13b) CBT in practice - additional cognitive techniques

Question 1

List some cognitive techniques (4)

Answer 1

• Structured problem-solving
• thought-records
• tables to examine evidence/appraisal (e.g., cost-benefit analyses, evidence for/against)
• pie charts to put things in perspective (e.g., responsibility pie-chart for OCD)

Question 2

Identify and describe the steps when using Structured Problem Solving. (5)

Answer 2

1) Identify the problem. Categorise problems
* Prioritise - what is a current problem
* Disregard/place on the back-burner problems that are: not priority right now, or not priority for client (world/country/systems)

2) Brainstorm possible options/alternatives

3) Weigh up solutions
* Could use a pro-cons table

4) Choose a solution
* Viable and effective
* Note: no perfect solutions

5) Action
* use the principle of small steps
* importance of action rather than waiting
* progress to the first step; review and refine
* progress to the next step; review and refine
* importance of staying the course before evaluation

Question 3

Describe the general steps/stages of delivering CBT to clients.

Answer 3

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation and other skills training
* Exposure therapy or variant (e.g., ERP, interoceptive)
* Behavioural activation

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries
* and others

5) Learning and discovery tasks
* Coping tasks e.g., exposure
* Skills training e.g., relaxation, problem solving skills, social skills, assertiveness skills, behavioural rehearsal
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 4

What are the steps/stages of delivering CBT to PANIC clients?

Answer 4

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation and other skills training
* Interoceptive exposure therapy

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries

5) Learning and discovery tasks
* Coping tasks e.g., interoceptive exposure
* Skills training e.g., relaxation,
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 5

What are the steps/stages of delivering CBT to PHOBIA clients?

Answer 5

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation skills training
* Social skills training (for Social phobia)
* Exposure therapy of groups (for Social phobia)
* In-vivo exposure (interoceptive & imaginal/stimulated as necessary) for Specific Phobia

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries

5) Learning and discovery tasks
* Coping tasks e.g., exposure
* Skills training e.g., relaxation, problem solving skills, social skills, assertiveness skills, behavioural rehearsal
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 6

What are the steps/stages of delivering CBT to OCD clients?

Answer 6

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation skills training
* Other skills training: sleep/time management techniques
* Exposure with response prevention

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries

5) Learning and discovery tasks
* Coping tasks e.g., exposure
* Skills training e.g., relaxation, problem solving skills, behavioural rehearsal
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 7

What are the steps/stages of delivering CBT to Illness Anxiety clients?

Answer 7

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation skills training
* Breathing retraining
* Mindfulness
* Exposure therapy depends on formulation - can be a combination of ERP and worry exposure

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries
* and others

5) Learning and discovery tasks
* Coping tasks e.g., exposure (ERP, worry exposure)
* Skills training e.g., relaxation, mindfulness, breathing retraining
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 8

What are the steps/stages of delivering CBT to GAD clients?

Answer 8

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation skills training
* Breathing retraining
* Mindfulness
* Problem Solving
* Sleep/time management techinques
* Worry exposure (worry time)

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries
* and others

5) Learning and discovery tasks
* Coping tasks e.g., worry exposure
* Skills training e.g., relaxation, problem solving skills, breathing retraining, mindfulness, sleep/time management skills
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 9

What are the steps/stages of delivering CBT to depression clients?

Answer 9

1) Assessment (Sessions 1-2)
* Diagnostic Assessment & Formulation
* CB assessment & formulation

2) Psychoeducation (Sessions 1-2)

3) Behavioural tasks as appropriate (mid-phase)
* Relaxation and other skills training
* Behavioural activation

4) Cognitive restructuring as appropriate, including combination of several within session
* Socratic dialogue
* Behavioural experiments
* use of thought records/thought-mood diaries
* and others

5) Learning and discovery tasks
* Coping tasks e.g., exposure
* Skills training e.g., relaxation, problem solving skills, social skills, assertiveness skills, behavioural rehearsal
* Discovery e.g., behavioural experiments, thought records

6) Relapse prevention
* Identification of early signs - have measures in place to deal with early signs
* Coping with likely life events and lapses
* Working on core beliefs, if needed (additional sessions)
* Building strengths and supportive networks

7) Closure
* Evaluations
* Future contact

Question 10

What are the CT competencies? (12)

Answer 10

• Agenda setting and adherence
• Feedback
• Collaboration
• Pacing and efficient use of time
• Interpersonal effectiveness (empathy, genuiness, warmth)
• Eliciting appropriate emotional expression (facilitating access, containment, encouraging differentiation)
• Eliciting key cognitions (eliciting skill, methods used)
• Eliciting behaviours
• Guided discovery and Socratic Dialogue
• Conceptual integration
• Application of change methods
• Homework settings

Question 11

How do you go about practising within your competence?

Answer 11

Seek supervision when in-training
* Complex cases including
 Multiple diagnoses
 Complex personality disorders (e.g., BPD)
 Forensic (e.g., compensation, legal issues)
* Severe disorders including
 Disorders with features of psychoses and bipolar presentations
 PTSD and OCD (obsessions and mental compulsions)
* Clients at high risk to harm self/other (e.g., anorexia, suicidality, violence)
* Clients not demonstrating improvement

When registered as psychologist:
* CPD
* Seek consultation
* Keep abreast with current standards of practice
* Undertake additional training