CCoorree BBeelliieeffss oonn TTrriiaall::
AA CCooggnniittiivvee TThheerraappyy AApppprrooaacchh ffoorr
PPssyycchhoopphhaarrmmaaccoollooggiissttss
Webinar Handout
To submit a question during the webinar:
• Locate the Questions? box at the right side of the screen
• Type your question in the field at the bottom of the box
• Click the button at the right end of the box (Send)
Sponsored by the Neuroscience Education Institute Additionally sponsored by the American Society for the Advancement of Pharmacotherapy
Supported solely by the sponsor, the Neuroscience Education Institute
Copyright © 2011 Neuroscience Education Institute
Copyright © 2010 Neuroscience Education Institute 2 Copyright © 2011 Neuroscience Education Institute 2
CME Information
Overview Persistent core beliefs that are negative, global, and personal regarding life events and adverse outcomes are risk factors for recurrence of most psychiatric disorders. To combat these risk factors, Dr. Irismar Reis De Oliveira has created a novel three-level, three-phase intervention to modify a patient's core beliefs.
Dr. Reis De Oliveira will teach how to use this novel intervention method, Trial-Based Cognitive Therapy (TBCT), through a webinar titled "Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists".
One of TBCT's main techniques is the Trial-Based Thought Record (TBTR), a structured strategy that is presented as an analogy to a trial, in which the therapist engages the client in a simulation of the judicial process, including investigation, prosecutor statements/arguments, defense attorney statements/arguments, and a jury verdict. It is an empirically validated method of belief change, with preliminary, but promising, results shown to help patients constructively reduce attachment to negative core beliefs and corresponding emotions.
Learning Objectives After participating in this webinar, participants should be able to:
Explain the cognitive model to the patient according to the Trial-Based Cognitive Therapy (TBCT) conceptualization diagram
Describe the role of the Trial-Based Thought Record (TBTR) in changing patients' core beliefs
Describe the main research findings supporting the efficacy of TBTR
Target Audience This activity has been developed for prescribers specializing in psychiatry. There are no prerequisites. All health care providers interested in psychopharmacology, especially primary care physicians, nurses, psychologists, and pharmacists, are welcome for advanced study.
Accreditation and Credit Designation Statements The Neuroscience Education Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Neuroscience Education Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The American Society for the Advancement of Pharmacotherapy is approved by the American Psychological Association to sponsor continuing education for psychologists. The American Society for the Advancement of Pharmacotherapy maintains responsibility for this program and its content.
The American Society for the Advancement of Pharmacotherapy designates this program for 1.0 CE credit for psychologists. Nurses: for ALL of your CE requirements for recertification, the ANCC will accept category 1 credits from organizations accredited by the ACCME. Physician Assistants: the AAPA accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. A certificate of participation for completing this activity will also be available.
Instructions for CME Credit/Certificates To receive your certificate of CME credit or participation, please complete the posttest and activity evaluation found at the end of the activity. Alternatively, you may access the posttest/evaluation from www.neiglobal.com/cme, available for 90 days following the activity. If a score of 70% or more is achieved, you will be able to immediately print your certificate. There is no fee for CME credits for this activity. If you have questions, please call 888-535-5600, or email [email protected].
Copyright © 2011 Neuroscience Education Institute 2
Copyright © 2010 Neuroscience Education Institute 3
CME Information, continued NEI Disclosure Policy It is the policy of the Neuroscience Education Institute to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. Therefore, all individuals in a position to influence or control content development are required by NEI to disclose any financial relationships or apparent conflicts of interest that may have a direct bearing on the subject matter of the activity. Although potential conflicts of interest are identified and resolved prior to the activity being presented, it remains for the participant to determine whether outside interests reflect a possible bias in either the exposition or the conclusions presented.
These materials have been peer-reviewed to ensure the scientific accuracy and medical relevance of information presented and its independence from commercial bias. The Neuroscience Education Institute takes responsibility for the content, quality, and scientific integrity of this CME activity.
Individual Disclosure Statements
Faculty Author / Presenter
Irismar Reis De Oliveira, MD, PhD Professor of Psychiatry, Department of Neurosciences and Mental Health, Post-Graduation Program, Professor Edgar Santos University Hospital, Federal University of Bahia, Salvador, Brazil Grant/Research: AstraZeneca, Dainippon Sumitomo, Lilly, Roche, Servier Content Editors
Meghan Grady Director, Content Development, Neuroscience Education Institute, Carlsbad, CA No other financial relationships to disclose.
Debbi Ann Morrissette, PhD Adjunct Professor, Biological Sciences, California State University, San Marcos Medical Writer, Neuroscience Education Institute, Carlsbad, CA No other financial relationships to disclose. Peer Reviewers
Ronnie Gorman Swift, MD Professor and Associate Chairman, Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla Professor of Clinical Public Health, School of Public Health, New York; New York Medical College, Valhalla Chief of Psychiatry and Associate Medical Director, Metropolitan Hospital Center, New York City No other financial relationships to disclose.
Owen Nichols, PsyD, MBA, NHA, CPM, ABPP, ABMP President and CEO, NorthKey Community Care, Covington, KY No other financial relationships to disclose. Program Development
Rory Daley, MPH, Associate Director, Program Development, Neuroscience Education Institute, Carlsbad, CA No other financial relationships to disclose.
Steve Smith, President and COO, Neuroscience Education Institute, Carlsbad, CA No other financial relationships to disclose. Disclosed financial relationships have been reviewed by the Neuroscience Education Institute CME Advisory Board to resolve any potential conflicts of interest. All faculty and planning committee members have attested that their financial relationships do not affect their ability to present well-balanced, evidence-based content for this activity.
Copyright © 2011 Neuroscience Education Institute 3
Copyright © 2010 Neuroscience Education Institute 4 Copyright © 2011 Neuroscience Education Institute 4
CME Information, continued
Disclosure of Off-Label Use This educational activity may include discussion of products or devices that are not currently labeled for such use by the FDA. Please consult the product prescribing information for full disclosure of labeled uses.
Disclaimer The information presented in this educational activity is not meant to define a standard of care, nor is it intended to dictate an exclusive course of patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this educational activity should not be used by clinicians without full evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Primary references and full prescribing information should be consulted.
Participants have an implied responsibility to use the newly acquired information from this activity to enhance patient outcomes and their own professional development. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.
