CBT Flashcards
Theory based off?
Based on Beck’s Cognitive Theory
- schemas are learned from early experiences, activated by “matching” events, and lead to symptoms that reflect the content of the schemas.
- Symptoms are made up of cognitions, behaviours, and emotions that are linked so that a change in any element produces changes in the others.
- Treatment based on Beck’s theory entails interventions designed to modify schemas, automatic thoughts, problem behaviours, and activating events and situations.
= Through experience we develop core beliefs and assumptions which may or may not be functional but allow us to make sense of our world.
= If we experience a critical event that triggers a CB or UA then unhelpful UAs can become more active, NATs evoked, and distressing emotions triggered -> leading to depression, anxiety etc. Then, interactions between NATs, emotions, behaviour and physiology may maintain the problem.
schema-related major stressful life events. For example, experiences involving loss may activate depressive schemas. Once such latent schemas
are activated, minor day-to-day stresses may trigger negative automatic thoughts. Negative automatic thoughts in turn typically lead to problematic mood states,
Cognitive therapy also proposes that once schemas are activated, people become prone to
interpreting ambiguous situations in problematic ways.
Therefore need to look at evidence of these through CBT
Principles
Cameron – cognitive
Bowling – behavioural
Coldy – continuum
Happy and neive – here and now
Inbetween
Emads – empirical
Immigrants – interpersonal
- Cognitive (thoughts mediate the relationship. between events and how we feel) – someone didn’t say hi example - it is the interpretation of events, not the events themselves which are critical.
Greek Philosopher Epictetus c. 50 – c. 135 AD
“Men are disturbed, not by things, but by principles and notions which they form concerning things” - Behavioural (what we do/don’t do crucial in maintaining or changing psychological state) – learning theories
- Continuum – mental health problems arising from exaggerated or extreme versions of normal processes
- Here and now – the main concerns are the processes currently maintaining the problem, (not what may have led to it)
- Interacting Systems – hot cross bun
- Empirical – science based
- Interpersonal (collaborative - not ‘administered’ or ‘done to’ a client)
Also; structured, time-limited, active
Behavioural techniques
BEHAVIOURAL ACTIVATION
ACTIVITY SCHEDULING
GRADED TASKS
SYSTEMATIC DESENSITIZATOIN
BEHAVIOURAL CONTRACTING:
Premack’s principle
Physical Techniques
- Relaxation
o Use to manage high arousal; anxiety, anger, urges/cravings, as aid to BEs, to begin/end intense sessions, as scheduled pleasant events etc
o PMR
o Imagery
o Meditation - Controlled breathing
Exercise: great research for effect on low mood, also good for chronic fatigue, self esteem, anxiety, sleep, anger - Applied Tension for blood and injection phobias; prevents fainting when phobic
Cognitive Techniques
Identify NATS, Psychoeducation, distraction, cognitive evaluation, behavioural experiments, structured problem solving
GOAL
* Teach clients that thoughts and feelings are not facts
* Give client a systematic and realistic way to identify and evaluate
their own thinking
* Teach client to become their own therapist
* To improve the client’s mood through cognitive and behavioual change
UNDERSTAND AND IDENTIFY COGNITIONS - HOT COGNITIONS
DISTRACTION
COGNITIVE EVALUATION
BEHAVIOURAL EXPERIMENTS
EXPOSURE WITH RESPONSE PREVENTION
PSYCHOEDUCATION
PROBLEM-SOLVING
Structure/Stages for CBT
First session:
Mihi
Whakawhanaungatanga
Check-in mood check
Agenda
Kaupapa/psychoeducation: what is CBT
Client expectations
Goal setting
HW
Feedback
Closing
Subsequent sessions:
* Mihi / Welcome
* Whakawhānaungatanga * Check in
* Kaupapa Agenda
* The “CBT mahi”
* Homework
* Feedback
* Poroporaki
Psychoeducation not about facts but empowering, awareness, tools…
Good to start with Activity Monitoring & Scheduling
- Makes sense to clients
- Make difference
- Less psychological jargon to them
- Note don’t say exercise “park further away, vacuum etc”, activity they can do even checking mail. Pleasurable activitiy can be going to mcaas
Myths (8)
The therapeutic relationship doesn’t matter
Just apply technique x to y
Positive thinking (No – about realistic thinking)
Deal with superficial problems (not the root)
Not interested in emotion
Confrontational (“challenging” thought)
Quick to learn.
