CR

Question 1

Introduction

Answer 1

• Cognitions are central to understanding problem maintenance
o Beck (1976)
o Berenbaum et al (2007)
• Cognitive biases or unhelpful thinking styles impact mood and may drive behaviours e.g. avoidance, and lead to cycles that maintain the problem
• Barlow, 2002

Question 2

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Answer 2

• This technique aims to break the cycle
• May be helpful to help the patient to identify the unhelpful thinking style as this can then be used to identify when behaviour is being driven by a particular thinking style.
o 4 categories of unhelpful thinking styles (Papworth and Marrinan, 2018)
 Self-reproach (taking things personal; self-criticism; name calling)
 Intuitive thinking (mind reading; negative fortune telling; emotional reasoning)
 Selective attention (overgeneralising; discounting positives; taking all responsibility; magnifying neg events)
 Extreme thinking (all or nothing; unrealistic standards; catastrophising)
• 3 stages of Thought challenging (Papworth and Marrinan, 2018)
o Orientate the client to the treatment
 Refer to formulations to illustrate the significance of their cognitions in maintaining mood
 Explain thoughts strongly affected by mood, which can further amplify the negativity of the thoughts if low mood or catastrophise them if anxious, further reinforce cycles

Question 3

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Answer 3

o Identify ‘hot’ thoughts
 Thoughts that are most associated with a negative alteration in mood.
 Can use a diary to identify these -describe the situation or trigger, thoughts and emotions. -helps the client identify situations and recognise patterns.
 Client must understand difference between thoughts and emotion. Thoughts = verbal commentary, reflect perception of events or self/ images Feelings = Emotional states -one-word descriptor.

Question 4

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Answer 4

o Evaluate and Challenge the ‘hot thoughts’
 Aim to develop balanced perspective
 Evidence that supports and contradicts hot thought
 Weighed up – worksheets can be useful for this e.g. the Judge.
 1. Determine which hot thought to tackle
 2. Create evidence to support it -MUST be factual and specific
 3. Create evidence against it
• (Greenberger and Padesky, 2015; Williams, 2014)
 4. Fresh perspective -weigh up evidence.
• May require practice to become proficient in thought challenging.
• Encourage - plan, where to keep materials/apps etc.

Question 5

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Answer 5

o When should thought challenging be introduced?
 Depression: Usually start with BA and then CR -increases in activity = increases in positive mood, can be difficult to shift cognitions if mood is low.
 Anxiety; Can be helpful prior to exposure or Behavioural experiments. Clients may be reluctant to carry out techniques, (Michie et al, 2011). Unlikely to be enough in treating A without additional exposure/B exp.

Question 6

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Answer 6

• Beck (1970, 1976), D’ZurilIa and Goldfried (1971), and Meichenbaum (1969, 1977) have developed variations of cognitive restructuring.
• These procedures have been effective treatments for clinical problems
o test anxiety (Meichenbaum, 1972),
o speech anxiety (Meichenbaum et al 1971; Fremouw & Zitter, 1978),
o depression (Rush et al, 1977).
o anger (Novaco, 1975),
o Bryant et al, 1998
 E- Longmore & Worrell (2007)

Question 7

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Answer 7

• Attempting to challenge entrenched beliefs
o Particularly with depression thoughts may be trenched – often lack capability to restructure these within LIPI
o 3 levels of cognition (Beck et al, 1979)
 Core beliefs – deepest level, enduring attitudes due to early experiences
 Assumptions/rules for living – guided principles, influence interactions, usually one thing is conditional upon another. Shaped by core beliefs -mental rule book for living (Beck, 1976)
 NATs – habitually pop into someone’s mind, arise from core beliefs and rules but are more specific, reflect appraisals of a situation.
o CR focuses on NATs (Kinsella and Garland, 2008)

Question 8

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Answer 8

• Challenging thoughts leads to limited change
o May have limited change in their belief rating after the thought is challenged, important to recognise small shifts are helpful =sense of relief and serve to demonstrate change is possible
o E- check if they are suitable thoughts, not a core belief
o E- are thoughts questions? Greer et al (2010)
o E- (Papworth and Marrinan, 2018)

Question 9

Conclusion

Answer 9

• CR can be used when cognitions are maintaining a client’s mood.
• Mixed evidence for its effectiveness
• Having awareness of the possible difficulties can help increase effectiveness