure and direction in graduated steps.
2. Encouraging the person to identify and challenge negative thoughts and assumptions characterized of their depression and to consider evidence for more realistic views of their experience;
3. Helping the person shift focus away from physical symptoms and negative mood associated with depression; and
4. Helping the person return to a routine pf pleasure able and productive activities on a scheduled basis.

The treatment also typically involves psycho education about depression that normalizes the symptoms as part of illness, which the person can do something about, rather than an indication of laziness or a deficit in character. In addition it often involves learning techniques to solve problems and prevent relapse. Feelings of hopelessness are treated early on in treatment because they are associated with sociality and individuals do better in cognition behavioural therapy when hopelessness is addressed effectively.

Cognition for depression has been successfully administered in individual, group and couples formats. Individuals who have a more chronic or recurring illness may often require repeated interventions, or a shift in interpersonal, and identify issues.

Diagnostic criteria for a depressive episode

For more than two weeks five of more of the following symptoms are present (either depressed mood or decreased interest or pleasure must be one of the five)

1. For most of nearly everyday interest of pleasure is markedly decreased in nearly all activities.
2. There is a marked loss or gain of weight or appetite is markedly decreased in nearly everyday.
3. Nearly everyday the patient sleeps excessively or not enough.
4. Nearly everyday others can see that the patient’s activity is agitated or compromised.
5. Nearly everyday threes a fatigue or loss of energy
6. Nearly every day the patient feels worthless or inappropriately guilty.
7. Nearly every day the patient is indecisive or has trouble thinking or concentrating.
8. The patient has had repeated thoughts about death, suicide, or has made a suicide Attempt.

The Use of Rational Emotive Behavioural Therapy

The work of dugas and colleagues (2003) illustrates the current approach to cognitive-behavioural therapy rearmament for generalized anxiety disorder (GAD) this approach includes

-Worry awareness training –this is necessary first step since most people with generalized anxiety disorder fear uncertainty and work to ensure predictability (that is usually whatever worked before) and so are purposely exposed to increasingly uncertain situations relevant to their worry themes. Trusted others (for example, partners, parents) are instructed not to provide reassurance when the person with

Approximate Lifetime Prevalence: 5 %

Diagnostic criteria for generalized anxiety disorder.

Excessive anxiety and worry (apprehensive expectation) about multiple events/activities.

• Worry occurs for more days than not over the past 6 months.
• The worry is hard to control.
• The anxiety is associated with 3 (or more) of:
  • Restlessness/being keyed up or on edge.
  • Being easily tired
  • Difficulty concentration or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance.
• The content of the worry and anxiety is not confined to the features of an Axis 1 disorder for example, being contaminated (as in obsessive-Compulsive Disorder).
• The anxiety, worry or physical symptoms cause clinically significant distress or impairment in functioning.

The disturbance is not due to the physiological effects of a substance or general medical condition and does not occur exclusively during the course of a mood disorder, psychotic disorder or pervasive developmental disorder.

Helping People Change

The essence of the change process is the DISPUTING of the validity of the core beliefs that the CT holds (D). Successful disputation, whether by CR or by (ultimately) CT, leads to a new EFFECT (E). This E to a new, more appropriate FEELING (F)>

Corey summarizes this process of change by listing the following 7 steps in what he calls a philosophical restructuring’ (p. 301) of the personality.

1. Acknowledge that we largely create our own emotional distress:
2. Accepting that we can change these disturbances significantly:
3. Recognizing that our distress come largely from irrational beliefs:
4. Identifying these core beliefs”
5. Believing in the value of disputing these beliefs
6. Realizing that hard work is needed to change these beliefs:
7. Practicing REBT methods for the rest of our lives.

Rational Emotive Behavioural Therapy Technics Used in Rebt

REBT is selectively ‘eclectic’ according to Ellis, so there are no techniques essential to REBT. Nevertheless, techniques tend to be drawn from cognitive, emotive and behavioural spheres.

