Cognitive Bx Therapies Flashcards
Beck’s CBT
-developed originally for depression
-EBP for bipolar d/o, generalized anxiety disorder, anorexia, bulimia, schizophrenia, OCD, PTSD
Psychological disturbances according to CBT
-due to maladaptive cog schemas, automatic thoughts, & cognitive distortions
Cognitive schemas
core beliefs developed during childhood
-result of experience and biological factors (ex bio reactivity to stress)
-enduring
-maladaptive or adaptive
-revealed in automatic thoughts
Cognitive profiles
-different disorders associated with different maladaptive schemas
Depression according to CBT
-negative beliefs about self, world, and the future
Automatic thoughts
-verbal self-statements or mental images that come to mind spontaneously when triggered by circumstances & intercede between an event or stimulus and emotional or behavioral reactions
-can be positive or negative
Negative automatic thoughts
-distortion of reality, emotional distress, and/or interfere with the pursuit of life goals
-can contribute to psychological distress
Dysfunctional Thought Record
-used to record negative thoughts outside of therapy
-record event/situation that led to unpleasant emotion, automatic thoughts that precede the emotion, type of emotion, intensity on scale from 1-100, alternative rational response to automatic thought, and outcome (emotion & any change in bx elicited by rational response)
Cognitive Distortions
-systematic errors in reasoning that effect thinking when a stressful situation triggers a dysfunctional schema that in turn affects the content of automatic thoughts
Common cognitive distortions
-arbitrary inference
-selective abstraction
-dichotomous thinking
-personalization
-emotional reasoning
Arbitrary inference
-drawing negative conclusions without any supporting evidence
Selective Abstraction
-paying attention to and exaggerating a minor negative detail of a situation while ignoring other aspects of the situation
Dichotomous thinking
-classify things into one of two extremes
Ex. Success or failure
Personalization
- concluding someone’s actions cause an external event without evidence for that conclusion
Emotional reasoning
- reliance on one’s emotional state to draw conclusions about self, others, & situations.
Goals of CBT
- correct faulty information processing
- help patients modify assumptions that maintain maladaptive behaviors and emotions
CBT therapist approach
- an active structured approach
- use a variety of cognitive and behavioral techniques
Cognitive techniques used in CBT
- redefining the problem
- reattribution
- decatastrophizing
Behavioral techniques used in CBT
- behavioral rehearsal
- exposure therapy
- guided imagery
Essential feature of CBT
- reliance on collaborative empiricism
- Socratic dialogue
Collaborative empiricism
- collaborative therapeutic alliance between the therapist and client
,- work as co-investigators and examine the evidence to accept support reevaluate or reject the client’s thoughts, assumptions, intentions and beliefs
Socratic dialogue
- involves asking the client questions that are designed to clarify and define the client’s problems
-identify the thoughts and assumptions that I underline those problems
- and evaluate the consequences. Maintaining maladaptive thoughts and assumptions
Rational emotive behavior therapy
-Ellis
- attribute psychological disturbances to irrational beliefs
Irrational beliefs
-rebt
- absolute or dogmatic
- expressed in the forms of mass, shoulds, odds, have tos
- lead to negative emotions at largely interfere with goal pursuit and attainment
A-B-C-D-E
-REBT
- explain psychological disturbance and the process of change in therapy
A
- activating event
B
- the clients irrational beliefs about that event
C
- the emotional or behavioral consequence of that belief
D
- the therapist use of techniques that dispute the client’s irrational belief
E
- the effects of these techniques
- the replacement of their rational beliefs with the more rational one
Practitioners of REBT
- use a variety of cognitive, behavioral, and emotive techniques
- active disputation of irrational beliefs
- rational-emotive imagery
- systematic desensitization
- skills training
Research on REBT
- It’s an effective treatment for depression, anxiety, conduct problems, anger, and several other disorders and conditions
Self-instructional training
-Miechenbaum
- initially developed to teach problem solving skills to kids with high levels of impulsivity
- five stages
Five stages of self-instructional training
- cognitive modeling stage
- over external guidance stage
- over itself guidance stage
- faded overt guidance stage
- cover self-instruction stage
Cognitive modeling stage
- self-instructional training
-stage 1
- children observe a model perform a task while the model verbalizes instructions aloud
Overt external guidance stage
-stage 2
Self-instructional training
children perform the same task while the model verbalizes instructions
Overt self-guidance stage
Self-instruction training
Stage 3
- children perform the task while verbalizing the instructions allowed to themselves
Faded over guidance stage
- self-instructional training
- stage 4
- children perform the task while whispering the instructions
Covert self-instruction stage
Self-instructional training
Stage 5
- children perform the task while repeating the instructions subvocally
Instructions in self -instructional training
- address 4 skills
- identifying the nature of the task
- focusing attention on the task and behaviors needed to complete it
- providing self reinforcement that sustains appropriate behavior
- evaluating performance and correcting errors
Stress inoculation training
-miechenbaum
- focuses on improving the ability for clients to deal with ongoing and future stressful situations by a teaching effective coping skills
- three phases
Three phases of stress inoculation training
- conceptualization/ education phase
- skills acquisition phase & consolidation phase
- application and follow through phase
Conceptualization/ education phase
- stage one
- stress inoculation training
- clients are provided with information about stress and it’s effects
- encouraged to view view stressful situations as problems to be solved
Skills acquisition phase and consolidation phase
Stress inoculation training
- stage 2
- learn a variety of cognitive and behavioral coping strategies which may include relaxation, self-instruction, and problem solving
