Final

Question 1

Cognitive Behavioural Therapy

Answer 1

An approach identifying and altering cognitive and behavioural aspects of coping
•Evidence based and present focused
•Uses rationale and explicit protocols for treatment
•Skills-Acquisition approach with goal setting being fundamental

Question 2

Cognitive Behavioural Therapy vs Traditional Behaviour Therapy

Answer 2

Similarities
•Both assume problems can be fixed by changing behaviour
•Both access outcome in measurable terms
Differences in views on how behaviour may change:
•Traditional: assumes behaviour change is directly linked to environment
•CBT: Believes both environment and cognitive change impact behaviour

Question 3

Assumptions of CBT

Answer 3

Cognitive activity impacts behaviour and emotions
Cognitive activity can be monitored and altered
Behaviour change can occur with cognitive change

Question 4

Evidence for CBT effectiveness

Answer 4

CBT developed from psychological research
CBT has always emphasized basing treatment methods off systematic controlled research
Thousands of controlled studies have been done on various CBT techniques for a variety of disorders

Question 5

Protocols for CBT Treatment

Answer 5

Interventions are explicitly described with detail (step by step process)
•Makes it easier to teach and evaluate

Question 6

CBT Present-Focused

Answer 6

Focuses on how someone is coping with a current situation and determine a stronger strategy
•Isn’t concerned with someone’s past
•Children live in the present: good therapy for them

Question 7

CBT Using Rationale

Answer 7

Client receives a rundown of how CBT works (so they are convinced its worth trying)
•There is a collaboration between therapist and client using socratic questioning (asking probing questions)
Children: rationale is altered (less detailed, more age appropriate – cognitive ability (perspective taking), more fun)

Question 8

CBT Skills-Acquisition Approach

Answer 8

CBT interventions: teaching new skills (combo of therapeutic relationship and training course)
Children: easier to accept because they do this daily (planners tracking their self-monitoring)

Question 9

CBT Goal Setting

Answer 9

Goals for treatment: can be measured/described precisely Children: may have difficulty setting long term goals
•Goals should be short-term, very concrete and specific, and have subtle reminders from adults

Question 10

CBT Model

Answer 10

Situations, actions, cognitions, emotions, physiology

Question 11

CBT Tools

Answer 11

Cognitive restructuring, automatic thoughts, depressive thoughts, systematic desensitization, relaxation techniques

Question 12

Cognitive Restructuring

Answer 12

Goals:
•Changing cognitive distortions (irrational negative thoughts), and increase positive self talk
Steps:
•Recognize and remove the negative self talk
•Counter the negative self talk with realistic positive self talk
•Believe the positive self talk

Question 13

Automatic Thoughts

Answer 13

Patterns of thinking that often lead to patterned behaviour such as:
•Mood and anxiety issues
•All or nothing: something isn’t perfect it’s a fail
•Overgeneralization: bad event means everything’s bad
•Mind reading: think you know what people think of you/why they act how they do towards you
•Catastrophizing: expecting things to turn out badly
•What Ifs: ask questions about bad things that could happen while being unsatisfied with any answer
•Should/Musts: Strict rules on how you should/must behave that guide your behaviour and judge others

Question 14

Depressive Thoughts

Answer 14

Discounting positives: automatically discount positive events
Locus of control: If it went well, it was easy, if it didn’t go well, it was my fault

Question 15

Systematic Desensitization

Answer 15

Exposure to anxiety provoking stimuli
•Anxiety hierarchy (work your way up)
•Pase set by therapist and client

Question 16

Relaxation Techniques

Answer 16

Progressive relaxation: contraction of muscle groups (top-down or bottom-up), with focus on relaxed feeling after contraction
Deep breathing: ‘box’ breathing (2-3 second durations), diaphragm
Imagery: focusing on positive memories to get away from negative thoughts

