CBT Final Flashcards
Cognitive and Behavioral Techniques
Some therapies use one or a blend. (Cognitive- Cognitive Processing/ Behavior- Prolonged Exposure Therapy)
Cognitive Techniques Goal vs versus feelings and questions
Monitor and then challenge thoughts that lead to unhelpful mood or actions
We do not challenge feelings and questions
Differentiating thoughts from feelings
Feelings are one word, thoughts are more than one word
Questioning thoughts
be curious and explore other possibilities
Labeling mistakes in thinking
Review common labels for unhelpful thoughts or mistakes in thinking with clients BEFORE teaching about thought record
Mistakes in thinking
10 or 11, they overlap, more important that clients choose one than the right one
1-3 Labels: Mistakes in Thinking
1) All or Nothing
2) Mental Filter (confirmatory or preservation bias)
3) Negative/ Distorted Filtering: Magnifying or exaggerating the negative (making mountains out of molehills) and minimizing discounting the positive
4-7 Labels: Mistakes in Thinking
4) Catastrophizing: it will be “unbearable”
5) Emotional Reasoning: “I feel sad, therefor this relationship is hopeless.
6) Labeling or Judging: Assigning global negative traits to oneself or other
7) Mind Reading: Assuming someones thoughts
8-11 Labeling: Mistakes in Thinking
8) Overgeneralization: Applying a few experiences to all events; “See? I knew that would happen, I ruin everything”
9) Fortune Telling and Jumping to Conclusions: Predicting a negative future
10) Personalization: Assigning 100% blame to oneself, not seeing other people or events as factors; taking things personally
11) Should and Must statements: Not accepting of reality- focusing on how one perceives the world should be rather than how it is; I should really work out more. I must get this done by Friday.
Thoughts??
tens of Thousands a day- often negative and repetitive
Three Levels of Thoughts
Automatic Thoughts
Intermediate Thoughts
Core Beliefs
Automatic Thoughts
ideas, words, images that seem to just pop into ones mind and are the most superficial
Intermediate beliefs:
reflect underlying assumptions, rules, attitudes (if I try new things, I will get embarrassed)
Core Beliefs (Schema)
deepest beliefs about oneself, others, and the world.
Negative, extreme, global, rigid, short
Automatic Thoughts timeline
occur after events but before emotional response
Automatic Thoughts outside awareness because?
Habitual, believable, and fast
Hot Cognitions
Different than automatic thoughts becuase emotions influence thoughts resulting in bias and low quality decision making
Affect Shift
Therapist notices and asks what thought was before
After client notices automatic thoughts then can start Thought Record
Basic Thought Record
Date, Event, Automatic Thoughts, Emotions
How to conduct thought record
Instruct client to choose meaningful events but they can be positive or negative
Teach client to write down the automatic thoughts and label and rate emotion intensity (0-100)
Evaluating Automatic Thoughts
Do not directly challenge the thought, use Collaborative Empiricism
Collaborative Empiricism
test usefulness and validity of thought then develop alternative adaptive response
Socratic Questioning
Systematic, disciplined, and deep
Usually focuses on fundamental concepts, principles, theories, issues or problems
More supportive or autonomy, engagement than didactic presentation
Using Socratic Questioning
Be neutral, collaborative, empathic, and curious, do not make judgmental or evaluative comments
Socratic Methods (5)
Revealing the issues
Conceiving Reasonable alternatives
Examining various potential consequences
Evaluate those consequences
Distancing
Revealing the issue
What evidence supports this idea? What evidence is against it being true?
Conceiving Reasonable Alternatives
“What might be another explanation or viewpoint of the situation?” Why else did it happen?
Examining various potential consequences
What are the worst, best, bearable and most
realistic outcomes?”
Evaluate those consequences
“What’s the
effect of thinking or believing this? What could
be the effect of thinking differently and no
longer holding onto this belief?
Distancing
“Imagine a specific friend/family
member in the same situation; if they viewed
the situation this way, what would you tell
them?
Alternative Responses (Advanced thought record)
What is the mistake in thinking?
- What is the evidence for/against this
idea? - Is there an alternative explanation of the
situation? - How much do you believe this thought (0-
100%) - What is the effect of you believing this
thought?
What should you do about it?
Outcome (Advanced thought record)
What emotions do you feel now?
- How intense are the emotions (0-100)?
- Do the alternative thoughts change your belief in
the original thought? - Do the alternative thoughts change your feelings and/or actions?What do you plan to do?
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ABCDEF Thought
Records
A=Activating event (what happened)
B=Belief or thought you are having
C=Consequence (feeling or behavior that results
from your belief)
D=Dispute, challenge, or “talk back” to your
thought; use evidence to develop your disputes
E=Evaluate (did the dispute change your feeling
about the event?). Sometimes Effective New
Belief
F=Functional consequence (what did you do?)
