Exam 2

Question 1

Acceptance

Answer 1

A key theme or feature of third-generation behavior therapies that involves embracing one’s current experience without judgment or recognizing what is instead of thinking about what should be.

Question 2

Mindfulness

Answer 2

A key theme or feature of third-generation behavior therapies that involves being aware of one’s present thoughts, emotions, and behaviors without judging them.

Question 3

Cognitive Fusion

Answer 3

A principle of psychological inflexibility in Acceptance and Commitment Therapy (ACT) that involves over-identifying or believing in one’s thoughts. For example, if one had the thought they were a bad mother and they believed that thought to be true, they are demonstrating cognitive fusion.

Question 4

Experiential avoidance

Answer 4

A principle of psychological inflexibility in Acceptance and Commitment Therapy (ACT) that involves the behavioral tendency to escape or avoid unwanted or unpleasant thoughts, emotions, or experiences. ACT would argue that experiential avoidance can contribute to suffering because our fear of unpleasantness is reinforced.

Question 5

Decentering

Answer 5

A goal of Mindfulness-Based Cognitive Therapy which involves seeing one’s thoughts as simply thoughts and not truths. Decentering one’s identity from one’s thoughts can help avoid the ruminative patterns that can lead to the recurrence of major depressive episodes.

Question 6

Describe the 3 generations of CBT

Answer 6

1st-generation behavior therapies focused on controlling environmental antecedents and consequences to change behavior. Examples: contingency management, stimulus-response, token economies, exposure therapy

2nd-generation behavior therapies recognized the importance of cognitions in changing behavior. Examples: cognitive restructuring, problem-solving

3rd-generation behavior therapies focus on the idea that some suffering is inevitable and rather than attempting to change the environment or our thoughts, we must learn to accept some psychological discomfort. Examples: ACT, DBT, MBCT

Question 7

What are the core themes of 3rd-generation behavioral therapies?

Answer 7

Expanded view of psychological health (some psychological discomfort is unavoidable - focus on the function of the problem rather than the form or frequency), Acceptance, Mindfulness, Creating a life consistent with one’s values

Question 8

Describe ACT and its basic tenents.

Answer 8

Acceptance and Commitment Therapy is a third-generation behavior therapy that focuses on increasing psychological flexibility by (1) decreasing cognitive fusion, (2) decreasing experiential avoidance, (3) increasing mindful contact with the present moment, and (4) clarifying the client’s goals and increasing behavior towards those goals.

Question 9

Describe DBT and its basic tenents.

Answer 9

Dialectical Behavior Therapy is a third-generation behavior therapy that focuses on both validating and accepting a client’s experience and helping them develop strategies or problem-solving behaviors that lead to positive changes in their lives. DBT focuses on:

(1) creating mindfulness by helping clients use their wise mind (the intersection of their rational and intuitive or emotional mind),
(2) developing interpersonal effectiveness skills,
(3) emotion-regulation skills, and
(4) increasing distress tolerance.

Question 10

Describe MBCT and its basic tenents.

Answer 10

The goal of Mindfulness-Based Cognitive Therapy is to prevent ruminative patterns of thinking and behaving by decentering or helping clients see thoughts as simply thoughts and not statements of fact. It involves learning mindfulness skills and increasing self-awareness of negative thoughts and feelings.

Question 11

Outcome vs. Process Research

Answer 11

Outcome research measures the effectiveness of a specific treatment on a dependent variable of interest. It answers the question, “does this treatment work?”

Process research tries to assess why the treatment works or the specific mechanism(s) of change. It seeks to answer the question, “how does this treatment work?”

Question 12

Case Study

Answer 12

A type of outcome research design that assesses one subject and includes a detailed description of a specific client and the treatment of that client.

Question 13

Multiple Baseline Study

Answer 13

A type of outcome research design in which the start of treatment is staggered in order to control for confounding variables. They can assess the impact of treatment across multiple target behaviors, across multiple clients, or across multiple settings.

Question 14

Reversal Study

Answer 14

ABAB Design; a type of outcome research design in which a baseline is assessed (A), the treatment is introduced (B), then the treatment is removed (A), and reintroduced again (B). If the dependent variable changes with the introduction of the treatment and then changes back with the return to baseline, this provides strong evidence of a treatment effect.

