9. CBT assessment + formulation Flashcards
CBT assessment, expanded cognitive model, CBT formulation
5 main elements of the CBT assessment
- assessing current problem
- identify triggers + modifying factors (antecendent)
- consequences as a result of current problems
- maintaining processes
- past history + problem development
CBT assessment
what exactly are you searching for when assessing a current problem?
- asking structured questions to obtain detailed info
- asking client to detail a recent occasion when problem sx were experienced “what exactly is happening?”
- break the problems into the internal systems model (cognition, emotion, behaviour, physiology)
CBT assessment
what’s a trigger?
what factors make problem more or less likely to occur
CBT assessment
what is a modifier?
contextual factors that impact how severe the problem is when it occurs
AKA a moderator
fill in the blank
consequences often give clues about _ processes
consequences often give clues about maintaining processes
give an example of a modifier in this situation:
you walk by a bar - you are more likely to drink
what’s a moderator of you deciding whether or not you should drink?
whether your friends are there, would you be alone? etc
CBT assessment
what are maintaining processes?
vicious cycles that keep the problem going
what are some examples of maintaining processes?
- escape + avoidance behaviours (negative reinforcement)
- reduction in activity
- short term rewards
what’s a circumstance in which a short-term reward would be positively reinforcing?
substance abuse
CBT assessment
what are vulnerability factors?
past and problem development
what’s another term that could similarly be defined?
things that set the stage for a problem to develop but are neither necessary not sufficient
diathesis
list the cognitive model
situation/event
l
automatic thought
l
reaction (emot, behav, phys)
why do we use the simple thought record?
- because all the info we get is introspective, good way to identify current feelings + initial reactions
- helps identify patterns
- prepares client for CBT – intro to tx
what elements compose the expanded cognitive model?
core beliefs
intermediate beliefs
automatic thoughts
what are some characteristics of core beliefs to look out for?
they’re:
* global
* rigid
* generalized
what’s an intermediate belief?
attitudes, rules, assumptions
fall between core beliefs + automatic thoughts
intermediate belief
how to distinguish a/n:
* attitude
* rule
* assumption
this one isn’t very important but i put it anyway – feel free to skip it
- attitude: general belief about outcomes, no specifics
- rule: “should”
- assumption: if…then
3 types of core beliefs
- incompetence
- unlovable
- worthless
core beliefs
beck originally had 2 core beliefs. which ones were they?
incompetence + unlovable
beck later added a 3rd core belief, which one is it? which clientele had it the most?
worthless - seen in people with depression suffering with suicidal ideation
worthless can encompass helpless + unlovable
what is the downward arrow technique used for?
identifying intermediate + core beliefs
what is the downward arrow technique? what questions arise from this technique?
what’s its composition?
asking client about meaning of key automatic thoughts that you suspect stem from core beliefs:
if the thought is true…
- what does it mean?
- what’s the worst part of the situation?
- what’s so bad about it?
- what does that mean about you?
what are some important components that outline CBT formulation?
- road map to therapy
- hypothesis refined by incoming data provided by client
- presentation of formulation to client to see if it “rings true” – diagrams
there are a lot, if you get over 4 it’s fine i think
questions to ask yourself while formulating CBT
most of these are common sense, so you should be fine ma belle!
- how did pt develop the dx? (vulnerabilities, risk factors)
- what are significant life events/experiences?
- what are pt basic beliefs about themselves, the world, others?
- what are pt attitudes, rules, assumptions?
- what strategies has pt used to cope with beliefs?
- what automatic thoughts, images, and behaviours maintain dx?
- how did beliefs interact with life events to make pt vulnerable to disorder?
- what’s going on in pt life rn and what’s their perceptions? what’s maintaining?
what is beck’s cognitive triad?
patient’s basic beliefs about
* themselves
* the world
* others
