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CBT > Week 5 > Flashcards

Week 5 Flashcards

1
Q

two categories of beliefs

A

intermediate beliefs
core beliefs

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2
Q

intermediate beliefs

A

composed of rules, attitudes, and assumptions

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3
Q

core beliefs

A

composed of global ideas about oneself, others, and / or the world

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4
Q

what is more malleable, core or intermediate

A

intermediate is more malleable

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5
Q

adaptive beliefs are

A

realistic and functional and not at an extreme

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6
Q

dysfunctional core beliefs are…

A

rigid and absolute, maintained through maladaptive information processing

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7
Q

characteristics of schemas

4

A

permeability (receptivity to change), magnitude (size compared to individuals general self-concept), charge (low to high, indicating levels of strength), and content.

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8
Q

once a schema is activated, what 3 things happen?

A
  1. client interprets this new experience in accordance with the core belief
  2. activation of the schema strengthens the core belief
  3. other kinds of schemas become activated too
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9
Q

adaptive mode

A

kind like healthy adult mode

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10
Q

3 categories of negative core beliefs (Beck)

A

helplessness, unlovability, worthlessness

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11
Q

I’m worthless can mean what

A

worthlessness category when client is concerned with their immorality or toxicity, not their effectiveness or lovability

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12
Q

what if you evaluate a negative belief too early

A

client might think therapist doesn’t understand me, if she did, she would know that my belief is true.

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13
Q

first thing to do with core beliefs

A

identify core beliefs that are more realistic and adaptive as early in treatment as possible. Ask where they were at their best

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14
Q

3 strategies useful in eliciting clients’ negative core beliefs

A

look for central themes in their automatic thought
using downward arrow technique
watch for core beliefs expressed as automatic thoughts

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15
Q

downward arrow technique

A

helps identify clients’ negative core beliefs

involves asking clients to assume their automatic thoughts are true and then questioning them about the meaning of their automatic thoughts

Dialogue:
Automatic thought (AT): The recital’s going to be a disaster.

Query: Is it? OK. And so what does that mean, if it is?

Belief: It means I’ve failed.

Query: And so what? if you’ve failed, what does that mean?

Belief: It means I’m a bad teacher.

Query: And what does that mean?

Core belief: It means I’m just… incapable.

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16
Q

3 techniques to identify intermediate beliefs and its categories (assumptions, attitudes, and rules)

A
  1. recognize when intermediate beliefs are expressed as automatic thoughts
  2. directly eliciting an intermediate belief
  3. reviewing a belief questionnaire
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17
Q

how are automatic thoughts related to situations?

A

they are situation specific. e.g. i shouldn’t have let my friend down when he asked me to help him with his mother

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18
Q

many intermediate beliefs contain…

A

a dysfunctional coping strategy

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19
Q

importance concepts about beliefs clients should understand

(5)

A
  1. beliefs are ideas, not truths, can be changed
  2. beliefs are learned
  3. beliefs can be rigid and feel as if they are true
  4. clients recognize data that seem to support their beliefs, disregard counter data
  5. beliefs originated through experiences which may not be accurate
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20
Q

4 techniques on educating clients about dysfunctional beliefs

A
  1. posing hypothesis about the problem
  2. using a metaphor to explain information processing
  3. determining when the belief originated
  4. explaining beliefs using a diagram
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21
Q

3 strategies to strengthen adaptive beliefs

A
  1. eliciting positive data and drawing helpful conclusions about their experiences
  2. eliciting the advantages of believing adaptive beliefs
  3. pointing out the meaning of positive data
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22
Q

other 3 strategies to strengthen adaptive beliefs (RUI)

A
  1. referencing other people
  2. using a chart to collect evidence
  3. inducing images of current and historical experiences
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23
Q

eliciting positive data and drawing conclusions example

A

what positive things happened since I saw you last?
what do these experiences say about you?

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24
Q

pointing out the meaning of positive data (therapist example)

A

getting your apartment in order really indicates you’re taking control; do you think so too?

