CBT OSCE - Cognitive Restructuring Techniques

Question 1

Thought catching

Answer 1

Ability to identify thoughts associated with a situation that triggers symptoms (i.e. anxious, depressive).

Question 2

Downward arrow

+ common core beliefs list?

Answer 2

Progressively specific questions, narrowing down to identify a core belief underlying a situation.

1) And if that were true, what would that mean?
2) And if that were true, what are you afraid that would mean for you?
3) And if this was the case, what could that mean to you?

Keep going until you reach a core belief –> global attribution i.e. ‘I am a failure’ –> ‘I am worthless’

Helpless - I am weak, I am a loser, I am trapped
Unlovable - I am unlovable, I will end up alone
Worthless - I don’t deserve to live, I am worthless
External danger - The world is a dangerous place

Question 3

Socratic questioning

Answer 3

Clarifying concepts. … What exactly does this mean?
Can you give me an example?

Probing assumptions. …
How would you describe your thinking about this?
What assumptions could be contributing to this belief?
What would happen if…?

Probing rationale, reasons and evidence. …
How do you know this is this is the case?
What evidence did you see to support that?

Questioning viewpoints and perspectives. …
What do you think other people could be thinking about this?

Probing implications and consequences.

IF this is true, what does this mean to you?

What might happen if you thoughts differently about this?

What do you think would follow on from this?

Questioning the question. Why do you think I’m getting you to do this task?

Question 4

Evidence for and against - past experience

Answer 4

What is the evidence here?

What happened when you felt like this before in the past?

What is the evidence that this is true?

What is the evidence that this is not true?

Question 5

Testing probability estimations

Answer 5

So we’ve talked about [insert negative predication], , and on a scale of 0 to 100%, where 0 relates to it never happening and 100% is that it definitely will happen, what would you rate the likelihood of it happening?

Why do you think that this is so likely to happen?

Ok, so X, Y, Z and do you think those are the main bits of supporting evidence for this?

What do you think is some evidence against?
IDK

Ok let’s go back a bit - maybe we can explore some of the cognitive errors that might be contributing to this

Question 6

Using thinking errors/cognitive distortions

Answer 6

Is the situation as black and white as it seems (?

Am I only focusing on the facts that I think apply - are there any others that apply? (mental filter)

Could other people have thought something different?
How do I know what they were thinking? (mindreading)

Question 7

Disputing questions

Answer 7

) If no one I care for ever cares for me, which is very unlikely, I can still find enjoyment in friendships, in work, in books, and in
other things.

is there any evidence that I am a loser?

Say I am a loser, what’s the worst that can happen from that?

What bad things can happen to me if I keep my belief?

What good things can occur if I change my belief?

Question 8

Continuum method

Answer 8

On a scale of 0 - 100 what is your level of belief?

Ok so let’s fill this out - I can’t trust people

So who is at 0, the most untrustowrthy, ok. And let’s work around and up.

And so this exercise can be really helpful in solidyfying those adaptive behaviours and reducing some of the issues around loneliness and isolation that you;ve mentoend.

Question 9

Downward comparison/zero point evaluation

Answer 9

What could be worse than this?

Question 10

Using thought records and other worksheets

https://www.youtube.com/watch?v=5eyE20HpaCo

Answer 10

.

Question 11

Devils advocate

Answer 11

herapist: It must be hard for you to have hope in a system that hasn’t been able to help you for the past 13 years.

Client: Yeah, I mean I am like. what’s the point.

Therapist: Yes, what is the point? You have seen therapist after therapist for 13 years. Why bother with treatment at this point?”

Client: I don’t know

Therapist: I mean really therapy can be expensive, it takes time why not just be at home watching television or doing something else.

Client: Because I can’t keep living like this!

Therapist: Living like what?

Client: Being miserable

Therapist: Well perhaps relationships are not an area of difficulty for you. It seems

that you are able to get involved in intimate relationships. So why bother

coming to treatment? [Devil’s advocate]

Client: Well I can get involved, but I can’t stay involved. We’re not together

anymore.

Therapist: What happened?

Question 12

Distancing methods

i.e. circular questioning

Answer 12

When you are not depressed, what do you enjoy the most about not being depressed?”

