Missed Lecture Slides Flashcards
2 ways of seeing psychopathology
- psychological inflexibility (inability to recognize and adapt to various situation demands)
- dyscontrol (involuntary, organismic impairment in psychological functioning
functional analysis
ABC
clarifying the context and function of target behavior
identifying eliciting factors + reinforcements and punishments (consequences) that contribute to a person’s maladaptive behaviors
S-delta
situations in which the behavior does NOT take place
discriminative stimuli
A stimulus that increases the probability of a response because of a previous history of reinforcement in the presence of that stimulus.
e.g. with alcoholism:
- upcoming social interaction
- the presence of alcohol
aka precipitating events
establishing operations
any event or procedure that changes the efficacy of a stimulus as a reinforcer or punisher.
For example, in an operant-conditioning study where food is used to positively reinforce behavior, the establishing operation may be food deprivation, which sets up food as a rewarding and reinforcing stimulus.
e.g. for alcoholism: withdrawal symptoms, drinking-related rules
aspects of a functional analysis graph
discriminative stimuli and establishing operations
hypothesized origins
behaviors
immediate reinforcing consequences
delayed aversive consequences
two parts of C (consequences) in functional analysis
immediate reinforcing consequences
delayed aversive consequences
two parts of A (antecedents) in functional analysis
discriminative stimuli
establishing operations
contingency management
managing the relation between antecedents, target behavior and consequences
step 2 of ABC
A2, B2, C2
A2 - Antecedents: structure, rules and agreements, communication
B2 - target behavior: new and positive and concrete
C2 - consequences: reinforcing / rewarding, ignoring, punishing
4 tips for A2 for antecedents
cmaa
cue elimination
modifying cues
adding stimulus cues
altering EO’s
learning by consequences is also defined as…
operant conditioning
Parent management training and its 6 components
12 - 20 sessions
parents of 0 - 12yr children
for disruptive behaviors
- psychoeducation
- ABCs of negative behaviour
- defining positive behaviour
- antecedent and consequent interventions
- ignoring and punishing
- time-out
3 paradigms of psychosis
- illness paradigm
- stress-vulnerability model
- symptom-focused paradigm
stress-vulnerability model
biologically and psychologically predisposed individuals may become psychotic if exposed to stressful life experiences
continuum approach
symptom-focused paradigm
CBT for each single symptom is done
stronger aim on understanding and coping with symptoms and functioning socially and professionally
structure of CBTp
5
- building a therapeutic alliance, psychoeducation
- working with hallucinations
- working with delusional thoughts
- working with negative symptoms and comorbid disorders
- relapse prevention
normalization and de-catastrophizing are main factors in..
predicting a good clinical outcome
3 pointers in psychoeducating symptoms
dep
- delusional beliefs are attempts to explain unusual experiences or emotions
- experiences are not problematic itself but main factor is how a person responds to unusual experiences (appraisal)
- psychotic symptoms make sense in the context of people’s lives
(when one experiences fear –> I’m going mad)
3 types of voices in psychosis
inner speech
- inner monologue that is falsely interpreted as external
intrusive memories
- similar to PTSD
- trauma memories can be distorted, fragmented
hypervigilance
- actively listening out
- background noise (misinterpretation of people chatting)
trauma and auditory hallucinations
3 characteristics
childhood trauma is associated with severity of hallucinations and delusions
most voice hearers report childhood trauma
content of their voices is related to their trauma
second step of psychoeducation
normalization of symptoms
normalise by providing information about symptoms
- voice hearing, paranoid thoughts all common, even famous people hear voices
cognitive model for hallucinations emphasizes on…
the role of subjective and cognitive appraisals (assessment) of voices
appraisal
the cognitive evaluation of the nature and significance of a phenomenon or event
working with hallucinations step and its 5 goals
rmlmf
address voices / convictions that are less firmly held
main goals:
- reduce perceived power of symptoms
- make sense of them, thereby reduce distress
- listen to auditory stimulation, reading out loud.
- mindful exercises
- focus attention to something else
techniques to challenge hallucinations
its aim and techniques
(4)
Aim is to stimulate doubt
ask client to try out:
- record voice when they speak
- walk towards or away from voices, does volume change?
- take a video or picture for visual hallucinations
- explore what other explanation there might be (noise from fridge)
working with delusional thoughts (4)
ieis
- importance of feeling safe
- emotional response is based on reality, even if explanation / belief is not
- interpretation is key
- socratic questioning
delusions associated with
reasoning biases
Patients with psychosis show:
- tendency to jump to conclusion
- tendency to construct unusual explanations for distressing events
- tendency to attribute negative outcomes to causes external to themselves
The three C’s
follow these steps to help assuage them and reframe yourself with a positive mindset
Catch It:
- what is the automatic thought
Check It:
- how did it make you feel
- what is the evidence for it?
