Maintenance and Relapse Flashcards
Define ‘cognitive restructuring’?
- the process of learning to refute cognitive distortions or ‘faulty thinking’ with the goal of replacing one’s irrational, counter-factual beliefs with more accurate and beneficial ones
What is cognitive restructuring theory?
- unrealistic beliefs are directly responsible for generating dysfunctional emotions and resultant behaviours (e.g. stress, depression, anxiety and social withdrawal)
- humans can be rid of emotions and effects by dismantling beliefs that give them life
How does cognitive restructuring allow the subject to replace irrational beliefs with more rational ones?
- gaining an awareness of detrimental thought habits
- learn to challenge them
- substitute life-enhancing thoughts and beliefs
Cognitive restructuring is a 2-part process by which individuals . . . .
1) become aware of the thinking behaviours that lead to feelings of stress of ineffectual behaviour
2) change these thoughts to produce more positive ones
What is the underlying assumption of the process of cognitive restructuring?
It is not what I experience, but what I tell myself about that experience before, during or after it that determines how I will feel and act in relation to it
What are the aims of cognitive restructuring?
Help individuals:
1. recognise faulty internal dialogues
2. develop and practice coping skills in response to such dialogues
This will facilitate changes in the physical and behavioural state of the individual
List some examples of faulty dialogue
- making irrational assumptions about the world and its events
- drawing conclusions when evidence is lacking and even contradictory
- exaggerating the meaning of an event
- disregarding important (and often positive) aspects of a situation
What are self-fulfilling prophecies?
- being too black and white and oversimplifying events instead of seeing them as relative, in context and with perspective
- overgeneralising from a single event
- specific self-defeating and negative self statements
List some coping skills techniques
- substituting positive self-statements
- relabelling one’s anxiety so it can be used more creatively
- inducing relaxation when I become anxious or angry; reminding myself to breathe out
- thought-stopping persistent and disturbing thoughts by silently shouting ‘STOP’ to myself and then following this with a more realistic or self-affirming thought
- making statements that assess the reality of a situation/dispute an irrational belief
In stuttering management, how does cognitive restructuring convert negative self-statements into rational, positive affirmations?
The 3 p’s; framing dialogue in the:
1. positive
2. present
3. person
Define ‘relapse’ in the sphere of stuttering management
When the client can no longer self manage their fluency and decisions being made around their stutter
List some risk factors for relapse.
- severity of stuttering before treatment (more severe, more likely to relapse)
- less successful treatment outcome
- feelings of helplessness post-treatment (external locus of control)
Provide a statistic regarding relapse in adolescent and adult PWS
- inevitable for 30-40% following ‘successful’ fluency shaping treatment, within 6 months of treatment
Contrast ‘regression’ with ‘relapse’
‘Regression’ is a slip in fluency that includes variations in stuttering across time and situation (temporary setbacks), whereas a ‘relapse’ is a pronounced and persistent return to pre-treatment levels of stuttering
As a clinician, what are some adaptive ways of dealing with stuttering that I could employ?
- effective self-talk and self-correction techniques
- adopt a problem-solving approach
- deal with feelings of fear, anxiety and disappointment
- identify internal and external factors that contribute to the relapse
- get back on track after a setback
Robust outcomes are a result of treatments that incorporate . . .
- speech restructuring
- relaxation and anxiety management
- cognitive restructuring (rational thinking, positive affirmations)
- acceptance and disclosure
List ways to combat relapse
Booster programs
- (speech restructuring + transfer tasks)
- speech restructuring + individual problem solving -> direct transfer tasks
Cognitive restructuring and anxiety control, as well as smooth speech practice
What are the 6 themes associated with the transition stage from unsuccessful to successful management of stuttering?
- Support from others (family, friends, support groups, professional counselling)
- Successful therapy (believing in the technique)
- Self-therapy and behavioural change (including self-disclosure)
- Cognitive change (risk-taking, reduction in fear of failure, taking responsibility for their speech, positive attitude, learning more about themselves as speakers)
- Utilisation of personal experience
- High levels of motivation and determination
What are some hints regarding relapse?
- to recover you need self-commitment
- need to have a support system
- believe that you are in control of your own behaviour and life outcomes (internal locus of control!)
- control intrusive thoughts
- motivate yourself to regain mastery
- make time for practise
List some more themes associated with stuttering relapse
- set achievable goals
- ability to control your environment
- keep practise interesting and varied
- accept some stuttering as ‘normal’
- remember that everyone is dysfluent to some degree
- failure can be viewed as an opportunity to employ more successful strategies in the future
List some unsuccessful and successful management techniques for stuttering relapse
Unsuccessful:
1. gradual awareness
2. negative reactions of listeners
3. negative emotions
4. restrictive lifestyle avoidance
5. inadequate therapy
Successful:
1. continued management
2. self-management and fear reduction
3. unrestricted interactions
4. a true sense of freedom
5. optimism
