{"id":1830,"date":"2016-05-30T07:46:21","date_gmt":"2016-05-30T14:46:21","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1830"},"modified":"2016-04-27T15:04:38","modified_gmt":"2016-04-27T22:04:38","slug":"cognitive-behavioral-therapy-series-lesson-1-cognitive-behavioral-restructuring","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1830","title":{"rendered":"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring"},"content":{"rendered":"<p><strong>10 Minute Mini Lesson One <\/strong>is designed to provide a basic understanding of the CBT concept of <strong>Cognitive Restructuring<\/strong>.<\/p>\n<p>Help them fill in the <strong>CBT Cycle Diagram<\/strong> to show what happened, what they were THINKING, how they FELT emotionally and physically, and how they BEHAVED:<\/p>\n<p><a href=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\"><img data-opt-id=1778044477  fetchpriority=\"high\" decoding=\"async\" class=\"  wp-image-1831 aligncenter\" src=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:191\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\" alt=\"CBT1\" width=\"397\" height=\"258\" \/><\/a><\/p>\n<p>HERE ARE SUGGESTED QUESTIONS TO ASK. Have patient if able write answer next to appropriate label in Diagram:<\/p>\n<ol>\n<li>WHAT HAPPENED?<\/li>\n<\/ol>\n<p>Q:\u00a0 Tell me about a specific, recent time when your pain increased.<\/p>\n<p>A: \u00a0<em>I got upset because I had too much back pain to even do the dishes.<\/em><\/p>\n<p>Q:\u00a0 When?<\/p>\n<p>A: <em>I guess it was 2 days ago<\/em><\/p>\n<p>Q:\u00a0 What time of day? (Or other questions like \u2018where were you?\u2019 to increase specificity.)<\/p>\n<p>A: \u00a0<em>In the afternoon<\/em><\/p>\n<ol start=\"2\">\n<li>WHAT WERE THEIR THOUGHTS:<\/li>\n<\/ol>\n<p>Q:\u00a0 What was running through your mind when [the event] happened?<\/p>\n<p>A: \u00a0<em>I\u2019ll never be able to do anything normal and my husband will leave me.<\/em><\/p>\n<p><strong>Typical THOUGHTS of chronic pain patients:<\/strong><\/p>\n<ul>\n<li>Catastrophising<\/li>\n<li>Unhelp beliefs, e.g., I should always rest, I need to get rid of the pain (vs. manage the pain)<\/li>\n<li>Hypervigilance, e.g., paying too much attention to one\u2019s body<\/li>\n<li>Self Criticism<\/li>\n<\/ul>\n<ol start=\"3\">\n<li>WHAT WERE THEIR FEELINGS:<\/li>\n<\/ol>\n<p>Q:\u00a0 How did that make you feel?<\/p>\n<p>A: \u00a0<em>I felt worthless and hopeless.<\/em><\/p>\n<p>Q:\u00a0 Did you have other feelings like [anger, fear, sadness]?<\/p>\n<p>A: \u00a0<em>Well, I guess anger because this has been going on so long.<\/em><\/p>\n<p><strong>Typical FEELINGS of chronic pain patients<\/strong><\/p>\n<ul>\n<li>Low mood<\/li>\n<li>Anger and frustration<\/li>\n<li>Anxiety and worry<\/li>\n<\/ul>\n<ol>\n<li>HOW DID THEIR BODY FEEL?<\/li>\n<\/ol>\n<p>Q: How did your body feel?<\/p>\n<p>A: <em>My back was on fire. I felt like I couldn\u2019t stand up.<\/em><\/p>\n<p><strong>Typical BODY FEELINGS of chronic pain patients<\/strong><\/p>\n<ul>\n<li>Pain, weakness, and stiffness<\/li>\n<li>Lethargy and fatigue<\/li>\n<li>Poor sleep<\/li>\n<li>Nervous symptoms<\/li>\n<\/ul>\n<ol start=\"2\">\n<li>WHAT DID THEY DO?<\/li>\n<\/ol>\n<p>Q: What did you do at that point?<\/p>\n<p>A: \u00a0<em>I took an extra pain pill but it didn\u2019t help, so I called for an appointment.<\/em><\/p>\n<p><strong>Typical BEHAVIORS of chronic pain patients<\/strong><\/p>\n<ul>\n<li>Sighing and groaning, talking about pain<\/li>\n<li>Reduced activity; excessive rest<\/li>\n<li>Social isolation and withdrawalTHIS IS HOW THE CBT CYCLE DIAGRAM MIGHT NOW LOOK:\n<p><a href=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT2.jpg\"><img data-opt-id=2081075746  fetchpriority=\"high\" decoding=\"async\" class=\"  wp-image-1832 aligncenter\" src=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:179\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT2.jpg\" alt=\"CBT2\" width=\"413\" height=\"253\" \/><\/a><\/p>\n<p>HELP PATIENT FIND NEW WAY OF THINKING ABOUT EVENT:<\/p>\n<p>Explore using yourself as a model. Use the patient\u2019s own words as much as possible. Help the patient make their own connections and discoveries. Your main goal is to get the patient to THINK DIFFERENTLY about their situation. Much of this THINKING may occur at home after the visit.<\/p>\n<p>OFFER COGNITIVE EMPATHY: If I thought I wasn\u2019t ever going to be normal and my spouse would leave me, I would also feel hopeless and worthless and angry and want the doctor to fix me.<\/p>\n<p>SUGGEST COGNITIVE RESTRUCTURING or REFRAMING:<\/p>\n<p>Q: Is there something different you could THINK about [event}?