Lecture 8 - CBT Assessment and Conceptualization Flashcards
What are the steps of CBT assessment?
➢Assessing current problem
▫Involves structured questions to obtain detailed information
▫Ask clients to detail a recent occasion when problem symptoms were experienced
▫Break presenting problems into four internal systems (cognitions, emotions, behaviour, physiology) and the environment
➢Identify triggers and modifying factors
▫Triggers: what factors make problem more or less likely to occur
▫Modifiers: contextual factors that impact how severe the problem is when it occurs
Ex: Alcoholic. trigger of walking past a bar, modifier = when with other people (ex: makes less likely)
➢Consequences
▫What has happened as a result of current problems?
▫Consequences often give clues about maintaining processes
➢Maintaining processes
▫The vicious cycles that keep the problem going
▫Different disorders have different common maintaining processes, but assessment must be individualized to client
▫e.g., escape/avoidance (Escape= escaping situation/symptoms, avoidance = avoiding completely situation); reduction in activity (ex :with depression, doing less activities that bring pleasure); short-term reward (ex: gambling)
➢Past history and problem development
▫Vulnerability factors
*Things that set the stage for a problem to develop, but are neither necessary nor sufficient
▫Precipitants
*Events or situations that provoke onset of symptoms
*Likely that event(s) activate a pre-existing vulnerability belief
▫Modifiers
*Changes to life circumstances that affect severity of problem
Cognitive model
Situation/event
ex: bad grade on exam
-
Automatic thought
ex: all my studying was useless
-
Reaction
(emotional, behavioural, physiological)
ex: feel sad and hopeless, don’t study next time
A simple thought record can be used for this
Write down situation (who, what, when, where), feelings (what did you feel and rate 0-100%), thoughts (what was going through your mind when you started to feel this way?, thoughts or images)
Why simple thought record?
Get familiar with process outside of session
Get more data, patterns
Explain the expanded cognitive model (core beliefs and intermediate beliefs).
➢Core Beliefs
▫Enduring cognitive phenomena that are deeply rooted
▫People focus selectively on information that confirms core beliefs, and disregard information that doesn’t
▫Global, rigid, overgeneralized
➢Intermediate beliefs
▫Attitudes, rules, and assumptions
Attitude = not an I statement, apply generally to the world “it is terrible to fail.”
Rule = should statement, I statement “I should give up if something is too hard”
Assumption = if then statement “If I try something difficult, then I’ll fail”
▫Fall in between core beliefs and automatic thoughts
Ex:
Core belief: I’m incompetent
-
Intermediate belief:
-Attitude: It is terrible to fail
-Rule: I should give up if something is too hard
-Assumption: if I try something difficult, I’ll fail
-
Automatic thought: All of my studying was useless!
What are the 3 categories of core beliefs?
Incompetent
“I am stupid”“I can’t do anything right”“I don’t measure up”“I am a failure”
Unlovable
“I’m unlovable”“I’m different”“I’m bound to be abandoned/ rejected”“I’m defective; others will not love me.”
Worthless
“I’m worthless”“I’m bad”“I’m evil”“I am a waste”*“I don’t deserve anything good”
What are the 3 categories of intermediate beliefs?
Helpless
*Rule: I should never ask others for help
*Attitude: Asking for help means you’re weak
*Assumption: ??
Unlovable
*Rule: I should leave people before they leave me
*Attitude: A break-up is crushing
*Assumption: ??
Worthless
*Rule: I should accept my fate
*Attitude: People get what they deserve in life
*Assumption: ??
How do you identify intermediate and core beliefs?
➢Downward Arrow Technique
▫Ask client about meaning of key automatic thoughts that you suspect stem from core beliefs
▫If the thought is true…
*What does that mean?
What is the worst part about the situation?What is so bad about that?
*What does that mean about you?
What is CBT Conceptualization?
➢Road map to therapy
➢Series of hypotheses about client that are refined based on incoming data
➢Will present conceptualization to client to see if it “rings true”
▫Often presented using diagrams
▫Modify conceptualization based on client feedback
➢How did patient develop this disorder?➢What were significant life events, experiences?
➢What are patient’s basic beliefs about himself, the world, and others?
➢What are patients’ attitudes, rules, and assumptions?
➢What strategies has patient used to cope with beliefs?
➢What automatic thoughts, images, and behaviors maintain disorder?
➢How did beliefs interact with life events to make patient vulnerable to disorder?➢What is happening in patient’s life right now and what are patient’s perceptions?
