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The role of CBT
in paediatric disorders.
Dr Caroline Dibnah
Clinical Psychologist
NW Surrey CAMHS
What is CBT?
 Cognitive Behavioural Therapy is:
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Evidence-based
Collaborative
Goal-oriented
Structured
Active
Basic CBT model
Padesky & Greenberger, 1995
Levels of Cognition (1)
Automatic thoughts
• Easiest to identify
• Situation specific, e.g. appraisal of an event or a
physical symptom
• Linked to emotion
• Thinking errors can occur leading to misinterpretation
of events.
Levels of Cognition (2)
Assumptions
• Rules for living
• Tend to be conditional
• Common themes are high standards, approval from
others, control
• When a situation occurs when conditions can’t be met
affects emotions
Levels of Cognition (3)
Core Beliefs / Schemas
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Global
Absolute
Formed in childhood & adolescent by experience
Give us our rules for living and effect how we perceive
the world.
• Related to how people think about themselves, the
world around them and other people.
Cognitive Behavioural Therapy
 Identifying, understanding and breaking the vicious
circle that is established between the person’s
cognitions, moods, physical symptoms, behaviours
and environment.
Why CBT?
Shown to be effective
 Depression
 Generalised anxiety
disorder
 Health anxiety
 IBS
 Chronic pain
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Panic disorder
OCD
Bulimia Nervosa
Chronic Fatigue
Syndrome
 Cancer
Why CBT?
 Variation in the impact of illness
 Cognitions can account for differences in responses
to illness
 Chronic medical problems are associated with
psychological problems
When to use CBT
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Helping patients manage psychological symptoms
Adjusting to life with a chronic illness
Beliefs about illness that effect recovery
Trauma
Medically unexplained symptoms
Case Study 1
Anxiety and poor management of diabetes
14 year old boy. Lives with his mother and younger brother.
Parents are divorced, some contact with father.
Diagnosed with Type-I diabetes 2 years ago. Feels very angry
about having the diagnosis. Management has become
increasingly poor, not checking blood levels and skipping some
injections.
Two bereavements in the past year; cousin and school friend.
He has always had a small group of friends and been fairly quiet
at school. But recently become very withdrawn. Not socialising
with friends. Poor attendance at school.
EARLY EXPERIENCES
Parental separation, bereavement
diagnosis of diabetes
CORE BELIEFS
The world is unfair
Only bad things happen to me
I’m not as good as others
ASSUMPTIONS
If people know I have diabetes they will think I’m weird.
If people know I’m different they won’t like me.
TRIGGER: Out with friends
NATs: They think I’m weird.
BEHAVIOUR
Avoid talking to people
Avoid doing blood tests
FEELINGS
Anxious, Self-conscious
Increase heart rate,
nervous stomach
Intervention
 Challenging of negative automatic thoughts
 Behavioural experiments
 Challenging of beliefs and assumptions
Case Study 2
Chronic Fatigue Syndrome and Depression
15 year old girl with a 2 year history of Chronic Fatigue
Syndrome. Extreme fatigue, aching muscles, dizziness,
concentration problems, sleep problems, low appetite.
Low school attendance. No other activities. Using a
wheelchair to get around. Mood had worsened recently.
EARLY EXPERIENCES
High Achieving Family
Emphasis on doing things perfectly
UNDERLYING ASSUMPTIONS / CORE BELIEFS
I should do things perfectly
If you can’t do things perfectly you’re worthless
PRECIPITATING FACTORS
Worsening physical symptoms
Stress of GCSEs
NEGATIVE THOUGHTS
I’ll never get better; I can’t go on; If I try to do anything,
I’ll make myself worse; I’m a burden to my family
BEHAVIOUR
Avoid people, don’t push
myself, focus on
symptoms
FEELINGS
Low mood, heavy heart,
lonely
Intervention
 Challenging of negative automatic thoughts
 Behavioural experiments
 Challenging of beliefs and assumptions