Cognitive Techniques irrational analysis

Focusing on specific incidents from cognitive technique’ lives and demonstrating the art of disputing the irrational beliefs underlying their distress.

ii. Double standard dispute if Cognitive technique are holding a “should’ or are self-downing about their behavior, ask them whether they recommend that their best friend hold this same; should’ or would they assess their friend in the same way. When Cognitive technique says no then help them to see that this action indicates the presence of a double standard.

Catastrophe Scale

Useful technique for getting ‘awful sings’ into perspective. Draw a vertical line down one side of a piece of paper. Put 100% at the top, zero% at the bottom and 10% intervals in between. Get CT to place the items she is catastrophising about on the scale. Fill in the other levels with items the CT thinks relevant too those levels. Then progressively alter the position of the feared event until it is in perspective in relation to the other items’ (Froggatt, P.9).

Devil’s Advocate

CR argues vigorously for irrational belief of CT while CT tries to convince CR that belief is irrational. Good to use for consolidation purpose.

Reframing

Re-evaluate bad events as ‘disappointing,’ ‘Concerning’, or ‘Uncomfortable’, rather than as ‘awful’ or ‘Unbearable’. A variation of this procedure is to list the positives of a negative event. (However, REBT is not wanting to suggest that bad experiences are actually good ones.)

Emotive Techniques

Rational-emotional imagery

A form of mental practice, according to Corey, that allows a person to imagine himself thinking, feeling and behaving exactly the way he would like to in actual life. First, the CT images a situation that would normally upset a great deal, to feel the inappropriately intense feelings about that event and then change them to more appropriate feelings. Ellis claims that the CT keeps practicing such a procedure’ several times a week for a few weeks’ (Corey P. 307) then the CT will reach a point where he is no longer troubled by the event.

Shame-attacking exercises

Aim of these exercises is for Cognitive technique to feel unashamed even when others disapprove of their actions. Corey lists a number of minor infractions of social conventions so as shouting out the stops on a bus or train, wearing loud clothes to attract attention, singing at the top of their lungs, asking a silly question at a lecture, or asking for a left-handed spanner and behavioural components).

Behavioural Techniques

According to Corey, REBT practioners use the standard behavioural methods when appropriate. REBT believes that actions can change cognitions.

Exposure

Strongly favored by REBT. Ellis recommended that lonely people go out and talk to a dozen people in their shopping centre or at their next party, thereby showing them that meeting people is not so unpleasant as they had previously thought.

Stepping out of character

The technique is the use of a paradoxical behavior. A perfectionist may be asked to deliberately do something that is not up to her normal standard; a person who doesn’t care for himself because he believes that to be selfish would be invited to indulge in a person treat each day for a week.

The content of the Therapy

Using Cognitive-Behavioural Theraphy(CBT) to treat specific phobias involves graduated and prolonged exposure to the feared situation in a controlled way (for example, real or imagined exposure) so that people can see that the consequences they fear do not occur. The goal of treatment is to enable people to cope with the feared situation or object as they encounter them in the real world (for example, someone with a spider phobia after a course of CBT should be able to catch a spider with a glass and postcard and take it outside). Consequently, it is important to the effectiveness of the treatment that people understand that they will need to continue to expose themselves to the feared object or situation after the treatment session.

Approximately Lifetime prevalent: 10-11%

Diagnosis Criteria for Specific phobias.

For more than two weeks, five or more people of the following symptoms are present (either depressed mood od decreased interest or pleasures must be one of the five):

• Marked and persistent fear that is excessive or unreasonable triggered by presence or anticipation of a specific object or situation, for example, flying, animals, receiving an injection.
• Exposure to the feared object leads to anxiety that can take the form of a panic attack.
• The fear is recognized as excessive or unreasonable.
• The phobic is avoided or endured with intense anxiety.
• The fear or avoidance interferences significantly with normal functioning.
• In children, the duration is at least 6 months and crying, tantrums or clinginess may express the anxiety. The child may not recognize the fear as excessive.

