CBT guide for workplace wellbeing

Cognitive Behaviour Therapy (CBT): preparing
organisations for psychological change
www.humanikaconsulting.com

Aims of This Discussion
• To understand how CBT can help
organisations with well being,
behaviour change and performance
• To reflect on workplace challenges,
training needs, and research
opportunities

Psychological theories & approaches in the
workplace
• CBT (Beck, 1979) and MI (Miller &
Rollnick, 1991; 2002) are psychological
approaches, underpinned by evidence,
that can help organisations and
individuals overcome challenges related
to physical, emotional, behavioural and
situational factors.
• Issues within the workplace maybe;
stress, resistance, burnout,
presenteeism, absenteeism, sickness ill
health, counter-productive work
behaviours, physical ill health, poor
mental health and so on.

WHAT IS THE AIM OF CBT?
• To increase self-awareness
• To encourage a better self-
understanding
• To help us recognize the
‘negative traps’ or ‘vicious
cycles’ we get caught in
• To improve self-control by
developing more
appropriate cognitive and
behavioural skills

Cognitive Behaviour Therapy
CBT is ‘a process and identifying and re-
evaluating self defeating thinking so that a person
is persuaded to engage in more effective ways of
thinking, feeling, and behaving’.
• A therapy using a mixture of cognitive
(thought processing) and behavioural
techniques to look at the links between a
person’s environment, thoughts, feelings and
behaviours and the impact of these on their
health and functioning
• Cognitive techniques address thoughts and
thought patterns which may be ‘unhelpful’ and
may trigger and/or increase anxiety
• Behavioural techniques address behaviours
which may be used by a person to reduce their
anxiety or avoid it altogether

Cognitive Behavior Therapy
Basic Tenets
– The main theories are Cognitive Behavior
Therapy, Rational Emotive Behavior
Therapy and Cognitive Behavior
Modification.
– The way individuals structure and interpret
experiences, determines their moods and
behaviors.
– Changing conceptualizations lies at the
heart of cognitive behavioral therapy.
– Combines both cognitive and behavioral
approaches.
“Copyright © Allyn & Bacon 2004”

Basic Tenets
– Cognitive therapy rests upon the belief that
what one thinks determines how one feels.
– The therapist is supportive and empathic and
uses experiments and empirical processes
along with a collaborative alliance with the
client, to explore thinking and alternatives.
– Cognitive therapy has been used with a
variety of disorders and problems (e.g.
anxiety, phobias, depression).

Situation
THOUGHTS
PHYSICAL REACTIONS
FEELINGS
BEHAVIOURS
Overly negative
Self-critical
Thinking things are going to go wrong
Thinking there is danger
Imagining people will judge you harshly
Imagining that you will look foolish
Unpleasant
Anxious
Angry
Depressed
Heart pounding
Feeling hot
Sweaty
Shakiness
Headache
Stomach ache/cramps
Nausea
Avoid situations
Run away from situations (escape)
Give up
Don’t try to go places or do things

Cognitive Behavioral Therapy is based on
the observation that cognition, emotion,
and behavior are reciprocally related.
Cognition
BehaviorEmotion

Emotion
• James-Lange Theory of Emotion
– Action or response precedes
emotion
– I run, therefore I must be
afraid.
• Canon-Bard Theory of Emotion
– Emotion precedes action.
– I am afraid, therefore I run.

Singer-Schacter Theory of Emotion

Emotion #3
 Emotion cannot be accessed
directly, but it can be elicited in
therapy.
 Experiences that are accompanied
by the arousal of strong emotion
have more powerful effects on
cognitive and behavioral patterns.
 Memory (learning) is mood
congruent. A recurrence of mood
triggers recall of learning. A
reminder of learning situation
triggers the original mood.

Emotional Symptoms
• Emotional excess
– Overreactions or unpredictable
emotions
– Excessive or overly extravagant
expression of emotion
– Emotionally labile
• Emotional insufficiency
– Difficulty in displaying emotion
– Difficulty in “reading” emotion
in others
– Difficulty in verbal expression of
emotion
– Lack of self-control, poor
frustration tolerance

• Judgment is the
emotionally (socially)
relevant use of
knowledge.
• Judgment takes place
in the frontal cortex.

Behavior
 Classical Conditioning
 The repeated pairing of a
stimulus with a (formerly)
neutral response, resulting in
the stimulus coming to
trigger the neutral response.
(Pavlovian)
 Aversion therapy
 Desensitization
 Flooding
 Stimulus control
 Alters antecedent conditions
to affect behavior

Behavior #2
• Operant Conditioning
– Modifies “voluntary behavior”
• Positive Reinforcement: a behavior is
followed by a reward. Increases
behavioral frequency.
• Negative Reinforcement: a behavior
is followed by the removal of an
aversive stimulus. Increases
behavioral frequency.
• Positive Punishment: a behavior is
followed by an aversive stimulus.
Decreases behavioral frequency.
• Negative Punishment: a behavior is
followed by the removal of a
favorable stimulus.