Question 15

Control Group

Answer 15

In an experimental design, a control group who either receives no treatment, a placebo, is waitlisted, or is given an alternative treatment, is compared to an experimental group that receives the treatment of interest (independent variable). This allows researchers to determine if there is a causal relationship between the treatment and the dependent variable(s) of interest.

Question 16

Efficacy vs. Effectiveness

Answer 16

Efficacy is a term used to assess whether an independent variable or treatment significantly changes a dependent variable in a controlled experiment. Effectiveness is a term that describes how well a treatment or independent variable works in a real-world setting and takes into account how easy the treatment is to use and potential side effects.

Question 17

Clinical vs. Statistical Significance

Answer 17

Statistical significance measures the relationship between two variables in a statistical analysis. Clinical significance assesses how meaningful a change is to an actual client’s life. A treatment may have a statistically significant impact on a dependent variable in an experiment, but may not have clinical significance.

Question 18

Transfer & Generalizability

Answer 18

Transfer refers to the phenomenon in which what a client learns in therapy transfers to their everyday life. Generalizability refers to the phenomenon in which therapeutic effects occur in areas of a client’s life not specifically targeted in therapy.

Question 19

Meta-analysis

Answer 19

A type of statistical analysis in which the results from several studies are compared and analyzed. Allows a more comprehensive view of the effectiveness of a treatment.

Question 20

Dismantling study

Answer 20

A type of process research that attempts to isolate specific aspects of a treatment in order to determine their effect on a dependent variable of interest. This allows researchers to identify which components or combination of components is responsible for the change in the dependent variable.

Question 21

Iatrogenic effects

Answer 21

Harmful or problematic effects of therapy or specific treatment that clients may experience. For example, therapists who deliver DID-oriented therapy have been shown to induce new alters in their clients.

Question 22

EST (Empirically-supported treatment)

Answer 22

Interventions that have been found to be efficacious for one or more psychological conditions. Treatments must meet specific APA criteria and be manualized in order to be considered ESTs.

Question 23

What are the benefits and limitations of Case Studies?

Answer 23

Benefits: allow you to document success of a specific tx, describe a new tx procedure, demonstrate a novel application of a tx, implement with a new or specific population of individuals

Limitations: can’t generalize, can’t determine causal relationships between tx and DVs

Question 24

What are the benefits and limitations of reversal studies?

Answer 24

Benefits: the reversal design allows you better control over confounding variables, can be more certain the treatment is what is impacting the DVs

Limitations: can’t generalize to general population, not useful if DVs aren’t maintained by external factors, withdrawing tx can be unethical, and if tx leads to skill development the removal of tx is not as impactful or easy to measure with this design

Question 25

What are the benefits and limitations of multiple baseline studies?

Answer 25

Benefits: different baseline lengths allow for more control over confounding variables, several types of baselines it can apply to (across target bx, clients, settings), useful when reversal studies aren’t feasible

Limitations: not generalizable

Question 26

Why would someone want to do an experimental design study instead of a case/reversal/multiple baseline study?

Answer 26

To determine causal relationships between variables. Experiments utilize control groups as comparisons which controls for confounding variables. If you want to establish a treatment as an empirically supported tx, you need to use an experimental design .

Question 27

How do you determine if a therapy is effective?

Answer 27

Several criteria inform effectiveness including:

• efficacy (demonstrated through research)
• effectiveness (demonstrated through meaningful change in real-world conditions for clients
• meaningfulness of change which includes both clinical and statistical significance
• Transfer from therapy to everyday settings and generalization across behaviors
• durability of change over time
• acceptability of the tx for both client and therapist

Question 28

What is a PHT and why do people continue to use them?

Answer 28

A PHT is a potentially harmful therapy that has demonstrated harmful psychological or physical effects in clients or others, those effects are enduring and have been replicated by independent research teams. People continue to use them because change is hard, there may be instances of individual improvement, clients may be satisfied, or there is an overestimation of negative impact when no tx is provided.