Prior to the exposure session, the qualified CBT practitioner makes a list of the catastrophic belief that the person may have about the feared object or situation. The exposure sessions are presented as a series of ‘behavioural experiments’ designed to challenge the individual’s beliefs regarding the danger of the feared object. During the session, the individual is encouraged to approach the feared object or situation and to remain in it, or in contract with it, until anxiety is reduces to at least half its original level. For some phobias, particularly, those involving fears of animals, the practitioner demonstrates how to interact wit the feared object before the individuals is encouraged to do so.

Treatment for animal phobias, claustrophobia, dental phobia, flying phobia and height phobia all follow a similar protocol.

There is a one-session, rapid treatment for specific phobias that results in significant, long-term improvement for a percentage of individuals. This treatment, developed by ost (1989) in Sweden, consists of intensive exposure to the feared situation or object during a single session. The rapid treatment technique used for the different specific phobias, led to improvement in 74% of people after 2-3 hours treatment. In addition, treatment gains were well maintained at one-year follow up.

Discussion

A stepped approach to care is designed to increase the efficiency of clinical services by targeting treatment that is proportional to the level, of need. There is a disorder severity gradient and treatment is thus also graded. Specifically, those with milder symptoms are more able to fend for themselves via the Internet. self-help groups or with printed materials. People may seek treatment at mild to moderate levels of severity, but more commonly when they are in “Crisis”.

At lower levels of need, less intensive interventions may be offered, with more complex and intensive forms of treatment following increased needs. A stepped or graded approach has the capacity to improve access to cognitive Behavioural Therapy (CBT) by increasing the availability of less intensive interventions for individuals with less severe presenting problems, while focusing more intensive treatments on the sunset of individuals who need them. Resources and additional treatment modalities are needed to serve those at both the higher and the lower end of the suzerainty continuum. A stepped approach emphasizes the importance of early detection, accessibility of service, public education, and continuity of care.

A large number of CBT interventions involve 16 to 24 sessions of face-face, one-to –one contact (spanning two months to one year) with a qualified CBT practitioner. The nature of alternative interventions varies widely, including the following:

• Group CBT, including psychoeducation.
• Self-help groups.
• Brief, individual CBNT consisting of 1 to 4 sessions
• Telephone-assisted CBT
• Guided self-help books.
• Audio and Videotapes.
• Internet-assisted CBT.
• Computer assisted CBT.

Practitioners should have an awareness of the potential benefits and limitations of self-help materials for mental health problems. This awareness may be particularly important for health c are professionals who are not experts in Cognitive-Behavioural Therapy (CBT). Also anyone using self-help materials should be encouraged to discuss them with his or her primary health care provider.

Each of these modified forms of CBT is summarized in table1, along with the circumstances in which there are data to support their efficacy.

Often these formats are combined, for example brief CBT supported by a self-help booklet. The interventions are generally directed at individuals with mild to moderate, but not severe psychopathology. They are most effective with the disorders in which dysfunctional beliefs can be identified and addressed (for example, a person with panic disorder believing that his racing heart means he is on the brink of having a heart attack).

The graded or stepped approach aspires to assign people to the, level intervention that their symptoms warrant. Careful treatment planning is always recommended before prescribing a “lower-level” intervention.

At present there are few established criteria on which to make these assignments, although the following should be considered.

• Research supports the use of the intervention for the mental disorder at the level of severity and complexity presented by the person.
• The individual is willing and able to engage in the intervention (for example, she has a computer for computer-assisted CBT; reading skills to use self-help booklet.
• The individual is not being denied a higher level and needed intervention that is available at present.
• The individual is prepared to undertake a more intensive level of care if the current “step” or “grade” is not sufficiently effective.

