Tanta University

Faculty of Nursing

Psychiatric and Mental Health

Prepared By:
1- Atef Talat Gomaa.
2- Abdelhamid Elsayed Ahmed.
3- Abdelhamid Abdelaal Mogahed .
4- Abdelhamid Ali Abdelhamid.
5- Shimaa Albelraouf Soliman.
6- Shimaa Abdelsalam Mohamed.
7- Shimaa Abdelatey Antar.
8- Shimaa Ali Sayed.
9- Shimaa mamon Ismael.
10- Shimaa Mahrous Atia.
11- Shimaa Mohamed Abdelmagid.

Under supervision of:

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Dr/Souzy Ragab

Mission of Psychiatric Nursing Department

The mission of the psychiatric and mental health nursing department is to

provide various educational opportunities in psychiatric nursing for
undergraduate and postgraduate students. It aims to help students
communicate effectively, think critically, intervene appropriately in
clients care and provide client and family teaching in a variety of clinical
setting.

Vision of Psychiatric Nursing Department

The psychiatric and mental health nursing department possesses the

potentials that qualify its members to provide excellent undergraduate
and graduate education and practice in psychiatric nursing. They are
capable of enhancing psychiatric nursing education and practice on the
national and international levels.

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Content:
❖ Introduction
❖ Cognitive theories:
• Aaron T. Beck
• Albert_Ellis (REBT)
❖ Cognitive theories
• Definition
• Indications
• Goals
• Techniques

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Introduction

Cognitive Therapy is a form of psychotherapy which was originally

developed by Aaron Beck in the 1960's to understand and treat
depression. Beck proposed that as human beings, we are constantly
engaged in a process of filtering and interpreting information in order to
make sense of the world and our experiences. Many cognitive theorists
believe that without these thought processes, we could have no emotions
and no behavior and would therefore not function. In other words,
thoughts always come before any feeling and before any action.

Cognitive theories:

1) Aaron T. Beck
2) Albert_Ellis (REBT)

1- Aaron T. Beck

Aaron Beck (1921) is considered the father of cognitive therapy. Beck

developed cognitive therapy with the belief that a person's experiences
result in cognitions or thoughts. These cognitions are connected
with schemas, which are core beliefs developed from early life, to create

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view of the world and determine emotional states and behaviors. Beck
believed disorders are maintained by negative attitudes and distorted
thinking.

Beck argued that many of the cognitive distortions of depressed patients

centered around the (Cognitive triad) which consist of negative thoughts
that depressed individuals have about themselves, about the world, and
about the future.

Basic Assumptions of cognitive Therapy

• .Beck used the term schemas; schemata are cognitive structure, or

patterns that consist of a person's beliefs, values, and assumptions
• Schema developed early in life from personal experiences & have
been learned overtimes and represent attitudes that one has been
formed on the basis of one's experiences.
• It influence people to interpret certain life situations in a biased or
distorted way

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For example one person may have experienced lifelong depression due
to variety of factor including a strong positive loading for depression and
serious life strains (ex: Childhood abuse, familial death) this person is
likely to have developed negative schemas such as I'm not good (self) ,
others can't be trusted (other) and effort doesn't pay off (future)

Basic Principles of Cognitive Therapy

Examples of cognitive distortions

1. All-or-nothing thinking

Evaluating the self, as well as events in life in extreme terms. It’s either
all good or all bad, either black or white, nothing in between.

Example: When an admired person makes a minor mistake, the

admiration is turned into contempt.
2. Overgeneralization.
In this cognitive distortion, come to a general conclusion based on a
single incident or a single piece of evidence. If something bad happens
only once, we expect it to happen over and over again. A person may see
a single, unpleasant event as part of a never-ending pattern of defeat.

3. Labeling
A more severe type of overgeneralization; attributing a person's actions to
their character instead of some accidental attribute. Rather than assuming
the behavior to be accidental or extrinsic, the person assigns a label to
someone or something that implies the character of that person or thing.

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Example of "labeling": Instead of believing that you made a mistake, you
believe that you are a loser, because only a loser would make that kind of
mistake.

4. Filtering.
We take the negative details and magnify them while filtering out all
positive aspects of a situation. For instance, a person may pick out a
single, unpleasant detail and dwell on it exclusively so that their vision of
reality becomes darkened or distorted.

5. Jumping to conclusions

Reaching preliminary conclusions (usually negative) from little (if any)

evidence.

6. .Magnification and minimization

Giving proportionally greater weight to a perceived failure, weakness or

threat, or lesser weight to a perceived success, strength or opportunity, so
the weight differs from that assigned to the event or thing by others. This
is common enough in the normal population to popularize idioms such as
"make a mountain out of a molehill". In depressed clients, often the
positive characteristics of other people are exaggerated and negative
characteristics are understated. There is one subtype of magnification:

a. Catastrophizing – Giving greater weight to the worst possible

outcome, however unlikely, or experiencing a situation as
unbearable or impossible when it is just uncomfortable.

Example: A teenager is too afraid to start driver's training because he

believes he would get himself into an accident.
7. Personalization.

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Personalization is a distortion where a person believes that everything
others do or say is some kind of direct, personal reaction to the person.
We also compare ourselves to others trying to determine who is smarter,
better looking, etc.

A person engaging in personalization may also see themselves as the

cause of some unhealthy external event that they were not responsible for.
For example, “We were late to the dinner party and caused the hostess to
overcook the meal. If I had only pushed my husband to leave on time, this
wouldn’t have happened.

8. Should and must statement.

We have a list of ironclad rules about how others and we should behave.
People who break the rules make us angry, and we feel guilty when we
violate these rules. A person may often believe they are trying to motivate
themselves with shoulds and shouldn’ts, as if they have to be punished
before they can do anything.