Behavior #3
• Operant conditioning =
instrumental learning
(Skinnerian)
– Extinction
– Differential Reinforcement
of Other Behavior (DRO)
– Avoidance learning (E.g.,
electric shock to reduce
arousal in presence of child
pornography)

Behavior #4
• A behavior that is rewarded
every time is acquired or
learned quickly.
• Fading the reward schedule to
intermittent makes the
behavior less vulnerable to
instances of non-reward. The
behavior persists for a
relatively long period of time,
even if not rewarded.

Effectiveness of consequences depends on:
• Immediacy
• Consistency
(reinforcement schedule)
• Potency (cost-benefit
ratio)
• Satiation (felt need for
the stimulus or response)

The Premack
Principle
• A desirable or often-engaged
in behavior or situation can
serve as a reinforcer for
another (new) behavior.
• Example: If you always brush
your teeth and need to
develop a habit of taking
medicine, pair the medicine
routine with the teeth-
brushing routine.

Social Conditioning
 Complex social behavior
increases and decreases in
frequency in response to
social reinforcement and
social “response cost” or
punishment.
 Example: A pat on the back or
a thank you from the boss
reinforces excellent work
habits better than an increase
in salary.

Behavioral Difficulties
• Behavioral excess
• Behavioral insufficiency
• Lack of skill (lack of “know-
how”)
• Restricted range of coping
strategies (“know-what”)
• Behavioral inconsistency
(“know-when”)
• Insufficient stimulus control
(difficulty with initiating or
maintaining behavior)
• Insufficient contingency control
(failure to reward self)

Behavioral Difficulties #2
• Disorders of Executive Control
– Planning
– Organization
– Time Management
– Task Management
– Delay of Gratification / Poor
Impulse Control (inhibition of
behavior)
– Goal Directedness (initiation of
behavior)

Cognition
• Human cognition tends to be categorical and
hierarchical. (We sort and categorize.) This is biologically
determined – it’s how the brain works.
• Sorting and categorizing makes learning possible,
through a process of assimilation and accommodation.
• Categorizing and comparing allows us to arrive at
efficient rules for sorting the vast amount of information
that confronts us every waking moment.

Cognition #2
• Early-acquired cognitive rules form basic schema that tell us what
information is important for survival:
– what data to actively seek,
– what data is relevant and noteworthy, and
– what can be safely ignored

Cognitive Schema
Early acquired schema (probably
prior to age 8 or so) form our
basic assumptions about
ourselves and the world and
the relationship between those
two. They form our Core
Beliefs or Basic Beliefs.
Schema tend to be partial
constructs, usually operating
outside our awareness. They
tend to be fragmentary,
visceral, iconic vs. verbal. They
are presumed true,
unquestioned.

Characteristics of Basic Schema
• They are absolutes.
• They are unquestioningly taken as
Truths.
• They are consistent across time and
situation.
• They function below the level of
awareness.
• They tend to be non-verbal, visceral &
iconic.
• They tend to be partial constructs.
• They are highly resistant to change.
• They are evident only indirectly in
patterns of cognition, emotion, &
behavior.

Cognitive Schema may be…
Compelling
Non-Compelling
Active Latent

Self-Schema
• Beliefs about Self are acquired
from:
– Stories told about the child
within his/her hearing
– Stories told directly to the child
about themselves
– Reflections of and reactions to
the child’s behavior by
significant others
– Stories erroneously adopted
(false memories)
• Events that happened to others
• Events in books or on television
– Personal experience
• Interpretations of early life
events
• Experiences of success and
failure

Characteristics of
Cognitive-Behavioral Therapies:
1. Thoughts cause
Feelings and
Behaviors.
2. Brief and Time-
Limited.
3. Emphasis placed on
current behavior.

4. CBT is a collaborative effort
between the therapist and the
client.
Client role - define goals,
express concerns,
learn & implement learning
Therapist role - help client
define goals, listen, teach,
encourage.
5. Teaches the benefit of
remaining calm or at least
neutral when faced with
difficult situations. (If you are
upset by your problems, you
now have 2 problems: 1) the
problem, and 2) your
upsetness.

6. Based on "rational
thought." - Fact not
assumptions.
7. CBT is structured and
directive. Based on
notion that maladaptive
behaviors are the
result of skill deficits.
8. Based on assumption
that most emotional and
behavioral reactions are
learned. Therefore, the
goal of therapy is to help
clients unlearn their
unwanted reactions and
to learn a new way of
reacting.
9. Homework is a central
feature of CBT.

Three assumptions
1. Cognitive activity impacts
behavior.
2. Cognitive activity can be
monitored and changed.
3. A desired change in behavior can
be accomplished through
changing cognitions.

