COGNITIVE BEHAVIOURAL THERAPY

Running head: COGNITIVE BEHAVIOURAL THERAPY
COGNITIVE BEHAVIOURAL THERAPY
Name of the student:
Name of the university:
Author note:

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COGNITIVE BEHAVIOURAL THERAPY
Introduction:
Cognitive-behavioural therapy (CBT) has emerged as an effective psychotherapy for the
patients suffering from mental disorders and psychological distress. It is used for altering the
thought process and providing them with a purposeful life. The core premise of this treatment
approach is the maladaptive cognitive factors which contributed to the development of
psychological distress. The case study involves a 52-year-old widow suffering from depression
after the death of her husband seven years ago. She experienced tearfulness, irritation,
exhaustion, increased self-critical thought. This paper aims to develop a Cognitive-behavioural
therapy treatment plan by considering the maladaptive behaviour of the patient.
Discussion:
Building therapeutic rapport:
In order to create a plan for cognitive behavioural therapy, it is fundamental to build trust
and rapport with patients. Harris (2013), suggested that while establishing a therapeutic
relationship with the mentally ill patients, effective communication is the fundamental skill that a
therapist is required to demonstrate. In this context, while interacting with Medina, therapist
must use open communication and maintain eye contact while introducing him/ her to Medina.
Additionally, the therapist must exhibit active listening, warmth, empathetic approach through
tone voice and accurate comprehension of Medina so that she feel and safe. After providing a
sense of comfort, the therapists must share conceptualization and treatment plan followed by
collaborative decision making (Chin & Ahmad, 2017). The communication with the patient must
provide a sense of optimism and a greater sense of self-efficacy. It will enable her to involve in
collaborative decision making and treatment plan.
Interview for the CBT:

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A semi-structured interview can be conducted using a technique such as the ‘Five Ws’ -
what, when, where, with and why question. These questions will encourage Medina to narrate
her problems in more detail and the therapist can gain a perception of her thoughts, beliefs and
values. Additionally, FIND method can be used for gaining an understanding of frequency,
intensity, number, duration of depressive symptoms.
Questions that can be asked to Medina are the following:
 Tell me what exactly you are feeling right now?
 How often do you feel the same thing?
 When do you feel these things can you tell me?
 Why do you think there is something is wrong with you?
 How often do you think something is wrong?
 Tell me about your relationship with your family members and son?
 Do you feel happy when you are them? How many times do you think something like this
in the day?
 What is going through your mind right now?
 Tell me about your relationship with your employer?
 Do you feel anxious when you recall the incident? Do you anxious and made negative
predictions?
 Tell me about your relationship with your husband?
 Do you recall any incidents where your husband made you anxious?
 Describe your mood and behaviour when you are anxious. Is it like turmoil or steady
emotion?
 Tell me more about your relationship with your husband?

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 Do you feel agitated when you lost control of the surrounding?
 Tell me about relationship with your siblings, Family members and peers?
Influence of thinking on behaviour, physiology and feelings:
Usually thinking of individuals reflected in the behaviour of the individuals. There is a
strong correlation between thinking and behaviour as observed in this case scenario. While
Medina involves in thinking regarding factors present in the situation and thinking triggers the
feeling. These maladaptive thinking process gradually developed and reflected in the behaviour
such as poor appetite, exhaustion (Clark & Egan, 2018). In this context, the cognitive model
would be the most suitable model for assessing the link between the maladaptive thought process
and behaviour. The model enables clients to identify their automatic thoughts, modify the beliefs
and current the behaviours exhibited when activating events triggers (Leder, 2017). Therefore,
the therapist is required to use guided discovery along with cognitive model for guiding Medina
in understanding the links between thinking and behaviour. Medina can be provided with self-
evaluation questions for evaluating the validity of the negative thinking such as “what are the
evidence that your thoughts are true ? “ (Harris,2013). What are the alternative way of the view
of the situation, what is the realistic outcome of it?
Core Beliefs, Unhelpful Assumptions and Rules:
Negative automatic thought is defined as negatively framed interpretation of how individuals
perceive themselves and surroundings. It was first defined by Beck for referring to negative
interpretation of the individuals (Philippi et al., 2016). It is often common instances for the
individuals with anxiety and depression where contributing factors are stress, traumatic events,
sleep deprivation, role dispute and poor interpersonal relationship. As observed in this case study

