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PFoMH > Cognitive therapy in principle and in practice > Flashcards

Cognitive therapy in principle and in practice Flashcards

1
Q

What are the three aims of cognitive therapy?

A
  1. Adress maladaptive content
    - NATs, cognitive distorsions, behavioural responses, schemas
  2. Positive therapeutic outcome
    - measured with symptom reduction
  3. Improve real life function
    - provide new insights and skills
    - reduce risk of further episodes
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2
Q

What is the difference between what most people often assume, and what clients may believe?

A

> People often assume that how we feel is governed by specific events or the general situation of our lives, past and present

> Clients may believe nothing can be done to control events or change their situation

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3
Q

What may a simple causal model (event-feelings) lead to in a client?

A
  • Distressing feelings of hopelessness and powerlessness

- Feeling of being trapped

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4
Q

What does the cognitive therapist do at the beginning of treatment?

A

Explain basic cognitive model, building over the course of therapy

  • emphasise the interrelationships between thoughts, feelings, and behaviours
  • > rationale for adjustment
  • offer element of control back to patients
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5
Q

What is the evidence of the effect of explaining the basic cognitive model to clients at the beginning of treatment?

A

People who understand and apply the model to their situation tend to:

  • engage more in the therapy process
  • have better outcomes
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6
Q

What is the principle of socialising the client to the cognitive model?

A

Explaining, understanding, and appreciating the model early in therapy
- using real examples that the client has described during an initial assessment

e.g. using a blank hot cross bun model, guiding the client to fill in the parts

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7
Q

What are the 12 fundamental characteristics of cognitive therapy?

A
  1. Explicit cognitive model
  2. Individual conceptualisation (‘formulation’)
  3. Collaborative
  4. Fixed-term
  5. Structured, session agenda
    - meeting weekly, 12-20 sessions in total
  6. ‘Here-and-now’
    - not focused on aetiology of problem
  7. Problem focused
    - practical approach
  8. Skills based
  9. Scientific approach
  10. Socratic dialogue
  11. Measurement and recording
    - from clients on their thoughts and feelings
  12. Homework
    - crucial to therapy outcomes
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8
Q

What is the importance of the collaborative alliance in cognitive therapy?

A

Important predictor of therapy outcome

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9
Q

What makes cognitive therapy skills based?

A

Work around understanding and modifying

  • the schema
  • and core beliefs shaping client’s thinking and behaviour
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10
Q

What are the steps of the scientific approach in cognitive therapy?

A
  1. Best guess hypothesis
    - based on available evidence on individual’s conceptualisation
  2. Look for evidence that client’s model is accurate
    - by guiding them
  3. Client encouraged to test accuracy of perceptions and expectations
    - identifying and challenging cognitive distorsions
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11
Q

What is the socratic dialogue used in cognitive therapy?

A

Pose questions to clients so they find the answers themselves

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12
Q

What does the sessions agenda in cognitive therapy refer to?

A

The purpose of a session is set out in advance, with summary at the end, and an outline for next session

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13
Q

What are the 6 techniques and tools that underline cognitive therapy and CBT?

A
  1. Understanding and recognising cognitive distorsions
  2. Recognising and identifying automatic thoughts and cognitive distorsions
  3. Challenging and replacing NATs
  4. Behavioural experiments
  5. Identifying core beliefs (schemas)
  6. Changing core beliefs
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14
Q

How are cognitive distorsions understood and recognised in cognitive therapy?

A

Help to recognise existence of biases and distortions

  • Examples and descriptions
  • Quizzes
  • In-session prompts

e.g. “Remember how we talked about how we can sometimes make mistakes in how we think? What sort of thinking errors might you have been making?”

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15
Q

What is the first skilled to be learned in cognitive therapy?

A

Separating out the NATs and connecting them to how we feel

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16
Q

How can you make the “thoughts and feeling connection” and recognise NATs in cognitive therapy?

A

Thought record:

  • clients are asked to write down examples of times when they felt upset
  • not at every instance, but enough to provide evidence for discussion
  • 3 columns: Situation, Feeling and emotion scale (0-100), Automatic thoughts
17
Q

What happens with the practice of thought record in cognitive therapy?

A

> Patient learns how th thoughts make sense in connecting the situation to the feeling

> Often, themes emerge: “hot thoughts”
- generalised and most directly related to the experience of negative emotion

18
Q

What is the purpose of helping clients to identify hot thoughts in cognitive therapy?

A

> Recognising them as they happen can be easier than monitoring the full range of thoughts

> If we recognise the hot thoughts at the time, we’re better able to del with them quickly AND prevent the vicious cycle forming

19
Q

How do you find evidence for alternative thinking in cognitive therapy?