Three C’s Correcting Automatic Thoughts
CATCH IT
CHECK IT
CHANGE IT
Catch It
What is the automatic thought?
What was going through your mind?
Check it
What is the evidence for/against it?
What would you say to a friend with that thought?
Is this a mistake in thinking (e.g., “jumping to
conclusions”; “all or nothing”)?
Change it
CHANGE IT:
What is an alternative? Another possibility?
Does the new thought help you reach your goal?
Downward Arrow Technique or “Vertical Descent
gets to core belief
Core Belief Worksheet
Challenging Distorted Thoughts
Thought record and naming distortions
Asking for evidence and probabilities
Looking for alternative explanations
Use therapeutic relationship for modeling and reinforcement
Client acting “As If” they do not believe negative thoughts
Other Cog Techniques
Cognitive rehearsal
Covert Modeling
Continuum Technique
Double Standard
Positive reframe
Possibility vs probability
Progress vs perfection
Role model approach
Inoculate/ manage the worse case
Pie technique
Challenging 20/20 hindsight
Metaphors
help illustrate concepts, connect ideas, and to enable more visual learners a different way to change ways of thinking
Self-Monitoring (assessment and intervention)
means tracking one behavior that the client wants to change, often over a week; inc. actions, thoughts, and physiology
Behavioral Techniques
Self-Monitoring
Progressive Muscle
Relaxation
Behavioral Activation
Scheduling Activities
Changing Habits
Exposure Therapy
Goals of Client
help determine the self-monitoring tasks; it could be related to hygiene, social interactions, medication compliance, chores, or behaviors with their romantic partner
Benefits of Self Monitoring of actions, thoughts, feelings.
Replaces affect laden self statement with more accurate self awareness
Tracking positive and negative behaviors
tracking positive behavior increases positive behavior/// and tracking negative behavior decreases negative
Self Monitoring and Distancing
rather than becoming overwhelmed by experience, clients can step back and observe and realize they have control
Turn toward rather than turn away
Chain Analysis
functional analysis
Three-term contingency
“ABC” analysis (Activating or Antecedent event, Behavior, and Consequence)
determine why a behavior occurred and why it may be maintained, through moment-to-moment
reviews
Purpose of Chain Analysis
define what a problem is, what prompted it, and how it is maintained
Chain Analysis and Weaving of Solution
Can weave in solutions throughout the chain- decrease chances of it happening again
(intervention and assessment)
PRT Theorist Joseph Wolpe
Reciprocal inhibition and systematic desensitization; presenting an incompatible response (e.g., relaxation) with gradually presented feared stimuli (in a hierarchy)
Behavioral Activation
Getting clients moving will almost always result in mood improvement
Bed= depression
AKA pleasurable activities; pleasant events; self-reliance training; in vivo exposure; activity scheduling; diversion techniques; building mastery
Guidelines for Activity
Scheduling
Provide a rationale for activity scheduling
Use questioning to elicit collaboration/ suggestions about how to schedule the activity
Start where the client is, and not where they think they “should” be
Be specific and concrete
Plan for possible obstacles
Environmental Control
A client’s behavior can be modified by changing
the environment (“antecedent control”)
Change stimulus
Changing Habits
18- 254 days
- Decide to change
- Focus awareness on the behavior
- Devise strategies to help in stopping the habit
- Replace the habit with an alternative behavior
- Persist by being consistent and tracking progress
- Expect and manage lapses
Exposure Therapy
- In vivo (in real life) exposure (feared but relatively safe activities or situations)
- Imaginal exposure (a narrative of an upsetting
memory) - Response prevention and safety behaviors (for treating OCD)
- Interoceptive exposure (internal cues or bodily sensations; for treating panic disorder)
CBT for Depression
- Determine goals, problems, and prioritization
- Collaborative empiricism
- Self monitoring
- Regular feedback
- Scheduling activities and modifying automatic thoughts, cognitive rehearsal (imagining each step)
- role playing
- Eliciting and questioning automatic thoughts
- Engaging in behavioral activation to combat the lack of environmental reinforcement and subsequent escape avoidance that maintains depression
- Assigning and reveling homework
CBT for Specific Phobia
- Exposure therapy: Start with fear hierarchy of
thoughts, images, objects, people, and situations - Imaginal and in vivo exposure and response
prevention and perhaps cognitive restructuring;
get SUDS reports every 5m
CBT for OCD
- Exposure therapy: Start with fear hierarchy
- Imaginal and in vivo exposure and response
prevention and perhaps cognitive restructuring;
get SUDS reports every 5m
CBT for GAD
Relaxation
* Cognitive restructuring
* Inhibit checking, reassurance seeking, etc.
