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CBT - Erhardt > CBT Core Concepts & Tenets > Flashcards

CBT Core Concepts & Tenets Flashcards

1
Q

Cognitive Therapy is “The Power of Positive Thinking”

A

That is a misconception
• CT is the power of adaptive thinking.
• CT encourages balanced, rational, and flexible thinking as opposed to extreme, irrational, and rigid thinking.

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2
Q

Cognitive Theory Claims that Negative Thoughts Cause Psychopathology

A
  • Distorted thoughts don’t cause psychopathology, but rather are part of an interconnected cycle of external events, thoughts, emotions, biology/ somatic responses, & behavior
    • Cognitions: May contribute to, maintain, or exacerbate problems
    • Cognitions: Often a fruitful place to intervene
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3
Q

CBT is Simplistic

A

• The basic theory underlying CT is fairly straightforward
and easy to understand
• The implementation/practice of CT is rarely simple or straightforward
• More recent forms of CBT are far more complex theoretically

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4
Q

CBT is Superficial

A
  • CT focuses on achieving the client’s stated, specific goals for therapy
  • CT may be “superficial” or “deep” depending on the client’s goals and the nature of his/her problems
  • “Deeper” when addressing entrenched, often nonconscious beliefs
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5
Q

CT is Talking People Out of their Problems

A
  • Misconception for Beck-model CBT
  • Confusing Albert Ellis’ disputational approach with CT
  • CT relies on collaborative “guided discovery” rather than debate
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6
Q

CBT Ignores or Seeks to Eliminate Emotion

A

• Emotional change is a very common goal
• CT’s goal is not to turn people into robots, but to help them understand and manage emotional reactions more effectively
• Helping clients to become more aware of their emotions and how they are triggered
is often an explicit part of CBT

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7
Q

CBT Ignores the Past

A
  • CT makes no presumption that one must deal with the past with every case
  • CT acknowledges that past experiences may be at the root of current problems
  • Problems can often be resolved by focusing primarily on the present
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8
Q

The Therapeutic Relationship is Unimportant in CBT

A
  • Therapeutic relationship is not regarded as the primary mechanism for change
  • Yet, a warm, trusting, empathic therapeutic relationship is essential for
  • Engaging clients in therapy
  • Collaborating effectively with clients
  • Relationship can be a tool for identifying & modifying dysfunctional client beliefs
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9
Q

CBT: Core Concepts

A

1) CBT Targets both mental content and process
a. Mental Content: What we think (Beliefs, knowledge, thought, images)
b. Mental Processes: How we think (awareness, attribution, attention, perception, reasoning, appraisal, interpretation, memory/recall, judgment, how we process information)
2) Our perceptions of an event or
experience powerfully affects our emotional, behavioral, and physiological response to it

3) Situations do not determine how we feel and act; it’s how we think about, interpret, or construe a situation that largely determines how we respond
4) The Interrelationship Between Thoughts, Feelings, and Behaviors

a. Behavior, thoughts, feelings, and the environment reciprocally influence each other
b. Thoughts influence emotions, behavior, bodily response
c. Emotions influence cognitive content & processes
d. Emotions influence behaviors
e. Behaviors influence our cognition
f. Behaviors influence our emotions

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10
Q

Beck’s Three Levels of Thoughts

A
  • Automatic Thoughts (closest to surface)
  • Attitudes, Rules, & Assumptions (intermediate level)
  • Core Beliefs (deepest level)
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11
Q

Automatic Thoughts (closest to surface)

A
  • The actual words and/or images that go through our minds
  • Tend to be brief and to spring up immediately in response to a certain situation
  • We may or may not be aware of our AT’s
  • Automatic thoughts shape our emotions and our actions in response to events
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12
Q

Core Beliefs (deepest level)

A

• Our most central, fundamental beliefs about ourselves, others, and the world
• Tend to be global, rigid, and overgeneralized
• Core beliefs may well be unarticulated
but nonetheless function as absolute truths to the person
• May be active or dormant; dormant beliefs may be activated by certain types of life events
• Certain CB’s may increase vulnerability to various forms of psychopathology

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13
Q

Attitudes, Rules, & Assumptions

A
  1. Core beliefs may influence their development
  2. Often represent logical extensions of core beliefs or responses to core beliefs
  3. Ex: Core Belief —> “I’m incompetent” —> Attitude: “It’s terrible to make mistakes,” Rule: “I must work as hard as I can all the time,” Assumption: “If I over prepare, I may fool people into thinking that I’m competent.”
  4. May operate in or outside of our awareness
  5. Consideration of attitudes, rules, assumptions, & core beliefs can help explain reactions that seem extreme or unjustified
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14
Q

