Intervention CBT Flashcards
INTERVENTIONS MUST KNOW….
TREAT THE PRESENTING CONCERN – TARGET THE MAINTAINING FACTORS!
If the Q involves a resistant client who does not know why they are there for Tx –
Always start with a Soft exploratory approach!
What are structured interventions?
They have;
a beginning
a middle and
an end
What is the client wants to start working on something else? or another issue comes up during therapy?
Finish working on what you are working on and then re contract with the client to work on other issues
There is an order of things - first contact assessment formulation intervention and endings
What is a basic skill of therapy before you embark on any interventions?
Identification of emotions; if client struggles with identifying emotional triggers for symptoms, you don’t have to embark in some complex desensitization process. You have to help them put emotions and sensations into words first.
If someone tells you that her husband cheated on her and that her son stole money from her don’t say “suck it up princess” or give her a Freudian interpretation or tell her how you can’t trust people in this world anymore and it also happened to you. Say something like: “You have been hurt by your husband and also your son” - what is this process called?
Clarifying thoughts (Reflecting and Paraphrasing)
What is the therapeutic alliance?
Therapeutic Alliance: The establishment of a collaborative relationship characterized by common goals and understanding.
What do you use when you focus on rapport and checking that you have understood the client correctly?
Paraphrasing and reflecting
What are some concepts to follow for any intervention question?
GENERAL CONCEPTS FOR ANY INTERVENTION QUESTION
• Think about the stages of treatment.
• Meet the client where they are at.
• Start slow and gentle (soft landing). Do not bombard clients with tests and scales. Do not start with an intervention!
• Start with validating and exploring client’s concerns/problems/resistance.
• Try to find common goals or ask clients (especially adolescents who do not want to be there or resistant clients) about their goals or their thoughts on how you can help them.
Start gently exploring, validating - not even assessment or semi-structured interview - explore why therapy will not work for you - what works, what doesn’t
NO ADVICE Or INTERVENTION STRAIGHT AWAY
Stick to structured therapies
For most of the approaches, they will expect you to identify what stage of treatment you are at and what would be the answer if you were at that stage
What are the 9 stages of therapy in general
SEQUENCE OF THERAPY
For most structured approaches:
- Establish rapport and/or therapeutic relationship
- Explore concerns
- Assessment
- Diagnosis and formulation
- Psycho-education, socialization to treatment.
- Develop treatment plan with client (goals, consent, planning) how many sessions
- Intervention (cognitive, behavioural, relationship analysis, expression of affect, problem-solving, etc)
- Evaluate treatment
- Closing: Summarise/consolidate/relapse prevention/discharge/link with other services/follow up
1-6 start
6-20 intervention (10-12 and 20 sessions)
15 - 20 at the end - discharging etc.
LOOK AT THE EVIDENCE-BASED TREATMENT LITERATURE REVIEWS
Which therapies go with which disorders?
LOOK AT THE EVIDENCE BASED TREATMENT LITERATURE REVIEWS
1. Depression: CBT, IPT, brief psychodynamic therapy 2. Anxiety: CBT! 3. Personality Disorders: psychodynamic, DBT, schema therapy 4. PTSD: TF-CBT, EMDR, prolonged exposure, psychodynamic 5. AOD: CBT, Motivational Interviewing 6. Adolescent child emotional/behavioural difficulties: Family therapy 7. ADHD: Parent Management training (no CBT with kids, no electrodes in front of a PC!)
What do you need to know about CBT for the exam? Who is it for?
CBT
First choice of treatment for anxiety, phobias, panic, PTSD, depression
• Always think of the two elements: cognitive and behavioural
• Short term and focused
• Negative emotions are elicited by cognitive processes developed through influences of learning and temperament.
• Adverse life events elicit automatic processing, which is viewed as the causal factor.
• Cognitive triad: Negative automatic thoughts centre around our understanding of:
• Ourselves
• Others (the world)
• Future
• Focus on examination of cognitive beliefs and developing rational responses to negative automatic thoughts.
If it’s a general question about CBT - my answer will have to include cognitive and behaviour intervention
Adverse life events can be a factor for dysfunction
What is transference?
Transference is subconsciously associating a person in the present with a past relationship. For example, you meet a new client who reminds you of a former lover. Countertransference is responding to them with all the thoughts and feelings attached to that past relationship.
What is countertransference?
Transference is subconsciously associating a person in the present with a past relationship. For example, you meet a new client who reminds you of a former lover.
