Final Flashcards
Cognitive Behavioural Therapy
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
Cognitive Behavioural Therapy vs Traditional Behaviour Therapy
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
Assumptions of CBT
Cognitive activity impacts behaviour and emotions
Cognitive activity can be monitored and altered
Behaviour change can occur with cognitive change
Evidence for CBT effectiveness
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
Protocols for CBT Treatment
Interventions are explicitly described with detail (step by step process)
•Makes it easier to teach and evaluate
CBT Present-Focused
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
CBT Using Rationale
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)
CBT Skills-Acquisition Approach
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)
CBT Goal Setting
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
CBT Model
Situations, actions, cognitions, emotions, physiology
CBT Tools
Cognitive restructuring, automatic thoughts, depressive thoughts, systematic desensitization, relaxation techniques
Cognitive Restructuring
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
Automatic Thoughts
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
Depressive Thoughts
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
Systematic Desensitization
Exposure to anxiety provoking stimuli
•Anxiety hierarchy (work your way up)
•Pase set by therapist and client
Relaxation Techniques
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
CBT Adaptations for ASD
Visual aids
Incorporation of child’s specific interests
Increased dependence on logic
Very structured sessions
Flexible on length and number of sessions
Walters: A systematic review of effective notifications to cognitive behavioural therapy for young people with ASD
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
Contraindications for CBT (when should it not be used)
Extreme symptom presentation (suicidal) Lack of cognitive abilities (intellectual delay) Developmental immaturity (ToM)
CBT Applications for ASD
Aggression, Anxiety, Depression, Social Skills, Sleep/Feeding, Angst
Aggression and ASD
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
Anxiety and ASD
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
Depression and ASD
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
ASD Memory Patterns and Mood Outcome
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
Social Skills and ASD
Individual/group treatment to break down steps, practice, reframe, and shift rationale for being social
Sleep/Feeding and ASD
Set up sleep hygiene protocols and challenging food diversity
Angst
Realizing “I’m just a speck of dust”
Meaning of life crisis: what’s in it for me/I’m going to die eventually
Intelligence
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
Potential Cofounds with ASD
- 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
Differentiating ASD and Low IQ (Pederson)
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
Vineland-11 (Adaptive Scale) (Doobay)
Communication, daily living, and socialization gifted without ASD scored better than gifted with ASD