Question 13

Behavioural Experiments

Answer 13

TCR

Question 14

Recognising mood shifts

Answer 14

Ask about - I can see that you seem a little more anxious around X. Tell me more about what that meant for you?

Question 15

Guided discovery

Answer 15

You’ve been talking about X that has been upsetting you. Can you give me a recent example of this? (time and a place)

Hmm..What happened then? what did she say?

And what went through your mind when X said that?

I can see how that would be distressing. And did you have any more thoughts?

Let’s try to stay with this a little longer. It is natural to want to edit some of these thoughts, but this is a non-judgmental space where we can get the best results if we hear your unfiltered thoughts.

Question 16

Thought recording

Answer 16

Working through events, automatic thoughts, emotions

Question 17

Role-play

Answer 17

Role play is one way in which to utilize this form of therapy to benefit a client. For example, with a client who is dreading an interview, the therapist takes on the role of the interviewer. By analyzing his/ her responses after enacting the mock-scene, the client can see what s/he tends to do. The next step is to consider how to do it differently next time.

I like to role play the scene several times, for 2 main purposes. First, each subsequent re-enactment pushes the client out of his/her comfort zone. They build-up confidence levels and deal with fears (often a fear of authority). Secondly, it can help to desensitize the client, so s/he actually feels less fearful of the interview and the interviewer. Often we do this in increments so it doesn’t become too overwhelming and frightening.

By the time the client actually goes to the interview, his/her responses will be much different from how they would have acted without the role play. Much of the self-defeating behaviour has been “worked out” and the client stands a much better chance of responding in ways that will result in a positive outcome.

Question 18

Imagery

Answer 18

The or she is experiencing in the session, and letting an image arise from the feeling. An image will usually arise spontaneously, but if not, a technique called multisensory evocation can help to clarify an image. For this technique, the therapist will direct the client through an exploration of the senses to help sharpen the image and identify more detail.

Prompted soliloquy – the therapist directs the client to identify as an object or entity from the image (e.g., a client who visualized a lake drying up was directed to “be the lake”), and speak from the position of this object or entity (e.g., the client would speak about how it felt to be the lake, and what its drying up meant).
Interview – in this technique, the client will once again take on the role of an object or entity from the image, and the therapist will ask specific questions of the client in this role.
Prompted dialogue – similar to the previous techniques, this technique involves the client taking on a role and addressing one of the other objects or people in the imagery (e.g., the client could identify as the lake and address the trees around the lake).
Prompted descriptions – this basic technique simply refers to the therapist’s use of frequent questions about what the client is seeing and feeling.
Prompted transformation – the therapist may suggest that the client shifts or changes the image; this can be especially helpful when the current image has reached the end of its usefulness as a discussion piece.

Question 19

Checklists

Answer 19

Pre-existing questions about automatic thoughts

Question 20

Psycho-education

Answer 20

Explaining the importance of emotions and the way that NATs work

Question 21

Generating rational alternatives

Answer 21

1) Imagine your friend saw was in this situation - what would they say?

What would you say to someone else going through this?

2) Let’s brainstorm these ideas - get into a creative flow, and see as many as we can find and then we can work out or rank their practicality and relevance later.
3) Move out of the current time frame - Can you think back to a time where you may have seen things differently?
i. e. when you were happy at work? What advice would your old self give you now?
4) Ask others for their opinion -

You mentioned that X was at the party. Have you asked her what she thought? How much do you trust her opinion? How do you think you could cope if you got a disappointing response?

Question 22

Decatastrophising

Answer 22

Because you are predicting a high likelihood of X, it might be useful to think ahead. What is the worst outcome that would happen?

I know it would be very tough if X happened, but let’s see how you could cope by unpacking some of those predicitons. You said if X then Y. Can we look at the evidne cfor that?

What parts of your life wouldn’t be ruined, if that were true?

Could you tolerate it for 15 mins?

So we’ve talked about how you could cope with Y, taht is by Z, L and M. What is your belief now on a scale of 0 -100 “i am a failure”?

What is the best outcome?

What is the worst?

What is the most realistic?

Question 23

Reattribution

-3 variables

Answer 23

Internal vs external - my fault vs world’s/life’s fault

general vs specific - everything is my fault vs I just suck at one thing

invariant vs variable - i am fixed as a crap person forever vs I can change