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CBT Final Flashcards

1
Q

Cognitive and Behavioral Techniques

A

Some therapies use one or a blend. (Cognitive- Cognitive Processing/ Behavior- Prolonged Exposure Therapy)

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2
Q

Cognitive Techniques Goal vs versus feelings and questions

A

Monitor and then challenge thoughts that lead to unhelpful mood or actions

We do not challenge feelings and questions

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3
Q

Differentiating thoughts from feelings

A

Feelings are one word, thoughts are more than one word

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4
Q

Questioning thoughts

A

be curious and explore other possibilities

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5
Q

Labeling mistakes in thinking

A

Review common labels for unhelpful thoughts or mistakes in thinking with clients BEFORE teaching about thought record

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6
Q

Mistakes in thinking

A

10 or 11, they overlap, more important that clients choose one than the right one

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7
Q

1-3 Labels: Mistakes in Thinking

A

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

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8
Q

4-7 Labels: Mistakes in Thinking

A

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

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9
Q

8-11 Labeling: Mistakes in Thinking

A

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.

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10
Q

Thoughts??

A

tens of Thousands a day- often negative and repetitive

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11
Q

Three Levels of Thoughts

A

Automatic Thoughts
Intermediate Thoughts
Core Beliefs

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12
Q

Automatic Thoughts

A

ideas, words, images that seem to just pop into ones mind and are the most superficial

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13
Q

Intermediate beliefs:

A

reflect underlying assumptions, rules, attitudes (if I try new things, I will get embarrassed)

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14
Q

Core Beliefs (Schema)

A

deepest beliefs about oneself, others, and the world.

Negative, extreme, global, rigid, short

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15
Q

Automatic Thoughts timeline

A

occur after events but before emotional response

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16
Q

Automatic Thoughts outside awareness because?

A

Habitual, believable, and fast

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17
Q

Hot Cognitions

A

Different than automatic thoughts becuase emotions influence thoughts resulting in bias and low quality decision making

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18
Q

Affect Shift

A

Therapist notices and asks what thought was before

After client notices automatic thoughts then can start Thought Record

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19
Q

Basic Thought Record

A

Date, Event, Automatic Thoughts, Emotions

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20
Q

How to conduct thought record

A

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)

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21
Q

Evaluating Automatic Thoughts

A

Do not directly challenge the thought, use Collaborative Empiricism

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22
Q

Collaborative Empiricism

A

test usefulness and validity of thought then develop alternative adaptive response

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23
Q

Socratic Questioning

A

Systematic, disciplined, and deep

Usually focuses on fundamental concepts, principles, theories, issues or problems

More supportive or autonomy, engagement than didactic presentation

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24
Q

Using Socratic Questioning

A

Be neutral, collaborative, empathic, and curious, do not make judgmental or evaluative comments

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25
Socratic Methods (5)
Revealing the issues Conceiving Reasonable alternatives Examining various potential consequences Evaluate those consequences Distancing
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Revealing the issue
What evidence supports this idea? What evidence is against it being true?
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Conceiving Reasonable Alternatives
"What might be another explanation or viewpoint of the situation?" Why else did it happen?
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Examining various potential consequences
What are the worst, best, bearable and most realistic outcomes?”
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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?
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Distancing
“Imagine a specific friend/family member in the same situation; if they viewed the situation this way, what would you tell them?
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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?
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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? 49
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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?)
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Three C's Correcting Automatic Thoughts
CATCH IT CHECK IT CHANGE IT
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Catch It
 What is the automatic thought?  What was going through your mind?
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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”)?
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Change it
CHANGE IT:  What is an alternative? Another possibility?  Does the new thought help you reach your goal?
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Downward Arrow Technique or “Vertical Descent
gets to core belief
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Core Belief Worksheet
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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
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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
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Metaphors
help illustrate concepts, connect ideas, and to enable more visual learners a different way to change ways of thinking
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Self-Monitoring (assessment and intervention)
means tracking one behavior that the client wants to change, often over a week; inc. actions, thoughts, and physiology
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Behavioral Techniques
Self-Monitoring Progressive Muscle Relaxation Behavioral Activation Scheduling Activities Changing Habits Exposure Therapy
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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
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Benefits of Self Monitoring of actions, thoughts, feelings.
Replaces affect laden self statement with more accurate self awareness
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Tracking positive and negative behaviors
tracking positive behavior increases positive behavior/// and tracking negative behavior decreases negative
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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
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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
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Purpose of Chain Analysis
define what a problem is, what prompted it, and how it is maintained
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Chain Analysis and Weaving of Solution
Can weave in solutions throughout the chain- decrease chances of it happening again (intervention and assessment)
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PRT Theorist Joseph Wolpe
Reciprocal inhibition and systematic desensitization; presenting an incompatible response (e.g., relaxation) with gradually presented feared stimuli (in a hierarchy)
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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
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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
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Environmental Control
A client’s behavior can be modified by changing the environment (“antecedent control”) Change stimulus
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Changing Habits
18- 254 days 1. Decide to change 2. Focus awareness on the behavior 3. Devise strategies to help in stopping the habit 4. Replace the habit with an alternative behavior 5. Persist by being consistent and tracking progress 6. Expect and manage lapses
57
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)
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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
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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
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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
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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
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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
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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
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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
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Substance Use and Addictive Behaviors
Behavioral Chain external triggers- internal triggers (thoughts) - Internal triggers (feelings)- behaviors- consequences (immediate and long term)
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Common Triggers
Cravings, presence of stimuli, offered the substance or activity, negative thoughts, interpersonal problems, intense emotions, celebrations, getting. case of the "sore its"
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Seemingly irrelevant Decisions
"Apparently unimportant decisions" - small steps that lead to problematic behavior - slippery slope, - consider for relapse prevention
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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
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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)
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“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
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Main focus of MI
exploring and resolving ambivalence
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MI skills
Oars, Affirmations, Reflective Listening, Summaries
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MI specific Skills
Change Talk
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DARN CAT
Desire Ability Reason Need Commitment Activation Taking Steps
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CBT for PTSD
- Stress Inoculation (Coping) - Prolonged Exposure (PE) therapy: Guiding the Client to address their fears - Cognitive Processing Therapy/ Cognitive Therapy
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CBTp for Schizophrenia and Psychosis
adjunct to antipsychotic medication and case management, and it works to address the “positive” sxs of schizophrenia
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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)
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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
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CBT-I Sleep and Nightmares
Subjective assessment of sleep through diagnostic interviews, questionnaires, functional analysis and sleep diaries
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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
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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
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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
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CBT for Anger
1. Education about anger, stress, aggression 2. Self-monitoring 3. Constructing anger hierarchy 4. PRT/PMR, breathing, guided imagery 5. Altering focus and modifying appraisals 6. Coping and assertiveness (vs. passivity or aggression or passive-aggression) 7. Practicing skills while visualizing and role-playing situations from hierarchy
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CBT for Children and Adolescents
CBT depression TF- CBT -sexual abuse and trauma
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Focus on coping skills
relaxation and perspective taking rather than addressing underlying schemas Physical activity share observed patterns of thoughts for the child
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Transdiagnostic and Process-Based CBTs
The transdx approach refers to the therapeutic principles and common underlying psychosocial problems across mental disorders
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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
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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
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what is different about 3rd wave CBTs?
value principles of behavior change but add acceptance

Psychotherapy (4 decks)

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