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25
Q

referencing other people

A

who in your life believed most strongly that you were competent
what have you done this week that I would consider a sign of competence?

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26
Q

inducing images of current and historical experiences

A

what was a situation in which you felt really competent

27
Q

empty chair work

A

a gestalt-type technique, can be useful in exposing clients to painful beliefs and emotions or distressing interpersonal situations

28
Q

3 techniques to modify negative beliefs

A

socratic questioning
reframing
behavioral experiments

29
Q

another 3 techniques to modify negative beliefs (SCU)

A

stories, movies, and metaphors
cognitive continuum
using others as a reference point

30
Q

last 3 techniques to modify negative beliefs (SIH)

A

self-disclosure
intellectual - emotional role plays
historical tests

31
Q

cognitive continuum

A

useful to modify both automatic thoughts and beliefs that reflect polarized thinking

use a line from 0 to 100%

32
Q

polarized thinking

A

when a client sees something in all-or-nothing terms

33
Q

intellectual-emotional role plays

(when is this useful?)

A

aka point-counterpoint

useful when clients say that intellectually they can see a belief is dysfunctional but emotionally they feel it’s true.

first provide rationale for asking clients to play the emotional part of their mind and therapist plays intellectual, then switch roles

34
Q

historical tests

A

Modifying dysfunctional beliefs by reframing relevant current experience or using current material as examples is sufficient for many clients.

Others benefit from discussing how and when a negative core belief originated and became maintained and why it made sense for the client to believe it at the time.

35
Q

the spiral of depression and inactivity (circle diagram)

A

a circle diagram

  1. behavior: inactivity
  2. negative thoughts
  3. depressed mood
  4. cycle repeats

patients depressed automatic thoughts frequently get in their way

36
Q

easiest way to get patients behaviorally activated is to review their typical daily schedule

what questions can therapist ask?

3

A
  • which activities are patients too little of, thus depriving themselves of obtaining a sense of achievement?
  • do patients have a good balance of mastery and pleasure?
  • which activities are lowest in mastery and / or pleasure?
37
Q

if you have a good idea of the activities your patient did before he got depressed you can write activities down on an…

A

activity chart

a day and week schedule where you can schedule activities from hour to hour.

Make activities small for depressed patients, e.g. dishes for 10 minutes

38
Q

how to review homework of activity chart

A

ask patient about his previous predictions (im too tired to do an activity).

discovering that his automatic thoughts were inaccurate can motivate the patient to get up earlier and engage in a greater number of pleasurable activities

39
Q

what if patients report that changing activities has no impact on their mood?

A

teach them how to rate their sense of achievement and pleasure on a 10 point scale, on activity chart

good technique when patients are skeptical that scheduling activities can help getting out of the depression

40
Q

when clients resist scheduling activities

3

A

psychoeducation

give himself credit

discuss unhelpful thoughts she might have before, during, after activities

41
Q

historical foundations of activating behavior

A

Jacobson et al assisted persons with depression in approaching and accessing potential sources of positive reinforcement while avoiding unpleasant and punishing events

act of approaching and accessing positive reinforcers was regarded as having natural antidepressant functions

42
Q

roots of behavioral activation in theories of depressions

A

functional analysis model
behavioral theory of depression
pleasant events schedule

43
Q

functional analysis model of depression

A

Link between depression and environmental factor and central role of passive responding, avoidance, escape and withdrawal in the development and maintenance of depression.

44
Q

behavioral theory of depression

3

A
  1. low rate of Response Contingent Positive Reinforcement
    (RCPR)
  2. Low rates of RCPR result in low rates of behavior and thus a lack of reducing opportunities to receive positive reinforcement:
  3. Extinction of some classes of behaviours
    (like positive ones –> resulting in depressive symptoms)
45
Q

pleasant events schedule

A

Clinical measure for evaluating participation
in pleasant activities –> Therapeutic strategy for promoting behaviors that produce positive reinforcement

46
Q

Differences between Lewinsohns’ approach and the behavioral activation approach

A

Lewinsohn assumes the existence of intrinsically pleasant and reinforcing events or activities for all
people, wheareas BA classifies events as reinforcing only when clearly influencing the individual’s
behavior.

