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CBT > Week 4 > Flashcards

Week 4 Flashcards

1
Q

cognitive therapy uses what 2 techniques?

A

guided discovery and socratic method

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2
Q

5 characteristics of cognitive therapy

A

problem oriented, directive, time-limited, structured, didactic approach

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3
Q

cognitive model

A

treatment approach based upon the notion that dysfunctional thinking plays a role in a number of psychological disorders

how you think influences how you feel

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4
Q

general model path of cognitive model

A

situation –> automatic thoughts –> reaction

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5
Q

cognitive layers

A

automatic thoughts, intermediate beliefs, and core beliefs

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6
Q

what maintains existing beliefs

A

information processing biases

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7
Q

cognitive layers with schizophrenia

A

Event: You are terrible, go kill yourself, kill your sister
Automatic thoughts: my sister is in danger, I have to hurt myself or something bad will happen
Intermediate Beliefs: I have to obey, voice is powerful
Core belief: I am vulnerable, the world is a dangerous place

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8
Q

cognitive layers with ocd

A

automatic thoughts: I forgot to turn off the gas
intermediate beliefs: If you are not sure, always check, it is terrible to fail
core beliefs: I am responsible

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9
Q

core belief examples

A

self-worth, incompetence, rejection, powerlessness

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10
Q

transdiagnostic model of anxiety

6 step process

A

learning experience > trigger > catastrophic misinterpretation > anxiety > safety behavior > anxiety confirming information

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11
Q

how to identify automatic thoughts (5)

(SAVER)

A

ask basic questions: what was going through your mind

use automatic thought records
use socratic questioning
use visualization (ask patient to close eyes and imagine)
exploring changes in present mood
role playing a problematic situation

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12
Q

socratic questioning characteristics (5)

A

promote self-reflection: examines beliefs and their contradictions

therapist should not interrogate, but ask questions the patient is able to answer

questions open rather than closed

therapist really wants to understand the patient’s inner world

not about asking the right questions, but rather about exhibiting an interested, exploring and modifying attitude

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13
Q

downward arrow technique

A

helps identify core beliefs

vertical exploration
start with automatic thought and try to see what’s beneath that.

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14
Q

example downard arrow technique

A

if i move, im having back pain

(whats so bad about that? - therapist)

if im having back pain, something has been damaged

if something has been damaged in my back, ill never get better

if i dont get better spontaneously, i have to be operated on

in order to be operated on, i have to be admitted to the hospital

in the hospital i will contract a fatal infection and then it will kill me

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15
Q

case conceptualization

A

translate patients psychopathology into a cognitive behavioral model, formulate hypotheses about disorder

explore relations between problems

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16
Q

empirical quality of case conceptualization

A

reliability is poor

validity little research

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17
Q

cognitive interventions to modify maladaptive beliefs (5)

A

socratic dialogue
evidence for / against - court technique
g-scheme / thought record
multidimensional evaluation
pie chart

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18
Q

columns of thought record (7)

A

situation, moods, automatic thoughts, evidence that supports the hot thought, evidence that does not support the hot thought, balanced thoughts, rate moods now

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19
Q

when is pie chart useful

A

with guilty feelings

e.g. what are explanations for the angry face of the cashier? fill in percentage with pie chart

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20
Q

probability calculation

A
  1. realistic chance per step
  2. multiply chances to calculate overall chance
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21
Q

1st stage to develop expertise as a cognitive behavior therapist

3

A
  • learn basic skills of conceptualizing a case in cognitive terms based on an intake evaluation and data collected in session.
  • You also learn to structure the session, use your
    conceptualization of a patient and good common sense to plan treatment, and help patients solve problems and view their dysfunctional thoughts in a different way.
  • You also learn to use basic cognitive and behavioral techniques
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22
Q

2nd stage for developing expertise as a cognitive behavioral therapist

3

A

you become more proficient at integrating your conceptualization with your knowledge of techniques.

You strengthen your ability to understand the flow of therapy.

You become more easily able to identify critical goals of treatment and more skillful at conceptualizing patients, refining your
conceptualization during the therapy session itself, and using the conceptualization to make decisions about interventions.

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23
Q

3rd stage of developing expertise as a cognitive behavioral therapist

A

you more automatically integrate new data into the conceptualization.

You refine your ability to make hypotheses to confirm or revise your view of the patient.

You vary the structure and techniques of basic cognitive behavior therapy as appropriate, particularly for patients with personality disorders and other difficult disorders and problems

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24
Q

basic premise of cognitive model

A

people’s emotions, behaviors and physiology are influenced by their perception of events

situation –> automatic thoughts –> reaction (emotion, behavior, physiological)

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25
Q

first attempt to challenge validity of automatic thoughts

A

ask yourself: what was just going through my mind?

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26
Q

origin of automatic thoughts

A

beliefs

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27
Q

automatic thoughts

A

quick and brief evaluative thoughts. Not a form of deliberation or reasoning. You are not aware of these thought but you are of the emotions or behavior that will follow these thoughts. If you are aware of the thoughts you accept them instantly.