For intelligent
Therapeutic relationship
10 Characteristics improve/facilitate change:
empathy, warmth (but too warm = too attached), flexibility, supportively challenging, genuineness, uses humour, emotional responsibility, honesty, confidence, rewarding/encouraging
Therapeutic relationship
Characteristics that DONT improve/facilitate change:
confronting (not challenging supportively), supporting (without direction), inflexible
Working Alience
Signs of raputre and repaire
- working alliance (Bordin 1979 found these 3 to be necessary for successful working alliance): 1) agreement on the task, 2) agreement on the therapy goals, 3) positive client-therapist bond
- How to build rela (Beck): Collaboration, adapting therapeutic style, elicit feedback
- establish early on and ongoing & NB repair ruptures (normal & opportunity to enhance rela)
- Signs of poss rupture: poor attendance, disengaged, pushing back, non-verbal cues
- How to repair: address with problem-solving attitude (non-punitive), see as a Tx target, but prioritise
transference and Countertransference
Transference: the ways in which the client responds to the therapist and may be influenced by their core beliefs and past experiences (may be a replaying of past rela) - use for formulation/tx information
Countertransference: occurs when the rela with the client activates clinicians core beliefs / past exp, and these cognitions could impact on thera rela (identify & seek supervision)
- Not just client-clinician: also within groups
How to deliver CBT for Maori
Before
During
Welcome
Connection
Understanding
Check-in
Agenda
Formulatino
Psychoeducation
5 stages to treatment
BEFORE
Come with a historic and current understanding of the social context – informed knowledge of nz colonial history and awareness of how generational factors might impact presenting problems for client
- Collectivist culture – include whanau in sessions
- Value system CBT might not fit (individualistic, here and now etc)
DURING
- Use of te reo
Welcome:
- Open and close with karakia or whakatauki
whakawhaunatanga:
- Big emphasis on whakawhaunatanga= purposeful, curious, genuine, human connection – not a check list - greater self-disclosure from therapist
- Deeper exploration of whakapapa (genealogy)
Understand:
- Aware of age, roles, for client – their level of involvement
- whakapa - genealogy: Use family tree to understand / time line/ location living
Checkin:
- Use te whare tapu wha rate 4 pillars 0-5 at check in and to measure pre and post scores
AGENDA:
- Use of maori proverb to guide sessions (card with maori and English proverb and picture/land scape)
Formulate
- using meihana model AND CBT USING:
- Use house for formulation: foundation = early experience, base = core beliefs, main part = rules for living, assumptions, roof = coping stratigies.
Psychoeducation
- Culturally relevant examples and educational material
Treatment phase: connection, understanding them (assessment), positive behaviour, positive cognitions
(BOTTOM TO TOP)
- 1) Whakawhanugatana – building relaitonships (if this isn’t there doesn’t matter how nice the topping/icing is)
- 2) Nga Maramatanga – developing insight (understanding what has bought them in)
- 3) Whanonga pai – positive behaviours (early win, activity scheduling)
- 4) Whakaaora pai – positive thinking
- 5) Ora pai – staying well (relapse)
CBT with children and FAMILIES
How can parents influence child in 3 ways + 3 traps
How can they be incorporated in treatment 2
Families
o Parent high expectations – criticism, conflict, low praise
o Low expectations = overinvolvement, reduced encouragement, low sense of mastery
o Parental modelling: avoidance, inhibited behaviour
o Parental language “you are stupid”
Family influences:
o The reassurance trap: Anxious kids reassurance from parents child feels better parent feels better child maintains view of world as dangerous don’t get chance to learn to reassure themselves rely on others to reduce anxiety
o Telling them what to do trap: parents try and fix by talking over and telling them what to do or say young people don’t learn how to cope alone rely on parents to cope
o The impatience trap: parent becomes frustrated with anxious young person do not promote young persons ability to cope with anxiety
Treatment with fam
o Psychoeducation around how their actions influence child
o Parents need to reinforce behaviour at home
CBT main consideration/differences when working with children?
Developmental level
* Identify child’s developmental abilities – speech and language
* Treatment plan to fit developmental age (simpler language - also not to simplified for teenagers)
* Some thinking/distortions may be normative developmentally
* Understanding physical responses to emotions is often a useful starting point
* behavioral before cognitive
* For young children changes to self talk are more useful than challenging thoughts. Self talk = short statements the client repeats to self “I am afraid, but I can cope” – get parents to reinforce this at home
* Explicit reinforcement often used
* accessing cognitions may be harder
Creativity
* In-vivo rather than imagery, ‘superhero’ imagery
* homework may be hard for teens- get creative
* More experiential/action orientated
* Use visuals or games
* Pictures and visuals help cognitive work eg cartoons
*. Teens interested in body/science/ neurons
Family involvement
* more family involvement, need for alliance with caregivers as well as child, intervention may be more about changing their context, parent in part of the session, and as coach between sessions
* Most often not just working with one ‘client’ / Multi informant: family, child alone, parent alone, school, multi informant psychometrics
OTHER
* Motivation – child typically doesn’t initiate referral
* Strong therapeutic relationship (alliance with child – [use collaborative language “we” validate feelings, encourage and praise], alliance with parent, instil hope, engage child in developmentally appropriate activities)
* Emotional literacy and regulation useful: Identifying emotions, rating intensity, grounding, cog techniques etc to manage
* Important to validate thoughts and spend time on these —- makes an adolescent feel heard. Challenging thoughts too quickly can feel dismissive and invalidating.
CBT with children - how to introduce link to emotions and thoughts
how to do pleasant activity scheduling
CBT intro example: 4 young people in same situation 4 feel differently what thoughts could each one been having?