Question 29

What is an EST and what are the criteria for being an EST?

Answer 29

An EST is an empirically supported treatment as designated by Division 12 of the American Psychological Association. They are interventions that have been found to be efficacious for one or more psychological conditions and have demonstrated:
-superiority to a placebo in two or more methodologically rigorous studies
OR
-equivalent to a well-established tx in several rigorous or independently controlled studies,
OR
-efficacious in a large series of single case-controlled studies (>9)
-manualized

Question 30

Yerkes-Dodson curve and anxiety

Answer 30

The Yerkes-Dodson curve looks out the relationship between stress and performance. It demonstrates that low amounts of stress/anxiety actually inhibit individual performance, while moderate amounts lead to peak performance, and high amounts again lead to lower performance levels, exhaustion, and burnout.

Question 31

2 paradigms of exposure

Answer 31

Brief/Graduated and Prolonged/Intense

Question 32

In vivo vs. imaginal exposure

Answer 32

In vivo = in real life, actual exposure

Imaginal = in one’s mind, no direct contact with source of fear

Question 33

Response prevention

Answer 33

An added feature or component of some exposure therapies in which a person’s typical cognitive/behavioral responses to exposure to a feared stimulus are prevented. Typical bx responses include avoidance, checking, counting, dependent others

Used often to treat OCD

Question 34

Competing response

Answer 34

An added feature or component of exposure therapy in which an individual uses a response such as progressive muscle relaxation to compete with their typical fear/anxiety response when exposed to a feared stimuli. A feature of systematic desensitization by reciprocal inhibition.

Question 35

Systematic desensitization

Answer 35

A type of exposure therapy developed by Joseph Wolpe in which a person is (1) taught a competing response such as PMR, (2) develops a fear hierarchy, (3) is gradually exposed to fear stimuli on hierarchy while engaging in competing response, and (4) moves up the fear hierarchy when exposure leads to no anxiety

Question 36

Flooding

Answer 36

A type of exposure therapy in which an individual is exposed to a feared stimulus for a prolonged period of time to provoke intense anxiety

Question 37

Interoceptive exposure

Answer 37

A type of exposure therapy used for panic disorders typically in which a person’s anxiety is centered on the physiological experience of fear (increased heart rate, shortness of breath, dizziness). The client exposure includes engaging in some activity that induces an anxious-feeling state such as breathing through a straw of spinning in a chair

Question 38

Fear hierarchy

Answer 38

A step in graduated/brief exposure therapies in which a person’s feared stimuli are broken down into components and ordered in terms of how much subjective distress they produce (SUDs). Then, typically a client will be exposed to each item starting with the one that induces the least amount of fear. Once they conquer that item or their distress is greatly reduced upon exposure, they move to the next item on their list.

Question 39

Cue exposure

Answer 39

A type of exposure therapy with response prevention that focuses on the specific environmental cues that provoke problem behaviors like substance use or disordered eating and then are prevented from using/eating. Gradually, the therapy hopes to break the association between the environmental cues and problem behaviors associated. Clients learn they can manage the cues without their typical responses.

Question 40

SUDS rating

Answer 40

Subjective Units of Distress - used to track anxiety levels during exposure therapy and to order feared stimuli in a fear hierarchy.

Question 41

What is the rationale for exposure?

Answer 41

• Enhance more adaptive processing of fears by helping clients face their fear in a safe environment
• Clients learn they can tolerate distress and their expectations about feared stimuli may be inaccurate
• Allows clients to gain more control over fear and stop restricting their lives around it

Question 42

What are the central features of exposure?

Answer 42

• Clients facing their fears in controlled, safe environments
• Induction of anxiety is key - long enough and strong enough that it starts to dissipate

Question 43

What are the criticisms of exposure therapy?

Answer 43

-Critics view exposure as “torture” or producing unnecessary distress
-high drop out rates, especially for flooding
-

Question 44

How is Mowrer’s Two-Factor Theory applied to fear networks?

