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CBT > Week 1 > Flashcards

Week 1 Flashcards

1
Q

history of cbt

A

started late 1950s - 1960s, 1st generation behavior therapy (classical and operant conditioning)
1970s - 1980s: 2nd generation cognitive therapy (negative automatic thoughts, cognitive restructuring, Socratic dialogue.)
2000s: 3rd generation (MBCT, ACT, DBT)

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2
Q

characteristics of CBT (5)

A
  • focus on present
  • focus on thoughts, behaviors, emotions
  • problem solving approach
  • goal oriented
  • time limited
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3
Q

first 3 phases of cbt

A

validation of patients complaints
building therapeutic relationship
explaining general treatment rationale

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4
Q

second 3 phases of cbt

A

cognitive and behavioral assessment
formulating realistic plan
designing treatment plan

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5
Q

last 3 phases of cbt

A

carrying out treatment plan
broadening to other areas of dysfunctioning
relapse prevention

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6
Q

behavioral is the result of a…

A

complex information system with antecedence and consequent factors (ABC)

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7
Q

learning

A

acquiring knowledge about the connection between events and can result in a behavioral change

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8
Q

learning model in CBT

A

abnormal behavior is achieved by the same learning processes as normal behavior: the ways of developing, maintaining, and changing behavior are the same

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9
Q

pros of cbt

3

A

short term , complaint driven, measurable effects

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10
Q

cbt effectiveness

A

50-60% who start CBT reach recovery

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11
Q

therapists beliefs and attitudes

A
  1. therapists rarely use manuals and dislike them even though using them results in better outcomes
  2. therapists believe the therapeutic alliance will do lots of the work for us
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12
Q

does alliance drive therapy outcome

A

not in cbt, important to focus on early behavioral change

first 5 sessions, if there is no difference in behavior change, no sense in continuing

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13
Q

how much of clinical outcome is associated with the alliance

A

clinician believes its 32%
actual evidence: 4-5%

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14
Q

therapy drift

A

they underperform, they dont provide patients with best treatment

because of this reality recovery percentage is around 30%

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15
Q

best indicator of therapist drift

A

experience

the more experience the lower the clinical outcome

the recently graduated are unsure more and they look in manual more

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16
Q

way to beat experience

A

keep learning as a therapist

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17
Q

basic principles of behavioral therapy

A

interaction of person with his or her environment

Antecedents of Behavior
Behavior
Consequences
(ABC)

behavior is maintained by its consequences

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18
Q

assessment of behavioral therapy (3)

A

intake evaluation: assessing problem behavior

registration of problem behavior and antecedents / consequences or thought records

functional analysis

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19
Q

functional analysis - antecedents (3)

A

discriminative stimuli

establishing operations

s-delta

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20
Q

discriminative stimuli

A

events or situations that elicit the behavior and predict reinforcement or punishment

a stimuli that reinforces a particular behavior

it must come first, then the behavior.

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21
Q

establishing operations

A

factors changing the reinforcing or punishing properties of a stimulus or environmental event.

e.g. drinking water after eating salty food

salty food momentarily increases the reinforcing effectiveness of drinking water

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22
Q

basic principles of cognitive therapy (5)

tbidc

A

thoughts give meaning to a neutral stimulus and determine feelings and behaviors

beliefs or schemas are developed through childhood experiences and form a filter

identify thoughts

distinguish between automatic thoughts, intermediate and core beliefs

challenge and change thoughts

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23
Q

mindfulness based cognitive therapy

A

non judgmental observation of present experiences, thoughts are observed, meditation

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24
Q

Beck’s model assumption for treating disorders

A

distorted and dysfunctional thinking influences mood and behavior and that such biased form of thinking are common in all psychological disorders

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25
Q

drapetomania

A

a mental disease given to black slaves who would run away from their masters to seek freedom

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26
Q

behavioral perspective assumption

A

there is nothing inherently defective or deviant about persons who report emotional or behavioral problems

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27
Q

what is regarded as psychopathology in behavioral perspective

A

problem in living

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28
Q

three term contingency and the ABC

A

refers to the interaction of the person with his environment and includes three elements:
- the occasion within which behavior occurs, (antecedents of behavior)
- the behavior itself, (behavior)
- and the consequences that follow the behavior (consequences)

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29
Q

behavior and its relationship with Darwinian evolutionary principles

A

behavior of an individual that is functional in particular environmental contexts is selected or made more likely, whereas behavior that is not functional is not selected or becomes extinguished.

