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3005PSY Counselling > Week 4 - Cognitive > Flashcards

Week 4 - Cognitive Flashcards

1
Q

Cognitive Therapy Was Developed when and by whom?

A

1960s by Aaron Beck for treatment of depression

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2
Q

What is the philosophy behind cognitive therapy?

A

Assumption that distorted thinking influences mood & behaviour

Distorted thinking is common to all psychological disturbance

Realistic evaluation & modification of distorted thinking will therefore improve symptoms

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3
Q

What is the cognitive model?

A

Situation (observe ambiguous non-verbal cue)

Thought (she thinks i’m an idiot)

Feeling (Anxiety)

Behaviour (avoidance/not expressing an opinion)

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4
Q

What are the Biases in Info processing in depression?

A

-ve view of self, world & future (-ve cognitive triad)

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5
Q

What are the Biases in Info processing in Anxiety?

A

overestimation of physical or psychological danger

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6
Q

What are the Biases in Info processing in Panic disorder?

A

catastrophic interpretation of physiological experiences

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7
Q

What are the Biases in Info processing in Paranoia?

A

attribution of bias to others

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8
Q

What are the Biases in Info processing in Suicidal ideation?

A

hopelessness regarding future & deficiencies in problem solving

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9
Q

Cognitive Distortions: All-or-nothing Thinking

A

dichotomous, black-or-white thinking

“If I don’t get a HD, I have failed”

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10
Q

Cognitive Distortions - Selective Abstraction:

A

selectively choosing facts to support –ve thinking

athlete focuses on 1 loss in otherwise successful career, which reinforces sense of incompetence

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11
Q

Cognitive Distortions - Mind-reading:

A

we know what others think of us

“I know she thinks I’m an idiot”

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12
Q

Cognitive Distortions - Negative prediction:

A

: -ve prediction of future in the absence of supporting evidence
“I just know that if I go, I’ll have a bad time”

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13
Q

Cognitive Distortions - Catastrophising

A

exaggerate the consequences of a future event into something fearful
“If I don’t get a HD, I’ll die”

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14
Q

Cognitive Distortions - Overgeneralisation

A

making a rule based on a few negative events

“I forgot my keys again…I can never remember anything”

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15
Q

Cognitive Distortions - Labelling & mislabelling

A

-ve view of self created by labelling based on a few mistakes:
rather than “I felt awkward talking to Sarah”, “I am a complete loser” (overgeneralisation at the identity level)

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16
Q

Cognitive distortions- Magnification/minimisation:

A

magnify imperfections, minimise good points
“my jeans are a little tight. I am so fat & disgusting” (mag)
“I did really well on that assignment. Total fluke”(min)

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17
Q

Cognitive Distortions - Personalisation:

A

taking an event unrelated to oneself & making it meaningful
“Another red light. Why does nothing ever go right for me?”

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18
Q

What are Automatic thoughts?

A 
Quick, evaluative thoughts
The outcome of cognitive distortions
Not the result of reasoned deliberation
May be outside full conscious awareness
Tend to uncritically accept them as true
Subsequently affect emotion & behaviour
Example:
AT “People won’t like me”
Emotion: Anxiety
Behaviour: Avoidance (stay home)
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19
Q

What are Core Beliefs ?

A

The breeding ground for distortions & automatic thoughts
Fundamental beliefs about oneself, the world & others that are unquestioningly accepted as absolute truths
Global, rigid, overgeneralised: “I’m stupid”, “I’m unlovable”
Again, often outside conscious awareness
Stem from early experiences (thus, predisposing factors)
Current experiences (i.e. Precipitating factors) trigger them

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20
Q

how are beliefs and schemas developed?

A

Often centre around competence & self-worth
Sufficient caregiver love & support = lovable & competent
Negative early experiences
Chronic, harsh criticism: I’m incompetent
Pervasive neglect, punishment: I’m not ok’/I’m not worth attention
Traumatic experiences: the world is a dangerous place; people will hurt me; I’m not safe

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21
Q

Behaving in Belief/Schema consistent ways _____ belief/schema

A

Behaving in belief/schema consistent ways reinforces belief/schema

Does not allow for a disconfirming experience (e.g. Expressing different opinion & not being rejected)

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22
Q

Cognitive Conceptualisation

A 
Relevant early experiences
                       |
      Core Belief / Schema     
                        |
Situation/Critical incident
                         |
Automatic Thought > Emotion > Behaviour
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23
Q

Predisposing factors:

A

Early childhood experiences which lead to the development of core beliefs/schemas
Explain how automatic thoughts are generated by schemas

24
Q

Precipitating Factors:

A

A critical incident/situation which triggers the core belief/schema

25
Q

Perpetuating Factors:

A

Ongoing cognitive distortions, acceptance of NAT as truth – perpetuate core belief/schema
Lack of experiences to disconfirm core belief

26
Q

What are Schemas? (Jeffrey Young)

A

Schema = broad organising principle for making sense of experience

27
Q

What are Early Maladaptive Schemas (EMS)?