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that Medina is suffering from depression. In this context, the negative automatic thoughts of
medina include
 “I am selfish”
 “If I am in control, then I will not be a nuisance so people will not hurt me”
 “I should be a sounding post and always put others first”
 “I must be perfect”
 “If I am not sympathetic and giving, then others will reject me”
Techniques that can assist Medina to identify and track NATS are stress journaling and
Validity testing. The stress journaling is effective in identifying thoughts and emotion
surrounding the situation and behaviour accompanied by the thought process as observed in this
case scenario (Mahali et al., 2020). Validity testing will enable patients to assess the experience
encountered in the past based on the behaviour.
Behaviours, Beliefs and consequences:
ABC model can be used for helping patients to identify the impact and consequences of
her thought process on everyday life (Hawley et al., 2017). ABC models explain patients the
impact of the behaviours on everyday life (Karyotaki et al., 2017). A part will provide the idea of
activating event, B part will provide the beliefs about the beliefs of and C part will provide
consequences. For example, due to the negative thought process, she experienced tearfulness,
loss of appetite and exhaustion. Therefore, the ABC model would be a suitable model in this
context.
Taking a deep insight into the situation, in this context, the activating events are
“accused of a work- related incident”, “never receiving apology” , “ expectation of parents to be
leader, “ her farther considering her as selfish, “ and “ teasing of family members for being
different”. Due to the activating events, Medina developed irrational believed about herself.

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Considering the ABC model, the common beliefs of Medina include “I am not good enough”,
“I should be a sounding post and always put others first”, “there is something wrong with me”, “
I am selfish” and “I must be perfect. These irrational beliefs resulted in consequences such as
tearfulness, loss of interest, frustration, disturbed sleep, exhaustion, poor appetite and amplified
self-critical thoughts. The only underlying reason is that individuals with depression often
develop a tendency to hold negative core beliefs about surroundings and surroundings.
Techniques for monitoring behaviours:
In this context, behavioural experiments can be used for assisting the patient to monitor
her behaviour. Medina can be assisted to track her behaviour using behavioural activation
techniques and cognitive reconstruction (Harris, 2013). In this context, Medina can be supported
to identify negative behaviours such as tearfulness, not eating food properly and spending time
into the bed. The behavioural activation along with cognitive reconstruction will enable Medina
to track her negative thought process per day. It will also assists Medina to replace negative
behaviour with positive behaviour by involving in reinforcing or pleasurable activities. For
tracking the negative behaviour, cognitive restructuring would be suitable process that will
increase awareness of Medina regarding her negative automated thoughts. The common
approaches of cognitive restructuring is to stabilize the turmoil, identify the activating events,
analyse the mood, identify the automated thought and find supportive evidence for validating the
negative thought process (Philippi et al., 2016). The common behavioural activation techniques
that will enable medina to improve her behaviour include self-journaling of activities and
mood, scheduling activities , tracking frequency of low mood and negative thought per day,
activity structuring (Harris,2013).

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Assessments for understanding the issue:
Mini mental state can be used for assessing the behaviour of the patient as it contains a
set of questions to assess the impact of cognitive function on the behaviour. Rotstein (2020),
suggested that mini-mental state is a tool used in psychology for measuring the cognitive
functioning of the patients. While it is not effective for making a diagnosis, it is effective to
provide an understanding of the cognitive functioning and behaviour associated with cognitive
functioning of the patient. Additionally, Beck's Depression Inventory can be used for assessing
the patient (Orgeta, Brede & Livingston, 2017). It is a highly valid scale for assessing state of
mind of a depressed based on the severity of the symptoms such as hopelessness, irritability, lack
of interest, weight loss. On the other hand, depending on the scores, the only way to deal with
the negative thought pattern is to focus on replacing it with positive thought pattern (Munteanu,
2018). In this context, the patient can be provided with education regarding cognitive models
prior to the process. After education, the patient can be provided with talk therapy to emphasize
on the positive thought process. The identification of the strength of Medina is only way in
which negative thought process can be altered (Harris, 013).. While altering the thought process,
her cultural values are required to incorporate so that she feels safe and contained.
Culture and gender based differences in CBT and techniques:
Gender and culture greatly shape the CBT techniques. While men and women may
receive equal benefit from emotional sharing in the therapy, they might have different starting
points. For example, women are considered to be more sensitive to the psychological issues
compared to men and both the genders have different strategies to cope with the ongoing stress
(Harris,2013). Women tend to be more tearful in therapy compared to men. Hence, it is often
common instances where therapists are extra empathetic towards women, maintain eye contact