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30
Q

environmental determinism

A

overarching process associated with the selection of variations in an individual’s behavior during his or her lifetime and in cultural practices over successive generations

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31
Q

contextualism

A

concerned with the context within which behavior is embedded or the contextual flow in which behavior occurs

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32
Q

how do behavioral therapists view motivation

A

a state or condition resulting from environmental events (therefore it is modifiable, something that can be increased as a result of environmental manipulations

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33
Q

4 response domains of assessing a client’s behavioral repertoire

A

overt motor behaviors (does avoidance occur)
thoughts and mental images (does the person have negative evaluations over the world)
emotions (does the client experience negative emotions excessively)
physiological sensations (does sweating come from a response pattern)

does avoidance occur?
does person have negative evaluation about world?
does client experience negative emotions excessively?
does sweating come from response pattern?

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34
Q

how is context evaluated in behavioral assessments of clients

4

A

ABC’s
Client’s learning history
Client’s current behavioral repertoire (4 domains)
Client’s motivation for change

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35
Q

two subtypes that account for behavior problems in alcoholism

A
  1. characterized by persons who display anxious dependent traits, binge drinking vs continuous episodes, and avoidant coping styles (negative reinforcement)
  2. early age of onset, continuous vs episodic binge drinking and engagement in aggressive or criminal behavior when intoxicated (positive reinforcement)
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36
Q

8 characteristics of behavioral interventions

A
  • empirical orientation
  • therapist - client collaboration
  • active orientation
  • flexible approach
  • emphasis on environment-behavior relations
  • time limited and present focus
  • problem and learning focus
  • emphasis on both change and acceptance processes
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37
Q

generalization

A

CRs often occurred in the presence of stimuli that resembled or were similar to the CS in some way

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38
Q

thorndike theory

A

referred to as law of effect: learning process and associated behaviors are influenced by the consequences that follow behavior

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39
Q

operant as defined by Skinner in operant theory of behavior

A

unit of behavior that operates on the environment by producing consequences

classical conditioning: stimulus event elicits a response (S –> R) but in operant conditioning, C (consequence) is emphasized R –> C

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40
Q

Mary Cover Jones

A

demonstrated that a child’s fear of an animal could be decreased through counterconditioning methods. Early effort to apply learning theory to behavior change (1924)

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41
Q

cbt was kickstarted by…

A

not until the 1970s and 1980s where cbt gained momentum, kickstarted by bandura social learning theory

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42
Q

next generation of cbt

A

acceptance and commitment therapy, dialectical behavior therapy

they incorporate mindfulness and acceptance principles into therapy

greater emphasis on context in which behavior occurs

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43
Q

primary goal associated with behavioral assessments

A

identification of potentially modifiable contextual features associated with maintenance of problematic behavior

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44
Q

medical model approach goal

A

evaluate presence of behavioral and physiological markers indicative of a disease and make a positive diagnosis when enough key markers are evidence

different from behavioral approaches of assessment

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45
Q

3 goals of behavioral assessments

A
  • a clarification of the nature of the client’s problems, and identification of associated target behaviors;
  • an evaluation of the extent to which the client’s problems impair his or her functioning (e.g., in the areas of family life, social and occupational functioning, personal distress);
  • the identification of factors that support and maintain problem areas;
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46
Q

6 distinguishing features of behavioral assessments and therapy

A
  • level of analysis in behavioral assessment is the act in context, or the whole person in interaction with the environment
  • recognition that each person lives in a unique context, assessment is tailored to the client’s uniqueness
  • behavior is viewed as situationally specific rather than cross situationally general
  • limited inference is used in behavioral assessment, diagnostic labels generally avoided as explanations of behavior
  • clients problem areas are clearly defined in behavioral terms
  • emphasis in therapy is on the development of effective behavior and competencies
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47
Q

important steps for first few contact with client

A

provide realistic expectations, establish warm therapeutic relationship

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48
Q

3 methods to develop a collaborative therapist-client relationship

A

encourage client to be involved in all aspects of therapy, highlighting importance of clients goals,
using we statements –> convey the ideas that we are a team

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49
Q

case formulation

A

hypothesis about the causes, precipitants, and maintaining influences of a person’s psychological, interpersonal, and behavioral problems

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50
Q

importance of listening for first 10 minutes without interrupting (3) (AKA free speech)

A
  • allows client to freely describe problem
  • conveys you are genuinely interested
  • you can generate hypothesis
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51
Q

what happens after free speech (4)

A

probe further, identify manifestations of problem
the context within which they emerge
consequences that follow
look into history of problem