Answer 44

The physiological and cognitive responses to feared stimuli are developed through respondent conditioning. For example, an individual who is attacked by a dog may come to have a fear response when cued by stimuli that are paired with the attack such as seeing a dog on tv, hearing a dog bark, or encountering an animal that is not a dog. Those aspects of the dog (US) are paired with a fear response due to the trauma (UR) and create a CR. Then, operant conditioning maintains or strengthens those fear structures as individuals avoid the feared stimuli and are negatively reinforced for doing so.

Question 45

Describe the 3 components of the Integrative/Emotional Processing theory of anxiety fear. Give an example using trauma.

Answer 45

The I/E theory of anxiety claims that when something traumatic happens, individuals develop a mental representation of the event called a fear structure which includes a stimuli, their cognitions about the stimuli, and their responses to the stimuli (bx emotional, physiological). Each component impacts and reinforces the other. A person who is trapped in their bathroom during a tornado may start to develop thoughts about how dangerous and deadly storms are, how little time someone has to find safety. They may feel physiologically aroused when dark clouds are present and avoid using the room they were trapped in during the storm itself.

Question 46

How do you decide which type of exposure to use with a client?

Answer 46

• type of anxiety or disorder would help dictate, certain types of exposure therapy work better for certain maladies (panic disorder & interoceptive exposure; cue response and substance use; exposure with response prevention and OCD)
• therapist would also work collaboratively with client to understand which approach might work best based on individual features of the feared stimuli, cognitions and behaviors surrounding stimuli
• practical considerations would determine certain aspects of the therapy as well. For example, in vivo exposure to fear of flying is expensive and time-consuming so imaginal may be more realistic

Question 47

Self-reinforcement

Answer 47

A key component of self-management that involves finding consequences for behaviors that are reinforcing in order to make adaptive or positive changes or increase performance in a specific area.

Question 48

Learned helplessness vs. laziness

Answer 48

Two types of problems self-management can address that are caused by non-contingent reinforcement.

Learned helplessness can occur when someone is exposed to frequent, uncontrollable punishment no matter what they do. This produces apathy, passivity, and even depression.

Learned laziness can occur when someone is exposed to frequent non-contingent positive reinforcement. This can produce apathy, passivity, and lack of motivation.

Question 49

Controlled vs. controlling behavior

Answer 49

Controlled behavior is something we want to change or a target behavior.

Controlling behaviors are behaviors that influence a controlled behavior.

Question 50

Live vs. Symbolic vs. Covert Modeling

Answer 50

All different types of models that can influence our behavior via vicarious punishment and reinforcement.

Live models are physically present

Symbolic models are models represented in media such as books, tv, or stories

Covert models are models we conjure using our imagination, imaging how someone would perform a behavior

Question 51

Coping vs. Mastery Models

Answer 51

Coping models are models that demonstrate fear or anxiety when performing some behavior, but cope with those feelings to successfully perform it. Commonly used to help with problems that stem from fear and anxiety.

Mastery models are models who successfully and skillfully perform a behavior from the start. Commonly used to help model targeted skills.

Question 52

Self-efficacy

Answer 52

A central component of Bandura’s Social Learning Theory, which is a judgment about whether or not one can perform a specific behavior. It is a belief in one’s ability to inability to perform. Self-efficacy is an important predictor of whether or not someone will initiate and maintain a behavior. It is situation-specific, not an overall trait.

Question 53

Assertiveness vs. Passivity vs. Aggressiveness

Answer 53

Assertiveness is a social skill or the ability to stand up for what one is entitled to without infringing upon the rights of others.

Passivity is when one lets others have their way, doesn’t stand up or speak up for one’s rights or express opinion.

Aggressiveness is when one demands to get their own way and does not care about the rights of others.

Question 54

Covert behavioral rehearsal

Answer 54

Imagining one performing a specific behavior successfully or thinking specific thoughts in response to a particular stimuli.

Question 55

Covert speech

Answer 55

A technique used in Meichenbaum’s Self-Instructional Training in which a person practices making self-efficacious statements when performing some targeted behavior. Helps in the acquisition and maintenance of learning new skills.

Question 56

Stressor vs. Stress

Answer 56

A stressor is an event or experience that elicits a response (trauma, storm, upcoming exam)_

Stress is our physiological and psychological reaction to a particular stressor.