Symptoms
Physical
FeelingsThoughts
Behavioural
Negative
automatic
thoughts
Incidents
Past
experience
in workplace
CBT and self defeating thinking in the
workplace
Core beliefs
Underlying
assumptions or
life rules

Strategies for Helping Clients
Beck’s cognitive psychotherapy
– The goals are to correct faulty information
processing and help clients modify their
assumptions that maintain their
maladaptive behaviors and emotions.
 Collaborative Empiricism:
Therapist and client are co-
investigators.
 Guided Discovery: Guided by the
therapist, the client engages in
experiments that result in more
adaptive ways of thinking.

Relaxation Training and Relaxation
Therapy
– A person cannot be in a state
of complete physical relaxation
while at the same time be
emotionally anxious.
– Works well for stress, anxiety,
physiological problems,
workplace pressures, and
coping with modern lifestyles.

Mental and Emotive Imagery
– Mental Imagery is a process
through which a person focuses
on vivid mental pictures of
experiences or events—past,
present or future.
– Emotive Imagery: It is a
procedure where the client
imagines the emotional
sensations and feelings of an
actual situation or behavior.

– Cognitive Modeling: Identification of
what maladaptive or bad thoughts or
emotions the client wishes to be rid of
and then the therapist models with
self-talk that the client will incorporate.
– Covert Modeling: A client imagines
engaging in the desired behaviors he
or she wants to learn or adopt.
– Thought Stopping: Interruption of
unwanted thoughts when they occur
by shouting “stop” whenever the
unwanted thought pops into
consciousness.

– Cognitive Restructuring:
Replacement of negative,
maladaptive thoughts with positive,
adaptive ones.
– Reframing: To modify or restructure
a person’s view or perception
regarding a problem or behavior.
– Stress Inoculation: A process of
teaching clients both cognitive and
physical skills for autonomously
coping with future stressful and
distressing situations.

– Meditation and Relaxation: Helps the client
concentrate on some internal or external stimulus that
serves to focus the client’s attention away from
aversive stimuli.
– Biofeedback: Uses technology to communicate to a
client what his or her own body is doing and then
allows that person to use mental processes to control
bodily functions.
– Neurolinguistic programming: Using the client’s
sensory language to fully experience the client’s inner
world (e.g. I see that (visual); I feel that (kinesthetic) ; I
hear that auditory).

– Eye Movement Desensitization Reprocessing (EMDR):
 Used primarily to treat traumatic memories.
 The client imagines the scene, is aware of the negative statement regarding
that scene (along with noxious feelings), and then follows the therapist’s
finger with his or her eyes.
 Then the client erases the image from his or her mind.
 This is continued over a series of steps until hopefully the painful image and
noxious feelings and memories are removed.

Advantages of Cognitive Behavior
Therapy
– It has established human thought
processes as data or events that can
be studied.
– It validated a number of relaxation
techniques.
– It has enhanced the rational therapies
such as Rational Emotive Behavior
Therapy.
– Uses the systematic scientist-
practitioner model.

Disadvantages of Cognitive Behavior Therapy
– It has been harshly judged by feminists,
multiculturalists and ecologists because it mirrors
masculine and Euro-American worldviews and does
not adequately take culture into consideration.
– It requires a lot of training and skill.
– The therapist needs to not only understand cognitive
techniques but also have a vast understanding of
behavioral and learning theories.
– The therapist needs to have strong discipline and
there is less tolerance for error.

Cognitive Behavior Therapy with Diverse
Populations
– It matches problems to treatments
without regard for race or cultural
considerations.
– It can be used effectively if culture and
the client’s worldview is take into
consideration.
– Therapy is a collaboration and depends
upon trust between counselor and client
and this can work well with culturally
diverse clients.

WHAT CAN DO?
COGNITIVE
• Identify negative thoughts and
thinking patterns which make you
feel unpleasant using a thought
diary (Appendix A)
• Label the type of ‘thinking error’
(Appendix B)
• Develop balanced thinking by
looking for evidence for and
against the thoughts and finding
new evidence you might
otherwise miss
• Learn new skills i.e. distraction,
positive self-talk, problem-solving
skills
BEHAVIOURAL
• Activity monitoring – link activity,
thoughts and feelings
• Become more active – this leaves
you less time to worry or listen to
your negative thoughts
• Increase pleasant activities
• Break tasks into small achievable
steps
• Face your fears – try to break
negative cycles by dropping
avoidance, escape and safety
behaviours

How understanding theory and practice
may help you and your organisation
• Help identify and achieve health and
work goals
In particular
Dealing with change and resistance
Modification of health and worked
related beliefs
Solution focused approach to
development of action plans
Training needs of yourself and your
workforce
Applying consultancy for your
organisational needs

Learning and
Giving For
Better
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CBT guide for workplace wellbeing

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