A

Pervasive theme or pattern
Consists of congruent memories, emotions, thoughts, physiological sensations – about self & others
Develop early in life (through to adolescence), due to unmet emotional needs
Were originally adaptive in some way
Become maladaptive – people behave in self-defeating ways in response to schemas

28
Q

Unmet Core Emotional Needs

A

Believed to be universal, individual difference in relative importance of needs
1. Secure attachment to others
Inc safety, nurturance & acceptance
2. Autonomy, competence, sense of self/identity
3. Freedom to express valid needs & emotions
4. Spontaneity & play
5. Realistic limits & self-control

29
Q

Schema Domain: Disconnection & Rejection

A

Abandonment/
Instability

Mistrust/abuse

Emotional deprivation

Defectiveness/
Shame

Social Isolation

30
Q

Schema Domain: Impaired Autonomy & Performance

A

Dependency/ incompetence

Vulnerability to harm

Enmeshment

Failure

31
Q

Schema Domain: Impaired Limits

A

Entitlement/ grandiosity

Lack of self-control/
self-discipline

32
Q

Schema Domain: Other-Directedness

A

Subjugation

Self-sacrifice

Approval seeking

33
Q

Schema Domain: Over-vigilance & Inhibitions

A

Negativity/ pessimism

Emotional inhibition

Unrelenting standards

Punitiveness

34
Q

Maladaptive Schemas (Jeffrey Young): (1) Disconnection & rejection:

A

belief that needs for safety, nurturance, care, belonging & acceptance will not be met
Family of origin: unstable, abusive, cold, rejecting, or isolated
Adulthood: difficulty forming secure & satisfying relationships

35
Q

Maladaptive Schemas: Impaired autonomy & performance

A

cannot function independently, will not manage responsibilities, will always fail
FO: overprotective parents who did everything, or failed to provide adequate direction (no reinforcement). Both extremes undermine development of self-confidence
Adulthood: difficulty creating own identity/sense of self, set goals & develop skills

36
Q

Maladaptive Schemas: 3) Impaired Limits

A

difficulties controlling own behaviour, self-discipline, respecting others, being cooperative. May seem selfish, irresponsible
FO: indulgent & permissive, not required to follow the rules or consider others, sense of superiority
Adulthood: entitlement, rules only apply to others, demanding, lack empathy, exaggerated sense of superiority, frustration intolerance prevents goal attainment

37
Q

Maladaptive Schemas 4) Other-Directedness

A

: putting others’ needs before own to gain approval, maintain r’ships or emotional connection or avoid retaliation.
FO: conditional acceptance; had to suppress own needs, aspects of themselves to receive love or avoid punishment. Parents’ needs (or social acceptance/status) valued more than needs of child
Adulthood: may lack awareness of own needs; self-sacrificing, excessive people pleaser, approval/recognition seeking, suppress emotions

38
Q

Maladaptive Schemas 5)Over-vigilance & inhibitions:

A

must suppress own spontaneous feelings, meet high & rigid expectations/unrelenting standards at expense of self
FO: repressed, strict, grim, punishing, self-control/denial emphasised over pleasure/play
Adulthood: sacrifice self-expression, relaxation/health, r’ships to meet goals, pessimism, worry, hypervigilance to harm, highly strung, perfectionistic

39
Q

Schema Therapy: 3 Maladaptive Coping Styles

A

1) Overcompensation: think, feel & behave as if the opposite were true
Failure schema: become an over-achiever
Emotional Deprivation: become emotionally demanding

2) Avoidance: arrange lives so schema is never activated
Failure schema: avoid challenges completely
Emotional Deprivation: avoid intimate relationships

3)Surrender: accept that the schema is true & behave congruently
Failure schema: do tasks in half-hearted way; don’t really try
Emotional Deprivation: select emotionally depriving partners; never ask for own needs to be met