Question 57

Describe the connection between controlled and controlling behaviors. Include definitions of both terms and an example of the process.

Answer 57

Controlled behaviors are behaviors that we want to target or change. For example, increasing the amount of exercise we do weekly. Controlling behaviors are behaviors that we can use to influence a target behavior. For example, we could put our workout clothes on right when we wake up to encourage exercise or give ourselves a reward for the successful completion of a workout.

Question 58

What are the 3 steps of the self-management process? Given an example of how you would use these steps to modify a behavior.

Answer 58

1. Stimulus-control - arranging or manipulating the conditions or environment to change a target behavior. Manipulating the antecedents. So, if I wanted to limit my caffeine intake, I could make sure not to keep caffeine in the house.
2. Performance of target - actually doing the behavior you want to change. For example, having just one cup of coffee during the course of a day.
3. Self-reinforcement - manipulating the consequences following a target behavior. Giving myself a reward for limiting my caffeine each day. For example, I could calculate the cost savings from having just one cup of coffee each week and use that money to buy something else I like.

Question 59

What are the 4 deficiencies that skills training addresses? Give an example of each and provide an example intervention for each.

Answer 59

1. Knowledge deficits - never learned to raise hand in class before speaking, teach person to raise hand
2. Proficiency deficits - never made to raise hand, practice raising hand before speaking
3. Discrimination deficits - doesn’t know when to raise hand and when not to raise hand, teach person to discriminate between classroom environments in which hand-raising is appropriate and other environments (home) - stimulus discrimination training
4. Motivation deficits - does not want to raise hand, reinforce hand-raising through positive reinforcement (sticker or praise every time it happens)

Question 60

Define social skills and discuss their importance.

Answer 60

Social skills are behaviors that are socially rewarding such as listening, smiling, turn-taking, eye contact, affect. They are important because improving one’s social skills can increase their self-esteem and the likelihood of acceptance by peers. Deficits in social skills can lead to negative consequences and create maladaptive patterns of thinking and behavior.

Question 61

How have social skills problems been conceptualized?

Answer 61

• Personality theory - social skills are a global personality trait, lack of social skills
• Social skills deficit - person never learned adaptive social skills, lack of knowledge
• Conditioned anxiety - emotional states inhibit social skills, don’t allow for performance
• Cognitive/evaluative - social skills exist but cognitions inhibit them
• Faulty discrimination - skills present but perceptions or what people pay attention to restrict correct performance of skills

Question 62

Provide a clinical example of a social skills problem and give an example of a social skills intervention to address it.

Answer 62

Social skills problems often show up in depression. Individuals become less motivated to engage socially and therefore experience less of the social rewards and opportunities for positive reinforcement of social behavior. In turn, they may develop conditions that confirm their self-assessment such as “I am not good at making friends.”

Lewisohn’s behavioral activation treatment can work to increase social engagement and the positive reinforcement that often accompanies such social behavior.

Question 63

Describe Assertiveness Skills Training.

Answer 63

Assertiveness skills training has the goal of increasing a person’s ability to stand up for their rights and voice their opinions w/o infringing upon others. It can involve role-playing, modeling, coaching, shaping, or cognitive components such as self-statements.

Question 64

Describe Meichenbaum’s model of Self-Instructional Training, including overall goals and 5 steps.

Answer 64

Meichenbaum’s Self-Instructional Training is a type of cognitive-behavioral therapy that aims to teach individuals more adaptive cognitive and behavioral coping responses to problematic situations. It is based on the premise that maladaptive thoughts mediate the knowledge and performance of a behavior. It teaches people to make positive self-statements when facing problematic situations.

5 Steps:
1. Cognitive modeling - therapist performs task while giving verbal instructions.

2. Cognitive participant modeling - client performs task while therapist gives verbal instructions.
3. Overt self-instructions - client performs task and gives verbal instructions.
4. Fading of overt self-instructions - client performs tasks while whispering instructions.
5. Covert self-instructions - client performs tasks while saying instructions to self

Question 65

Describe Problem-Solving Therapy, including the purpose and 6 steps. What are some of the factors that impact the effectiveness?

