Case formulation Flashcards
What is a case formulation
Eliciting appropriate information and application and integration of theoretical psychological knowledge to a specific clinical problem to understand the origins, maintenance and development of that problem
Content of a case formulation
presentation (symptoms and problems)
predisposing life events or stressors
precipitating life events or stressors
perpetuating factors
a mechanism that links the preceding categories together
Diagnosis based treatment
Assessment - diagnosis - treatment
Formulation based treatment
Assessment - diagnosis/formulation (interrelated) - treatment (which also feeds back to assessment)
factors for CC
pairing is most likely if the CS precedes UCS by 0.5s, if UCS even slightly precedes CS then conditioning will usually not occur
greater the number of pairings, more likely CS is to elicit CR
Consistent pairing will make it more likely
conditioning stronger if both are intense
Clinical application of CC
Stimulus control techniques in alcohol/drug problems
Extinction techniques in exposure therapy for phobia
Use of cue word ‘relax’ in applied RT
Clinical applications of OC
Reinforcement of positive behaviour in children with behaviour problems
punishment of drinking behaviour through disulfiram
use of random intermittent reinforcement of good behaviour, leading to resilience of this behaviour to extinction when reinforcers are faded
reinforcement schedules
continuous reinforcement (rapid acquisition, poor resistance)
variable ratio reinforcement (slower acquisition, stronger resistance)
habituation
gradual reduction in anxiety associated with novel or anxiety provoking stimuli over time
performance of behaviour from modelling depends on
observed consequences of actions
nature of behaviour observed
nature of organism performing behaviour
skills deficits and skills training
deficits in skills may contribute to origin and perpetuation of psychopathology
some may have deficits in ability to select appropriate skills from their behavioural repertoire
applications: training in assertiveness skills, parenting skills etc.
cognitive content
content of individuals thoughts and beliefs may contribute to origin and perpetuation of psychopathology (negative automatic thoughts, catastrophic cognitions, responsibility beliefs)
cognitive restructuring
training client to monitor, evaluate and modify cognitive content
objectivity, utility, consistency
objectivity
is this belief objectively true
what is the evidence for/against this belief
is there an alternative explanation
utility
what is the effect of my thinking this way
what would be the effect of changing my thinking
consistency
do i always believe this
do others believe the same thing
cognitive restructuring
collaborative
increasing awareness of content
facilitation of evaluation of content
assistance in exploring rationality of beliefs
assistance in planning tests of beliefs
discussion of utility of beliefs
collaborative investigation of effects of changing beliefs
core belief
most central ideas about self
early maladaptive schema
broad pervasive theme or pattern
comprised of memories, emotions, cognitions and bodily sensations
regarding oneself and one’s relationship with others
developed during childhood or adolescence
elaborated throughout one’s lifetime
dysfunctional to a significant degree
schemas
triggged/activated by events consistent with the schema
distort thinking and behaviour
schema-driven behaviour can produce outcomes that provide evidence to confirm the schema
symptom typography reflects schema content
schemas are learned through early experience
schemas do not easily change in response to conflicting evidence
schema change requires schema activation
self efficacy beliefs
perceived ability to effectively carry out a particular behaviour
domain specfic
expectancies
if then contingencies about the perceived outcomes of actions or events
can become self fulfilling prophecies that contribute to maintenance of problem behaviour
metacognition
cognition applied to cognition
monitors, controls and appraises the products and processes of awareness
thought suppression
voluntary conscious attempt to exclude certain cognitive content from consciousness
attention biases
may arise out of information processing errors associated with beliefs/schemas
memory biases
schemas, beliefs and emotions lead to retrieval of memories that are consistent with these beliefs/states
state dependent memory
six p’s
presentation
predisposing
precipitating
perpetuating
positive/stregnths
predictions/prognosis
MDD formulation
early experience - dysfunctional assumptions - critical incident - negative automatic thoughts related with symptoms - behavioural/motivational/affective/cognitive/somatic
panic disorder formulation
trigger - normal psychiological changes - catastophic misappraisal - increased anxiety and arousal symptoms (feeds back to normal physiological changes) - exhaustion and decreased anxiety - hypervigilance - hypersensitivity to symptoms- back to normal physiological changes in cycle
GAD formulation
trigger - positive meta beliefs (strategy choice) - type 1 worry - negative meta beliefs - type 2 worry (meta worry) - emotion/thought control/behaviour
SORCK analysis
stimuli (historical, contextual, imediate)
organism
response
consequences (immediate, long term/delayed)
kontingencies
SORCK- historical stimuli
Stimuli that historically precede the behaviour, but are not sufficient to
elicit it directly
SORCK contextual stimuli
These stimuli are not sufficient to elicit the behaviour under scrutiny, but
increase the likelihood that it will occur.
SORCK immediate stimuli
These stimuli directly elicit the target behaviour
* Conditioned Stimulus
* Discriminative Stimulus
SORCK organismic variables
The current state of the organism, related to factors moderating the
relationship between antecedents and the response.
* Cognitions
* Drugs
* Illness
* Affective state
* etc., etc.
SORCK long term/delayed consequences
Consequences which do not affect the frequency of the target
behaviour, but instead serve to alter the contextual stimuli, changing the
likelihood of it occurring
SORCK kontingency
Formulation ideas about the maintenance of the behaviour under
scrutiny.
SORCK
SORCK allows detailed investigation of single discrete
target behaviours, their antecedents and consequences
* SORCK allows integration of cognitive content to a
minimal level
* A series of SORCKs may be done where several
behaviours are under scrutiny
* More complex cases with broader determinants of
psychopathology may be too complex to conceptualise in
a long series of SORCKs