Change It:
- what is an alternative
- what is a new thought to help you reach your goal?
common intermediate beliefs of psychosis
If I don’t remain on guard all the time, other people will take advantage of me
working with negative symptoms (3)
apply CBT techniques like
- behavioral self monitoring
- behavioral activation and activity scheduling
- social skills training
key dimensions for relapse prevention in psychosis
5
- recognise and modify emotional distress
- interpersonal trust
- install hope
- identify and change triggers
- address help-seeking behavior
goals of cbt for eating disorders
- helping the patient decide to change
- normalizing the eating pattern
- tackle the core psychopathology of over-evaluation eating, shape, weight, and their control
how to help patients decide to change in eating disorders
3
try to help patients
- become interested in making a fresh start
- becoming intrigued about discovering their true personality
- be hopeful about the future
how to fix body checking for eating disordered
3
- help patients stop non-normative forms of shape checking
- help patients modify / reduce normative forms of shape checking
- educate about mirror use
how to address feelings of being fat
3
- identify peaks of feeling fat
- identify their triggers
- address the triggers
antecedents examples of binge eating
DS:
- time
- place
EO:
- feelings
- cognitions
- physical response
- sleep deprivation
- prolonged food deprivation
consequences (C) of binge eating
Reinforcing consequences:
- comfort
- satisfaction
- no more craving
delayed aversive consequences
- negative emotions
- low self-esteem
- weight gain
- compensating behaviour
food cue reactivity is significantly stronger in…
concerned eaters such as bulimia, binge eaters, obese people
food cue reactivity during exposure to tasty food is normal response but it is different with obese people, etc.
increased food cue reactivity motivates eating
cue exposure and response prevention aim and main points
aim is to extinguish food cue reactivity and decrease cued overeating
- to fool your body
- new connections between cues and not-eating
- they are highly effective
protocol of cue exposure with eating disorders
6
- explain rationale
- registration of ABCs
- write script of all antecedents
- play the script and increase craving as much as you can (smelling, licking, etc)
- don’t eat (response prevention)
- craving disappears slowly to zero
violates “If CS, then US” beliefs
If I am alone at home with a box of chocolate, I will eat it all
mirror exposure
focus on most attractive body parts (positive exposure)
several styles (positive exposure, negative, neutral, etc) are effective.
effective treatment for body dissatisfaction
Treatment of ARFID (3)
- CBT with exposure
- trauma therapy
- parents
3 underlying mechanisms in the maintenance of eating disorders
- attentional processes towards food and body
- sensitivity to punishing and rewarding information
- improving body image
CS, US, CR examples for dog phobia, panic disorder, OCD,
OCD: shaking hands (CS) –> serious illness (US) –> fear (CR)
Panic Attack: dizziness (CS) –> Faint (US) –> fear (CR)
Dog phobia: walk in park (CS) –> bite attack (US) –> fear (CR)
Mowrer’s two-factor theory
- classical conditioning to develop fear
- operant conditioning to maintain fear
exposure is to which: CS, US, or CR?
CS, conditioned stimulus
cognitive conceptualization of depression (3)
- focus on content of thoughts
- self-critical thoughts
- prediction of effectiveness of behaviour
behavioural conceptualization of depression (3)
- focus on behaviour
- development and maintenance of depression lie in the environment
- a person’s actions and non-actions
3 behavioural aspects of depression
- depression is regarded as an extinction phenomenon
- lack of response contingent positive reinforcement (RCPR)
- excess of negative reinforcement (personal, social)
negative spiral of depression
you feel depressed
v
you undertake few activities
v
you feel more depressed
v
you undertake less activities
v
you feel desperately down
positive spiral from depression
you feel depressed
v
you have a positive experience
v
you feel a little better
v
you undertake more activities
v
you feel even better
contributing factors to pandemic depression
Lack of RCPR during pandemic:
- confined to own house
- lack of social interaction
- loneliness
implementation of behavioral activation
4 stages
- activity monitoring
- individualize treatment targets
- construction of behavioral activation hierarchy
- behavioral activation assignments
how to identify pleasant activities for depressed
- problem solving approach (brainstorm, behavioral experiments)
- administer the Pleasant Events Schedule
schema ABC
A - activating event
B - beliefs (cognitive schemas and experiences)
C - consequences
schema
an extremely stable, enduring negative pattern of thoughts, feelings and behavior that develops during childhood or adolescence and is elaborated throughout an individual’s life
schema therapy’s focus
- childhood: traumas and early relationships
- current problems: here and now
- therapeutic relationship (e.g. limited reparenting)
core childhood needs (7)
(G-SLAVES)
- safety
- empathy
- acceptance & praise
- guidance & protection
- stable base, predictability
- love, nurturing & attention
- validation of feelings
general treatment strategy of schema therapy (5)
- schema identification
- detecting schema coping
- identifying early maladaptive schemas
- changing schemas
- adopting more positive schemas
how to identify early maladaptive schemes (3)
- use young schema questionnaire
- using imagery
- affect bridge (go back to significant moment in childhood that relates to this particular schema)
Affect bridge example
“So you felt so small and worthless again last week in that
situation, okay now focus on that feeling of worthlessness while
letting go of the situation. You feel it? Now go back in time and
see if any situation pops up while you keep focussing on that
feeling.”
how to identify schema (2)
- apply downward arrow technique
- combine horizontal and vertical exploration
3 general coping strategies
- schema avoidance
- schema overcompensation
- schema surrender
how to detect schema coping
- what do you do to avoid your schema being triggered?
- what do you do to compensate the effects of your schema?
central phase of schema therapy
3
- link current problems to early patterns
- break with coping - modi
- processing using experiential techniques
3 examples of experiential techniques
empathic confrontation (showing empathy for the reason driving the behavior, but insist on changing behavior)
empty chair technique
imagery rescripting
imagery rescripting process aim and its 4 phases
aim is to change the meaning of the events that happened in the past
Phase 1: past is relived from child perspective
Phase 2: therapist steps in and rescripts
Phase 3: patient steps in with healthy adult mode and rescripts
Phase 4: rescripting by self, experienced through the child perspective
schema therapy vs clarification-oriented psychotherapy vs treatment as usual
ST > TAU > COP
schema therapy was cost effective
clarification-oriented psychotherapy was not cost effective
cons of cbt (3)
- difficult to define CBT
- fuzzy boundaries with other schools of therapy
- too many claims to fame