Cultural and Linguistic Competency A variety of resources addressing cultural and linguistic competency can be found in this linked handout (http://www.neiglobal.com/forms/cme/regulations/CA_AB_1195_handout_NON-CA_2008.pdf).
Sponsor Sponsored by the Neuroscience Education Institute. Additionally sponsored by the American Society for the Advancement of Pharmacotherapy.
Support This activity is supported solely by the sponsor, Neuroscience Education Institute.
Special Needs Neuroscience Education Institute is committed to making its activities accessible to all individuals. If you have special needs as addressed by the Americans with Disabilities Act (ADA) and need assistance, contact NEI at 888-535-5600 or [email protected].
To submit a question during the webinar:
Locate the Questions? box at the right side of the screen
Type your question in the field at the bottom of the box
Click the button at the right end of the box (Send)
Copyright © 2011 Neuroscience Education Institute 4
CCoorree BBeelliieeffss oonn TTrriiaall:: AA CCooggnniittiivvee TThheerraappyy AApppprrooaacchh ffoorr
PPssyycchhoopphhaarrmmaaccoollooggiissttss
Learning Objectives
• Explain the cognitive model to the patient according to the Trial-Based Cognitive Therapy (TBCT) conceptualization diagram
• Describe the role of the Trial-Based Thought Record (TBTR) in changing patients' core beliefs
• Describe the main research findings supporting the efficacy of TBTR
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 5
9/6/2011
1
C B li f T i lCore Beliefs on Trial:A Cognitive Therapy Approach for
P h h l i tPsychopharmacologists
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 6
9/6/2011
2
Learning Objectives
After participating in this webinar, participants p p g , p pshould be able to:
• Explain the cognitive model to the patient according to th T i l B d C iti Th (TBCT)the Trial-Based Cognitive Therapy (TBCT) conceptualization diagram
• Describe the role of the Trial-Based Thought RecordDescribe the role of the Trial Based Thought Record (TBTR) in changing patients' core beliefs
• Describe the main research findings supporting the ffi f TBTRefficacy of TBTR
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 7
9/6/2011
3
Trial-Based Cognitive Therapy
1. Important definitions• Automatic thoughts, underlying assumptions, and core
beliefs
2. Conceptualization diagram• Circuits hypothesis
3. Trial-Based Thought Record• Obsessive-Compulsive Disorder• Panic disorder
4. Research• Trial-Based Thought Recordg
o First useo Social anxiety disorder
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 8
9/6/2011
4
What is cognitive therapy?
• A generally short-term psychotherapy modelo Developed by Aaron Beck at the University of Pennsylvania
o Goal-directed
Present orientedo Present-oriented
o Based on the cognitive model of psychopathology and learning theory
• Emphasis on:o Current thoughts, emotions, and behaviorsg , ,
o Undoing old learning and teaching new behaviors
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 9
9/6/2011
5
Important Definitions
• Automatic thoughtsAutomatic thoughts
• Underlying assumptions
• Core beliefs
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 10
9/6/2011
6
Automatic Thoughts
• Perceptions that occur rapidly in responsePerceptions that occur rapidly in response to a situation
• Are not subjected to systematic logicalAre not subjected to systematic, logical analysis
• A person may be unaware of their presenceA person may be unaware of their presence or significance
• May or may not be distorted• May or may not be distorted
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 11
9/6/2011
7
Definitions and Examples of 15 Cognitive Distortions
Cognitive Distortion Definition Example
1 Dichotomous thinking (also called “all-or-nothing” or
I view a situation, a person, or an event only in all- or-nothing terms, fitting them
“I made a mistake, therefore I’m a failure.” “I ate more than I planned, so I blew my diet completely.”called all or nothing or
“black and white”)only in all or nothing terms, fitting them into only 2 extreme categories instead of on a continuum.
more than I planned, so I blew my diet completely.
2 Fortune telling (also called “catastrophizing”)
I predict the future in negative terms and believe that what will happen will be so awful that I will not be able to stand it.
“I will fail, and this will be unbearable.” “I’ll be so upset that I won’t be able to concentrate for the exam.”
Di ti I di lif d di t iti “I d th b t I j t l k ” “G i t3 Discounting or disqualifying the positive
I disqualify and discount positive experiences or events, insisting that they do not count.
“I passed the exam, but I was just lucky.” “Going to college is not a big deal; anyone can do it.”
4 Emotional reasoning I believe my emotions reflect reality and let them guide my attitudes and judgments.
“I feel she loves me, so it must be true.” “I am terrified of airplanes, so flying must be dangerous.”
5 Labeling I put a fixed global label usually negative “I’m a loser ” “He’s a rotten person ” “She’s a5 Labeling I put a fixed, global label, usually negative, on myself or others.
I m a loser. He s a rotten person. She s a complete jerk.”
6 Magnification/minimization I evaluate myself, others, and situations, magnifying the negatives and/or minimizing the positives.
“I got a B. This proves how inferior I am.” “I got an A. It doesn’t mean I’m smart.”
7 Selective abstraction (also I pay attention to one or a few details and “My boss said he liked my presentation but since he7 Selective abstraction (also called “mental filter” and “tunnel vision”)
I pay attention to one or a few details and fail to see the whole picture.
My boss said he liked my presentation, but since he corrected a slide, I know he did not mean it.” “Even though the group said my work was good, one person pointed out an error so I know I will be fired.”
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 12
9/6/2011
8
Definitions and Examples of 15 Cognitive Distortions
Cognitive Distortion Definition Example
1 Dichotomous thinking (also called “all-or-nothing” or
I view a situation, a person, or an event only in all- or-nothing terms, fitting them
“I made a mistake, therefore I’m a failure.” “I ate more than I planned, so I blew my diet completely.”called all or nothing or
“black and white”)only in all or nothing terms, fitting them into only 2 extreme categories instead of on a continuum.
more than I planned, so I blew my diet completely.
2 Fortune telling (also called “catastrophizing”)
I predict the future in negative terms and believe that what will happen will be so awful that I will not be able to stand it.
“I will fail, and this will be unbearable.” “I’ll be so upset that I won’t be able to concentrate for the exam.”
f “ “G3 Discounting or disqualifying the positive
I disqualify and discount positive experiences or events, insisting that they do not count.
“I passed the exam, but I was just lucky.” “Going to college is not a big deal; anyone can do it.”
4 Emotional reasoning I believe my emotions reflect reality and let them guide my attitudes and judgments.
“I feel she loves me, so it must be true.” “I am terrified of airplanes, so flying must be dangerous.”