Application and follow through phase
Stress inoculation training
Stage 3
- new use newly acquired coping skills first and imagined and role playing situations and then in real life encounters
Acceptance and commitment therapy
- based on the assumptions that psychological pain is both universal and normal, part of what makes us human
- psychological and flexibility causes psychological problems and is characterized by rigid dominance of psychological reactions chosen over values and contingencies and guiding action
Pain in ACT
- clean pain
- dirty pain
Clean pain
ACT
- also known as clean discomfort
- refers to natural levels of physical and psychological discomfort that are inevitable and cannot be controlled
Dirty pain
ACT
- ALSO KNOWN AS DIRTY DISCOMFORT
- emotional suffering that is caused by attempts to control or resist clean pain
Goal of ACT
- increase psychological flexibility by addressing the six core processes that foster acceptance, mindfulness, commitment, and behavior changed and counter the process that contributes to psychological inflexibility
Experiential acceptance
ACT
- COUNTERS EXPERIENTIAL AVOIDANCE AND IS THE ACTIVE AND AWARE EMBRACE OF PRIVATE EXPERIENCES WITHOUT UNNECESSARY ATTEMPTS TO CHANGE THEIR FREQUENCY OR FORM
Cognitive diffusion
ACT
- counters cognitive fusion
- ability to distance one cell from one’s thoughts and feelings and view them as experiences rather than reality
Awareness of self as context
ACT
- counters attachment to the conceptualized self
- the ability to view oneself as a context in which one’s thoughts and feelings occur rather than the thoughts and feelings themselves
Values-based actions
ACT
- COUNTER UNCLEAR, COMPLIANT, OR AVOIDED MOTIVES
- depend on the ability to use ones freely chosen values to guide one’s behaviors
Committed action
ACT
- COUNTERS IN ACTION, IMPULSIVITY, AND AVOIDANT PERSISTENCE
- The commitment to continue to act in ways consistent with one’s values in the future, even when faced with obstacles
ACT interventions
- Target the six processes and include metaphors, mindfulness strategies and experiential exercises
What disorders is a CT evidence-based treatment for?
- chronic pain
- psychosis
- depression
- anxiety disorders
-OCD
Mindfulness
- the moment to moment awareness of one’s experiences without judgment
Mindfulness
- has been incorporated into several therapeutic approaches including act and DBT
- core strategy of mindfulness-based stress reduction and mindfulness base cognitive therapy
MBSR
– mindfulness space stress reduction
- was originally developed to make mindfulness meditation available and accessible, and a Western medical setting while remaining true to the essence of the Buddhist teaching
- used to help people cope with stress, pain, and illness
- consists of eight session group program which focuses on teaching participants. Several mindfulness meditation practices including breathing, yoga, and sitting and walking meditation
MBCT
Mindfulness space cognitive therapy
- combines elements of MBSR and CBT
- originally developed as a method for treating recurrent depression
- effective treatment for depression, anxiety, chronic pain and insomnia
Primary goals of MBCT
- enable clients to become self-aware so that they can learn to decent her from distressing, thoughts, feelings, body sensations and behaviors
Interventions of MBCT
- incorporate psycho education, mindfulness meditation practice, and cognitive behavioral techniques
- eight session group program
Research on MBCT
- effective for treating psychological disorders and physical/ medical conditions
- more effective for psychological disorders, especially depression, anxiety and stress
- no clear consensus about the mechanisms that are responsible for its effectiveness, but several mechanisms have been proposed
Mechanisms proposed for the effectiveness of MBCT
- attention regulation, emotion regulation, body awareness and decentering
Body awareness
- MBCT
- the awareness of one’s internal states
Decentering
Mbct
- reperceiving
- the ability to separate one’s thoughts and emotions and view them objectively as transient mental events
Cognitive behavioral therapy for suicide intervention
- several versions
- cognitive therapy for suicide prevention (CT-SP)
- brief cognitive therapy for suicide prevention (BCBT)
- cognitive behavioral therapy for suicide prevention (CBT-SP)
CT-SP
- was designed to prevent suicide attempts by adults who recently attempted suicide
BC BT
- developed for active duty members of the military
- incorporates many of the elements of CT-SP
CT-SP and BCBT
- consist of three phases that focus on emotion regulation, cognitive flexibility, and relapse prevention
CBT-SP
- developed for adolescents who recently attempted suicide and combines elements of CBT and DBT
- acute and continuation phases that include individual and family sessions
Acute phases of CBT-SP
- consist of chain analysis, safety planning, psycho education, addressing reasons for living, and case conceptualization
Chain analysis
- identification of events that led to the suicide attempt
Continuation phase
- CBT-SP
- focuses on generalizing and consolidating behaviors and cognitive skills and relapse prevention
Safety planning intervention
- essential component of cognitive behavioral therapy for suicide prevention
- can be used as a component of CBT or standalone intervention in emergency departments or other emergency situations or any other time when long-term care is not feasible or available
Six steps of safety planning intervention
- start with the use of internal strategies and switch to external strategies when internal strategies do not work
- Recognize the warning signs of imminent suicidal crisis
- Use internal coping strategies
- Utilizing social contracts as a means of distraction or support
- Contacting family or friends that may help resolve the crisis
- Contacting mental health professionals or agencies
- Reducing access to legal means
Research on SPI
- SPI and other safety plans are useful for reducing suicidality
- no empirical evidence supporting the use of no suicide contracts
Effectiveness of cognitive behavioral therapies for suicide prevention
- reduce suicidal ideations and suicide attempts, feelings of hopelessness and depression
These benefits occur regardless of the person’s gender, severity of suicidal ideation, and the number of suicide attempts