Answer 65

Problem-Solving Therapy is a type of cog-beh coping skills training used to treat an immediate problem and teach skills to deal with future problems.

Step 1 - problem identification and description

Step 2 - identify goals

Step 3 - generate solutions to achieve goals

Step 4 - decision-making (identify consequences of solutions)

Step 5 - implement solution

Step 6 - evaluate effectiveness

The effectiveness of the therapy depends on actually learning the problem-solving skills/steps, being able or motivated to apply them to one’s life, benefitting from the solution, actually solving the problem.

Question 66

What is Stress Inoculation Training? What are the 3 phases?

Answer 66

SIT is a type of cog-beh coping skills training used to help clients develop ways of managing stressful situations or experiences.

The 3 phases are:

1. Conceptualization - includes psychoeducation about stress and stressor, explanation of coping as a multistep process
2. Skills Acquisition - teach new skills like PMR, relaxation, cognitive restructuring, self-reinforcement
3. Application - simulations, and real stress-evoking events (gradually)
4. Application

Question 67

Token economy

Answer 67

A type of behavioral management system in which target behaviors are positively reinforced with tokens that hold real community or monetary value. Tokens can be exchanged for back-up reinforcers which include meaningful objects, privileges, or activities.

Question 68

Back-up reinforcers

Answer 68

Used in a token economy, back-up reinforcers are things or experiences that people find valuable and can trade their tokens for. Examples include privileges, gift certificates, activities, or other objects. Back-up reinforcers are most effective when they are decided on by the participants in the community.

Question 69

Individual, standard, and group contingency

Answer 69

Different types of contingencies in a token economy.

Individual means that only a specific individual’s target behaviors are rewarded.

Standard means that every member of a community is rewarded based on unique or standard contingencies.

Group means that the group is rewarded when all members collaborate to satisfy a group contingency.

Question 70

Manipulation of antecedents vs. reinforcers

Answer 70

Two strategies for changing target behaviors. Manipulation of antecedents involves changing something about the environment or cues in order to attempt to change a bx. For example, changing a seating arrangement may change disruptive behavior in a classroom. Manipulation of reinforcers involves changing what happens in response to a particular behavior in order to change it. For example, a teacher praising students who are listening attentively may encourage that bx to occur more frequently.

Question 71

What is a token economy and its required elements?

Answer 71

A token economy is a bx management system used to shift target bx in an individual or group setting. It is a 4-step process. (1) Decide on target behaviors, they must be operationalized and rank-ordered, establish baseline (2) Decide on back-up reinforcers, ideally these would be decided by the community or individual being targeted for most impact, some short-term some long (3) Identify the specific tokens you will use and (4) Put in place a system of rules and procedures for system operation including a schedule of reinforcement & system of exchange,

Question 72

What are the advantages and disadvantages of a token economy?

Answer 72

Advantages - flexible delivery, convenient, more effective than social praise or attention, organized/fair approach, result in increased attention to appropriate bx, Teach concept of rewards being tied to bx

Disadvantages - authority figure required, Bx might not generalize outside of token economy, Costly, Demeaning or bribery?

Question 73

Review the premise of Contingency Management Tx. Use substance abuse tx as an example, including descriptions of typical target bx and reinforcers.

Answer 73

Contingency management tx for substance use disorders involves providing a positive, supportive environment to help a problem that is typically treated with punishment. Reinforcements are provided for procedures that help change addictive behaviors such as clean urine samples, attendance at individual or group therapy, attending medical appointments, etc. Generally, reinforcements have a monetary basis such as gift certificates, movie theater tickers, clothing, or vouchers.

Question 74

What are some of the keys to implementing a daily report card?

Answer 74

A type of behavioral management intervention that spans the school and home environment. Specific target bx are identified then operationalized. Authority figures at school track the target behaviors and send home a daily report card to parents who then reinforce them. DRC are individualized and flexible, allow for increased communication between parents and teachers, and allow for positive attention to treat problems that are often criticized or punished.

Question 75

What are some of the key components to parent management training?

