6 Cog Interventions Flashcards
Ch1
What is CBT
In 1960’s revolution in the field of mental health by Beck
He believes that theories needed to be demonstrated as empirically valid
He identified distorted, negative cognition (primarily thoughts and beliefs) as a primary feature of depression and developed a short term treatment, one of the primary targets way the reality testing of patients depressed thinking
Beck developed a form of psychotherapy (1960) that he termed “cognitive therapy” now also called “cognitive behavior therapy”
- Beck devised a structured, short-term, present-oriented psychotherapy for depression, directed toward solving current problems and modifying dsyfunctional (inaccurate and/ or unhelpfull) thinking and behavior.
Treatment is also based on a conceptualization, or understanding, of individual patients (their specific beliefs and patterns of behavior).
- Therapists seek variety of ways to produce cognitive change, modify patients thinking and belief system
Number of forms of cognitive behaviour theory that share characteristics of Beck’s theory
- Beck’s CBT often incorporates techniques from all of these
For all kinds of patients
- Can also be used in different settings
- It is possible to change the during of a session (normally 45 minutes) if someone cannot tolerate the full session
Ch1
What is the theory underlying CBT
The cognitive model proposes that dysfunctional thinking (which influences the patient’s mood and behavior) is common to all psychological disturbances.
- When people learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and in their behavior.
For lasting improvement in patients’ mood and behavior, cognitive therapists work at a deeper level of cognition
- patients’ basic beliefs about themselves, their world, and other people.
- More enduring
Ch1
What does research say?
CBT had been extensively tested since the First outcome study published in 1977.
More than 500 outcome studies have demonstrated the efficacy of cbt for a wide range of psychiatric disorders, psychological problems, and medical problems with psychological components.
Ch1
How was Beck’s CBT developed?
In 1950 early 60’s Beck decided to test the psycho-analytic concept that depression is the result of hostility turned inward toward the self.
- He investigated the dreams of depressed patients, which, he predicted, would manifest greater themes of hostility that the dreams of normal controls.
- To his surprise, he ultimately found that the dreams of depressed patients contained fewer themes of hostility and far greater themes of defectiveness, deprivation and loss.
- So this led to the conclusion that the psychoanalytic concepts were not valid, so he searched for an explanation for the understanding of depression.
When listening to his patients Beck reported two streams of thinking:
- a free-association stream
- and quick, evaluative thoughts about themselves.
- Dr. Beck recognized that all of them experiences “automatic” negative thoughts such as these, and that this second stream of thoughts was closely tied to their emotions.
He began to help his patients identify, evaluate, and respond to their unrealistic and maladaptive thinking.
- This was one of the First times that a talk therapy ad been compared to a medication
Important components of cbt for depression include a focus on helping patients solve problems;
- become behaviorally activated;
- and identify, evaluate, and respond to their depressed thinking, especially to negative thoughts about themselves, their worlds, and their future.
Patients with anxiety however needed to better assess the risk of situations they feared, to consider their internal and external resources, and improve upon their resources.
- They also needed to decrease their negative predictions behaviorally
Ch1
What are the basic principles of treatment
Although therapy must be tailored to the individual, there are, nevertheless, certain principles that underlie CBT for all patients.
- CBT is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms.
- Cognitive behavior therapy requires a sound therapeutic alliance
- warmth, empathy, caring, genuine regard, and competence - Cognitive behavior therapy emphasizes collaboration and active participation.
- Cognitive behavior therapy is goal oriented and problem focused.
- Cognitive behavior therapy initially emphasizes the present.
- The treatment of most patients involves a strong focus on current problems and on specific situations that are distressing to them - Cognitive behavior therapy is educative, aims to teach the patient to be her own therapist, and emphasizes relapse prevention.
- Cognitive behavior therapy aims to be time limited.
- 6-14 sessions - Cognitive behavior therapy sessions are structured
- No matter what the diagnosis or stage of treatment, following a certain structure in each session maximizes efficiency and effectiveness
- Intro part (doing a mood check, briefly reviewing the week, collaboratively setting an agenda for the session),
- middle part (reviewing homework, discussing problems on the agenda, setting new homework, summarizing)
- final part (eliciting feedback). - Cognitive behavior therapy teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs
- Patients can have many dozens or even hundreds of automatic thoughts a day that affect their mood, behavior, and/or physiology (the last is especially pertinent to anxiety).