Countertransference is responding to them with all the thoughts and feelings attached to that past relationship.
COGNITIVE STRATEGIES
CHALLENGING, RESTRUCTURING- What are the steps?
- Define Situation
- Clarify meaning of cognitive appraisal
- What was going through your mind just then?
- What did the situation mean for you?
- Evaluate interpretation
- Evidence: For and against this belief?
- Alternatives:Any other explanation(s)?
- Implications: So what….?
BEHAVIOURAL STRATEGIES
EXPOSURE - what is exposure?
Exposure involves systematic, repeated, and prolonged presentation of objects, situations, or stimuli (either internal or external) that are avoided because of anxiety-provoking properties.
What conditions would you use exposure for?
Used most often with specific phobias, panic disorder and agoraphobic avoidance, OCD and social phobia (usually a graded exposure)
There are three types of exposure interventions that can be used in fear reduction:
Situational (in vivo) - Involves contact with physical objects or actual situations that are avoided in the external environment
Imaginal - Involves presentation of symbolic fear stimuli (prolonged and repeated over time with the same event that has caused the symptoms - phoenix aust excellent training on this CBT for PTSD
Internal/interoceptive - Self-focused; involves exposure to feared physical sensations e.g panic - afraid of physical symptoms - hyperventalation - being dizzy
Most therapists conduct exposure in a graduated fashion guided by an exposure hierarchy. Often called systematic de-sensitisation.
what is Imaginal exposure?
Imaginal - Involves presentation of symbolic fear stimuli (prolonged and repeated over time with the same event that has caused the symptoms - phoenix aust excellent training on this CBT for PTSD
What is invivo exposure?
Situational (in vivo) - Involves contact with physical objects or actual situations that are avoided in the external environment
What is interoceptive exposure?
Situational (in vivo) - Involves contact with physical objects or actual situations that are avoided in the external environment
What is graded exposure?
Most therapists conduct exposure in a graduated fashion guided by an exposure hierarchy. Often called systematic de-sensitisation.
What else do you call graded exposure?
Call SYTEMATIC DESENSITISATION - GRADED EXPOUSURE OR GRADUAL EXPOSURE
BEHAVIOURAL STRATEGIES BEHAVIOURAL ACTIVATION (BA) What is it and what condition is it for?
One of the most important goals for depressed patients is increasing their activity levels. Most have withdrawn from at least some activities that had previously given them a sense of achievement or pleasure and lifted mood.
Behaviours often increased: staying in bed, watching television, spending time ruminating, avoidance. These maintain or increase current dysphoria.
Underlying assumption often is they cannot change how they feel emotionally. Therefore, resulting in increased feelings of hopelessness and helplessness.
BA includes the re-establishment of routines as well as the establishment of new (desirable and positively) reinforcing behaviours
New behaviours are difficult to establish initially, so focus on pre-depression routines to begin with (e.g activities the person engaged in prior to being depressed that they have ceased doing now)
Start with small, achievable goals. Work collaboratively with client to make a plan.
CBT for Anxiety where would you start?
CBT FOR ANXIETY/DEPRESSION/OCD/PTSD
Anxiety: Start with cognitive interventions to assist clients to come up with less catastrophic and more helpful thoughts so they are able to do exposure. Exposure for anxiety usually graded exposure/systematic de-sensitization including imaginal and in vivo exposure.
CBT for Depression where would you start?
Depression: therapists often start with BA as usually improves mood quite significantly. - normally baby steps BA is hard t get going
CBT for Panic Disorder wher would you start?
Panic Disorder: cognitive interventions and then graded exposure including imaginal, in vivo and interoceptive.
CBT for OCD where would you start?
OCD: Cognitive interventions and then graded exposure and response prevention (eg can’t wash hands after they touch the keyboard) only evidence for OCD
If severe research indicates most people will need medication
Scared of spiders (arachnophobia) where would you start with a CBt intervention?
Scared of spiders - expose with picture of spider, picture, real thing, same room as a big hairy spider - start with imaginal then and do that until the anxiety decreases - it can takes weeks to months to do this
What would trauma focused CBt involve for PTSD?
PTSD (TF-CBT) cognitive interventions and imaginal exposure for traumatic memories.
What are SUD’s
Subjective Units of Distress
What is socratic questioning?
Socratic questioning is a way of Socrates used to ask question - way of asking so people get to their own answer - figure it out by themselves
If there is a question on anxiety for interventions what option would you choose?
If she included systematic desensitization (graded exposure) - choose that - always choose this first for anxiety