5 Labeling I put a fixed global label usually negative “I’m a loser ” “He’s a rotten person ” “She’s a5 Labeling I put a fixed, global label, usually negative, on myself or others.
“I’m a loser.” “He’s a rotten person.” “She’s a complete jerk.”
6 Magnification/minimization I evaluate myself, others, and situations, magnifying the negatives and/or minimizing the positives.
“I got a B. This proves how inferior I am.” “I got an A. It doesn’t mean I’m smart.”
7 Selective abstraction (also I pay attention to one or a few details and “My boss said he liked my presentation but since he7 Selective abstraction (also called “mental filter” and “tunnel vision”)
I pay attention to one or a few details and fail to see the whole picture.
My boss said he liked my presentation, but since he corrected a slide, I know he did not mean it.” “Even though the group said my work was good, one person pointed out an error so I know I will be fired.”
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 13
9/6/2011
9
Underlying Assumptions
• Conditional rules or “should” statements used to guide our behavior, emotional expression, and understanding of how the world operates (Padesky & Greenberger 1995)(Padesky & Greenberger, 1995)
• Usually expressed as “if… then…” statementso “If I go to the party then people will know I amo If I go to the party, then people will know I am
awkward.”
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 14
9/6/2011
10
Core Beliefs
• Also sometimes called “schemas”
• Are global, rigid, and fundamental beliefs that people have about themselves, the world, and/or the future
• Influence the types of thoughts (cognitions) that peopleInfluence the types of thoughts (cognitions) that people experience in specific situations
o “I am incompetent” will likely predict that he will be unable to function adequately during a job interviewfunction adequately during a job interview
o “I am unlikable” will likely predict that others will not be interested in what she has to say at a social gathering
o As a result, both of these people would likely experience a great deal of social anxiety
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 15
9/6/2011
11
Cognitive Model
Behaviors
Situation Automatic thoughts Emotions
Behaviors
Underlying assumptions
Physiologicalresponses
Core beliefs(Schemas)(Schemas)
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 16
9/6/2011
12
A More Complex Cognitive Model
Emotions
Situation Automatic thoughts Behaviors1st level
Underlying assumptions
Physiologicalresponses
2nd level
Core beliefs(Schemas)
3rd level
(Schemas)
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 17
9/6/2011
13
Trial-Based Cognitive Therapy
1. Important definitions• Automatic thoughts, underlying assumptions, and core
beliefs
2. Conceptualization diagram• Circuits hypothesis
3. Trial-Based Thought Record• Obsessive-Compulsive Disorder• Panic disorder
4. Research• Trial-Based Thought Record
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
go First useo Social anxiety disorder
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 18
9/6/2011
14
TBCT Conceptualization Diagram
Same components as standard cognitive therapy, but…
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 19
9/6/2011
15
TBCT Conceptualization DiagramPhase 1: Before Treatment
Negative core beliefs predominantly activated
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 20
9/6/2011
16
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 21
9/6/2011
17
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
-
Activated negativecore belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 22
9/6/2011
18
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
-
SchemaSchemaactivation
Activated negativecore belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 23
9/6/2011
19
Situation
Automatic thought Circuit 1
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 24
9/6/2011
20
Situation
Automatic thought Circuit 1
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Circuit 1
Automatic Thought → Emotion→ Behavior and/or Physiological Response
→ Automatic Thought
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 25
9/6/2011
21
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticized
AnxiousEmotional reaction
Behavioral and/or physiological response
I do not go to the party1st level
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 26
9/6/2011
22
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople will find me awkward Anxious
More anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to the partyI avoid people
1st level
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 27
9/6/2011
23
Situation
I am not invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
new party People really find me awkward
AnxiousEmotional reaction
Behavioral and/or physiological response
I continue to avoid people1st level
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 28
9/6/2011
24
Situation
I am not invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
new party People really find me awkward
AnxiousEmotional reaction
Behavioral and/or physiological response
I continue to avoid people1st level
I am awkward
Activated negativecore belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 29
9/6/2011
25
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:
2nd level
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 30
9/6/2011
26
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 31
9/6/2011
27
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptionsCircuit 2
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Circuit 2
Underlying Assumption → Safety Behavior → [Automatic Thought]* → Emotion → Behavior and/or[Automatic Thought] → Emotion → Behavior and/or Physiological Response → Underlying Assumption
*May not exist or may be implicitCopyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 32
9/6/2011
28
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople think I amawkward Anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to the partyI avoid people
1st level
Underlying assumptions/rules:
2nd level
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Avoidance
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 33
9/6/2011
29
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople think I am awkward Anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to partiesI avoid people
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Avoidance
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 34
9/6/2011
30
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople think I am awkward Anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to partiesI avoid people
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
If I do not avoid people, then they will criticize meCompensatory strategies/safety behaviors:
Avoidance
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 35
9/6/2011
31
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 1
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
3rd levelCircuit 3 Relevant childhood data for:
1) Negative core belief
Activated negativecore belief
Inactive positivecore belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 36
9/6/2011
32
C 3
TBCT Conceptualization Diagram Phase 1
Circuit 3
Underlying Assumption → Safety Behavior → Core Belief → Underlying
Ass mption1st level
Assumption
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
3rd levelCircuit 3 Relevant childhood data for:
1) Negative core belief
Activated negativecore belief
Inactive positivecore belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 37
9/6/2011
33
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople think I am awkward Anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to partiesI avoid people
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
If I do not avoid people, then they willcriticize meCompensatory strategies/safety behaviors:
Avoidance
I am awkward3rd levelCircuit 3 Relevant childhood data for:
1) Negative core belief
Activated negativecore belief
