Cognitions

Question 1

Cognitive distortions

JAMMED with SLOP C

Answer 1

JAMMED with SLOP

Jumping to conclusions (mind reading and fortune telling)
All or nothing thinking / black and white
Mental Filter - focusing on one bad thing
Magnify/minimize - exaggerating the importance of negative events and underestimating the importance of positive events.
Emotional reasoning - assuming that feelings reflect fact
Disqualifying positive - rejecting, downgrading or dismissing as unimportant any positive event.

Shoulds/ musts (unrealistic expectations)
Labelling - Attaching harsh and demeaning names to self (or others) - see as totally bad
Overgeneralising - seeing a single event as indicating everything is negative (eg never always)
Personalising - attributing others’ feelings, actions or external events to yourself

Catastrophising - predicting the worst, overestimating probability and cost/coping

Question 2

Two main components of CT

Answer 2

Identify and modify NATS

Question 3

CT sequence

Answer 3

Identify the Activating Events (A) or situations​

Identify the Consequences (C):​

Assess Consequences (C):​ rate intensity and SUDS

Elicit the Beliefs or Thoughts (Bs)​ and rating

Make the B-C connection​

Become familiar with cognitive errors​

Dispute the unhelpful beliefs​

Develop helpful beliefs​

Re-rate the strength of belief and intensity of emotion.​

Set homework

Question 4

Rationale

Answer 4

Based on CF and links between components

Question 5

CBT principles

Answer 5

how think det how feel - thoughts can be rational or not
life experiences teach us to think rationally or not
change emotions by change thinking and behavior
realistic thinking reduces your emotional distress

Question 6

The cognitive principle

Answer 6

it is how we make meaning of what happens to us not what happens to us that influences emotions and behavior

Question 7

The behaviour principle

Answer 7

CBT considers what we do as crucial in maintaining – or in changing – psychological states.

Question 8

The cognitive model based in early learning

Answer 8

Core beliefs
          V
Assumptions/rules
           V 
A > NAT > Consequences

Core beliefs based on early life experiences, usually dormant until a triggering life event that matches schemas are activated - then NATS’s in response to these. Eg asked to trivia IF

Assumptions protect from negative core beliefs being activated by high risk situation

Too broad - and rigid

Question 9

Cognitive therapy sequence

Answer 9

Mood signal thoughts present
Write down what thinking or doing
Assess duration and intensity of consequences - use SUDS
ID NATS - use recent example

Question 10

Difficulties in ID thought

Answer 10

What does this situation mean?
What does this mean about others?
What does it tell you about life, self, world, future?

Question 11

Thoughts

Answer 11

Emotion is road to cognitions

in session emotion usually indicate NATS

Question 12

Guided discovery or socratic questioning to get cognition

Answer 12

Asking good questions to elicit more awareness

Use questions that stimulate emotion
target one recent specific situation to elicits NAT’S
Dig deeper
use empathy
use the CF for direction and to make suggestions
use imagery in the present tense to uncover hot thoughts
Role play
worst case scenario
Empty chair technique
in vivo experiments elicit cognition’s

Question 13

Strategies for cognitions

Answer 13

Distraction using pleasant thoughts and activity - self safe hypnosis - reduce physiology and distracts
Mindfulness to redirect attention
Defusion
Action towards a goal

Problem solving

Using coping statement to replace thoughts
2 column method of thought appraisal
learning how to cope with distressing but realistic thoughts
Challenging unhelpful thoughts

Question 14

Distraction

Answer 14

Self safe hypnosis - reduce physiology and distracts
Focus on environment
count breathing
Serial sevens
ABC game
Remind yourself that it is important to stay task oriented
Visualize your favorite place in detail
Combine any of these attention diversion strategies with a physical activity eg whilst going for a brisk walk, count your breathing, and focus on the environment around you

Question 15

Decentring

Answer 15

ability to observe one’s own thoughts – to view cognition as mental events rather than an expression of reality

label the thinking process rather than dwelling on the content. ​

Thought replacement

Question 16

Self Coping statement

Answer 16

It is sometimes useful early in treatment to use positive self-statements with physiological and behavioral strategies

Question 17

2 column method of appraisal

Answer 17

using ABC but column for irrational belief and one for evidence based rational response and one for outcome

Question 18

Themes of assumptions

Answer 18

Control, approval, fairness and justice, perfectionism, love, achievement

Question 19

What are assumption

Answer 19

Rigid, overgeneralised and extreme 
Prevent goals
Dont reflect reality
Should must or IF then
not easily accessed

Question 20

Techniques for assumption

Answer 20

Use downward arrow techniques-
behaviour experiments

Questions to ask - what way unhelpful, unreasonable, where did it come from, what would be a more moderate alternative??

Question 21

In what way is the assumption unreasonable?​

Answer 21

“What is evidence?” calls for an assessment of the facts as far as they can be ascertained. ​

Does the assumption fit the way the world works? ​

In what way does it fail to reflect the reality of human experience? ​

For example, it is unreasonable to demand that life should always be fair, because the fact of the matter is that it is not.​

Question 22

In what way is the assumption unhelpful?

Answer 22

Does it help you to get what you want out of life, or does it hinder you? ​

A valuable strategy here is to list the advantages and disadvantages of holding the belief and weigh them up. ​
For example, perfectionistic assumptions may genuinely produce high quality performance on occasions. ​

However, they often arouse a degree of anxiety, which is incompatible with quality performance and may lead to avoidance of challenges and opportunities.

Question 23

Where did the assumption come from?

Answer 23

Understanding how your dysfunctional assumptions were formed can help you to get a distance from them and prevent any tendency for self blame. ​

Think of childhood memories, family sayings, messages from your upbringing. (Don’t be selfish).​

Example:​

A woman recalled that as a child she believed that her survival depended upon ensuring that she, at no time displeased her mother. Re-evaluation as an adult showed her that these conditions no longer applied. She could modify her assumption that she must please others to avoid rejection or worse

Question 24

What would be a more moderate alternative, one that would confer the advantages of the dysfunctional assumption without its disadvantages?

Answer 24

Formulating an alternative, which takes account of shades of grey, will prepare a person to deal more effectively with those situations, which currently, in terms of their original assumption, would count as failures and lead to depression.​

Question 25

Behavioral Experiments can modify assumptions

Answer 25

Because dysfunctional assumptions are usually long-standing it is unrealistic to expect change to occur overnight. Behavioral experiments can work to chip away at assumptions. ​

Experiments may include:​

Gathering information about other people’s standards (rather than assuming one’s own are universal).​

Observing what other people do (evidence of different standards).​

Acting against assumptions and observing the consequences.

Important to remind the client to – “Expect anxiety initially, but stick with it and give yourself the opportunity to learn that the consequence(s) you fear, may not happen. You can cope.”​