- Therapists help patients identify key cognitions and adopt more realistic, adaptive perspectives, which leads patients to feel better emotionally, behave more functionally, and/or decrease their physiological arousal.
- They do so through the process of guided discovery, using questioning (often labeled or mislabeled as “Socratic questioning”) to evaluate their thinking (rather than persuasion, debate, or lecturing). - Cognitive behavior therapy uses a variety of techniques to change thinking, mood, and behavior.
- Although cognitive strategies such as Socratic questioning and guided discovery are central to cognitive behavior therapy, behavioral and problem-solving techniques are essential, as are techniques from other orientations that are implemented within a cognitive framework
Ch1
What is a therapy session like?
The structure of therapy sessions is quite similar for the various disorders, but interventions can vary considerably from patient to patient
At the beginning of sessions, you will reestablish the therapeutic alliance, check on patients’ mood, symptoms, and experiences in the past week, and ask them to name the problems they most want help in solving
- You will also review the self-help activities (“homework” or “action plan”) patients engaged in since the previous session.
Then, in the context of discussing a specific problem patients have put on the agenda, you will collect data about the problem, cognitively conceptualize patients’ difficulties (asking for their specific thoughts, emotions, and behaviors associated with the problem), and collaboratively plan a strategy.]
The strategy most often includes straightforward problem solving, evaluating patients’ negative thinking associated with the problem, and/or behavior change
Ch1
Developing as a CB therapist
The cognitive model, the proposition that one’s thoughts influence one’s emotions and behavior, is quite straightforward.
Experienced cognitive behavior therapists, however, accomplish many tasks at once
- conceptualizing the case, building rapport, socializing and educating the patient, identifying problems, collecting data, testing hypotheses, and summarizing
Developing expertise as a cognitive behavior therapist can be viewed in three stages
1. You learn basic skills of conceptualizing a case in cognitive terms based on an intake evaluation and data collected in session
- You also learn to structure the session, use your conceptualization of a patient and good common sense to plan treatment, and help patients solve problems and view their dysfunctional thoughts in a different way.
- You also learn to use basic cognitive and behavioral techniques
2. You become more proficient at integrating your conceptualization with your knowledge of techniques.
- You become more easily able to identify critical goals of treatment and more skillful at conceptualizing patients, refining your conceptualization during the therapy session itself, and using the conceptualization to make decisions about interventions.
3. You more automatically integrate new data into the conceptualization.
- You refine your ability to make hypotheses to confirm or revise your view of the patient.
- You vary the structure and techniques of basic cognitive behavior therapy as appropriate, particularly for patients with personality disorders and other difficult disorders and problems
Ch2
Intro
A positive alliance between therapist and client is correlated with positive treatment outcomes
- Trust is important
1. Demonstrate good counselling skills
2. Sharing conceptualisation and treatment plan
3. Making collaborative decisions
4. Seeking feedback
5. Varying your style
6. Helping patient alleviate their distress
Ch2
Homework consists of
- problem solving and/or skills training in session that leads to behavioral changes (e.g. isolation-> might lead to calling friends & being overloaded at work-> might lead to discussing it with your supervisor).
- identifying automatic thoughts and beliefs and then evaluating and responding to their cognitions (e.g. reading therapy notes that remembers you of doing the good thing).
- Plan homework assignments carefully, based on your conceptualization and review the homework the following weak
Ch3
The cognitive model
CBT based on this model
It says that people’s emotions, behaviors and physiology are influenced by their perception of events.
It’s not the situation per see, but the perception what is important in how they see it/construe the situation
Thinking is what cognitive behavior therapist find particularly interesting.
There are two levels of thinking:
1. Thinking about the content of this summary for example;
2. Automatic thought: quick and brief evaluative thoughts. Not a form of deliberation or reasoning. You are not aware of these thought but you are of the emotions or behavior that will follow these thoughts. If you are aware of the thoughts you accept them instantly.