<\/p>\n<p>THIS IS HOW THE CBT CYCLE DIAGRAM MIGHT NOW LOOK:<\/p>\n<p><a href=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT3.jpg\"><img data-opt-id=613613043  data-opt-src=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:156\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT3.jpg\"  decoding=\"async\" class=\"  wp-image-1833 aligncenter\" src=\"data:image/svg+xml,%3Csvg%20viewBox%3D%220%200%20300%20156%22%20width%3D%22300%22%20height%3D%22156%22%20xmlns%3D%22http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%22%3E%3Crect%20width%3D%22300%22%20height%3D%22156%22%20fill%3D%22transparent%22%2F%3E%3C%2Fsvg%3E\" alt=\"CBT3\" width=\"566\" height=\"301\" \/><\/a><\/p>\n<p>HELP PATIENT FIND NEW WAY OF THINKING ABOUT EVENT:<\/p>\n<p>Explore using yourself as a model. Use the patient\u2019s own words as much as possible. Help the patient make their own connections and discoveries. Your main goal is to get the patient to THINK DIFFERENTLY about their situation. Much of this THINKING may occur at home after the visit.<\/p>\n<p>OFFER COGNITIVE EMPATHY: If I thought I wasn\u2019t ever going to be normal and my spouse would leave me, I would also feel hopeless and worthless and angry and want the doctor to fix me.<\/p>\n<p>SUGGEST COGNITIVE RESTRUCTURING or REFRAMING:<\/p>\n<p>Q: Is there something different you could THINK about [event}?<\/p>\n<p>A:\u00a0 <em>I need to find a different way to get this done. Dirty dishes are not the end of the world.<\/em><\/p>\n<p>COACH on possible answers if they don\u2019t come up with any on their own.<\/p>\n<p>Q: How might you FEEL if you thought <em>that<\/em> about the dishes?<\/p>\n<p>A: <em>I\u2019d be happy that I had a good idea. I wouldn\u2019t worry about it as much.<\/em><\/p>\n<p>Q:\u00a0 How would your BODY FEEL?<\/p>\n<p>A: \u00a0<em>Maybe I wouldn\u2019t feel so tense.<\/em><\/p>\n<p>Q:\u00a0 What would you DO differently?<\/p>\n<p>A:\u00a0 <em>I\u2019d wash five dishes and then go watch my favorite soap for 10 minutes.<\/em><\/p>\n<p>HOMEWORK ASSIGNMENT: Ask patient to fill out a new CBT Cycle Diagram AT HOME with the NEW thoughts, emotional and physical feelings, and behaviors (which might look like this). Encourage patient to use this new skill at least once a day (supply them with blank CBT Cycle Diagram forms). Ensure them that regular practice will lessen their pain, improve their mood and self-confidence, and make them less dependent on medications.<\/p>\n<p>NEXT CBT Mini Lesson: Mindfulness and Relaxation Exercises<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>10 Minute Mini Lesson One is designed to provide a basic understanding of the CBT concept of Cognitive Restructuring. Help them fill in the CBT Cycle Diagram to show what happened, what they were THINKING, how they FELT emotionally and &hellip; <a href=\"https:\/\/phcprimarycare.org\/?p=1830\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1830","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=1830\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog\" \/>\n<meta property=\"og:description\" content=\"10 Minute Mini Lesson One is designed to provide a basic understanding of the CBT concept of Cognitive Restructuring. Help them fill in the CBT Cycle Diagram to show what happened, what they were THINKING, how they FELT emotionally and &hellip; Continue reading &rarr;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/phcprimarycare.org\/?p=1830\" \/>\n<meta property=\"og:site_name\" content=\"PHC Primary Care Blog\" \/>\n<meta property=\"article:published_time\" content=\"2016-05-30T14:46:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:191\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\" \/>\n<meta name=\"author\" content=\"RMoore\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"RMoore\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830\",\"url\":\"https:\/\/phcprimarycare.org\/?p=1830\",\"name\":\"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog\",\"isPartOf\":{\"@id\":\"https:\/\/phcprimarycare.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830#primaryimage\"},\"image\":{\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830#primaryimage\"},\"thumbnailUrl\":\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:191\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\",\"datePublished\":\"2016-05-30T14:46:21+00:00\",\"author\":{\"@id\":\"https:\/\/phcprimarycare.org\/#\/schema\/person\/e2261897cb15c2610b283200b210f79c\"},\"breadcrumb\":{\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/phcprimarycare.org\/?p=1830\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830#primaryimage\",\"url\":\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\",\"contentUrl\":\"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg\",\"width\":598,\"height\":381},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/phcprimarycare.org\/?p=1830#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/phcprimarycare.