9. Disqualifying the positive

Discounting positive events.

Example: Upon receiving a congratulation, a person dismisses it out-

of-hand, believing it to be undeserved, and automatically interpreting
the compliment (at least inwardly) as an attempt at flattery or perhaps
as arising out of naïveté.
10. Emotional reasoning

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Presuming that negative feelings expose the true nature of things, and
experiencing reality as a reflection of emotionally linked thoughts.
Thinking something is true, solely based on a feeling.

Example: "I feel (i.e. think that I am) stupid or boring, therefore I must be
Or, feeling that fear of flying in planes means planes are a very dangerous
way to travel. Or, concluding that it's hopeless to clean one's house due to
being overwhelmed by the prospect of cleaning

2) Albert_Ellis( REBT)

Rational emotive behavior therapy (REBT) Is a type of therapy

introduced by Albert Ellis In the 1950s. It’s an approach that helps you
identify irrational beliefs and negative thought patterns that may lead to
emotional or behavioral Issues. The goal of the therapy is to change
irrational beliefs to more rational ones.

REBT can be particularly helpful for people living with a variety of

issues, including:

• Depression
• Anxiety
• Addictive behaviors
• Phobias
• Overwhelming feelings of anger, guilt, or rage

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 • Procrastination
• Disordered eating habits
• Aggression
• Sleep problem

Principles of REBT:

• REBT is grounded in the idea that people generally want to do well

in life. For example, you probably want to achieve your goals and
find happiness. But sometimes, irrational thoughts and feelings get
in the way. These beliefs can influence how you perceive
circumstances and events — usually not for the better.
• Imagine you’ve texted someone you’ve been dating for a month.
You see they’ve read the message, but several hours pass with no
reply. By the next day, they still haven’t replied.
• You might then:
• Start to think they’re ignoring you because they don’t want to see
you
• Worry you did something wrong when you last saw them
• Tell yourself relationships never work out and that you’ll be alone
for the rest of your life.

Here’s how this example illustrates the core principles — called the
ABCs of REBT:

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 —

A refers to the (a)activating event or situation that triggers a negative

reaction or response. In this example, the A is the lack of reply.

B refers to the (b)beliefs or irrational thoughts you might have about an

event or situation. The B in the example is the belief that they don’t want
to see you anymore or that you’ve done something wrong and that you
will be alone for the rest of your life.

C refers to the (c)consequences, often the distressing emotions, that

result from the irrational thoughts or beliefs. In this example, that might
include feelings of worthlessness or not being good enough.

Definition:

Cognitive: Relating to the mental processes of thinking and reasoning.

Cognitive therapy: is a type of psychotherapy based on the concept of
pathological mental processing. The focus of treatment is on the modification
of distorted cognitions and maladaptive behaviors.

Indications:

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Cognitive therapy was originally developed for use with depression.
Today it is used for a broad range of emotional disorders.
The proponents of cognitive therapy suggest that the emphasis of
therapy must be varied and individualized for clients according to
▪ their specific diagnosis,
▪ symptoms, and
▪ level of functioning.
In addition to depression, cognitive therapy may be used with the
following clinical conditions:
▪ Panic disorder,
▪ Generalized anxiety disorder,
▪ Social phobias,
▪ Obsessive-compulsive disorder,
▪ Posttraumatic stress disorder,
▪ Eating disorders,
▪ Substance abuse,
▪ Personality disorders,
▪ Schizophrenia,
▪ bipolar disorder,
▪ Somatoform disorder

Goals:

1-the promotion of self-awareness and emotional intelligence by teaching

clients to “read” their emotions and distinguish healthy from unhealthy
feelings

2-helping clients understand how distorted perceptions and thoughts

contribute to painful feelings

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3-the rapid reduction of symptoms with an emphasis on examining the
client’s current situation and solving current problems

4-the development of self-control by teaching clients specific techniques

to identify and challenge distorted thinking

5-prevention of future episodes of emotional distress and development of

personal growth by helping clients change core beliefs that are often at
the heart of their suffering

Techniques

Best Cognitive Therapy Techniques for Practitioners

CT is a short-term and solution-oriented approach to change maladaptive

thoughts and behaviors. A variety of practical cognitive therapy
techniques (some previously touched on) are used depending on the
client’s needs and goals for therapy.

1-Exposure therapy:

is an effective Cognitive Therapy technique used for anxiety and

phobias. It involves exposing the client to a person, place, situation, or
object that creates fear. The idea is to confront fears in a safe setting and
overcome negative emotions and reaction.

2_Thought recording

Creating a thought journal is a cornerstone for CT. Clients capture,

evaluate, and restructure negative or anxious automatic thoughts.

3_Role-play

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Role-play is an effective technique in CT. A therapist can help a client
practice or experience a situation/event in a safe space by acting out the
interaction.

4_Pleasurable activity scheduling:

Activity scheduling and behavioral activation are methods of putting

action before thoughts or motivation. Scheduling positive activities and
doing them results in more positive thoughts and feelings.

For example, scheduling a morning walk or evening bath can provide

energy in the morning and relaxation at night. In the same way that
thoughts and emotions influence behavior, behavior can influence our
thoughts and feelings.

Reference

▪ mosby,USA,2011;27:28.

▪ Elizabesth M. Varcarolis,Essentials of Psychiatric Mental Health

Nursing;2nd ed ; Elsevier,Canada,2013 ; 31:30

▪ http://study.com/academy/lesson/aaron-beck-cognitive-therapy-

theory-lesson-quiz.html

▪ https://www.simplypsychology.org/cognitive-therapy.html

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