Beck Ch 8

Question 1

The more depressed clients are feeling at the beginning of treatment, the more their actions plans should initially emphasize…

Answer 1

Initial cognitive work will likely focus on…

Behaviour change, through activity scheduling, with initial cognitive work often involving modifying automatic thoughts that could interfere with carrying out, or interfere with gaining a sense of achievement, pleasure, or connection from engaging in planned activities.

Question 2

A good action plan provides opportunities for clients to: (6)

Answer 2

1. Draw positive conclusions about their experiences and about themselves,
2. Educate themselves (e.g., through bibliotherapy),
3. Collect data (e.g., through monitoring their thoughts, feelings, and behavior)
4. Evaluate and modify (or disengage from) their cognitions,
5. Practice cognitive and behavioral skills, and
6. Experiment with new behaviors.

Question 3

In addition to scheduling activities, many Action Plans contain the following ongoing activities (1-5)

Answer 3

1.Reading therapy notes
2.Monitoring automatic thoughts
3.Evaluating and responding to automatic thoughts
4.Doing behavioural experiments
5. Disengaging from thoughts

Question 4

In addition to scheduling activities, many Action Plans contain the following ongoing activities (6-11)

Answer 4

6.Implementing steps towards their goals
7.Engaging in activities to lift affect
8.Credit lists
9.Practicing behavioural skills
10.Engaging in bibliotherapy
11. Preparing for the next therapy session

Question 5

What are some guidelines to follow when setting action plans (that will help increase compliance)? (8)

Answer 5

1.Tailor Action Plans to the individual.
2.Provide or elicit the rationale.
3.Set Action Plans collaboratively; seek the client’s input and agreement.
4.Make Action Plans easier rather than harder.
5.Provide explicit instructions.
6.Set up a reminder system.
7.Begin the Action Plan (when possible) in session.
8.Ask clients to imagine completing an Action Plan.

Question 6

What should be taken into account in order to tailor actions plans to a client? (6)

Answer 6

1. Their aspirations, goals, strengths, and personal assets
2. Their reading, writing, and intellectual abilities
3. Their preferences
4. Their level of motivation
5. Their current level of distress, symptoms, executive functioning, and general functioning (cognitive, emotional, behavioral, and social)
6. Practical constraints (e.g., time, opportunity, and lack of cooperation by family members)

Question 7

How can you elicit a rationale for an action plan from a client? Provide an example

Answer 7

By asking them how the action plan might be linked to their aspirations or goals

E.g., “What would it say about you if you were able to help your neighbors?”

Question 8

What are some strategies for setting up a reminder system for an action plan? (4)

Answer 8

1. Pair an Action Plan with another daily activity
2. Post notes on their refrigerator, their bathroom mirror, their computer, or the dashboard of their car
3. Use their appointment book, device, timer, or computer to cue them
4. Ask another person to remind them

Question 9

What steps should be taken to anticipate and prevent problems in completing action plans? (6)

Answer 9

1. Check on the likelihood of completion.
2. Anticipate obstacles and covert rehearsal
3. Be alert for clients’ negative reactions.
4. Examine advantages and disadvantages.
5. Change the Action Plan.
6. Make Action Plans a no-lose proposition initially.

Question 10

How can you check in on the likelihood of completion?

Answer 10

Ask: “How likely are you to do this, 0–100%?”

Question 11

If a client is less than 100% sure they will complete an action plan, what should you do? How do you do this

Answer 11

Identify Obstacles and Do Covert Rehearsal

Ask them “What’s the 25% part of you that thinks you won’t do it?”
Depending on their answer help them:
* problem-solve,
* do skills training,
* help them respond to their interfering automatic thoughts, and/or
* make the Action Plan easier or optional.

Question 12

What is Covert Rehearsal?

Answer 12

Getting the client to visualize carrying out the action plan and help them respond to obstacles and interfering thoughts

Question 13

How should you respond when a client expresses negative reactions to setting action plans?

Answer 13

1. Validate their feelings and positively reinforce them for letting you know
2. Identify the problem and its meaning to the client (e.g., client is feeling overwhelmed and like CBT maybe isn’t for them)
3. Intervene (or mark for intervention at next session if not enough time) e.g., making some or all of the action plan optional

Question 14

If, after trying other strategies, a client is still unsure they complete an action plan, what is the best strategy? Why is this the best strategy?

Answer 14

To modify it and make it easier

It’s better to have an easy action plan the client will likely do than to establish a habit of the client not doing what they agree to in session.

Question 15

What are some ways than an action plan can be modified to make it easier?

