Mood disorders

Question 1

What is the most difficult aspect of treating depression

Answer 1

relapse prevention

Question 2

Overall CBT process for depression

Answer 2

behavioural activation
introducing the cognitive model
monitoring automatic thoughts
evaluating automatic thoughts
challenging/restructuring automatic thoughts
intermediate beliefs
schemas and core beliefs

Question 3

Beck’s cognitive model of depression

Answer 3

early experience
dysfunctional assumptions
critical incident
negative automatic thoughts
symptoms (affect each other)

Question 4

cognitive conceptualisation

Answer 4

relevant childhood data
core beliefs
conditional assumptions, beliefs, rules
compensatory strategies
situation - automatic thought- meaning of automatic thought- emotion - behaviour

Question 5

2 main CBT core beliefs

Answer 5

central beliefs that maintain the presenting problem
helplessness
unloveability

Question 6

conditional assumptions, beliefs, rules

Answer 6

assumptions generated to assist in coping with the core belief
e.g. if i am liked by everyone then i am worthwhile
therefore if anyone does not like me i am not worthwhile

Question 7

compensatory strategies

Answer 7

behaviours performed that assist in coping with core beliefs
used to maintain the positive version of the conditional assumption

Question 8

negative cognitive triad

Answer 8

self: i am a failure
world: the world sucks, people are trying to take advantage of me
future: things are never going to get better, my life will always be this bad

Question 9

attributional style for negative events

Answer 9

depressed individuals have a tendency to attribute INTERNAL for negative events and this attribution is STABLE over time as well as GLOBAL across other contexts and situations

Question 10

key characteristics of CBT

Answer 10

agenda setting
goal focus
cooperative, explicit approach
collaborative empiricism
time limited
directive/skills based

Question 11

goal setting in CBT should be

Answer 11

realistic
specific rather than general
described in behavioural terms- “what would you be doing if you were happier?”

Question 12

rationale for behavioural activation

Answer 12

decreased engagement with environment denies opportunity for positive reinforcement
depressed client views day or week as uniformly negative
by increasing activity, chance of positive reinforcement is increased

Question 13

Lewinsohn’s model of depression:

Answer 13

: thoughts about depression happening in two phases. Explains that being around and listening to an individual experiencing depression can be fatiguing, and cause people to distance themselves from someone who is chronically depressed. People with depression have an interpersonal style that initially elicits sympathy (reinforcing), but eventually people may isolate themselves from the person (affirms depression related core beliefs, alienating)

Question 14

behavioural activation procedure

Answer 14

Provide the rationale for activity scheduling
Monitor pre-intervention activity levels
Have the patient prepare their environment / significant others for change
Identify potential activities. This can be done using either a broad list of activities, or by providing general areas for the patient to select from.
Compile a list of activities and rank them in order of difficulty.
Organize the activities into a hierarchy.
Monitor and reward progress.

Question 15

Common problems- behavioural activation

Answer 15

poorly specified schedules or activities
too much, too soon (use a hierarchy)
activities that appear monolithic to the client (break down into smaller, more manageable tasks)

Question 16

ACTION- dealing with avoidance

Answer 16

assess my behaviour
choose whether to activate/engage in helpful behaviours or continue to avoid the experience
try the behaviour I’ve chosen
Integrate the new behaviour into a regular routine
Observe the outcome of the behaviour
Never give up

Question 17

demonstrating the importance of cognitions

Answer 17

create an emotion
thought injection
case of dreaming
examples from clients own history
examples where the situation is the same but different beliefs lead to different emotions

Question 18

overall guideline for depression treatment

Answer 18

goal setting and overview
behavioural activation introduced
automatic thoughts introduced
cognitive distortions introduction
DTR introduced
ATs sessions 5-8
IBs/CBs sessions 9-12
Closing sessions 13-15+

Question 19

session structure

Answer 19

brief update and mood check
bridge from previous session
agenda setting
homework review
discussion of agenda items (summaries, consolidations, homework setting during session discussions)
final summary and homework tie up
feedback

Question 20

thought vs belief

Answer 20

thoughts are fleeting
beliefs tend to stick

Question 21

reframing questions in AT

Answer 21

questions are difficult to challenge and not subject to evaluation of validity
reframe them as statements

Question 22

content specificity hypothesis

Answer 22

proposes that each emotional state is associated with different automatic thought content
AT that have themes of sadness, loss, deprivation are associated with emotions of sadness, sorrow etc.; AT that have themes of threat, anxiety are associated with emotions of anxiety; AT that have themes of injustrice, retribution, violation, are associated with emotions of anger; AT that have self critical themes are associated with emotions of guilt

Question 23

cognitive distortions

Answer 23

logical errors made in information processing that lead to dysphoria
help show patterns in types of errors made

Question 24

cognitive distortion types

Answer 24

all or nothing thinking: black or white categories
overgeneralisation: a single event is seen as part of a never ending pattern
mental filter: pick out one negative aspect and dwell on it excessively
mind reading: making guesses about what other people might be thinking based on inadequate evidence
fortune telling: making guesses about what may happen in future based on inadequate evidence
arbitrary inference/jumping to conclusions: drawing negative conclusions even when no definite facts to support it (types of this are mind reading and fortune telling)
magnification and catastrophisation: exaggerates the importance of something
emotional reasoning: drawing conclusions based on their emotions themselves
should sstatements: comparison of how things actually with how we would like them to be, counterfactual thinking
labelling and mislabelling: instead of describing an error, behaviour or problem, sometimes a person may attribute it to a character flaw in themselves or others
personalisation: seeing yourself as the cause or reason for an event for which you were not fully responsible