* Worry time (typically an hour set aside each day)
* CBT for GAD doesn’t work as well for older adults
* Acceptance based approaches
CBT for PaniC Disorder
Describe sis, rate intensity, similarity and fear
fear hierarchy
- Begin In vivo- therapist can go with
- INtrospective exposure through induction exercises to elicit and maintain somatic symptoms to help clients learn that they are not harmful
CBT for Social Anxiety
Address cogntivino and behavior and safety behaviors
- fear hierarchy
- Therapist provides feedback
- Client can ask others for feedback
- Client can be video recorded
Social Mishap/Bandwidth Exposures
Behavioral experiments aimed at altering a client’s
perception of what is socially acceptable
People with social anxiety will learn that they can
tolerate such “worst case scenario” situation
Substance Use and
Addictive Behaviors
Behavioral Chain
external triggers- internal triggers (thoughts) - Internal triggers (feelings)- behaviors- consequences (immediate and long term)
Common Triggers
Cravings, presence of stimuli, offered the substance or activity, negative thoughts, interpersonal problems, intense emotions, celebrations, getting. case of the “sore its”
Seemingly irrelevant Decisions
“Apparently unimportant decisions”
- small steps that lead to problematic behavior
- slippery slope,
- consider for relapse prevention
Coping to “break” the chain
- MI
- Surf the urge
- Cognitive restructuring (Weigh evidence, generate alternatives
- positive self talk
- Stay in a stressful busy safe situation until you habituate
- Leave situation where substances are present
Coping to break the chain, more skills
- Role play and practice assertive communication
- Attend a 12 step, talk it out
- Harm reduction and smart recovery
- Engage in alternative distracting activity
- Contingency management (CM)
“Righting Reflex”
An automatic response that people have, to correct someone/ something. To
offer advice or to correct whatever is “wrong”
When addicts don’t think they have a problem
Main focus of MI
exploring and resolving ambivalence
MI skills
Oars, Affirmations, Reflective Listening, Summaries
MI specific Skills
Change Talk
DARN CAT
Desire
Ability
Reason
Need
Commitment
Activation
Taking Steps
CBT for PTSD
- Stress Inoculation (Coping)
- Prolonged Exposure (PE) therapy: Guiding the Client to address their fears
- Cognitive Processing Therapy/ Cognitive Therapy
CBTp for Schizophrenia and Psychosis
adjunct to antipsychotic medication and case management, and it works to address the “positive” sxs of schizophrenia
Coping strategies
- Attention switching (inhibiting current response and initiating an alternative)
- Attention narrowing (focusing on a restricted range of stimuli)
- Modified self statements
- Reattribution (only my thoughts and I don’t have to believe them)
Psychosis
Reality testing through behavioral experiments can be used with outcomes predicted and tested
Cognitive PROCESSES are modified first, then cognitive CONTENT after arousal and attention re more controlled
Thoughts disorder- therapists can ask for an explanation fo the meaning which may help reveal the internal logic
CBT-I Sleep and Nightmares
Subjective assessment of sleep through diagnostic interviews, questionnaires, functional analysis and sleep diaries
Sleep Restriction
involves matching the time spent in bed to the time the client thinks they sleep each night to improve the natural sleep drive and reduce the association between the bed and wakefulness
Stimulus Control
Reconditioning the connection between bed and insomnia
- Only go to bed when sleepy
- Get out of bed if unable to fall asleep in 15 minutes
- Keep the bedroom for sleep and sex
- Avoid napping
Sleep hygiene
- Education about sleep interference from alcohol,
tobacco, and caffeine - Before bed, a small snack is okay but not heavy
meals - Exercise is good for sleep, but avoid it in the
couple of hours before bedtime - Keep bedroom quiet, dark, and cool
CBT for Anger
- Education about anger, stress, aggression
- Self-monitoring
- Constructing anger hierarchy
- PRT/PMR, breathing, guided imagery
- Altering focus and modifying appraisals
- Coping and assertiveness (vs. passivity or aggression or passive-aggression)
- Practicing skills while visualizing and role-playing
situations from hierarchy
CBT for Children and Adolescents
CBT depression
TF- CBT -sexual abuse and trauma
Focus on coping skills
relaxation and perspective taking rather than addressing underlying schemas
Physical activity share observed patterns of thoughts for the child
Transdiagnostic and Process-Based CBTs
The transdx approach refers to the therapeutic principles and common underlying psychosocial problems across mental disorders
The Approach of Transdx
(1) is a process-based
approach, based on common underlying
processes across disorders
(2) yields txs for comorbid disorders through the
development of new and unified therapeutic
protocols
3rd Wave CBTs
earlier waves focused on
changing the form, content, frequency, or
intensity of behaviors (including overt
actions or private thoughts and feelings)
third wave CBTs have worked to address the
context and function of the behaviors
what is different about 3rd wave CBTs?
value principles of behavior change but add acceptance