Answer 15

Making it optional

Decrease the difficulty, frequency, or duration of an action plan item

Question 16

What is something you should say to clients when creating the first few action plans to reduce the possible negative impact if they fail to complete the action plan? What might you say specifically?

Answer 16

Stress that, even if they fail to complete the action plan, we will still get a lot of useful data from it

“If you get this Action Plan done, that’s good. But if you have trouble doing it, that’s okay—just see if you can figure out what thoughts are getting in your way, and we’ll talk about them next time. Okay?”

Question 17

What should you do if a client fails to complete a good proportion of their action plan 2 weeks in a row or does it right before therapy instead of daily?

Answer 17

Stress the importance of the action plan

Move away from making the action plan a no-lose proposition

Question 18

What can you do with clients to help them prepare for the possibility of a negative outcome from their action plan? Give an example

Answer 18

Prepare a note for the client to read in case it doesn’t work out how they hoped

E.g., if action plan is to visit with mom, but worried mom might be critical, could write a note saying “if the visit with mom doesn’t go well, remind myself…..”

Question 19

When might you want to spend more of the session time focused on action plans?

Answer 19

1. They cover an important, ongoing issue or goal that requires further discussion;
2. Clients have not completed a task; and/or
3. Clients have difficulty drawing conclusions from successfully fulfilling their Action Plans or when they are critical of themselves for not doing a good enough job.

Question 20

When a client has successfully completed an Action Plan, what are some examples of questions you can ask to help them derive positive meanings and strengthen positive beliefs about themselves?

Answer 20

“Were you able to give yourself credit for doing that?”
“What was good about the experience”
“What emotions did you experience”
“What did the experience mean to you”
“What did the experience show about you”

Question 21

When a client has difficulty completing their Action Plan, what questions should you ask to help you conceptualize the problem?

Answer 21

Was it a practical problem?
An interfering cognition?
An interfering cognition masked as a practical problem?
A problem related to your cognitions?

Question 22

What are 3 common practical problems (that don’t necessarily involve cognitions) that get in the way of completing an Action Plan?

Answer 22

1. Forgetting the rationale for the Action Plan
2. Disorganization or lack of accountability
3. Difficulty with an Action Plan item (e.g., too difficult, ill defined)

Question 23

How can you avoid/address the problem of a client not remembering the rationale for an Action Plan?

Answer 23

-If the client forgot: Having clients record the rationale next to the action plan
-If the client isn’t convinced of the rationale: Strengthen the rationale by examining advantages and disadvantages of doing vs not doing the action plan

Question 24

What should you do when a client has difficulty with an action plan because it was too difficult or ill defined?

Answer 24

1. Take accountability so that they don’t unfairly criticize themselves
2. Apologize for it not being clear or it being too hard
3. Come up with a more clear or better suited action plan

Question 25

What are some types of cognitions that clients might have that get in the way of doing an Action Plan?

Answer 25

1. Negative predictions
2. Overestimating the demands of an action plan
3. Procrastination and avoidance related cognitions

Note: also has doing action plans at the last minute, kinda weird how this section is laid out because the first two listed are types of cognitions, but the last two aren’t..

Question 26

What are some strategies you can use to help overcome negative predictions about Action Plans?

Answer 26

1. Help them identify the negative thought/prediction
2. Test negative predictions with behavioural experiments
3. Evaluate the negative thought/prediction using Socratic questioning
4. Have the client write down a response to the thought if they have it again

Question 27

What are some aspects of the Action Plan that clients may over estimate the Demands on?

Answer 27

• Inconvenience
• Time
• Energy

Question 28

What can you do to help clients who overestimate the time involved in an Action Plan?

Answer 28

1. Provide them with a more realistic estimate of the time involved
2. Connect the Action Plan to values, highlight it’s importance to client
3. Problem solve

Question 29

What are 2 helpful things to do when a client is procrastinating on an Action Plan?

Answer 29

1. Ask: “Do you think you might focus on how you’re feeling at the moment instead of how you’ll feel when you finish it? Would it also help to remind yourself what goal you’re trying to reach and why?”
2. Tell clients what you do when you find yourself procrastinating

Question 30

When a client proposes a practical problem is getting in the way of an action plan, but you suspect thoughts or beliefs might be involved, what should you do?
What might you say to the client?

Answer 30

Investigate the possibility that thoughts or beliefs are involved BEFORE discussing the practical problem

“Okay, you couldn’t do the Action Plan because you didn’t have time. Let’s pretend for a moment that this problem magically disappears. Let’s say you have a whole day free. Now how likely are you do to the Action Plan? Would anything else interfere? Would any thoughts get in the way?”