3/4) CB Assessment and Formulation Flashcards
How are Diagnostic assessments (6) and CB assessments (8) different?
Diagnostic assessments:
o Information about diagnosis based on DSM
o Little information about aetiology, maintenance
Instead, more of symptoms and signs
* Symptoms = what the client presents with
* Signs = what psych observes
o Often, no more than broad guidelines about treatment
o Assumptions: Medical model
o Focus on What: what features (signs and symptoms) are present/absent
CB assessments:
o Critical to case conceptualisation
o Informative about aetiological and maintaining factors
o Clear implications for treatment - directly linked to choice of treatment strategies
o Assumptions: CB theory
o Focus on How: how features arise and are perpetuated, how linked to others.
o Inaccurate Assessment = Unproductive therapy
o Not always as easy as might first seem
o Re-examine conceptualisation if therapy is not progressing well
What are some assumptions held for CB assessments? (3; 3; 3)
(1) Like all other behaviours, problem behaviours are influenced by principles of learning.
o Classical & Instrumental conditioning.
o Patterns of reinforcement
(2) What a person thinks with regard to a problem influences the way a person feels and behaves, and vice versa
o Person’s appraisal of problems and solutions is governed by a network of beliefs
o Thinking/processing biases are common and often influence frequency and severity of problem behaviours
(3) It is useful to conceptualize problems as being related to antecedents and consequences.
o For purposes of assessment and understanding.
o For purposes of planning and implementing treatment.
Identify the 5 stages in a CB assessment
Stage 1: Identify the problem behaviours
Stage 2: Identify antecedents of the problem behaviours
o What triggers the behaviour?
Stage 3: Identify consequences of the problem behaviours
o What are the factors that will increase and decrease the severity of the problem?
Stage 4: Identify strengths and resources (modifiers) that influence stage 2 or 3.
Stage 5: Integrate the information into a formulation
Draw a flowchart of CB assessment (7 + 1 + 2)
What else do you need to consider during assessment phase? (1)
What else do you need to consider during treatment phase? (2)
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Decide what further info will help test hypotheses.
Note further info acquired during treatment.
Possible need to modify formulation.
What is the ABC model of Assessment, and what does it differ from?
o A: Antecedents
o B: Problem Behaviour
o C: Consequences
A’s different from ABC model of Rational Emotive therapy where A stands for antecedents, B for Beliefs, C for consequences
How would you define problem behaviours in the context of Stage 1 of the CB assessment? (4)
Problems behaviours are defined broadly in this context.
They are often symptoms that the client want changed (e.g., panic attacks, binges, or feeling sad), but may sometimes represent therapist goals rather than client goals (e.g., reduce drug dependence to reduce aggression).
They may represent desirable behaviours that need to be increased (e.g., assertive, or socially appropriate behaviours) or behaviours than need to be reduced (aggressive outbursts, tantrums, severe anxiety).
They may represent covert behaviours such as thoughts and images (E.g., Obsessional thoughts, flashbacks) or overt behaviours (aggression)
Define antecedents of problem behaviours. (3)
Antecedents are
o Triggers
o Events that occur before B
o Exert influence on B (increase or decrease frequency, duration, likelihood of occurrence)
B = problem behaviours
What are the differences between stimulus events (4) and precipitating events (2) [Stage 2 of CB assessment]?
Give examples (2;1).
Stimulus events
o Proximal
o Often influences maintenance of problem behaviours
o Can make symptoms better or worse, on a day-to-day level
o More characteristic of CB vs dynamic approaches
Eg: Dinner as antecedent to smoking behaviour
Eg. Binge as antecedent to vomiting behaviour
Precipitating events
o May be distant
o May trigger initial onset of a problem behaviour
o e.g., Relationship loss may trigger depression
How do you go about Stage 2 of CB assessments? (3)
Ask open-ended questions, and if you don’t get relevant information. Become more specific with questions
Ask about BASIC-P: What are key (B/A/S/I/C/P) that make this problem worse/make the problem more likely for you?
Behaviour, affect, situational, interpersonal, cognitions, physiology
Ask about triggers (precipitating events) and modifiers (stimulus events).