47
Q

BA assumes that depression is primarily the result of…

A

problematic life events and circumstances, not
the result of deficits or dysfunctions that reside within the person

48
Q

BA may be the most important ingredient for

A

cbt for depression

49
Q

central assumption of behavioral activation approach

A

Factors that contribute to the development and maintenance of
depression reside in the environment, not within the person, and are related to the outcomes of the person’s actions. –> depression results from person-environment interactions.

50
Q

BA for depression aims to …

(3)

A
  • increase activity,
  • counteract avoidance behavior
  • increase individuals access to positive reinforcers
51
Q

duration of BA

A

16 - 24 weeks

52
Q

4 phases of BA

A
  1. self-monitor activities and moods and the associations between the two
  2. using problem solving and behavioral experimentation to identify activities associated with positive moods
  3. blocking avoidance behavior and facilitation approach behavior
  4. decreasing vulnerability to future episodes of depression
53
Q

how to do phase 1 of BA (self-monitor activities and moods and the associations between the two)

A

activity monitoring form

1) Describing one’s activities and associated moods in detail, on an hour-to-hour basis each day for at least 1 week –> helps reveal the client’s current level of activity, connections
between activity level and mood and level of engagement in avoidance behaviors.

2) Look for patterns. –> Revelation of depression loops

54
Q

how to do phase 2 of BA (using problem solving and behavioral experimentation to identify activities associated with positive moods) (4)

A

Generating plans for testing Ideas from her activity monitoring form:
1. set up a functional analysis with the discriminative stimuli, person variables, behaviours, immediate reinforcing consequences and delayed aversive consequences.
2. Reviewing the diagram with the client –> evaluating the behavioural patterns of the client and discuss the effectiveness of the behaviours.
3. Make a list of alternative activities
4. Schedule the activities (concrete planning)

55
Q

how to do phase 3 (blocking avoidance behavior and facilitation approach behavior) (3)

A
  1. conceptualize avoidance patterns, the TRAP
  2. after identifying a TRAP, helping the client get back on TRAC
  3. overall process of identifying and overcoming avoidance coping = ACTION
56
Q

TRAP

A

T - trigger
R - response
A - avoidance
P - pattern

57
Q

TRAC

A

T - trigger
R - response
A - alternative
C - coping

58
Q

ACTION

A

A - assess behavior and mood
C - choose alternative behaviors
T - try the selected alternative behaviors
I - integrate the alternative behavior into a regular routine
O - observe the outcome of behavior
N - never give up

59
Q

SUDS

A

subjective units of distress, rate level of distress 0 - 100

60
Q

during BA therapy, the mental rehearsal is central, this means…

A

The therapist encourages the client to imagine and mentally rehearse activities he/she will perform, including the setting and the actual behaviors.

61
Q

countering mood-dependent behaviors

A

strategy for blocking avoidance

Go forward and participate in valued activities despite the presence of a negative mood, to learn that it’s possible to behave independently of acute moods and that it could even result in a mood change.

62
Q

Acting ‘as if’

A

Another strategy for countering mood-dependent behavior patterns: Acting as if the obstacles blocking actions are not present.

By intentionally acting differently when feeling blocked by negative moods one might learn that goals are obtainable regardless of emotional states and thoughts and that pursuing valued goals often change mood and thinking in desirable directions.

63
Q

graded task assignments

A

strategy for taking small significant steps toward a goal or overcoming avoidance patterns by approaching avoided activities in small units

64
Q

how to do phase 4 (decreasing vulnerability to future episodes of depression)

3

A
  1. skills generalization - encourage clients to apply principles of behavioral activation to other areas of their lives
  2. reduce vulnerability for a depressed mood - identify life circumstances, situations and issues that may increase this vulnerability –> reduce influence of the past
  3. establish regular routines - keeps individuals in regular contact with events that maintain behavior (positive reinforcement)

CBT (8 decks)

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