Schemas & Core Beliefs

A

The terms schema and core belief are often used interchangeably
• Aaron Beck distinguishes the terms:
• Schemas are cognitive structures in the mind, the content of which are core beliefs
• Regards schemas as a template that contains our core, fundamental beliefs

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15
Q

Core Beliefs Bias How we Process Information

A
  • In-coming & out-going information is filtered through our active core beliefs
  • The nature of our active core beliefs guides our attention & memory: We tend to focus selectively on/recall information that confirms our core beliefs and to disregard, discount, or forget information that runs contrary to our core beliefs
  • This biasing effect makes core beliefs highly stable & resistant to change
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16
Q

Origins of Core Beliefs

A

• Develop on the basis of life experiences and interactions with others
• Particularly those that are:
o From childhood
o Impactful
o Repeated
• Core and intermediate beliefs arise as people try to organize & make sense of their experience in a coherent way

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17
Q

Common Cognitive Distortions

A
  1. All or Nothing Thinking
  2. Arbitrary Inference (Jumping to Conclusions)
  3. Overgeneralization
  4. Personalization
  5. Predicting the Future (Fortune Telling)
  6. Catastrophizing
  7. Disqualifying or Discounting the Positive (Minimization)
  8. Emotional Reasoning
  9. Labeling
  10. Mental Filter (Selective Abstraction)
  11. Mind Reading
  12. Imperatives (Should or Must Statements)
18
Q

All or Nothing Thinking

A
  • Viewing a situation in only two opposing categories instead of on a continuum
  • Seeing things in only black and white
  • -I got a B in one of my classes; I’m doing horribly
  • -If I weigh more than 115, then I’m fat.
  • -Since I used again, I’m back to square one
19
Q

Arbitrary Inference (Jumping to Conclusions)

A
  • The process of drawing a typically negative conclusion in the absence of specific evidence to support that conclusion
  • -I’m going to fail the exam
  • -They don’t like me
  • -My wife’s late getting home-Something horrible has happened
  • -I’m a failure
20
Q

Overgeneralization

A
  • Formulating sweeping rules or conclusions that go far beyond the current facts or situation
  • Exaggerating a single incident into a pattern
  • Drawing an overly general rule or conclusion from a specific instance and applying it to broad, unrelated situations
  • -My talk didn’t go well. I’ll never be good at public speaking.
  • -I struck out twice today. I’m a horrible player.
  • -That was a lousy date; I’m never going to click with anyone.
  • -Everything sucks.
21
Q

Personalization

A
  • Drawing a conclusion about oneself from an event or situation that may have other meanings
  • Assuming personal causality for events, situations and reactions of others without the evidence to support it
  • Believing others are behaving negatively because of you, without considering more plausible explanations
  • -Ellen didn’t return my call from yesterday. She must be mad at me.
  • -Those girls were whispering when I walked by; They’ve noticed I’ve gained weight.
22
Q

Predicting the Future (Fortune Telling)

A
  • Predicting the future negatively without considering other, potentially more likely outcomes
  • Distorted views of the present often lead to erroneous predictions about the future.
  • Concept overlaps with arbitrary influence
  • -If I go to the party, I’ll be overwhelmed with anxiety and fall apart.
  • -I’ll be alone for the rest of my life
  • -I’ll never feel any better
  • -I’ll never be any good as a therapist
23
Q

Catastrophizing

A

• The process of evaluating a situation in such a way that one believes that the worst possible outcome will or did occur.
o Drawing conclusions, often about the future that involve exaggerated horrendous outcomes
o Viewing an undesirable but tolerable outcome as tragic, horrific, and or unbearable
• Involves blowing out of proportion either a current event or a feared future event
• -If I blow this interview, my career is over.
• -My heart is beating faster; I must be having a heart attack
• -If I show up without a date, I’ll die of embarrassment

24
Q

Disqualifying or Discounting the Positive (Minimization)

