St. Luke’s College of Medicine – William H.

Quasha Memorial
PSYCHIATRY II Cognitive-Behavior Therapies, Therapeutic Milieu and other
Lecture: Date: March 1, 2018
Blk 5 – Lec 3.2 Psychological Intervention
Lecturer: Christian Irving C. Cayetano, MD, DPBP Trans Team: Team 3

Topic Outline
I. Cognitive Behaviour Therapy V. Quiz
A. Cognitive Therapy
B. Behaviour Therapy
C. Cognitive Behaviour
Therapy
II. Milieu Therapy
III. Psychosocial Self-Help B. BEHAVIOR THERAPY Change behavior
Programs Behavior Modification
IV. Social Skills Training
 Changes the behaviour of patients to reduce dysfunction and improve
PPT Audio Book Transers Subhead quality of life
th
Kaplan & Sadocks Synopsis of Psych 10 ed, Chapter 28.7  Behavioural techniques test and change maladaptive and inaccurate
cognitions
I. Cognitive Behaviour-Therapy  Helps patients understand the inaccuracy of their cognitive
assumptions and learn new strategies and ways of dealing with issues
 Has 8 main principles
A. COGNITIVE THERAPY Change cognitive process 1. Concentrates on behaviour rather than on underlying cause
 Uses an active, directive, time-limited (25 weeks), structured 2. It assumes that maladaptive behaviours are learned
approach with techniques that seek to approach and produce 3. Assumes that learning principles can be effective in
change in the cognitive processes by altering affect and modifying behaviours
behaviour 4. It sets clearly defined specific goals
 Emphasis on the “cognitive triad” TPF 5. Rejects the classical traits theory
 beliefs about themselves 6. The therapists adapt the method of treatment
 beliefs about their personal world (including the people in their 7. Concentrates on the here and now
lives) 8. Therapists gets from the empirical support for their treatment
 beliefs about their future CEB
Beliefs
 cognition will affect and determine your emotion which in turn Techniques
will affect behaviour  Behaviours to be altered are identified
 The premise is that thoughts and faulty learning determine the  Determine goals, means, and procedures of treatment
behaviour, therefore, the misconceive their environment  Develop treatment plan
 Focus includes:  Implementation of the plan
PSAE  Perceptions  Objective evaluation of the results
 Self-statements  Systematic Desensitization
SSEPP
 Attributions o Identifying least anxiety producing item to the highest
 Expectations anxiety producing item
 Emphasize modifying distorted beliefs  Self-control desensitization
 Compensates perceived deficits in cognitive skills o Meditational process where one learns to interrupt
maladaptive thinking through relaxation
Theoretical Issues  Exposure
 Rational-emotive therapy whose objective is to substitute o Imaginal or in vivo desensitization
adaptive thoughts for maladaptive thoughts o Actual confrontation of the feared stimuli
Cognition  Positive reinforcements
Techniques o To increase the response or behaviour
 Uses active collaboration between patient and therapist o Most believe that this is actually better than punishments
 Usually conducted on an individual basis, but group methods are o Ex. Rewards and praise
sometimes helpful o Reinforcements are consequences that increase the frequency of
 Problem-solving techniques the behaviour that it follows
o Inability to generate alternative solutions to interpersonal  Punishments
problems o Adverse stimulus
o Focus on ends and goals o May also be positive or negative, a positive punishment is
o Foresee consequences of their actions introducing something aversive while negative punishment
 Systematic Rational Restructuring is taking away or removing something treasured or
o Focuses on the immediate cognitive factors that mediate rewarding
maladaptive behaviours and emotions
o The way a situation is evaluated determines the emotional
POG-DSEEA Indications
reaction  Phobias
o Therapist helps rationally re-evaluate these cognitions  Obsessive compulsive disorder
 GAD
 Depression
 Substance abuse – most difficult to treat with BT
 Eating disorders – most difficult to treat with BT
 Enuresis
 Self-Instruction Training  Aggression
o Step by step approach that includes defining the problem,
Behavioral assessment
focusing on the task, and self-evaluation C. COGNITIVE BEHAVIOR THERAPY Combination of both
 Drugs may be prescribed in conjunction with therapy  Uses a problem-solving model in which the clinician acts as a
coach to teach the patient a set of adaptive coping skills and
Indications also to unlearn un-skilful coping behaviours for specific
 Depression DAC-POPS symptoms associated with distress and impairment in the
o From a cognitive perspective, depression can be explained by present
the cognitive triad, which explains the patient’s negative  Behavioural assessment
thoughts about the self, world, and future.  Cornerstone of CBT
o Thus, changing the way a person thinks can alleviate the o Careful functional analysis of problem behaviour
psychiatric disorder. o Normal and problematic behaviours are governed by
 Anxiety Disorders environmental contingencies
 Childhood Disorders o Relations of both thoughts, feelings, and behaviours are
! Panic disorder the focus
! Obsessive-compulsive disorder o Behavioural assessment is continued all throughout the
! Personality disorders process
! Somatoform disorders
 PSYCHIATRY II| Lec 3.2 | Title | V. 1

 Suited for patients with identifiable problem and active desire

to change their behaviour to reduce their suffering.
DAM
 Disruptive Behaviour Disorders
 Anxiety Disorders
 Major Depressive Disorders
- the example that Doc gave for CBT is the laughing yoga where
one who leads “laughs” first and the rest follow because of its
contagiousness

II. Milieu Therapy

 Locus is living, learning, or working environment
 A team provides treatment any time while the patient is in the
environment
 The environment is used as a form of therapy
 One of the goals include providing structure that will help the
patient develop stability  ultimate goal is to regain ego-
functioning
 The set-up serves to prepare the patient for leaving the
psychiatric unit  preparing in a sense before he/she gets
plunged back to the real world independently on his/her own
feet 

III. Psychosocial Self-Help Programs

 Alcoholic Anonymous
 Narcotic Anonymous
 Shopaholic Anonymous

IV. Social Skills Training

 Social competence is assessed
 To train targeted behavioural excess or deficits during
treatment
 Indications:
o Schizophrenia SIDS
o Patients have inadequate expressive behaviours and
inappropriate stimulus control of their social behaviours (ex.
they do not pick up on social cues)
o Depression
o Social phobia

Goals
 Improved social skill in specific situations
o Skills include making requests, making complaints, and
responding to complaints
 Acquisition or relearning of conversational skills
 Decrease social anxiety

V. Quiz
1. False about cognitive therapy:
a. Used to treat Depression, anxiety disorders, phobias and
other forms of mental disorders
b. Places emphasis on the cognitive triad
c. Medication can be used in conjunction with this approach
d. Long-term treatment for depression

True 2. T/F. Cognitive therapy is based on the theory that individuals

with depression, anxiety and other emotional disorders have
maladaptive patterns of information processing and behavioral-
related difficulties.

3. Hope is notably shy and is always avoiding eye con-tact.

When talking to others, she only makes brief statements and
minimizes self-disclosure. What is the best thing to do for her?
a. Psychosocial self-help program
b. Social skills training
c. Cognitive behaviour therapy
d. Anti-depressants

Answers:
1. D. Cognitive therapy is short term.
2. True.
3. B. Hope has social phobia which is an indication for social
skills training.

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