What are the feared stimuli for: Agoraphobia, social phobia, specific phobia, coronophobia
Agoraphobia = places and situations that might cause panic, helplessness or embarrassment
Social phobia = social situations where individual is exposed to possible scrutiny by others
Specific phobia = fear about a specific object or situation (e.g., flying, heights, animals etc. )
Coronophobia = fear of contracting SARS-CoV-2 and/or dying of it and socio-personal-occupational loss
Define consequences of problem behaviours. (2)
o Follow a behaviour
o Exert an influence on the behaviour (e.g., maintain it, lead to additional problems)
How do you go about Stage 3 of CB assessments? (2)
Clarify consequences in terms of key dimensions (e.g., BASIC-P)
Clarify unclear and vague answers
What are some modifiers that can exert a positive influence (3;2)?
Self
o Capabilities and achievements
o Positive coping styles
o Beliefs and attributions
Others
o Relationships
o Support within family/community
What questions could you ask in Stage 4 of CB assessments? (3)
coping mechanisms
what do you/others like about yourself?
Are there “positive” periods? tell me more…
How do you go about Stage 5 of CB assessments? (2)
Stage 5 = integrating info into formulation
Integrate the information, ask additional questions to find out how they link with each other and how they match with the Consequences.
If they don’t match, get additional information.
Clarify links between items on the different domains. e.g., sensations and cognitions
Describe the advanced stage of integrating info into formulation (2)
o Build up a conceptualisation of how the problem behaviour has originated and is maintained
o Draw a flow-chart to indicate which aspects lead to what
o Use arrows to indicate direction of effects
o CB models of disorders may help, although specific aspects for the individual concerned may require mention
What does an adequate formulation…
Identify…
Enable…
o An adequate formulation identifies “signature patterns” for the individual
o An adequate formulation enables making and testing predictions
Draw up a flowchart for Escape/avoidance in the maintenance of fear
Fear (of a particular situation/object) –> Escape/avoidance (client tries to avoid feared situation, or escape from it as soon as possible) –> No change to fear beliefs (Client does not learn coping strategies or expose beliefs to disconfirmation)
Draw up a flowchart for reduced activity in the maintenance of depressed mood
Depressed mood –> Negative thoughts (activity seen as pointless, not enjoyable, too demanding, etc.) –> Reduced activity (general reduction in activity, social withdrawal, etc.) –> loss of positive rewards (loss of activities that used to give on a sense of pleasure, achievement or social acceptance
Identify some useful strategies for CB assessment. (7)
Use open-ended questions first
Multiple-choice strategies
o MCQs from broad to the narrow
o Choice between categories/classes of people
Some report A whilst others B (e.g., head/heart/bowel in PD)
o Comparison of/choice between different client experiences (eg. panic attack, asthma attack, attack of sneezing…..would these be accompanied by the same cognitions?)
Fill in the blanks strategies
o e.g., “what if” thoughts when…
Go beyond the general; get to specifics
o what is individualistic for the clients
o Clarify vague and general statements until they are clear and specific.
o Elicit the underlying (unsaid) feared consequence or catastrophe.
Focus on proximal events
o CBT holds a microscope to covert and overt events immediately preceding and following the behaviour targeted for change
Vary assessment methods
o Cognitive behaviour assessment interview
o Self-monitoring (e.g., Diaries, behavioural charts)
o Standardized inventories
o Subjective and observer rating scales
o Observation in-vivo (e.g., In clinic or natural setting
o Observation in simulated contexts (e.g., Role-play; Imagined contexts)
o Physiological recording (e.g., In lab or in natural environment)
Examine and link thoughts, assumptions and beliefs
o Explore and identify NATs: thoughts, images, from self and others
o Explore and identify intermediate beliefs
o Explore and identify core beliefs
What should you do for complex problems during a CB assessment? (i.e., there are several problematic behaviours, antecedent factors and consequences that interact in a complex way, in a manner that resembles circular rather than linear causality) (3)
identify the elements linked together in this circular fashion
identify weak link(s) between elements and then choose one or more points of intervention
Prioritise problems and focus your CB assessment on the main or pivotal problem
CBT formulations aim to provide a concise description of: (3)
key features of a problem
how it started
what keeps the problem going
CBT assessments are used to gather the information for … (2).
a CBT formulation
test out the key hypotheses of a CBT formulation
Results = a framework that is based on evidence, and makes sense to both client and therapist
What should the CBT formulation be informed by?
An established treatment model that has an evidence base for its efficacy.
