Week 4 - Cognitive Flashcards
Cognitive Therapy Was Developed when and by whom?
1960s by Aaron Beck for treatment of depression
What is the philosophy behind cognitive therapy?
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
What is the cognitive model?
Situation (observe ambiguous non-verbal cue)
Thought (she thinks i’m an idiot)
Feeling (Anxiety)
Behaviour (avoidance/not expressing an opinion)
What are the Biases in Info processing in depression?
-ve view of self, world & future (-ve cognitive triad)
What are the Biases in Info processing in Anxiety?
overestimation of physical or psychological danger
What are the Biases in Info processing in Panic disorder?
catastrophic interpretation of physiological experiences
What are the Biases in Info processing in Paranoia?
attribution of bias to others
What are the Biases in Info processing in Suicidal ideation?
hopelessness regarding future & deficiencies in problem solving
Cognitive Distortions: All-or-nothing Thinking
dichotomous, black-or-white thinking
“If I don’t get a HD, I have failed”
Cognitive Distortions - Selective Abstraction:
selectively choosing facts to support –ve thinking
athlete focuses on 1 loss in otherwise successful career, which reinforces sense of incompetence
Cognitive Distortions - Mind-reading:
we know what others think of us
“I know she thinks I’m an idiot”
Cognitive Distortions - Negative prediction:
: -ve prediction of future in the absence of supporting evidence
“I just know that if I go, I’ll have a bad time”
Cognitive Distortions - Catastrophising
exaggerate the consequences of a future event into something fearful
“If I don’t get a HD, I’ll die”
Cognitive Distortions - Overgeneralisation
making a rule based on a few negative events
“I forgot my keys again…I can never remember anything”
Cognitive Distortions - Labelling & mislabelling
-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)
Cognitive distortions- Magnification/minimisation:
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)
Cognitive Distortions - Personalisation:
taking an event unrelated to oneself & making it meaningful
“Another red light. Why does nothing ever go right for me?”
What are Automatic thoughts?
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)
What are Core Beliefs ?
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
how are beliefs and schemas developed?
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
Behaving in Belief/Schema consistent ways _____ belief/schema
Behaving in belief/schema consistent ways reinforces belief/schema
Does not allow for a disconfirming experience (e.g. Expressing different opinion & not being rejected)
Cognitive Conceptualisation
Relevant early experiences
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Core Belief / Schema
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Situation/Critical incident
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Automatic Thought > Emotion > BehaviourPredisposing factors:
Early childhood experiences which lead to the development of core beliefs/schemas
Explain how automatic thoughts are generated by schemas
Precipitating Factors:
A critical incident/situation which triggers the core belief/schema
Perpetuating Factors:
Ongoing cognitive distortions, acceptance of NAT as truth – perpetuate core belief/schema
Lack of experiences to disconfirm core belief
What are Schemas? (Jeffrey Young)
Schema = broad organising principle for making sense of experience
What are Early Maladaptive Schemas (EMS)?
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
Unmet Core Emotional Needs
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
Schema Domain: Disconnection & Rejection
Abandonment/
Instability
Mistrust/abuse
Emotional deprivation
Defectiveness/
Shame
Social Isolation
Schema Domain: Impaired Autonomy & Performance
Dependency/ incompetence
Vulnerability to harm
Enmeshment
Failure
Schema Domain: Impaired Limits
Entitlement/ grandiosity
Lack of self-control/
self-discipline
Schema Domain: Other-Directedness
Subjugation
Self-sacrifice
Approval seeking
Schema Domain: Over-vigilance & Inhibitions
Negativity/ pessimism
Emotional inhibition
Unrelenting standards
Punitiveness
Maladaptive Schemas (Jeffrey Young): (1) Disconnection & rejection:
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
Maladaptive Schemas: Impaired autonomy & performance
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
Maladaptive Schemas: 3) Impaired Limits
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
Maladaptive Schemas 4) Other-Directedness
: 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
Maladaptive Schemas 5)Over-vigilance & inhibitions:
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
Schema Therapy: 3 Maladaptive Coping Styles
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
Schema Therapy Conceptualisation
Early Experiences & Core Unmet Needs
(Predisposing Factors)
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Schema
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Activation of Schema (Precipitating factor)
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Overcompensation Surrender Avoidance
(perpetuating factors)
Treatment
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)
Fundamental Concepts
Socratic Dialogue
Guided Discovery: therapist serves as a guide, who helps clients design behavioural experiments to develop new skills/interpretations
Initial Stage
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
Identify Automatic Thoughts
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
Identify Subsequent Emotions/Behaviour
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”
ABC Record
Antecedent
The Situation/critical incident
Belief
The subsequent cognition
Consequence
Emotions or Behaviour
Evaluate AT
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
Dysfunctional Thought Record (Beck, 1995)
Day situation AT Emotion (how'd you feel, rate intensity) Adaptive response (what was the distortion?, compose at response) rate belief in response Outcome
Identifying Core Beliefs
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
Challenging Core Beliefs
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
Behavioural Experiments
Core Belief
Experiment
Prediction, if belief is true
What actually happened?
Working with Schemas (Young)
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’
Working with Schemas again
Test validity of schema
Reframe evidence supporting schema
Evaluate advantages & disadvantages of having schema
Develop schema flash cards
Schema Flash Card
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 ______
Behavioural Pattern-breaking
Rehearse more adaptive behaviour in imagery, role-plays
Look for opportunities to practice schema-inconsistent behaviour
Start with small challenges
