CBT II

Question 1

describe stimulus control as a treatment

Answer 1

• pt learns to perform a behavior only under certain stimulus conditions
  
  • ex: sleeping or eating only at set times and places
  • goal: bring such behaviors under appropriate stimulus control
  • commonly used in CBT programs:
    
    • weight reduction: to break the learned association between eating and a host of inapprorpiate stimuli
    • sleeping: bed should be a stimulus for sleep (or sex) ONLY

Question 2

give an example of stimulus control and eating behavior

Answer 2

• problem: eating has become associated with a number of stimulus situations and internal mood states
  
  • e.g. when socializing or watching TV, or when depressed, happy or anxious
• the presence of these discriminatory stimuli make the behavior of “eating” much more likely
• treatment goal: bring “eating behavior” under appropriate stimulus control
  
  • e.g. eating only at mealtimes in dining room

Question 3

describe CBT approaches to pain management

Answer 3

• focus is on pain behaviors such as complaining, missing work and inactivity
• goal: stop reinforcing such pain behaviors and reinforce only healthy behaviors
• pain-relieving drugs are very powerful reinforcers and how they are administered is important:
  
  • time contingent: meds made available on set time schedule – does not reinforce pain behaviors
  • pain contingent: seen in hospice settings

Question 4

goal not necessarily to eliminate pain but to _____ associated with it

Answer 4

goal not necessarily to eliminate pain but to lessen disability associated with it

Question 5

describe hypnosis used in CBT pain management

Answer 5

• hypnosis: an underused pain management option
• works through a combination of relaxation, distraction and perceptual alteration
• pain is a subjective experience–most pts can learn to alter their pain sensations somewhat through hypnosis
• ex: a post-hypnotic suggestion might be that the pain is another sensation such as warmth

Question 6

describe cognitive distortions

Answer 6

• all or none thinking: it’s all “black and white” – “I’m either a success or a failure”
• overgeneralization: viewing a negative event in our life as a never-ending pattern of defeat
• mental filter: dwelling on negatives, ignoring positives
• jumping to conclusions: assuming others are reacting negatively toward you without evidence
• labeling: instead of saying “I made a mistake” you tell yourself “I’m a fool” or “I’m a loser”

Question 7

describe the “musts and shoulds” cognitive distortion

Answer 7

• when the world doesn’t conform to our irrational demands, we become emotionally upset and depressed
  
  • I must have this man or woman in my life
  • I must be accepted by this group of people
  • I should be getting all A’s

Question 8

describe cognitive restructuring

Answer 8

• involves the therapist identifying, challenging and correcting such distorted and irrational ways of viewing the world

Question 9

describe rational emotive therapy

Answer 9

• RET emphasizes that it is our thoughts, beliefs and interpretation of events that cause our emotioanl distress and depression

Question 10

describe the negative triad

Answer 10

• depression is caused by our negative interpretation of self, life events and future
  
  • negative thinking causes depression
• negative “self-schema”: negative filters through which we view the world distort world and cause depression

Question 11

describe learned helplessness

Answer 11

• when healthy avoidance responses are prevented, passivity, and depression result, along with the self-defeating belief
  
  • “why should I make the effort to feel better when nothing I do helps?”

Question 12

describe social cognitive theory

Answer 12

• emphasizes learning through observation (modeling and vicarious conditioning)
• much human behavior is learned through observing others interacting with the environment
• a person’s behavior is both influenced by and influences personal factors (e.g. personality and the way we think) and the social environment

Question 13

describe dialectical behavior therapy

Answer 13

• DBT involves a range of CBT including behavioral skills training, emotion regulation and mindfulness
• aimed at breaking the vicious cycle of addictive, explosive, self-harmful behavior, primarily in patients with borderline PD
• emphasis is on pt acceptance of themselves as they are (not as they’d like to be) and their commitment to change destructive behaviors

Question 14

describe mindfulness-based stress reduction

Answer 14

• aimed at stress reduction and pain management
• based on mindfulness meditation and yoga
• mindfulness: nonjudgmental acceptance of what is–now–being fully present in the moment

Question 15

describe the system approach in family and couples therapy

Answer 15

• a systems approach: views pathology as a reflection of disturbance within family or dyad
• the family is a self-regulating system–it seeks equilibrium and resists change
• the therapist works to disrupt the family’s dysfunctional equilibrium
• this intervention may be resisted, resulting in non-compliance on part of family or couple