Inactive positivecore belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 38
9/6/2011
34
Situation
I am invited to a Automatic thought
John’s TBCT Conceptualization Diagram Phase 1
party I will be criticizedPeople think I am awkward Anxious
Emotional reaction
Behavioral and/or physiological response
I do not go to partiesI avoid people
1st level
Underlying assumptions/rules:
2nd levelModulation by underlying
assumptions
Underlying assumptions/rules:
If I do not avoid people, then they will criticize meCompensatory strategies/safety behaviors:
Avoidance
I am awkward3rd levelRelevant childhood data for:1) Negative core belief
Activated negativecore belief
Inactive positivecore belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 39
9/6/2011
35
Phase 2: During TreatmentPositive core belief activation with TBCT
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 40
9/6/2011
36
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 2
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:
Modulation by underlying assumptions
2nd level
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
3rd levelRelevant childhood data for:1) Negative core belief
2) Positive core beliefInactive negative
core beliefActivated positive
core belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 41
9/6/2011
37
Situation
Automatic thought
TBCT Conceptualization Diagram Phase 2
Emotional reaction
Behavioral and/or physiological response
1st level
Underlying assumptions/rules:Trial I
Modulation by underlying assumptions
2nd level
Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Trial ITrial II.1
RG
3rd levelCircuit 3 Relevant childhood data for:
1) Negative core belief
2) Positive core beliefInactive negative
core beliefActivated positive
core belief
2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 42
9/6/2011
38
Phase 3: After Treatmentase 3 te eat e tBalance between positive and negative core belief activation
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 43
9/6/2011
39
Situation
Automatic thought
CD‐QuestIntraDTR
TBCT Conceptualization Diagram Phase 3
Emotional reaction
Behavioral and/or physiological response
InterDTR
1st level
CRP and behavioral experiments Underlying assumptions/rules:
Modulation by underlying assumptions
2nd level
CRP and behavioral experiments Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
Relevant childhood data for:Trial I and II3rd level
Activated negativecore belief
Activated positivecore belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 44
9/6/2011
40
Situation
Automatic thought
CD‐QuestIntraDTR
TBCT Conceptualization Diagram Phase 3
Emotional reaction
Behavioral and/or physiological response
InterDTR
1st level
CRP and behavioral experiments Underlying assumptions/rules:
Modulation by underlying assumptions
2nd level
CRP and behavioral experiments Underlying assumptions/rules:
Compensatory strategies/safety behaviors:
I am normal
Trial I and II3rd level
Relevant childhood data for:1) Negative core belief
normalActivated negative
core beliefActivated positive
core belief2) Positive core belief
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 45
9/6/2011
41
Trial-Based Cognitive Therapy
1. Important definitionsAutomatic thoughts underlying assumptions and core• Automatic thoughts, underlying assumptions, and core beliefs
2. Conceptualization diagramCi it h th i• Circuits hypothesis
3. Trial-Based Thought Record• Obsessive-Compulsive Disorder• Panic disorder
4. Research• Trial-Based Thought Record
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
o First useo Social anxiety disorder
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 46
9/6/2011
42
Franz Kafka 1883-1924
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 47
9/6/2011
43
Literary Work
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 48
9/6/2011
44
Trial-Based Thought Record (Trial I)
• Designed to change core beliefs or schemas
• Inspiration from Franz Kafka’s surreal novel The Trial• Inspiration from Franz Kafka s surreal novel The Trialo Self-accusation as a universal principle?
• Analogy or metaphor to a judicial processI i (d d )o Inquiry (downward arrow)
o Prosecutor’s plea (evidence supporting the core belief)o Defense attorney’s plea (evidence not supporting the core belief)o Prosecutor’s response to the defendant’s plea (discounting the p p ( g
evidence)o Defense attorney’s response to the prosecutor’s plea (sentence
reversal)o Jurors’ verdict (debriefing)
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
( g)o Preparation for the appeal (upward arrow and positive self-statements
log) as homework
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 49
9/6/2011
45
Wh i th d f tt ?Where is the defense attorney?
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 50
9/6/2011
46
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 51
9/6/2011
47
1. Inquiry
2. Prosecutor’s
3.Defense
4.Prosecutor’s
5.Defense
6.Meaning of the
7.Juror
Trial-Based Thought Record (Trial I)q y
plea attorney’s plea response(but…)
attorney’s response(Sentence reversal)
gresponse:“It means
that…”
Who was more convincing? Who presented more
evidence? Whose evidence was more
based on facts? Who made fewer
(cognitive) distortions?
Automaticthoughts:
Downward arrow
(core belief)
Verdict:
Upward arrow
(new core belief)
I b li i
(core belief)
I am...
(new core belief)
I am...
I believe in the accusation:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 52
9/6/2011
48
1. Inquiry
2. Prosecutor’s
3.Defense
4.Prosecutor’s
5.Defense
6.Meaning of the
7.Juror
Trial-Based Thought Record (Trial I)q y
plea attorney’s plea response(but…)
attorney’s response(Sentence reversal)
gresponse:“It means
that…”
Who was more convincing? Who presented more
evidence? Whose evidence was more
based on facts? Who made fewer
(cognitive) distortions?
Automaticthoughts:
Deconstructive language
Downward arrow
(negative core
Verdict:
Upward arrow
(positive core
Constructive language
I b li i
(negative core belief)
I am...
(positive core belief)
I am...
I believe in the accusation:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
I believe:
Emotion:
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 53
9/6/2011
49
Defense Attorney’s Preparation for the Appeal (Positive Self-Statements Log)I am... (positive belief derived from the upward arrow technique)
Homework Assignment
Date (90%)1.
2.
3.
Date ( %)1.
2.
3.
Date ( %)1.
2.
3.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 54
9/6/2011
50
Case ReportCase ReportObsessive Compulsive Disorder and Borderline Personality Disorder
Described in the Common Language for Psychotherapy Procedureshttp://www.commonlanguagepsychotherapy.org/
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 55
9/6/2011
51
Case Illustration
Ida, married and in her 30s, had been anxious, d i f 3 Sh h dangry, and aggressive for 3 years. She had
difficulty dealing with subordinates (she was a manager in a company) and went on sick leave.g p y)
Her depression worsened. Ida could not resume work and stopped her master’s degree studies. She mutilated herself and attempted suicide due to severe anxiety, which did not reduce with antidepressants and high doses of
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
antidepressants and high doses of benzodiazepines.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 56
9/6/2011
52
Case Illustration (cont.)
Her benzodiazepines were tapered and l d ith ti i Sh l h d klreplaced with quetiapine. She also had weekly
cognitive restructuring of beliefs such as “I’m a failure, incompetent, and inadequate” by p q yexamining evidence for and against them.
Though her anxiety decreased, external events reactivated her beliefs, and she mutilated herself again.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 57
9/6/2011
53
Case Illustration (cont.)
Six months before the session yielding the Trial i d ib d i thi t ti Idsession described in this presentation, Ida
started to repeatedly verify her wallet for hours daily, checking 13 items by touching and reading y g y g geach word in the documents and cards.