Answer 75

Parent training programs involve increasing positive reinforcement to improve the negative cycle in parent-child relationships. They also train parents to decrease their reinforcement of undesired behaviors by actively ignoring them. They also involve discipline or punishment of undesirable behaviors but ONLY after relationships has improved.

Question 76

Ambivalence

Answer 76

A normal human state in which one both wants to change and not to change or when one has reasons both for and against change. Ambivalence about behavior change is the target of Motivational Interviewing (MI).

Question 77

Cognitive Dissonance Theory

Answer 77

Cognitive dissonance is a state in which an individual’s beliefs, attitudes, and/or behavior are at odds or don’t agree with one another. This state leads to discomfort and typically results in individuals either shifting their beliefs or changing their behavior to create agreement.

Question 78

Self-perception Theory

Answer 78

A theory based on the idea that individuals derive their beliefs and attitudes from their behavior. Behavior comes first. So if someone engages in regular exercise, they may infer that they are someone who values health and wellness.

Question 79

Decisional Balance Matrix

Answer 79

A tool used in MI in which clients lay out the pros and cons both for the status quo and for behavior change.

Question 80

4 components to the spirit of MI and definitions for each

Answer 80

Acceptance - of client for who their and their choices about their bx, value autonomy, value the inherent worth of every individual

Collaboration - viewing therapy as a collaborative effort, not an opportunity to utilize the righting reflex, taking a non-judgmental stance to clients decisions, using we statements, asking permission to offer advice

Evocation - assumption that motivation to change lies within each person, drawing on client’s values, experiences, knowledge to help them lay out a case for and against change

Compassion - deliberate effort to pursue the client’s best interests and encourage their belief in the possibility of change.

Question 81

Transtheoretical Model of Change

Answer 81

Precontemplative - client see’s no reason for change, but others may

Contemplative - client exploring the possibility of change

Determinism - client decides either for or against change

Action - if deciding to change bx, client implements the plan for change

Maintenance - client strategies for maintaining behavior change

Relapse -

Question 82

What are the key skills used in MI?

Answer 82

OARS

Open-ended questions

Affirmations

Reflective Listening

Summarizing

Question 83

What is Motivational Interviewing (MI)?

Answer 83

An approach or style used to help clients who are ambivalent about changing a behavior uncover their own personal reasons for and against behavior change in a non-judgmental and collaborative way.

Question 84

Cognitive Distortion/Irrational Belief

Answer 84

In cognitive therapy, cognitive distortions are errors in thinking or faulty beliefs that contribute to or are the source of psychopathology or maladaptive functioning. Common cognitive distortions include alwaysness & neverness, disqualifying the positive, all or nothing thinking, fortune-telling, jumping to conclusions, and minimization.

Question 85

CBT Triad

Answer 85

According to Beck, the cognitive behavioral triad consists of core schema or beliefs about the self, the world, and the future that create a lens through which we interpret the world and our experiences in it. Different errors in the cognitive triad lead to different psychological disorders. For example, I suck, everything sucks, everything will always suck is a common framework for people who experience depression.

Question 86

3 examples of cognitive distortions.

Answer 86

I am sad now so I will always be sad. -alwaysness & neverness

I did well on this exam but it’s only because the material wasn’t that difficult - disqualifying the positive

She is definitely going to ignore me because everyone always ignores me. - fortune-telling AND alwaysness & neverness

Question 87

Cognitive restructuring

Answer 87

The process by which errors in thinking or cognitive distortions are identified, the events that elicit them and their emotional and behavioral consequences are identified and certain strategies are used to challenge them and replace them with more adaptive ways of thinking. Based on the idea that clients have an EXCESS of maladaptive thoughts.

Question 88

Goals of Beck’s Cognitive Therapy

Answer 88

1. Identify & correct faulty information-processing
2. Modify beliefs maintaining maladaptive behaviors & emotions.
3. Provide skills for adaptive thinking

Question 89

Automatic thoughts, assumptions, core beliefs/schema

Answer 89

This is how Beck conceptualized different levels of cognitive distortions and their relationship to one another.

Automatic thoughts arise quickly and automatically in response to different stimuli. They are informed by….