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and tend to involve in more nurturing activities compared to men (Liddon, Kingerlee & Barry
2018). On the other hand, women often prefer same gender therapists similar to men. Therefore,
CBT techniques are modified in such a way that female therapists can carry out for female
clients. In this context, medina can be provided with a female therapist and involve in more
sensitive activities.
Considering the cultural standpoint, individuals belong to a different culture and religion
have a different presence for the CBT techniques. For example, individuals belong to the Muslim
religion or Jewish religion often prefer traditional healing rather than conventional techniques. In
this context, therapists often consider the cultural values of the clients and modify the technique
towards traditional healing and spirituality so that they receive maximum benefit (Harris,2013).
Therefore, cultural values and beliefs of Medina are required to consider during the therapy.
Provide an overall summary:
On a concluding note, it can be said that Medina is suffering from depression due to past
events that trigger a range of negative automated thoughts such as “I am selfish”, “I must be
perfect”. In this context, it impacted the behaviour of Medina such as loss of appetite, poor
sleeping pattern. In this context, she can be a good candidate for CBT as CBT can reduce her
negative thought process. In order to test her belief, self-assessment scoring techniques can be
used for assessing the beliefs. The mini-mental state can be used for assessing body language and
cognitive and Beck’s inventory depression can be used for assessing thought pattern.
Considering the scoring, she can support with talk therapy that can alter her negative thought
pattern. Additionally, cognitive restructuring through role-play exercises would be effective as it
would allow the therapist and medina to act out appropriate reaction to a different
situation. Since the majority of the negative thought process was present in the 8th session, 18 to

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20 sessions would be effective. The agenda would be problem-solving through alteration of
negative process, Increase ability to question negative thoughts, reduce avoidance of social
situations and reduce frequency and intensity of negative thoughts at the end of 20th session.

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References:
Chin, L. S., & Ahmad, N. S. B. (2017). Effect of cognitive behavioural therapy (CBT) anger
management module for adolescents. International Journal of Guidance and
Counselling, 3(2), 68-78.
Clark, G. I., & Egan, S. J. (2018). Clarifying the Role of the Socratic Method in CBT: a Survey
of Expert Opinion. International Journal of Cognitive Therapy, 11(2), 184-199.
Harris, S. (2013). Cognitive Behavioural Therapy: Basics and Beyond (2nd edn.) Judith S. Beck
New York: The Guilford Press, 2011. pp. 391,£ 34.99 (hb). ISBN: 978-160918-504-
6. Behavioural and Cognitive Psychotherapy, 41(1), 124-125.
Hawley, L. L., Padesky, C. A., Hollon, S. D., Mancuso, E., Laposa, J. M., Brozina, K., & Segal,
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Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., ... & Andersson, G.
(2017). Efficacy of self-guided internet-based cognitive behavioral therapy in the
treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA
psychiatry, 74(4), 351-359.
Leder, G. (2017). Know thyself? Questioning the theoretical foundations of cognitive behavioral
therapy. Review of Philosophy and Psychology, 8(2), 391-410.
Liddon, L., Kingerlee, R., & Barry, J. A. (2018). Gender differences in preferences for
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of Clinical Psychology, 57(1), 42-58.

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Mahali, S. C., Beshai, S., Feeney, J. R., & Mishra, S. (2020). Associations of negative
cognitions, emotional regulation, and depression symptoms across four continents:
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