Intensive exposure, ritual prevention, and cognitive restructuring therapy (2‒3 weekly sessions to a total of 18 sessions) stopped her checking within 2 monthschecking within 2 months.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 58
9/6/2011
54
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I am too anxious
I will not finish my master’s degree course
ACCUSATION:___________VERDICT:ACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
VERDICT:
Initial Final100%100%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 59
9/6/2011
55
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly
I’m slow at reasoning
I d ’t d ll
ACCUSATION:
I don’t do well when interacting with people and controlling my environment
___________VERDICT:ACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
VERDICT:
Initial Final100% 100%
100%100%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 60
9/6/2011
56
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life
1. I don’t check my driver’s license, and I haven’t lost control
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly
I’m slow at reasoning
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
ACCUSATION:
I don’t do well when interacting with people and controlling my environment
reread the book
4. I’m completing theevidence chart
___________VERDICT:ACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
VERDICT:
Initial Final100% 100%
100%100%
80%80%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 61
9/6/2011
57
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life
1. I don’t check my driver’s license, and I haven’t lost control
1. I check on other items
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly
I’m slow at reasoning
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
2. I’m not cured
3. I can’t remember them all
ACCUSATION:
I don’t do well when interacting with people and controlling my environment
reread the book
4. I’m completing theevidence chart
4. I still believe I’m imperfect
___________VERDICT:ACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
VERDICT:
Initial Final100% 100%
100%100%
80%80%
90%90%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 62
9/6/2011
58
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life
1. I don’t check my driver’s license, and I haven’t lost control
1. I check on other items
1. I check on other items, BUT I don’t check my driver’s license and haven’t lost control
1. I can stop myself checking
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly
I’m slow at reasoning
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
2. I’m not cured
3. I can’t remember them all.
control
2. I’m not cured, BUT my OCD score fell today
3. I can’t remember them all, BUT I can remember some of the techniques without h i t d th b k
2. I can cure myself
3. I can learn
ACCUSATION
I don’t do well when interacting with people and controlling my environment
reread the book
4. I’m completing theevidence chart
4. I still believe I’m imperfect
having to reread the book
4. I still believe I’m imperfect, BUT I’m completing theevidence chart
4. I see the other side of my imperfection (that I am normal)
___________VERDICTACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
normal) VERDICT:
Initial Final100% 100%
100%100%
80%80%
90%90%
70%70%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 63
9/6/2011
59
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life (A)
1. I don’t check my driver’s license, and I haven’t lost control
1. I check on other items (B)
1. I check on other items, BUT I don’t check my driver’s license and haven’t lost control
1. I can stop myself checking
The prosecutor made errors:overgeneralization (A), discounting
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly (C)
I’m slow at reasoning (C)
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
2. I’m not cured (B)
3. I can’t remember them all (B)
control
2. I’m not cured, BUT my OCD score fell today
3. I can’t remember them all, BUT I can remember some of the techniques without h i t d th b k
2. I can cure myself
3. I can learn
discounting positives (B), and all-or-nothing thinking (C)
The defense attorney
d
ACCUSATION
I don’t do well when interacting with people and controlling my environment (B, C)
reread the book
4. I’m completing theevidence chart
4. I still believe I’m imperfect (B)
having to reread the book
4. I still believe I’m imperfect, BUT I’m completing theevidence chart
4. I see the other side of my imperfection (that I am normal)
made no distortions and gave fairer and more consistent arguments___________VERDICTACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
normal) VERDICT:
Initial Final100% 100%
100%100%
80%80%
90%90%
70%70%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 64
9/6/2011
60
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life (A)
1. I don’t check my driver’s license and I haven’t lost control
1. I check on other items (B)
1. I check on other items, BUT I don’t check my driver’s license and haven’t lost control
1. I can stop myself checking
The prosecutor made errors:overgeneralization (A), discounting
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly (C)
I’m slow at reasoning (C)
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
2. I’m not cured (B)
3. I can’t remember them all (B)
control
2. I’m not cured, BUT my OCD score fell today
3. I can’t remember them all, BUT I can remember some of the techniques without h i t d th b k
2. I can cure myself
3. I can learn
discounting positives (B), and all-or-nothing thinking (C)
The defense attorney
d
ACCUSATION:
I don’t do well when interacting with people and controlling my environment (B, C)
reread the book
4. I’m completing theevidence chart
4. I still believe I’m imperfect (B)
having to reread the book
4. I still believe I’m imperfect, BUT I’m completing theevidence chart
4. I see the other side of my imperfection (that I am normal)
made no distortions and gave fairer and more consistent arguments___________VERDICT:ACCUSATION:
I AM IMPERFECT
EMOTION:ANXIETY
normal) VERDICT:
Innocent
Initial Final100% 100%
100%100%
80%80%
90%90%
70%70%
55%55%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 65
9/6/2011
61
Upward Arrow Technique
T: If the defense attorney’s statements are right, what do they mean about
?you?
P: I AM NORMAL!
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
De-Oliveira IR (2007) Sentence-reversion-based thought record (SRBTR): a new strategy to deal with “yes, but...” dysfunctional thoughts in cognitive therapy. European Review of Applied Psychology, 57:17-22.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 66
9/6/2011
62
Homework AssignmentDefense Attorney’s Preparation for the Appeal (Positive Self-Statements Logs)
I am normal (positive belief derived from the upward arrow technique)
Date (60%)1. I succeeded in conquering the driver’s license2. I managed to conquer the student cardcard3.
Date ( %)1.
2.
3.
Date ( %)1.
2.
3.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 67
9/6/2011
63
TBTR: Described in the Common Language for Psychotherapy Procedures
INQUIRY(downward
PROSECUTOR(evidence
i h
DEFENSE ATTORNEY( id
PROSECUTOR’S RESPONSE( b )
DEFENSE ATTORNEY’S RESPONSE( l)
IT MEANS THAT...