Annotated Bibliography

• Www.academyofct.org- the academy of Cognitive Therapy was founded by Aaron T.Beck, who is credited with originating cognitive theraphy in the early 1960s. Its members are among the leading international figures in the science and practice of CBT. The website emphasizes the importance of appropriate training and links to courses and workshops around the world, and publishes a regular newsletter.
• Www.anxietybc.com- The Anxiety Disorders Association of British Columbia works to increase awareness about anxiety disorders; promote education of the general public, affected persons, and health care providers’ and increase access to evidence-based resources and treatments.
• www.babcp.com- The British Association of Behavioural and Cognitive psychotherapies is the UK organization for CBT therapists. It is responsible for formally accredited CBT practitioners, organizing annual conferences and providing support to over 6.000 members. The website includes information about UK and international CBT conferences, and pamphlets for patients on a range of psychological disorders.
• www.camh.net- Centre for Addition and Mental Health in Toronto, ON is Canada’s leading mental health and addictions teaching hospital.
• www.cognitivetherapy.com –An informational website containing CBT resources such as training opportunities, links, and a directory of therapists.
• www.healthyplace.com –Healthyplace.com is a large consumer mental health site, providing comprehensive information on psychological disorders and psychiatric medications from both a consumer and expert point view.
• www.heretohelp.bc.ca – A mental health information site by the BC partners for mental Health and Addictions information.
• www.mentalhealth.com – This site provides information about different mental disorders, diagnosis, medication, and reseach. Information on CBT is given for several mental disorders.
• www.mentalhealthcanada.com – Searchable Canadian Directory of Mental Health Professionals.
• www.mgh.harvard.edu/madiresourcecenter/moodandanxietyvideos.asp – Massachusetts General Hospital, Mood and Mood and Anxiety Disorders institute this website is a general resource for information on Mood and Anxiety Disorders. Of particular relevance are two online presentations by Dr. Michael Otto, Associate Professor of Psychology, Harvard Medical school, and Director of the Cognition-Behaviour Theraphy program at Massachusetts General Hospital. In one video, he explains CBT for anxiety and mood disorders and in a second video he explains CBT for schizophrenia.
• www.mind.org.uk/information/booklets/Making+sense/MakingsenseCBT.htm – Produced by Mind.org in the UK, this fact sheet outlines what CBT is, how it works, and how to find a therapist.
• www.MindOverMood.com –Center for Cognitive Theraphy provides resources for the public from Christine padesky, an international leader in cognitive-behaviour theraphy, author of several highly influential books on CBT, and Founder of the Center for Cognitive Theraphy in Huntington Beach Califonia. Her professional website (www.padesky.com) provides written and video/audio training materials for health professionals, and information about consultation and upcoming international workshops.
• www.nice.org.uk – The national Institute of Clinical Excellence (UK) is an organization created as part of the National Health Service in the UK. Its mandate is to systematically evaluate the state-of-the-art in treatment research and make specific guidelines for clinical practice for hedalth. Authorities within the UK. While its guidelines cover a wide area, many have specific relevance for the practice of CBT. In particular, there are published guidelines for Unpopular Depression, Generalized Anxiety and Panic Disorder, PTSD, and Schizophrenia, and an evaluation of computer-Assisted Treatments for Depression and Anxiety. Treatment guidelines for Bipolar Disorder are in development.

Anxiety disorders

Barlow, D. (2004). Anxiety and its Disorders: the Nature and Treatment of Anxiety and panic. New York: Guilford press.

Wells, A (1997). Cognitive Theraphy of Anxiety Disorders: a Practice Manual and Conceptual Guide. Chichester, UK: Wiley.

Beck,A.T., Emery,G.,& Greenberg,R L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.

Barbe, R.P., Bridge,J.,Birmaher,B.,Kolko,D., & Brent,D.A. (2002). Suicidality and its relationships to treatment outcome in depressed adolescents. Paper presented at the 49^th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, san Francisco,CA.

Clarke,G.N., Hawkins,W., Murphy,M,Sheeber,L. B., Lewinsohn, P. M., & Seely, J.R (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescents Psychiatry,34, 312-321.