Assumptions which are deeper beliefs usually rules or if-then statements about the way the world works. They are informed by…

Schemas are the deepest level of beliefs, patterns of thinking that organize and process information. They are tightly held ideas about the way the world works and one’s place in the world.

Question 90

Types of core beliefs

Answer 90

Core beliefs are usually about the self, the world, and the future.

Question 91

Typical content of core beliefs

Answer 91

Schemas are typically around themes like safety, trust, emotional deprivation, shame, and social isolation.

Question 92

Downward arrow technique

Answer 92

A type of Socratic questioning used to uncover and change cognitive distortions which involves finding the deeper beliefs below the automatic thoughts. Trying to find the deeper meaning of a cognition in order to challenge it specifically, and uncover the roadmap to therapeutic change.

Question 93

Cognitive Processing Therapy

Answer 93

A type of cognitive therapy developed specifically for people with PTSD. Identifies and challenges beliefs or cognitive distortions typical in people who have experienced trauma usually surrounding ideas about safety, trust, and intimacy.

Question 94

Describe the common features of cognitive therapies.

Answer 94

Cognitive therapies all target faulty beliefs or errors in thinking in order to produce therapeutic change. They are empirical and rational in that they help clients identify beliefs that may be leading to maladaptive patterns of behavior and emotions, track them, and find evidence to support the beliefs. Cognitive therapists believe covert behavior like thoughts can be identified, tracked, and operationalized.

Question 95

What are the differences between Ellis and Beck? Limitations of each? Provide an example of a question each therapist might ask.

Answer 95

Ellis believed faulty cognitions were the result of the inevitable irrationality humans come into the world with. His strategy for shifting maladaptive beliefs was to directly challenge them. He saw himself as a rational expert of sorts who should actively dispute flaws in thinking in order to make clients see their maladaptive behaviors and emotions were based on faulty logic. Ellis might directly confront a client by saying. “So what you are saying is that if you make mistakes, you are no good. Isn’t that so?” He is directly challenging the faulty belief that mistakes mean you are not a good person.

Beck also believed that cognitive distortions were the source of maladaptive behavioral and emotional patterns, but targeted them in a gentler, more collaborative way than Ellis. Beck thought individual schema were the source of cognitive distortions, not necessarily a human inevitability. He saw his role as a collaborator or guide in the process of identifying and challenging cognitive distortions but that the change was more impactful if the clients were able to find the answers on their own rather than being directly confronted. He might ask, “tell me more about what you mean by the word ‘troubled.’”

Question 96

Describe the two main interventions of Beck’s Cognitive Therapy. Include information on goals and techniques.

Answer 96

Overt behavioral interventions - you can intervene directly on behavior (exposure or decrease lethargy through social activity) OR have the client conduct behavioral experiments to gather evidence about beliefs.

Cognitive interventions or restructuring to help client directly challenge the cognitive distortions. Identify, monitor, and categorize automatic thoughts, find deeper meaning through Socratic questioning.

Question 97

What is Socratic questioning or dialogue?

Answer 97

A technique used in Beck’s Cognitive Therapy to lead or guide clients to the deeper assumptions and meanings of their automatic thoughts and to uncover errors in thinking that may be maintaining maladaptive behaviors and emotions.

Question 98

What are the guiding principles of Socratic questioning?

Answer 98

• Wisdom lies within each individual and can be uncovered with questions.
• Warmth is an important quality for uncovering that knowledge that lies within.
• Knowledge that is discovered is more effective or impactful than knowledge that is told. The power of “coming to know.”
• Knowledge is not a commodity.
• Patient autonomy is critical - guided discovery and collaborative empiricism.

Question 99

Describe the ABC’s of Socratic Questioning

Answer 99

Ask, Be on their team, be Critical of their logic (not them)

Question 100

Describe the Socratic Questioning hierarchy and give an example of each component of the hierarchy.

Answer 100

CARD
Clarifying - What do you mean by “troubled.”
Assumptions - This is the “how did you come to that idea?” What makes you believe you are troubled?
Real Evidence - What evidence do you have that others consider you a troubled person? Can you give me an example?
Deeper Meaning - What does it say about people when they are troubled? What would that mean about you?