JUROR(debriefing)
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I am not succeeding in studying
I’ve lost control of my whole life (A)
1. I don’t check my driver’s license, and I haven’t lost control
1. I check on other items (B)
1. I check on other items, BUT I don’t check my driver’s license and haven’t lost control
1. I can stop myself checking
The prosecutor made errors:overgeneralization (A), discounting
I am too anxious
I will not finish my master’s degree course
I can’t absorbinformation quickly (C)
I’m slow at reasoning (C)
I d ’t d ll
control
2. My OCD score fell today
3. I can remember some techniques without having to
d th b k
2. I’m not cured (B)
3. I can’t remember them all (B)
control
2. I’m not cured, BUT my OCD score fell today
3. I can’t remember them all, BUT I can remember some of the techniques without having t d th b k
2. I can cure myself
3. I can learn
(A), discounting positives (B), and all-or-nothing thinking (C)
The defense attorneymade no di t ti dI don’t do well
when interacting with people and controlling my environment (B, C)
reread the book
4. I’m completing theevidence chart
4. I still believe I’m imperfect (B)
to reread the book
4. I still believe I’m imperfect, BUT I’m completing theevidence chart
4. I see the other side of my imperfection (that I am normal)
distortions and gave fairer and more consistent arguments
___________VERDICT:
ACCUSATION:I AM
IMPERFECT
EMOTION:ANXIETY
normal)
Innocent
Initial Final100% 40%100% 40%
100%100%
80%80%
90%90%
70%70%
55%55%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 68
9/6/2011
64
I am a capable
I am normal I am asse ti e
I am a t thf l
I am lovable I am a easonable
Homework Assignment
capable person
assertive truthfulperson
reasonable person
11/10 – 40%1. I sent comments to my supervisor
11/10 – 60% 11/10 – 40%1. I sent comments to my supervisor
11/10 – 50% 11/10 – 60%1. My husband told me I was the most
11/10 – 50%1. I gave a telephone call to Ry p
2. I reviewed a thesis
y p2. I reviewed a thesis
important person for him
12/10 – 45% 12/10 – 60%1. I woke up
12/10 – 45%1. I sent a card
12/10 – 55%1. I told my
12/10 – 60% 12/10 – 55%1. I sent a card 1. I woke up
feeling well1. I sent a card to my goddaughter
1. I told my mother I would not have lunch with her today
1. I sent a card to my goddaughter
13/10 – 50%1. I got to limit my OCD rituals2. I was able to leave the bedroom this
13/10 – 60% 13/10 – 50%1. I got to limit my OCD rituals
13/10 – 55% 13/10 – 60%1. My husband gave me support while I was feeling pain
13/10 – 60%
bedroom this morning
p
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 69
9/6/2011
65
Case ReportCase ReportPanic Disorder
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Described in the Common Language for Psychotherapy Procedureshttp://www.commonlanguagepsychotherapy.org/
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 70
9/6/2011
66
Case Illustration
Two weeks before consulting a psychiatrist, Karen, age 28, developed panic attacks and stopped g , p p ppgoing out alone for fear of further panics. Panic attacks vanished for a whole year within weeks of starting escitalopram and clonazepam butstarting escitalopram and clonazepam, but returned after drug discontinuation; resuming those medications no longer helped.
Karen’s panic attacks improved dramatically with 2 sessions of cognitive restructuring and interoceptive exposure and she was able to
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
interoceptive exposure, and she was able to resume normal activities.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 71
9/6/2011
67
Case Illustration (cont.)
Karen remained well during a year, even not taking any medication. Then, during a stressful period, y , g p ,Karen started fearing new panic attacks, and worrying about health problems and dying. She was no longer able to go out alonewas no longer able to go out alone.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 72
9/6/2011
68
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
A psychological disorder may evolve into a physical disease.
ACCUSATION
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
Initial Final70%50%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 73
9/6/2011
69
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ACCUSATION
to a viral infection.
I have panic disorder.
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
Initial Final70%50%
90%80%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 74
9/6/2011
70
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
1) I have gone through many difficult situations, and I always
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ysurvived.
2) I have never had a serious disease; to the contrary, I am always the last to become ill.
ACCUSATION
to a viral infection.
I have panic disorder.
3) My eating habits are healthy, I do physical exercises, and I visit the doctor regularly.
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
g y
Initial Final70%50%
90%80%
50%20%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 75
9/6/2011
71
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
1) I have gone through many difficult situations, and I always
1) … BUT I can go through a worse situation and not survive.
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ysurvived.
2) I have never had a serious disease; to the contrary, I am always the last to become ill.
2) ... BUT I may have a physical disease.
ACCUSATION
to a viral infection.
I have panic disorder.
3) My eating habits are healthy, I do physical exercises, and I visit the doctor regularly.
3) ... BUT I may have a genetic predisposition to a physical disease. ___________
VERDICT:ACCUSATION:
I AM VULNERABLE
EMOTION:SAD
g y
Initial Final70%50%
90%80%
50%20%
90%80%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 76
9/6/2011
72
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
1) I have gone through many difficult situations, and I always
1) … BUT I can go through a worse situation and not survive.
1) I can go through a worse situation and not survive, BUT I have gone through many difficult situations and I
1)... the expression “I can” is abstract. Indeed, I always
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ysurvived.
2) I have never had a serious disease; to the contrary, I am always the last to become ill.
2) ... BUT I may have a physical disease.
always survived.
2) I may have a physical disease, BUT I have never had a serious disease; to the contrary, I am always the last to become ill.
, ysurvived.
2) ... the expression “I may” is just an assumption and, in fact, I have
h d
ACCUSATION
to a viral infection.
I have panic disorder.
3) My eating habits are healthy, I do physical exercises, and I visit the doctor regularly.
3) ... BUT I may have a genetic predisposition to a physical disease.
3) I may have a genetic predisposition to a physical disease, BUT my eating habits are healthy, I do physical exercises, and I visit
never had a serious disease.
3) ... I have always behaved in the most careful and preventive way.
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
g y p y ,the doctor regularly.
y
Initial Final70%50%
90%80%
50%20%
90%80%
0%0%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 77
9/6/2011
73
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
1) I have gone through many difficult situations, and I always
1) … BUT I can go through a worse situation and not survive.
1) I can go through a worse situation and not survive, BUT I have gone through many difficult situations and I
1)... the expression “I can” is abstract. Indeed, I always
The defense attorney seems more convincing and
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ysurvived.
2) I have never had a serious disease; to the contrary, I am always the last to become ill.
2) ... BUT I may have a physical disease.
always survived.
2) I may have a physical disease, BUT I have never had a serious disease; to the contrary, I am always the last to become ill.
, ysurvived.
2) ... the expression “I may” is just an assumption and, in fact, I have
h d
convincing and presented more evidence based on facts. The prosecutor tends to make more distortions as
ACCUSATION
to a viral infection.
I have panic disorder.
3) My eating habits are healthy, I do physical exercises, and I visit the doctor regularly.
3) ... BUT I may have a genetic predisposition to a physical disease.