28
Q

core beliefs are…

3

A

global, rigid and overgeneralized

29
Q

if you want to give good therapy to the patient, you need to know the…

6

(PBABTI)

A

the problem, the beliefs, automatic thoughts, behavior, techniques, and improve alliance

30
Q

conceptualization is like

A

the road map

31
Q

2 kinds of automatic thoughts outside of sessions

A

thoughts they have already identified and evaluated in session (make sure they have written responses)

novel thoughts (for these you teach patients to use list of socratic questions or worksheet)

32
Q

what to do after you ask patients to evaluate automatic thought

A

ask them to record it and have them listen to it multiple times a day, so they can integrate this thinking into their thinking

33
Q

Thought Record (TR)

A

worksheet that prompts patients to evaluate their automatic thoughts when they feel distressed

consists of: date, situation, automatic thought, emotion, adaptive response and outcome

34
Q

how to introduce TR

A

in two stages, first 4 columns in first sessions, another session for final 2 columns

35
Q

Testing your thoughts worksheet

A

for use when thought record is too confusing or elaborate for patients, a simplified version of TR

36
Q

AWARE technique

A

use when patients have anxious, obsessive thoughts

A - accepting their anxiety
W - watching their anxiety without judgment
A - acting with their anxiety, as if they aren’t anxious
R - repeating the first 3 steps
E - expecting the best

37
Q

modifiability of intermediate beliefs, automatic thoughts and core beliefs

A

automatic thoughts most modifiable
then intermediate beliefs
then core beliefs least modifiable

38
Q

cognitive conceptualization diagram

A

depicts relationship between core beliefs, intermediate beliefs, and current automatic thoughts

Provides a cognitive map of patients psychopathology and helps organize the multitude of data that the patient presents

39
Q

dysfunctional automatic thoughts are almost always negative unless patient is

A

manic or hypomanic

40
Q

automatic thoughts can be evaluated according to their…

A

validity and utility

41
Q

automatic thoughts can be in what forms

A

verbal, visual or both

42
Q

3 types of automatic thoughts

A
  1. distorted and occurs despite objective evidence to contrary
  2. accurate, but the conclusion patient draws is not.
  3. valid, but decidedly dysfunctional
43
Q

basic question to identify automatic thoughts for patients

A

what was going through your mind?

44
Q

hot thoughts

A

important automatic thoughts and images that arise in the therapy session itself, and are associated with a change or increase in emotion

45
Q

if patients are unable to answer the question (what was going through your mind) you can:

4

A

ask them how they were feeling and where in their body they experience the emotion

elicit a detailed description

visualizing the situation (imagine you were back in class, etc)

role play

46
Q

what to do when patient has difficulty identifying a particular situation or issue that is troublesome to them (3 step process)

A
  1. propose a number of upsetting problems,
  2. eliminate them one by one,
  3. determining how much relief the patient feels
47
Q

in order to evaluate automatic thoughts effectively, patients need to…

A

patients need to learn to specify the actual words that go through their minds

48
Q

3 examples of automatic thoughts

A

I shouldn’t be angry at him, I’m a bad person

I’m so weak, i just cant get my eating under control

what if there’s something seriously wrong with me?

49
Q

what to evaluate and not evaluate in a patient

A

evaluate thoughts and beliefs but NOT emotions

50
Q

Emotion chart

A

helps patients to label their emotions more effectively

they list current or previous situations in why they felt emotion

Angry Sad Anxious
brother mom doesn’t seeing low money
cancels plans return call in bank account

51
Q

how to tell if thought is important to focus on?

3 questions to ask yourself as therapist

A

is it significantly distressing currently or unhelpful and likely to recur?

how much did you believe it at the time and how about now? Use 0 - 100 scale

how intense was the emotion then and how about now?

52
Q

why do clients bring up problems or automatic thoughts that aren’t important

A

they aren’t socialized well enough to treatment, or they bring up problems that just happened before therapy

53
Q

automatic thoughts are rarely…

A

completely erroneous, they contain some truth

54
Q

challenging a cognition violates a fundamental principal of CBT, that of…

A

collaborative empiricism: you and the client examine the automatic thought together, test its validity or utility and develop a more adaptive response

55
Q

instead of challenging automatic thoughts, use…

A

Socratic questioning

56
Q

6 types of questions to evaluate automatic thought

eadidp

A

evidence questions
alternative explanation questions
decatastrophizing questions
impact of the automatic thought questions
distancing questions
problem solving questions

57
Q

evidence question

A

what is the evidence that Charlie won’t want to hear from you?

58
Q

alternative explanation questions

A

is there another way to look at this?

59
Q

decatastrophizing questions

A

what is the worst think that could possibly happen and the best that could happen?

60
Q

impact of automatic thought questions

A

help client assess consequences of responding and not responding to distorted thinking

what could be the effect of changing your thinking?

61
Q

distancing questions

A

imagine what they would tell to a close friend in a similar situation

62
Q

problem-solving questions

A

what would you like to do about this situation

63
Q

common reasons why evaluation of automatic thought was ineffective

4

A
  • other more central automatic thoughts unevaluated
  • evaluation was inadequate
  • automatic thought itself is a core belief
  • does not belief automatic though on emotional level
64
Q

3 alternative methods to help patients examine their thinking

A

vary your questions

identify the cognitive distortion

use self-disclosure

65
Q

what to do when automatic thoughts are true

3

A

focus on problem solving

investigate whether patient has drawn an invalid or dysfunctional conclusion

work on acceptance

CBT (8 decks)

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