MindMate Notes

Cognitive-behavioural therapy (CBT)

Overview

CBT is a type of psychological treatment, also known as a talking therapy. There is a large evidence base (The British Association for Behavioural & Cognitive Psychotherapies BABCP) which suggests that it is very effective for conditions including:

·  Low self esteem

·  Depression

·  Anxiety problems

·  Obsessive-compulsive disorder (OCD)

·  Post-traumatic stress disorder (PTSD)

CBT works by helping the client to understand the links between

·  What you think (Your thoughts, beliefs and assumptions)

·  What you feel (your emotions)

·  What you do (your behaviour)

CBT is based on the concept that thoughts, feelings, physical sensations and actions are interconnected and that negative thoughts and feelings can trap the client in a vicious cycle. It breaks down overwhelming problems into smaller parts and challenges negative beliefs. CBT deals with current problems and does not focus on issues in the client’s past.

CBT teaches skills for coping and can be of great benefit in schools. CBT is usually offered by trained therapists, however, school staff can be trained to work with less severe problems, supported by good supervision from a trained practitioner.

What can this look like in schools?

CBT can be used in schools to help students control their own behaviour rather than the use of external enforcement alone. It can help students learn “how to think” not “what to think” and develops student’s self control. Used alongside a solution focussed approach, it can challenge pupils and staff to solve problems rather than stay with what is not going well.

CBT strategies can be used with individuals and whole class groups.

Helpful approaches in school.

Introducing lessons in CBT to children in primary schools can significantly reduce anxiety levels (The Lancet Psychiatry 2017) and research also suggests that the impact is helpful for secondary education too. This links into the Growth Mindset work which refers to a way of thinking, learning and taking on challenges, which is practiced in many schools.

There are several evidence-based school programmes based on CBT intervention. The FRIENDS programme teaches younger children to effectively manage their anxiety (evaluated by University of Bath). It encourages young people to apply problem solving techniques to everyday issues. This might take the form of:

·  Identify problem or difficulty

·  Identify possible solutions

·  Choose the best or least worst solution

·  Advantage of this solution

·  Disadvantage of this solution

·  What steps do you need to put this solution into action?

CBT in the classroom

The Cognitive Model: Situation è Thought è Emotion è Behaviour

Something happens; situation is interpreted; a feeling occurs; action in response

Practice STOPP

STOP / Take a breath / Observe / Pull back. Put in some perspective / Practice what works
Stop and step back from the situation, in
your mind / Breathe slowly once or twice / What’s happening?
What am I reacting to?
What am I thinking and
feeling?
What are the words that my mind is saying?
What physical sensations do I
notice in my body?
Where is my focus of attention? / Is this fact or opinion?
See the situation as an outside observer.
Is there another way of looking at it?
What would someone else see and make of it?
What advice would I give to someone else?
What’s ‘the helicopter view’?
What meaning am I giving this event for me to react in this way? How important is it right
now, and will it be in 6 months?
Is my reaction in proportion to the actual
event?
What will be the consequences of my action? / What can I do that will be most helpful?
Will it be effective and appropriate?
Is it in keeping with my values and
principles?
What is best thing to do, for me, for others, for the situation?

www.getselfhelp.co.uk © Carol Vivyan 2010. Permission to use for therapy purposes. Adapted from Ciarrochi & Bailey 2008 www.get.gg

Automatic Thoughts

Our thoughts control how we feel about ourselves and how we see the world around us. Positive thoughts can make us feel good about ourselves and negative thoughts can put us down. Sometimes our thoughts happen so quickly that we aren’t aware of them, but they can affect our mood. These are called automatic thoughts.

Sometimes our automatic thoughts are negative and irrational, based on our core beliefs. If we can identify these negative thoughts and replace them with new rational thoughts, we can improve our mood.

Trigger / Automatic Thought / New Thought
Example: I didn’t get good marks at school today. / “I’m can’t do this work. I’m no good at Maths. I’m no good at anything.” / “I made a simple mistake. I can see where I went wrong and I can try again tomorrow.”

We can teach children to identify and question their automatic thoughts and encourage them to see different sides to the problem/ situation.

Game: Stand in a circle with one child in the centre. In turn, everyone says what they can see of him/her. E.g. 2 eyes, 1 eye, 1 ear, the back of head and hair.

Everyone in circle changes places and says what they can see. This will have changed because they are standing in a different place. Teaching point: people see different things and have different perceptions. Encourage empathy and seeing issues from a different point of view.

Encouraging alternative thoughts:

What is the trigger?
What are my thoughts in response to the trigger?
What are the facts about the situation?
Are my thoughts based on facts?
YES No

Am I doing any of the following?

Putting myself down / Negative comparisons / Having unrealistic expectations about myself
Exaggerating the likelihood of bad things happening / Jumping to negative conclusions / Blowing things out of proportion
Mind-reading / ‘What if?’ thinking / Blaming myself
Predicting worst-case scenario / ‘I can’t’ thinking / Expecting the worst
How can I think more realistically about the situation?

(Adapted from Collins-Donnelly, K.(2013) Starving the Anxiety Gremlin. JKP)

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