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/phcprimarycare.org\/#website\",\"url\":\"https:\/\/phcprimarycare.org\/\",\"name\":\"PHC Primary Care Blog\",\"description\":\"Partnership HealthPlan of California\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/phcprimarycare.org\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/phcprimarycare.org\/#\/schema\/person\/e2261897cb15c2610b283200b210f79c\",\"name\":\"RMoore\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/phcprimarycare.org\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/f0ba7e9946a1ad594a0070ed009f75ea00cb69b3f7271511fd722377966e54bd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/f0ba7e9946a1ad594a0070ed009f75ea00cb69b3f7271511fd722377966e54bd?s=96&d=mm&r=g\",\"caption\":\"RMoore\"},\"url\":\"https:\/\/phcprimarycare.org\/?author=2\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/phcprimarycare.org\/?p=1830","og_locale":"en_US","og_type":"article","og_title":"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog","og_description":"10 Minute Mini Lesson One is designed to provide a basic understanding of the CBT concept of Cognitive Restructuring. Help them fill in the CBT Cycle Diagram to show what happened, what they were THINKING, how they FELT emotionally and &hellip; Continue reading &rarr;","og_url":"https:\/\/phcprimarycare.org\/?p=1830","og_site_name":"PHC Primary Care Blog","article_published_time":"2016-05-30T14:46:21+00:00","og_image":[{"url":"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:191\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg","type":"","width":"","height":""}],"author":"RMoore","twitter_misc":{"Written by":"RMoore","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/phcprimarycare.org\/?p=1830","url":"https:\/\/phcprimarycare.org\/?p=1830","name":"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring - PHC Primary Care Blog","isPartOf":{"@id":"https:\/\/phcprimarycare.org\/#website"},"primaryImageOfPage":{"@id":"https:\/\/phcprimarycare.org\/?p=1830#primaryimage"},"image":{"@id":"https:\/\/phcprimarycare.org\/?p=1830#primaryimage"},"thumbnailUrl":"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:300\/h:191\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg","datePublished":"2016-05-30T14:46:21+00:00","author":{"@id":"https:\/\/phcprimarycare.org\/#\/schema\/person\/e2261897cb15c2610b283200b210f79c"},"breadcrumb":{"@id":"https:\/\/phcprimarycare.org\/?p=1830#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/phcprimarycare.org\/?p=1830"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/phcprimarycare.org\/?p=1830#primaryimage","url":"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg","contentUrl":"https:\/\/ml3zltbr0lxh.i.optimole.com\/w:auto\/h:auto\/q:mauto\/ig:avif\/https:\/\/phcprimarycare.org\/wp-content\/uploads\/2016\/04\/CBT1.jpg","width":598,"height":381},{"@type":"BreadcrumbList","@id":"https:\/\/phcprimarycare.org\/?p=1830#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/phcprimarycare.org\/"},{"@type":"ListItem","position":2,"name":"Cognitive Behavioral Therapy Series: Lesson 1 Cognitive Behavioral Restructuring"}]},{"@type":"WebSite","@id":"https:\/\/phcprimarycare.org\/#website","url":"https:\/\/phcprimarycare.org\/","name":"PHC Primary Care Blog","description":"Partnership HealthPlan of California","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/phcprimarycare.org\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/phcprimarycare.org\/#\/schema\/person\/e2261897cb15c2610b283200b210f79c","name":"RMoore","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/phcprimarycare.org\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/f0ba7e9946a1ad594a0070ed009f75ea00cb69b3f7271511fd722377966e54bd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/f0ba7e9946a1ad594a0070ed009f75ea00cb69b3f7271511fd722377966e54bd?s=96&d=mm&r=g","caption":"RMoore"},"url":"https:\/\/phcprimarycare.org\/?author=2"}]}},"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p293xY-tw","_links":{"self":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/1830","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1830"}],"version-history":[{"count":1,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/1830\/revisions"}],"predecessor-version":[{"id":1834,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/1830\/revisions\/1834"}],"wp:attachment":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1830"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1830"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1830"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}