3) I may have a genetic predisposition to a physical disease, BUT my eating habits are healthy, I do physical exercises, and I visit
never had a serious disease.
3) ... I have always behaved in the most careful and preventive way.
discounting positives and catastrophic thinking.
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
g y p y ,the doctor regularly.
y
Initial Final70%50%
90%80%
50%20%
90%80%
0%0%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 78
9/6/2011
74
INQUIRY(downward
PROSECUTOR(evidence
ti th
DEFENSE ATTORNEY( id t
PROSECUTOR’S RESPONSE( b t )
DEFENSE ATTORNEY’S RESPONSE( t l)
IT MEANS THAT...
JUROR(debriefing)
TBTR: Described in the Common Language for Psychotherapy Procedures
arrow technique)
supporting the accusation)
(evidence not supporting)
(yes, but...) (sentence reversal)
I have several chronic diseases that can lead to sudden death.
My grandfather died suddenly.
I have a genetic
1) I have gone through many difficult situations, and I always
1) … BUT I can go through a worse situation and not survive.
1) I can go through a worse situation and not survive, BUT I have gone through many difficult situations and I
1)... the expression “I can” is abstract. Indeed, I always
The defense attorney seems more convincing and
A psychological disorder may evolve into a physical disease.
gpredisposition, and I can also die.
My sister had an infarction when she was 13, due t i l
ysurvived.
2) I have never had a serious disease; to the contrary, I am always the last to become ill.
2) ... BUT I may have a physical disease.
always survived.
2) I may have a physical disease, BUT I have never had a serious disease; to the contrary, I am always the last to become ill.
, ysurvived.
2) ... the expression “I may” is just an assumption and, in fact, I have
h d
convincing and presented more evidence based on facts. The prosecutor tends to make more distortions as
ACCUSATION
to a viral infection.
I have panic disorder.
3) My eating habits are healthy, I do physical exercises, and I visit the doctor regularly.
3) ... BUT I may have a genetic predisposition to a physical disease.
3) I may have a genetic predisposition to a physical disease, BUT my eating habits are healthy, I do physical exercises, and I visit
never had a serious disease.
3) ... I have always behaved in the most careful and preventive way.
discounting positives and catastrophic thinking.
___________VERDICT:
ACCUSATION:I AM
VULNERABLE
EMOTION:SAD
g y p y ,the doctor regularly.
y
Innocent
Initial Final70%50%
90%80%
50%20%
90%80%
0%0%
0%0%
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 79
9/6/2011
75
Upward Arrow Technique
T: If the defense attorney’s statements are right, what do they mean about
?you?
P: I AM NORMAL!
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.75
De-Oliveira IR (2007) Sentence-reversion-based thought record (SRBTR): a new strategy to deal with “yes, but...” dysfunctional thoughts in cognitive therapy. European Review of Applied Psychology, 57:17-22.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 80
9/6/2011
76
Homework AssignmentDefense Attorney’s Preparation for the Appeal (Positive Self-Statements Logs)
I am normal (positive belief derived from the upward arrow technique)
Date.... (90%)1. I came to therapyby myself.
2. I took care of mychildren this morning.
3.
Date ( %)1.
2.
3.
Date ( %)11.
2.
3.
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 81
9/6/2011
77
Trial-Based Cognitive Therapy
1. Important definitions• Automatic thoughts underlying assumptions and coreAutomatic thoughts, underlying assumptions, and core
beliefs
2. Conceptualization diagram• Circuits hypothesis• Circuits hypothesis
3. Trial-Based Thought Record• Obsessive-Compulsive Disorder
Panic disorder• Panic disorder
4. Research• Trial-Based Thought Record
Fi to First useo Social anxiety disorder
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 82
9/6/2011
78
Revista Brasileira de Psiquiatria, 30(1):12-18, 2008Impact factor: 1.25p
Trial-Based Thought Record: Preliminary data on a strategy to deal with core beliefs by combining sentence reversion and the use of analogywith a judicial processwith a judicial process
Irismar Reis de OliveiraD t t f N i d M t l H lthDepartment of Neurosciences and Mental HealthFederal University of Bahia
http://www.scielo.br/scielo.php?pid=1516-4446&script=sci_serial
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 83
9/6/2011
79
TBTR Applied to 30 Patients WithDifferent Psychiatric Diagnoses
80,276,180 0
90,0 BeliefResults:
T1 – Inquiry
40 7
67,872,8
67,5
50 0
60,0
70,0
80,0 Emotion T2 – ProsecutorT3 – Defense attorneyT4 – Prosecutor’s responseT5 – Defense attorney’s responseT6 Verdict by the juror40,7
26,832,8
30,5
58,2
39,3
25,820 0
30,0
40,0
50,0
(%) T6 – Verdict by the juror
T1-T3, p < 0,001 (B and E)T1-T6, p < 0,001 (B and E)T1-T6, p < 0,001 (B and E)T3-T5, p = 0,009 (B and E),
0,0
10,0
20,0
T1 T2 T3 T4 T5 T6
T3 T5, p 0,009 (B and E)T5-T6, p = 0,005 (B)T5-T6, p = 0,02 (E)
Kruskal-Wallis andWilcoxon’s Signed Rank TestT1 T2 T3 T4 T5 T6B= BeliefE= Emotion
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 84
9/6/2011
80
Efficacy of the Trial-Based Thought Record, a New Cognitive Therapy Strategy Designed To
Change Core Beliefs in Social Phobia:Change Core Beliefs, in Social Phobia: A Randomized Controlled Study
De Oliveira et al (2011)De Oliveira et al. (2011)Journal of Clinical Pharmacy and Therapeutics (in press)
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 85
9/6/2011
81
ResultsAssessed for eligibility: n = 77
Excluded: n = 30Not meeting inclusion criteria ormeeting exclusion criteria
Randomized: n = 47
Allocated to TBTR: n = 25 Allocated to conventional: n = 22
Dropouts before intervention: n=3
Received allocated intervention: n = 19
Dropouts before intervention: n = 8
Received allocated intervention: n = 17 (intention‐to‐treat analysis) Completers analysis: n = 14
