Week 5: Cognitive Therapy in Theory and in Practice Flashcards
Maladaptive Contents
- NATs (Negative Automatic Thoughts)
- Cognitive Distortions
- Behavioural Responses (Avoidance and Safety)
- Schemas
Goals of Cognitive Therapy
- Positive therapeutic outcome measured in terms of symptom reduction
- Address maladaptive contents
- Improve real-life function
- Provide new insights and skills
- Reduce risks of future episodes
Fundamentals of Cognitive Therapy
- Make the cognitive model explicit from the beginning (explain what, how, why)
- Socialize client to the cognitive model (i.e., guide them in filling out hot cross bun)
- Develop an individualized model (formulation/conceptualization)
- Outline the schedule of therapy sessions
- Have a structured session/agenda
- Current state and problem (Here and now)
- Problem-focused
- Skills-based approach
- Scientific approach
Collaborative Alliance (Therapist and Client)
Building a so-called collaborative alliance is an important predictor of therapy outcomes.
Being able to recognize when we are making thinking errors allows us to correct them.
Individualized Model (Conceptualization / Formulation)
This draws together the client’s specific circumstances, concerns, and ways of dealing with them that may serve
to maintain their distress.
Structured Session/Agenda in each Therapy Session
- Clear agenda set out in advance with a clear agenda
- Summary towards the end of the session
- Outline for the next session.
Scientific Approach to Cognitive Therapy
- Best guess (Hypothesis) and can be adjusted
- Find evidence to support accuracy of the model
- Test accuracy of perceptions and expectations
How to Test Client Accuracy of Perceptions/Expectations
- Socratic Dialogue
- Measurement & Recording: keep records and diaries and provide numerical ratings of their thoughts,
feelings, and behaviors - Homework: self-monitoring and record keeping, exercises around distorted thinking, or changing aspects of their behavior. Without it or without the client actively engaging with it, outcomes tend to be less good.
Scientific Approach to Cognitive Therapy
It is based on teaching the client to appraise the evidence for and against their distorted thinking and the conclusions that they draw from them.
The typical starting point for this is the negative automatic thought, captured by the client’s thought diary and expressed during the session.
Socratic Method/Dialogue
This is a method of instruction attributed to the
philosopher Socrates, who did not teach by telling his students the solutions or what to do, but posed
questions to guide them in finding solutions for themselves.
Techniques & Tools of Cognitive Therapy & CBT
- Understanding and recognizing cognitive Distortions
- Recognizing and identifying NATs
- Challenging and replacing NATs
- Behavioural experiments
- Identifying core beliefs (schemas)
- Challenging core beliefs
Homework
Used to help clients think about their thinking.
Our thoughts are often like a background narrative, and we tend to spend more time focusing on
how we feel than on the thoughts themselves. T
Thought Record
Separating out the negative thoughts and connecting them to how we feel is the first skill to be learned.
Situation > Feeling/Emotion > Automatic Thoughts
Triggers
Events that precede negative emotions
Hot Thoughts
Several recurring themes emerging from thoughts that the client has across different situations.
Are generalized and most directly related to the experience of negative emotion.
If recognized early, we are better able to deal with them quickly and prevent the vicious cycle from developing.