40
Q

Schema Therapy Conceptualisation

A

Early Experiences & Core Unmet Needs
(Predisposing Factors)
|
Schema
|
Activation of Schema (Precipitating factor)
| | |
Overcompensation Surrender Avoidance
(perpetuating factors)

41
Q

Treatment

A

Treatment Goal: explore & modify distorted cognitive processes thus alleviate symptoms
Goal-oriented, time-limited & structured (agenda setting)
Primary focus on present
Involves psychoeducation: client to become own therapist
Collaborative & active participation by client (homework tasks)

42
Q

Fundamental Concepts

A

Socratic Dialogue
Guided Discovery: therapist serves as a guide, who helps clients design behavioural experiments to develop new skills/interpretations

43
Q

Initial Stage

A

Goal setting: concrete, specific & measurable
Socialisation to therapy; elicit expectations
Psychometric assessments
E.g. Beck Depression Inventory
Young Schema Questionnaire
Psychoeducation about Cognitive Model (Situation-Thought-Emotion-Behaviour)
Psychoeducation about Schemas

44
Q

Identify Automatic Thoughts

A

Learn to identify AT
Identifying thoughts:
What went through your mind when that happened? What did this situation mean to you? What did this situation say about you? What were you thinking about when you felt x?
HW: identify ATs between sessions

45
Q

Identify Subsequent Emotions/Behaviour

A

Learn to identify emotions
How did you feel at the time? (Emotion vocab if necessary)
Rate the intensity of emotion
On a scale of 0 – 100…how anxious were you?
Link AT to emotion
“ So when you had the thought ‘she thinks I’m an idiot’, you then became anxious?”
And link to behaviour
“That made you suppress your own ideas & just go with hers”

46
Q

ABC Record

A

Antecedent
The Situation/critical incident

Belief
The subsequent cognition

Consequence
Emotions or Behaviour

47
Q

Evaluate AT

A

How much did you believe that thought? (apply %)
Evaluate thought
What is the evidence that supports this?
Is there an alternative explanation?
This is an example of an overgeneralisation (identify distortion)
What would you tell a friend in the same situation?
Re-evaluate belief in thought

48
Q

Dysfunctional Thought Record (Beck, 1995)

A 
Day
situation
AT 
Emotion (how'd you feel, rate intensity)
Adaptive response (what was the distortion?, compose at response) rate belief in response
Outcome
49
Q

Identifying Core Beliefs

A 
The Downward Arrow Technique
Progression from AT to the deeper core belief level
Questions:
If that’s true, what does it mean?
What’s bad about that?
What does that say about me?
Example:
C: I was so anxious, and kept thinking I am so stupid
T: If that were true, what would it mean for you to be stupid?
C: It would be the worst possible thing
T: What would it say about you?
C: That I have no value as a human being
50
Q

Challenging Core Beliefs

A

Aim is to develop a more balanced/realistic belief system
What experiences has the client has that suggest that this belief is not true 100% of the time?
Maladaptive belief:
Noone will ever like me
Balanced belief:
Not everyone will like me all the time, but I will be quite likable to some people
Behavioural Experiments to test belief

51
Q

Behavioural Experiments

A

Core Belief

Experiment

Prediction, if belief is true

What actually happened?

52
Q

Working with Schemas (Young)

A

Psychoed about schemas
Identify origins of schema
Identify how schemas continue to operate
Acknowledge schemas were once adaptive, but have become maladaptive
Empathic confrontation: Validate & empathise with schema, while acknowledging –ve consequences
Conduct debate between ‘schema side’ & ‘healthy side’

53
Q

Working with Schemas again

A

Test validity of schema
Reframe evidence supporting schema
Evaluate advantages & disadvantages of having schema
Develop schema flash cards

54
Q

Schema Flash Card

A

Acknowledgment of current feeling: Right now I feel ____, because____
Identification of schema: However I know this is probably my _____ schema, which I learned through _____. This schema leads me to exaggerate the degree to which _____
Reality-testing: Even though I believe _____, the reality is that _____. The evidence in my life that supports the healthy view is_____
Behavioural Instruction: therefore, even though I feel like _______, I could instead ______

55
Q

Behavioural Pattern-breaking

A

Rehearse more adaptive behaviour in imagery, role-plays
Look for opportunities to practice schema-inconsistent behaviour
Start with small challenges

3005PSY Counselling (5 decks)

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