(intention‐to‐treat analysis)Completers analysis: n = 16
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 86
9/6/2011
82
Social phobia scale, social avoidance and distress scale, fear of negative evaluation scale, Beck anxiety inventory, and clinical global impression-improvement at baseline and week 14 in the groups*
TBTR (n= 17) Conventional (n= 19) P**TBTR (n= 17) Conventional (n= 19) PSocial phobia scale (Liebowitz, 1987)
BaselineFinalP***
86.82 (28.23)54.94 (32.17)
0.000
82.58 (24.31)61.63 (25.37)
0.000
0.640.49
Social avoidance and distress scaleBaselineFinalP***
21.88 (6.32)12.18 (8.43)
0.000
22.05 (4.22)17.47 (6.57)
0.000
0.920.04
Fear of negative evaluationFear of negative evaluationBaselineFinalP***
23.76 (5.87)17.41 (7.08)
0.003
26.16 (4.27)24.95 (5.65)
0.19
0.170.001
Beck anxiety inventoryBaseline 18 76 (9 40) 21 21 (12 53) 0 52BaselineFinalP***
18.76 (9.40)7.12 (5.66)
0.000
21.21 (12.53)11.32 (11.22)
0.000
0.520.17
CGI‐IBaselineFi l
4.06 (1.09)1 82 (1 13)
4.11 (1.15)2 21 (1 08)
0.900 30Final
P***1.82 (1.13)
0.0002.21 (1.08)
0.0000.30
*Intention-to-treat analysis**Independent-samples t-test***Paired-samples t-test
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 87
9/6/2011
83
Social phobia scale, social avoidance and distress scale, fear of negative evaluation scale, Beck anxiety inventory, and clinical global impression-improvement at baseline and week 14 in the groups*
TBTR (n= 17) Conventional (n= 19) P**TBTR (n= 17) Conventional (n= 19) PSocial phobia scale (Liebowitz, 1987)
BaselineFinalP***
86.82 (28.23)54.94 (32.17)
0.000
82.58 (24.31)61.63 (25.37)
0.000
0.640.49
Social avoidance and distress scaleBaselineFinalP***
21.88 (6.32)12.18 (8.43)
0.000
22.05 (4.22)17.47 (6.57)
0.000
0.920.04
Fear of negative evaluationFear of negative evaluationBaselineFinalP***
23.76 (5.87)17.41 (7.08)
0.003
26.16 (4.27)24.95 (5.65)
0.19
0.170.001
Beck anxiety inventoryBaseline 18 76 (9 40) 21 21 (12 53) 0 52BaselineFinalP***
18.76 (9.40)7.12 (5.66)
0.000
21.21 (12.53)11.32 (11.22)
0.000
0.520.17
CGI‐IBaselineFi l
4.06 (1.09)1 82 (1 13)
4.11 (1.15)2 21 (1 08)
0.900 30Final
P***1.82 (1.13)
0.0002.21 (1.08)
0.0000.30
*Intention-to-treat analysis**Independent-samples t-test***Paired-samples t-test
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 88
9/6/2011
84
Social phobia scale, social avoidance and distress scale, fear of negative evaluation scale, Beck anxiety inventory, and clinical global impression-improvement at baseline and week 14 in the groups*
TBTR (n= 17) Conventional (n= 19) P**TBTR (n= 17) Conventional (n= 19) PSocial phobia scale (Liebowitz, 1987)
BaselineFinalP***
86.82 (28.23)54.94 (32.17)
0.000
82.58 (24.31)61.63 (25.37)
0.000
0.640.49
Social avoidance and distress scaleBaselineFinalP***
21.88 (6.32)12.18 (8.43)
0.000
22.05 (4.22)17.47 (6.57)
0.000
0.920.04
Fear of negative evaluationFear of negative evaluationBaselineFinalP***
23.76 (5.87)17.41 (7.08)
0.003
26.16 (4.27)24.95 (5.65)
0.19
0.170.001
Beck anxiety inventoryBaseline 18 76 (9 40) 21 21 (12 53) 0 52BaselineFinalP***
18.76 (9.40)7.12 (5.66)
0.000
21.21 (12.53)11.32 (11.22)
0.000
0.520.17
CGI‐IBaselineFinal
4.06 (1.09)1 82 (1 13)
4.11 (1.15)2 21 (1 08)
0.900 30Final
P***1.82 (1.13)
0.0002.21 (1.08)
0.0000.30
*Intention-to-treat analysis**Independent-samples t-test***Paired-samples t-test
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 89
9/6/2011
85
Conclusion
• In this study, TBTR seemed to be:o as efficacious as conventional CBT regarding LiebowitzSocial Anxiety Scale and Beck Anxiety Inventory scores;
o more efficacious than conventional CBT regarding Fearo more efficacious than conventional CBT regarding Fearof Negative Evaluation and Social Avoidance andDistress Scale scores
• Results support other studies of TBTR in social anxiety disorder and other psychiatric disorders
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 90
9/6/2011
86
Trial-Based Cognitive Therapy
Techniques/Diagrams/Forms Session
TBCT Conceptualization Diagram All sessionsTBCT Conceptualization Diagram All sessions
Cognitive Distortions Questionnaire (CD-Quest) All from session 2 on
Intrapersonal Thought Record (IntraTR) Any from session 2 or 3 as neededp g ( ) y
Interpersonal Thought Record (InterTR) Any from session 2 or 3 as needed
Consensus Role-Play (CRP) Any from session 3 or 4 as needed
Responsibility Grid (RG) Any session (as needed) for guilt/shame
Trial-Based Thought Record (TBTR or “Trial I”) Usually from session 5 on
U ll f i 7
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.
Trial II.1 Usually from session 7 on
Trial II.2 (Trial-Based Empty Chair) Usually from session 8 on
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 91
9/6/2011
87
Question & Answer PeriodQuestion & Answer Period
Host
Dr. Irismar Reis de Oliveira
To submit a question: • Locate the Questions? box at the right side of the screen
Type your question in the field at the bottom of the box• Type your question in the field at the bottom of the box
• Click the button at the right end of the box (Send)
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 92
9/6/2011
88
This concludes this Webinar presentation.
Certificate InstructionsClick Here to complete the posttest and to print your certificate Click Here to complete the posttest and to print your certificate
(note—the posttest may open behind the webinar window).You also can access the posttest from www.neiglobal.com/cme
(available for 90 days following the activity).
If you do not remember your NEI website log-in information,please call customer service at 888-535-5600 or email
[email protected]. [email protected].
Thank you for participating in this webinar activity.
Core Beliefs on Trial: A Cognitive Therapy Approach for Psychopharmacologists
Copyright © 2011 Irismar Reis de Oliveira. All rights reserved. 93
Top Related