52
Q

checklist data often useful in behavioral assessment because…

2

A

indicates frequency and severity of problem behavior
frequently suggest specific behavioral targets

53
Q

what two broad categories to categorize problematic behaviors

A

behavioral excesses and behavioral deficits

54
Q

behavioral excesses

A

when a person displays forms of behavior that are excessive in terms of frequency, intensity or duration

55
Q

behavioral deficits

A

when persons do not demonstrate an adequate range of behavior in a variety of contexts, or do not display adequate flexibility when adjust behaviors in accordance with shifting circumstances

56
Q

two reasons for behavioral deficits

A
  1. past environments did not adequately model, shape, or reinforce such behaviors
  2. absent behaviors have been learned at one time and are part of the person’s repertoire
57
Q

examples of coping skills targeted for strengthening within CBT (5)

A

problem solving skills, social skills, self-regulation skills, mindfulness skills and acceptance skills

58
Q

what 3 types of individuals is acceptance helpful with?

A

for individuals who are

overly reactive,

highly sensitive

and impulsive.

59
Q

3 reasons for evaluating degree of functional impairment associated with client’s problems

A
  1. degree and pervasiveness of impairment indicate the severity of the problem
  2. level or nature of impairment can have relevance for the choice, course, or emphases of therapy interventions
  3. psychological disorders are often defined by presence of behavioral patterns associated with subjective distress or impairment in social and occupational funcitoning
60
Q

3 example questions for evaluating severity

A

Has this problem resulted in avoiding situations?
What difficulties has this problem caused you?
Have you had difficulty sleeping?

61
Q

when assessing family and social situation , it is important to distinguish between what 4 factors?

A
  1. avoidance tendencies
  2. social skills deficits
  3. suppression of social behavior by environment
  4. low rate of positive reinforcement for social behavior
62
Q

what areas should be assessed for impairements of functioning (7)

A

personal functioning
family and social relations
occupational and school functioning
legal difficulties or proceedings
health and medical status
current life situation and quality of life
suicide risk and other risks

63
Q

example questions for establishing antecedents of target behaviors

A

what is happening right before the problem occurs?

64
Q

example questions for evaluating associations that learning history or personal variables have with target behaviors

A

what was going on in your life then?
when did the problem first begin?

65
Q

example questions for evaluating the consistency of problem behaviors with values or goals

A

how might life be like if this were not a problem for you?

66
Q

two types of antecedents that set the occasion for behavior

A

discriminative stimuli
establishing operations

67
Q

discriminative stimuli

A

events that provide information about likelihood that reinforcement or punishment will follow the engagement in some type of behavior.
e.g. upcoming social interaction, presence of alcohol

68
Q

establishing operations (aka motivational operations)

A

references the influence that environmental events or conditions have on behavior by altering the reinforcing or punishing properties of other environmental events
e.g. withdrawal symptoms of alcohol abuse, drinking related rules (if i drink, I’ll have more fun)

69
Q

rule governed behavior

A

refers to those behaviors influenced by verbal rules that specify the operating contingencies associated with behavior.

e.g. If I speak (behavior) in front of a large audience (antecedent condition / context), I will be evaluated negatively and humiliated (consequence)

70
Q

factors that increase or maintain behavior

A

positive reinforcement and negative reinforcement

71
Q

positive reinforcement

A

occurs when behavior results in the application or provision of a reinforcing event, which increases the probability of the behavior in future similar situations

72
Q

negative reinforcement

A

occurs when behavior results in the removal or termination of an aversive event or condition, which increase the probability of the behavior in future similar situations

73
Q

abuse of reinforcers

A

when substance abuse is instrumental in producing pleasant or desirable consequences (euphoria), it is regarded as positively reinforced behavior

when substance abuse produces relief (escape) from aversive states, it is regarded as negatively reinforced behavior

74
Q

two types of punishment

A

positive punishment and negative punishment

both decrease future likelihood of punished behavior under similar stimulus conditions

75
Q

positive punishment

A

occurs when behavior results in the application or provision of an aversive event, which decreases probability of behavior in future situations

76
Q

negative punishment

A

occurs when behavior results in the removal of a reinforcing event, which decreases probability of behavior in future situation

77
Q

another type of process that results in elimination of behavior other than the two punishments

A

extinction: occurs when previously reinforced behavior reliably fails to produce reinforcing consequences. If it fails at reliably reinforcing behaviors, then the behavior will drop out over time

