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Cognitive behavior therapy in pediatrics. Dec 16; 5mrks.

 CBT is problem oriented treatment centered on correcting problematic patterns of thinking & behavior that leads to emotional difficulties and functional impairments.

Core components & characteristics:

  1. 60-90min session per week for 6-12 weeks

  2. Symptom measures are collected frequently

  3. Rx is goal oriented & collaborative c pt as active participant

  4. Rx is focused on changing current problematic thoughts & behaviour

  5. Weekly home work is typically assigned

Focused on identifying &

  1. Changing cognitive distortions

    • Learned helplessness

    • Irrational fears

  2. Avoid distressing situations

  3. Practice distress reducing behavior

Key tools to facilitate achieving CBT goals

  1. Self monitoring

    • Daily thought record

  2. Self instruction

    • Brief sentences, asserting thoughts that are comforting & adaptive

  3. Self reinforcement

    • Rewarding oneself

CBT has good quality evidence in treatment of Anxiety , Depression, OCD , Behavior disorder , substance abuse , insomnia

For many childhood psychiatric disorders CBT alone is comparable to psychotropic medication alone and the combination may have additional benefits in symptom & harm reduction.

Modified versions are CBT are used such as

  1. Trauma focused CBT

  2. Dialectical behavior therapy

Trauma focused CBT (TF-CBT):

First line of Rx in PTSD (post traumatic stress disorder)

It is a combination of

  1. Psychoeducation

  • Teaching effective relaxation

  • Affective modulation

  • Cognitive copying & processing skills

  1. Engaging in trauma narrative

  2. Mastering trauma remainders

  3. Enhancing future safety & development

Dialectical behaviour therapy:

Targeted at emotional & behavioral dysregulation due to integration of seemingly opposite strategies of acceptance & change.

Skill modules

  1. Mindfulness

    • Practice of being fully aware & present in the moment

  2. Distress tolerance

    • How to tolerate emotional pain

  3. Interpersonal effectiveness

    • How to maintain self respect

    • Effective communication in relationship to others

  4. Emotion regulation

    • How to manage complex emotions

Order of priority in treatment targets:

  • Life threatening behavior ( suicidal & self injurious behavior) > 

  • therapy interfering behaviors ( late to session, canceling appointments, non collaborative towards achieving goals) > 

  • quality of life behavior (relationship, occupational, financial) > 

  • skills acquisition to achieve Rx goals


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