CBT in practice

CBT is brief (6-12 sessions) and problem-oriented, and it demands active participation both from the therapist, who provides a structured approach and sometimes a substantial educational input, and from the patient. Structure is provided by several factors, including the following:

• prior agreement on the number of sessions

• setting of agreed, tangible goals (such as a patient with social phobia going shopping alone)

• planned structure for each session

A typical session includes:

• setting agenda for session

• review of homework

• review of events since previous session

• feedback on last session

• problems to be addressed in session

• setting homework

Components of the therapy include the following:

• cognitive techniques, such as the following:

- questioning negative automatic thoughts

- distraction techniques to take the patient's attention away from negative thoughts

• behavioural techniques:

- keeping a diary: simple notes on thoughts/feelings/activity to establish the influence of thoughts on mood

- activity scheduling: planning pleasurable experiences/activities.

Many of these are first tried out within the session, and then practised as agreed specific homework tasks.

The skill of the therapist lies not only in using these techniques and structures, but doing so in a sensitive and supportive way, for the building of good rapport between patient and therapist is as essential here as in all kinds of therapy. Trust in the therapist will encourage the patient to engage in prescribed tasks that are often anxiety-provoking or even unpleasant in themselves, such as going out for the socially phobic person, or challenging a negative self-concept for the depressed.

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