The origin of these automatic thoughts can be found in more enduring cognitive phenomena: beliefs
Ch3
Beliefs
Core-beliefs: : the most central way of ideas about yourself developed already in childhood about themselves, others and the world. They are accepted as ‘truths’
According to Piaget, The Schema is a hypothesized mental structure that organizes information.
Inside the schema you can find the core beliefs.
- Four things can happen when the core belief is activated:
1. Confirming to negative data [example: difficulty with new computer skills (-)]
2. Positive data cannot fit into the schema
3. Positive data are being transformed (praise from boss but I didn’t deserve it)
4. Positive data who are not being noticed
The most fundamental ones are:
1. Core beliefs which are global, rigid and overgeneralized.
2. The superficial ones are: Automatic thoughts which contains the actual words or images that go through the mind and are situation specific.
3. In between these two you can find Intermediate beliefs
Core beliefs -> Intermediate beliefs
(attitudes, rules, assumptions) -> Automatic thoughts
Attitude: ‘failing is terrible’
Rule: ‘if you can’t handle it, you can give up’
Assumptions: when I can’t do it, I will fail. If I avoid it, I will have a good feeling.
The quickest way to help these people is to change the core belief.
- Hard as a core belief is who the person is
- So, the best way is try to identify and change automatic thoughts. They can learn…
o Believing something does not directly mean that it is true.
o When thinking is changed in a more reality based and useful way, it will lead to a better feeling and progress.
Ch3
Relationship of behaviour to automatic thoughts
Core beliefs
- > Intermediate beliefs (attitudes, rules, assumption)
- > Situation
- > Automatic thoughts
- > Reaction (emotional, behavioral, physiological
Ch4
Goal of the Assessment session
In addition to diagnosing patients, you should:
- Formulate the case and create an initial cognitive conceptualization (which you refine in future sessions)
- Determine whether you will be an appropriate therapist
- Determine whether you can provide the appropriate amount of therapy (whether you are available enough to meet the needs of the client)
- Determine whether additional treatment or service (e.g., medication) should be provided
- Initiate a therapeutic alliance with the patient (and family members, if relevant) x Begin with accustoming the patient to the structure and process of therapy
- Identify important problems and set bread goals
You should collect as much information as possible before you see your patient.
Think of relevant reports of mental health and health professionals, questionnaires and self-report forms filled in by the patient etc.
You may also consider to invite a partner/family member/friend (from now on referred to as family member) who can provide additional information
Ch4
The assessment phase of the evaluation session
You will need to know about the following areas both current and past in order to develop a treatment plan, develop a therapeutic alliance, set goals with the client and carry out the treatment:
1. Patient demographics
2. Main complaints and current problems
3. History of present illness and precipitating events
4. Coping strategies (adaptive and maladaptive) (histoy and current status)
5. Psychiatric history- including kinds of treatments and perceived helpfulness of these, hospitalisations, medication and suicide attempts and determine the degree to which patient might currently be suicidal
6. Substance use history (and current status)
7. Medical status history and current status
8. Family psychiatric history and current status
9. Developmental history
10. General family history
11. Educational history
12. Vocational history
It is also helpful to let a patient describe his/her typical day, look for:
1. Variations in mood
2. Whether and how thet interact with family freidns and people at work
3. How they are generally functioning at home, work and elsewhere
4. How they spend their free time
5. Also what they are actively avoiding
A description of a day helps to discover difficulties but it is also important to ask about positive aspects.
Throughout the assessment you should be alert for the patients insecurity about committing to the treatment.
Ch4
Devising an initial cognitive conceptualisation and treatment plan
For the cognitive conceptualization you will hypothesize about the development of problems:
- Important early life events may have led to development of negative core beliefs
- Describe the negative core beliefs
- Describe what precipitates the disorder
- Did the patient put and adverse construction on certain precipitating events?
- How do the patient’s thinking and behaviour contribute to the maintenance of the disorder?
- The cognitive conceptualisation is used to develop a broad treatment plan