78
Q

reinforcer

A

an operation that increases behavior frequency over time

79
Q

punisher

A

an operation that decreases behavior over time

80
Q

type of consequences in reinforcements, punishments and extinction

A

pos. reinforce: rewarding
neg. reinforce: relieving
extinction: frustrating
pos. punish: aversive
neg. punish: penalizing

81
Q

two important considerations when examining consequences of behavior

A
  1. definition of what constitutes a reinforcer or punisher is determined by the effect the consequence has on future behavior
  2. whether consequences are short term or immediate vs long term or delayed
82
Q

person variables

A

aka organismic variables

include biological characteristics of the individual and the effects of past learning

e.g. genetic predisposition, physical appearance, etc.

83
Q

functional response classes

A

groups of behaviors that produce similar outcomes, even though they may assume several forms

e.g. self harm, phobic behavior, substance abuse, etc.

84
Q

functional analysis example

A

discriminative stimuli (social interaction) + establishing operations (withdrawal symptoms) –> person variables (restricted coping skills) –> behaviors (consumption of alcohol)
–> reinforcing consequences (taste of alcohol) and aversive consequences (onset of withdrawal symptoms)

85
Q

self-monitoring

A

assessment procedure in which client collects data on behaviors of interest as they occur within naturalistic settings

86
Q

what can self-monitoring be useful in (3)

A

identifying antecedents that precede behaviors of interest, also provides insight into frequency of behaviors, also can provide info on which treatment was most useful in providing behavioral change

87
Q

functional analysis

A

examines causes and consequences of behavior

the classic ABC can be used to collect information

88
Q

functional analytic psychotherapy assumptions

A

therapeutic environment is a social context that has similarities to interpersonal situations that clients participate in outside of therapy

89
Q

role play situations

A

a way for therapists to observe clients social behavior in simulated environment (a direct observation technique)

90
Q

important things to address before closing initial interview

A

check if there is anything that is important to know, ask for further questions, any discomforts during sessions, also summarize main points of sessions

91
Q

first 4 important steps initial interview

A
  • Provide the client with a description of what to expect during the first few sessions, and work with the client to establish a warm and collaborative therapeutic relationship.
  • Convey that CBT is an action-oriented therapy and that the
    client will have an active role in making decisions about his
    or her treatment and in carrying out therapy-related activities.
  • Broadly assess the client’s functioning, including strengths and behavioral skills.
  • Emphasize what the client does and describe relevant behaviors in behavioral terms.
92
Q

middle 4 important steps initial interview

A

in brief:
- identify antecedents
- explore consequences of relevant behavior
- assess history of problem areas
- evaluate level of impairment associated with behavior

  • Identify the circumstances or situations in which the client is more likely to engage in clinically relevant patterns of behavior.
  • Explore the consequences that clinically relevant behavior
    patterns often produce, with emphasis placed on the processes that account for the maintenance of these behaviors over time.
  • Assess the history associated with the client’s problem areas; consider any biological conditions that might be associated with such behavior patterns.
  • evaluate the level and pervasiveness of impairment associated with clinically relevant behaviors.
93
Q

last 4 important steps initial interview

A
  • Consider and implement methods for assessing behaviors of
    clinical interest.
  • Continue to develop, explore, and refine hypotheses concerning how clinically relevant behavior patterns might be related; that is, work toward the development of a case formulation.
  • Inquire about the existence of other important areas that were
    not discussed before closing the initial interview, explore the
    client’s overall sense of the therapeutic process thus far, and
    anticipate with the client what the next meeting or two might
    cover
94
Q

EST

A

empirically supported therapies

95
Q

the EST approach is…

A

protocol driven and variable centered (i.e. on diagnosis or symptom presentation)

96
Q

behavioral assessment vs EST approach

A

behavioral assessment is tailored to individual client

97
Q

two phases to narrowing down client’s problem areas

A

broadly surveying possible problem areas

transitioning from broad survey to focal assessments

98
Q

techniques to broadly surveying possible problem areas

A

client’s complaint, broadband questionnaires, diagnostic interviews

99
Q

multi-problem clients often display some combination of:

(6)

bbdfep

A

behavioral excesses
behavioral deficits
difficulties in stimulus control
failures to display appropriate behavior in relevant contexts
excessively high or low performance standards
problems in self-regulation or control

100
Q

second and third phase of narrowing down client’s problem areas

A

second: focus narrows, end of this phase includes definition of clients problem area, a diagnosis, or some other means of classification

third: focus narrows further, goal of this phase is to identify specific target behaviors and design intervention strategies linked to assessment information