A
  • Ignoring or devaluing positive evidence, events and information – Telling yourself that positive experiences, deeds or qualities do not count
  • -Yeah I got an A but it was an easy test
  • -It’s got nothing to do with me; He’s nice to everybody
  • -My getting promoted was only a fluke.
25
Emotional Reasoning
* Inferring facts about the world from emotional experiences * Using an emotional state to form conclusions about oneself, others or situations * Thinking something must be true if you feel it so strongly * -I know I just got promoted but I still feel like I’m a failure at work * -I feel terrified; Something really bad is about to happen * -I’m very frightened on airplanes; It must be very dangerous to fly * -My interpretation was accurate because the client became very uncomfortable.
26
Labeling
* Using negative, global terms to draw conclusions about yourself or others * -I’m a loser * -Men are pigs
27
Mental Filter (Selective Abstraction)
* Paying undue attention to one negative detail instead of seeing the whole picture * Selective attention to negative information * -I saw a person yawn during the talk; I must be a total bore. * -That one mediocre rating on my evaluation means my supervisor thinks I’m a lousy therapist
28
Mind Reading
* Making inferences about another person’s thoughts or feelings without collecting direct information * Believing you know what others are thinking, failing to consider other, more likely possibilities * -She thinks I’m a dork * -He blames me for the problem
29
Imperatives (Should or Must Statements)
* Transforming our wishes and preferences into moral imperatives for oneself or others * Having precise, fixed ideas of how you or others should behave and overestimating how bad it is when those expectations are not met. * -I must succeed. * -I shouldn’t have gotten angry; I’m a terrible person. * -Bad behavior should not be rewarded.
30
CBT is _______________ and _________________.
Goal Oriented and Problem-Focused
31
Generic Goals of CBT
* Symptom relief * Facilitate remission of disorder * Help to resolve most pressing presenting problems * Teach client tools to reduce the likelihood of relapse
32
Individualized Goals
* Client and therapist work collaboratively from the start to identify problems and to set & prioritize goals for treatment * Specific * Concrete * Operationalized * Focus typically on addressing current problems
33
The Process of Cognitive-Behavioral Therapy is Educational
• Therapist will educate the client about: o The nature of his/her disorder (if applicable) o The process of cognitive therapy o The cognitive model o Sharing the case conceptualization o Presenting CB techniques as skills to be learned through practice o Therapist acts, in part, as teacher & coach
34
CBT is Structured
* CB therapists tend to adhere to a set structure or format for session * Structure is beneficial * Helps to make the best use of limited time * Limits unproductive digressions * Makes the therapeutic process more consistent, understandable, & predictable * Increases the client’s ability to generalize the skills taught in therapy
35
CBT is Typically Time-Limited
• Uncomplicated cases of depression or anxiety may require < 15 sessions • Cases where focus is on modifying long-standing core beliefs & behavior patterns may require 1-2+ years o Striving to keep therapy short-term is part of encouraging client independence & self- sufficiency
36
CBT is Active and Directive
``` • Applies to therapist: o Setting & prioritizing goals o Agenda setting for session o Questioning to guide client discovery o Suggesting & implementing interventions o Interrupting & redirecting ``` o Applies to client: Setting & prioritizing goals o Agenda setting for session o Practicing skills (“homework”) o Applying skills in real-life circumstances
37
Homework Assignments are part of CBT
* Most of the therapeutic work takes place outside of sessions * HW helps to accelerate the pace of therapy * HW is essential in enabling the client to apply what has been learned in sessions to his/her everyday life
38
CBT Tends to Focus on the Present
* Focus tends to be on current problems & situations * No presumption that it is always possible or necessary to identify etiology or to work at the level of “root causes” * Focus largely on current factors that maintain problems rather than on their origins * Attention shifts to past in 3 circumstances: * Client request * Present-focus leads to little or no progress * Therapist judgment that understanding when & how key dysfunctional beliefs originated is important Trend: Increased attention to reprocessing past events & resulting beliefs
39
Successful CBT Requires a Strong Therapeutic Relationship
• Like any effective therapy, CBT depends on a client-therapist relationship of: • Confidence, openness, caring, and trust • Therapist must demonstrate: Warmth, empathy, caring, genuine regard, trustworthiness, and competence
40
CBT Includes Specific Interventions to Prevent Relapse
• CBT works explicitly to prepare clients to deal with the possibility of future set-backs & the reemergence of symptoms • Clients encouraged to anticipate problems (“high risk situations”), identify early warning signs, and to develop coping plans • Relapse prevention has proven to be an important and effective component of CBT
41
CT Relies on Guided Discovery Using Socratic Questioning
* CT relies on a process of guided discovery rather than on persuasion, confrontation, lecturing, or debate * Socratic Questioning: Using questions to help guide the client towards his or her own __________ * Helps clients to think about something in a new way * Ideally, questions are asked so that the client’s answers persuade themselves away from maladaptive thinking * Promotes collaboration, reduced resistance, sense of ownership & pride in client, and generalization

CBT - Erhardt (5 decks)

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