A

> 5-column thought record (adding 2 to the previous ones)

  • Situation
  • Feeling or emotion scale (0-100)
  • Automatic thoughts
  • Evidence that supports the hot thought
  • Evidence that does not support the hot thought

> Gathering new evidence

  • surveys
  • behavioural experiments
20
Q

What characterises the column of evidence supporting the hot thought, in the patient’s thought record?

A

> Usually what the client finds easy to complete

> Facilitated by negative self schema
- it will have biassed their perceptions and interpretations of events at the time and subsequent memories of them

21
Q

What characterises the column of evidence not supporting the hot thought, in the patient’s thought record?

A

> More difficult to fill in, typically at the beginning of therapy

> With cognitive distortions, alternative evidence is not looked for or tends to be minimized

22
Q

When does the client ideally fill in the columns of the thought record?

A

Completed by the client as soon as possible after upsetting event
- reviewed in next session with the therapist

23
Q

Why does the therapist use prompts in a session?

A

To help client start to adjust their mental filters to look for contradictory evidence
-> encouraging to be suspicious of our own thoughts and start the process of questioning them

  • presented to the client as a skill that develops in practice
24
Q

What are the steps to work the client’s thought records, to find alternative explanations?

A
  1. Record details of the situation where negative emotion was experienced (column 1)
  2. Describe emotion and rate its intensity (column 2)
  3. Describe NATs (column 3)
  4. Identify ‘hot thought’
  5. Suggest evidence that supports the hot-thought (column 4)
  6. Suggest evidence that does not support the hot-thought (column 5)
  7. Find alternative or balancing thought
  8. Ask client to rate belief in alternative thought
  9. Re-rate mood and feelings AND add any new feelings
25
Q

What is the influence of the situations the client is avoiding?

A
  • Reinforce maladaptive behaviour
  • Reinforce negative emotions
  • Prevent gathering of new information to challenge the client’s beliefs
26
Q

What can the therapist do when the client is avoiding situations?

A

Proactive approach: help clients gather new evidence

  • clients can test how accurate or useful certain thoughts and beliefs are (test hypotheses)
  • without having to wait for a situation to arise in normal course their day
  • > Surveys: straight forward
  • > Behavioural experiments: complex, but potentially more powerful
27
Q

How do you test client’s hypotheses with survey evidence in cognitive therapy?

A

Survey: get opinions or feedback on hot thought or core beliefs
- client carries out a survey with a number of people

  • client may still discount alternative evidence from survey, but it is harder to ignore
28
Q

In which case a therapist shouldn’t use surveys with the client to gather alternative evidence?

A

When the client’s negative beliefs are likely to be supported

-> use with caution

29
Q

What characterises a CBT behavioural experiment?

A

> Test predictions against actual outcomes

  • do something different than in the real world
  • observe outcome -> new information

> Experiments used selectively and carefully
- may involve only a single exposure or test

> Information obtained is used to support further aspects of the treatment
- used in a constructive way in therapy

> Careful planning
- experiments do not always work out well

> Experiment should not be likely to produce unwanted outcome that is too difficult to the client

30
Q

What are the 4 parts of a behavioural experiment in cognitive therapy?

A

Before experiment:

  1. Prediction
    - client writes predictions
    - rates his belief in the prediction
  2. Experiment
    - client specifies nature of the experiment
    - therapist helps in writing the protocol (action plan)

After experiment:
3. Outcome and reflection

  1. Learning and re-rating belief in original prediction
31
Q

What is the schema for Beck?

A

The set of core beliefs developed and held by the individual, that underpins their views about themselves, the world and the future (cognitive triad)

  • the schema is introduced later in the course of therapy
32
Q

What is the difference between the client’s surface thought and his/her core beliefs?

A

> Surface thought is accessible to consciousness

> Core beliefs shaping the schema may be hidden

-> thoughts may reflect the beliefs that may not be identical

33
Q

What is the principle of the download arrow technique?

A

Technique to identify and address client’s core beliefs

> Starting with a particular NAT and posing questions encouraging reflection on its meaning and significance to the client

> Can very rapidly lead to a statement more clearly representing a core belief held by the client
- a topic to address in therapy

34
Q

What are intermediate beliefs?

A

Between core beliefs and automatic surface thoughts
- expectations of ourselves, others, the world

-> idiosyncratic rules for living

35
Q

What is the process to modify maladaptive cognitive processes (NATs, assumptions, core beliefs)?

A
  1. Identify and recognise assumptions and beliefs
  2. Understanding their links to feelings and behaviour
  3. Identifying evidence for and against
  4. Identifying and strengthening alternative assumptions and beliefs
  5. Gathering new evidence
36
Q

How does the focus on the client’s thoughts, assumptions and beliefs change in therapy

A

Over the course of therapy, less time is spent on the surface thoughts, and more time is spent on the client’s assumptions and beliefs

PFoMH (18 decks)

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