101
Q

nomothetic principles

A

general principles

102
Q

case formulation consists

A

identification of a set of problem areas and generation of hypotheses about factors associated with their development and maintenance

103
Q

assumptions associated with behavioral formulations (3)

A
  1. behavior and environmental context are not seen as parts to be analyzed separately, they are analyzed as a unit
  2. distinguish development of a psychological condition, and the maintenance of the condition over time
  3. problematic behavior indicates absence of alternative and effective behaviors in a person repertoire
104
Q

EX/RP

A

exposure and ritual prevention

105
Q

EX/RP teaches…

A

teaches an individual to approach, rather than avoid, fear-producing stimuli (exposure) coupled with the prevention of fear-neutralizing rituals (response prevention)

106
Q

underlying cause of ocd is…

A

multifactorial, complex interaction between, genetic, physiological, and behavioral factors

107
Q

two-factor model of fear

A

early learning model of ocd, proposes that when an individual is faced with a situation that elicits a physiological fear or anxiety state, an unconditioned behavioral to escape that state is initiated. If the action is successful in reducing anxiety, it is strengthened (negative reinforcement)

108
Q

EX/RP is based on assumption that

A

if an individual is systematically exposed to stimuli that elicit obsessional thoughts and associated anxiety, and is prevented from escaping, the anxiety will diminish over time through process of extinction

109
Q

EX/RP research effectiveness

A

60 to 90 percent effectiveness, 50 to 80 percent symptom reduction

110
Q

Caroline primary OC symptoms

A

fear that she will cause harm to those around her by spreading bad energy or illness which will result in injury, harm or death to friends, family, etc in her proximity. Feelings of dust on hands and tongue

pathological sense of responsibility for preventing harm

111
Q

Caroline rituals

A

flick her fingers to remove dust, closing hands to contain dust, praying to God to protect those around her, etc.

112
Q

goal for Caroline

A

confront feared stimulus and deliberately elaborate or focus upon the fears in the moment, rather than to engage in attempts to stop obsessions and discomfort from occurring.

113
Q

2 commandments of successful EX/RP

A

patients should
1. expect to feel uncomfortable
2. should not try to fight the discomfort

114
Q

how many session will most patients respond well in

A

12 to 15 sessions, 60 to 90 minutes each

115
Q

session 1 goals EX/RP

5

RPPTB

A

review of ocd symptoms
psychoeducation
present functional model of OCD and rationale for EX/RP
teach symptoms monitoring and rating (SUDS)
begin development of fear hierarchy

116
Q

session 2 goals EX/RP

3

A

continue fear hierarchy
plan for exposure exercises
develop strategies for ritual prevention

117
Q

session 3 - 12 goals EX/RP

4

bawa

A

begin in session therapist guided exposure tasks with response prevention
assign out of session homework
work through hierarchy
assess ocd symptoms periodically

118
Q

session 13 - 15 goals EX/RP

3

A

conduct final exposures

take steps to promote generalization and maintenance

prepare for future challenges and create plan for relapse prevention

119
Q

yale-brown obsessive compulsive scale (Y-BOCS)

A

gold standard instrument for assessing ocd symptoms in adults

120
Q

what to do when patient is focused on cause of ocd

A

say that ocd is a neurobehavioral disorder whose causes are not yet fully understood

121
Q

primary goal of ex/rp is

A

to help person understand how their rituals are currently maintained, not how they came to be in the first place

122
Q

4 most important aspect of successful exposure are…

A
  1. conduct exposure exercises that are manageable
  2. refrain from all ritualistic behavior during that exposure
  3. continue the exposure until it can be performed with relative ease both inside and outside of therapy sessions
  4. conduct the exposure repeatedly
123
Q

5 common reasons to noncompliance of treatment exercises

A

lack of motivation, disagreement, poor therapist-client match, moving too rapidly on hierarchy, comorbid conditions (depression, anxiety)

124
Q

4 common barriers to treatment

A
  1. noncompliance of exposure exercises
  2. unintentional subtle avoidance
  3. when patient’s family members become involved in rituals
  4. comorbid psychological disorders
125
Q

reassurance seeking questions problem

A

unintentional subtle avoidance
when answering these questions, it reinforces OCD
common in ocd patients
answer the question by saying “Who is asking, you or OCD?”

126
Q

caroline indicators of positive prognosis (3)

A

She is seeking treatment, has social support, and a symptoms profile amenable to EX/RP.

CBT (8 decks)

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