Question 17

CBT Adaptations for ASD

Answer 17

Visual aids
Incorporation of child’s specific interests
Increased dependence on logic
Very structured sessions
Flexible on length and number of sessions

Question 18

Walters: A systematic review of effective notifications to cognitive behavioural therapy for young people with ASD

Answer 18

Anxiety:
•More breaks to maintain focus
•More parental involvement 
•Incorporate special interests into therapy 
•Incorporate social stories and acronyms (ACE)
OCD: 
•Up to 20 sessions 
Depression:
•Shorter duration 
•Improving social skills
•Thought recording 
•Mindfulness rather than relaxation training

Question 19

Contraindications for CBT (when should it not be used)

Answer 19

Extreme symptom presentation (suicidal) 
Lack of cognitive abilities (intellectual delay)
Developmental immaturity (ToM)

Question 20

CBT Applications for ASD

Answer 20

Aggression, Anxiety, Depression, Social Skills, Sleep/Feeding, Angst

Question 21

Aggression and ASD

Answer 21

Social aggression: reaction to real/perceived threats
•Goal: move away from egocentric thinking (“I wouldn’t have hit him if he didn’t do that”)
Sensory aggression: reaction to over/under stimulation of senses

Question 22

Anxiety and ASD

Answer 22

Responds to CBT approaches well when:
•Separate sensory reactions
•Increase accuracy of self-rating anxiety (1-10)
•Better sensitivity = better awareness of change
•Teach fight/flight/freeze model
•What Ifs: work through scenario with logic and using creativity to combat negative imagery
•Teach (box) Breathing: helping understand physiological reasoning (relaxing diaphragm) with practice

Question 23

Depression and ASD

Answer 23

Can be:
•Trauma, situational, flat affect, lack of filter
Contributing factors:
•Negative life events, alexithymia, negative memory patterns, in the moment
Cofounds:
•Alexinthymia, flat affective/unusual facial expression Female > Male ratio
Transient Mood states are somewhat common
Scaling average (-10-10): 0- -3

Question 24

ASD Memory Patterns and Mood Outcome

Answer 24

Sequential Thinkers
•If current situation is negative, it will be folded into negative memories
•Flow of memories are played out in sequence and the feelings associated with each will be re-experienced
•May need to play out but moving through list will worsen negative mood
•Designed to understand why but almost never does
•Thought-stopping (distraction) is helpful

Question 25

Social Skills and ASD

Answer 25

Individual/group treatment to break down steps, practice, reframe, and shift rationale for being social

Question 26

Sleep/Feeding and ASD

Answer 26

Set up sleep hygiene protocols and challenging food diversity

Question 27

Angst

Answer 27

Realizing “I’m just a speck of dust”

Meaning of life crisis: what’s in it for me/I’m going to die eventually

Question 28

Intelligence

Answer 28

IQ: The capacity of the individual to act purposefully, think rationally, and to deal efficiently with his environment (standardized tests)
Wechsler:
•Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
•Wechsler Intelligence Scale for Children (WISC)
•Wechsler Adult Intelligence Scale (WAIS)
Domains:
•Verbal, visual, and glacial comprehension
•Fluid reasoning. working memory, processing speed
Intelligence Assumptions: stable overtime, IQ score reflects ability, norms apply to all groups

Question 29

Potential Cofounds with ASD

Answer 29

• Processing speed can impact results
• All or nothing response may not allow for elaboration/guessing
• ToM may lead to reduced effort (not knowing the impact of not trying)
• Abstraction/inferential thinking

Question 30

Differentiating ASD and Low IQ (Pederson)

Answer 30

Observed symptoms that differentiated ID only and ID and ASD:
•Impaired relationships
•No shared enjoyment
•No make believe play
•Restricted interest
•Adherence to routines 
•Stereotyped/repetitive behaviours 
•Preoccupation with object parts

Question 31

Vineland-11 (Adaptive Scale) (Doobay)

Answer 31

Communication, daily living, and socialization gifted without ASD scored better than gifted with ASD