Question 25

six types of socratic questions

Answer 25

clarification
probe assumptions
probe reason and evidence
viewpoints and other perspectives
probe implications and consequences
questions about the question

Question 26

questions to evaluate ATs

Answer 26

objectivity - what is the evidence, is there an alternative explanation, what is the worst that could happen
utility - what is the effect of believing this, is it useful to achieving my goals
consistency- what would i tell friend in same situation, have there been times i thought differently

Question 27

Dysfunctional thought record (DTR)

Answer 27

Client identifies automatic thought
clear link drawn between thought and emotion
distortions inherent in the though are recognised
goes through process of evaluating thought
change in belief strength is quantified and highlighted
change in emotional intensity is quantified and highlighted
action planning/solution focus is engaged

Question 28

when an evaluation of an AT is ineffective

Answer 28

more central ATs left unevaluated
implausible, superficial or inadequate evaluation
not sufficiently expressed the evidence they believe supports the AT
AT itself also a core belief
believes intellectually that AT is distorted but not on an emotional level
discounts the evaluation

Question 29

aim of behavioural experiments

Answer 29

used as a follow up to verbal discussion of beliefs
aim to gather evidence for or against a belief, try out a new belief, consolidate a new belief

Question 30

types of behavioural experiments

Answer 30

hypothesis testing: testing theories
discovery: what happens when i do _
active: client is an active participant
observational: client observes without interacting

Question 31

ideal behavioural experiment is capable of

Answer 31

determining decisively whether a belief is true

Question 32

types of intermediate beliefs

Answer 32

attitudes: it is intolerable to be disliked
assumptions: so long as everyone likes me im ok, if someone doesnt like me im flawed
rules/operating rules: i should do everything i can to make people like me

Question 33

compensatory behaviours

Answer 33

intermediate beliefs can be associated with compensatory behaviours, serving a defensive function

Question 34

six methods of uncovering intermediate beliefs

Answer 34

through identifying that a patient has reported an intermediate belief as an automatic thought
by cueing the patient using the first part of an assumption
through direct enquiry about a patient’s rules or attitudes
using the downward arrow technique
through identifying common themes through the patient’s automatic thoughts
through use of questionnaires

Question 35

evaluating intermediate beliefs

Answer 35

logical objective evaluation
utility evaluation
consistency of the belief across time person and place

Question 36

methods for modifying intermediate beliefs

Answer 36

socratic questioning
behavioural experiments
cognitive continuum
rational emotional roleplays
using others as a reference point
acting ‘as if’

Question 37

cognitive continuum

Answer 37

used to modify beliefs that reflect polarised or dichotomous thinking
recalibration of standards

Question 38

rational emotive roleplay

Answer 38

define the original belief
have the therapist assume the role of the original belief while the client agrees to take on the role of the new belief
therapist should begin by articulating the original belief, and have the client respond to this with evidence for the more rational belief
continue until the therapist exhausts all lines of argument
particularly useful for clients who feel the need to ‘defend’ their beliefs

Question 39

using others as a reference point

Answer 39

considering the beliefs of others
aiming to recalibrate one’s own beliefs through considering the viewpoint of others in similar situations

Question 40

acting ‘as if’

Answer 40

client agrees to a behavioural experiment in which they act ‘as if’ the new belief (not original) were true

Question 41

schemas v core beliefs

Answer 41

schemas are the cognitive structures within the mind
core beliefs are the content of these cognitive structures

Question 42

symptom typography reflects

Answer 42

schema content

Question 43

schema change requires

Answer 43

schema activation

Question 44

two types of core beliefs

Answer 44

helplessness
unloveability

Question 45

Young’s schemas

Answer 45

disconnection and rejection: abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, social isolation/alienation

Impaired autonomy and performance: dependence/incompetence, vulnerability to harm or illness, enmeshment/undeveloped self, failure

impaired limits: entitlement/grandiosity, insufficient self control/self discipline

Other directedness: subjugation, self sacrifice, approval/recognition seeking

Over vigilance and inhibition: negativity/pessimism, emotional inhibition, unrelenting standards/hypercriticalness, punitiveness

Question 46

knowing when a core belief is uncovered

Answer 46

uncovering associated with strong emotional response
core beliefs tend to be general and asolutistic
tend to be exaggerations

Question 47

downward arrow

Answer 47

choose salient AT
thought written at top of page and arrow drawn under
asked questions to uncover deeper meaning like what would this mean to you, what would be so bad about, what would be the worst thing about it being true, what would that say about you, why would this be so upsetting
each step down should go from more specific to general and global beliefs
should not response with statement of desire or wishes about how they would like things to be or feelings/emotions

Question 48

techniques used to modify core beliefs

Answer 48

core belief worksheet
extreme contrasts
developing metaphors
historical tests
restructuring early memories
coping cards

Question 49

extreme contrasts

Answer 49

ask to compare self with an extreme example of a core belief they report

Question 50

metaphor/analogy for core beliefs

Answer 50

particularly useful when client can relate it to personal experience

Question 51

restructuring early memories

Answer 51

The client can be asked to respond to earlier statements said to them in the same fashion as they respond to their own internal beliefs

Question 52

coping cards

Answer 52

patients can compile coping cards that record key pieces of information for use in distressing situations
Their core belief
Their explanation for how the core belief arose.
Evidence that refutes the core belief
Alternative beliefs or reframed evidence.