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CBT > Week 6 > Flashcards

Week 6 Flashcards

1
Q

5 schemas of disconnection and rejection

(AMEDS)

A

abandonment / instability
mistrust / abuse
emotional deprivation
defectiveness / shame
social isolation / alienation

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2
Q

3 forms of emotional deprivation

A

deprivation of nurturance: no attention, warmth, and companionship

deprivation of empathy: no one listens to you, understands you or can share your feelings

deprivation of protection: no one gives you advice or direction

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3
Q

emotional deprivation

A

patient thinks that her primary emotional needs are either not met or inadequately met by others

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4
Q

4 schemas of impaired autonomy and performance

dvef

A

dependence / incompetence
vulnerability to harm or illness
enmeshment / undeveloped self
failure

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5
Q

impaired autonomy and performance meaning

A

patient expects that she is incapable of functioning and performing on her own and independently of others

possibly comes from clingy family

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6
Q

vulnerability to harm or illness meaning

A

patient convinced that at any given moment something terrible could happen to her

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7
Q

enmeshment / undeveloped self-meaning

A

patient is overly involved with and connected to one or more of her caregiver. They are unable to develop her own identity. Patient feels she does not exist without other person and feels empty and without goals

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8
Q

2 schemas of impaired limits

A

entitlement / grandiosity
insufficient self-control / self-discipline

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9
Q

6 characteristics of Impaired Limits

A

patient has inadequate boundaries,
feelings of responsibility and
frustration tolerance.
Not good at setting realistic long-term goals,
difficulty working with others,
comes from family who gave a sense of superiority to world.

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10
Q

3 schemas of Other-Directedness

A

Subjugation
Self-sacrifice
Approval-seeking / recognition-seeking

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11
Q

Other-Directedness meaning

A

Patient always takes the needs of others into consideration and suppresses her own needs. This is done to receive love from others. Needs and status of the parents took priority over character of child. Family only accepted her given certain conditions.

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12
Q

subjugation meaning

A

patient gives herself over to the will of others to avoid negative consequences. Patient thinks that her desires, opinions, and feelings are not cared for by others which leads to pent-up rage.

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13
Q

4 schemas of Overvigilance and Inhibition

A

negativity / pessimism
emotional inhibition
unrelenting standards / hypercriticalness
punitiveness

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14
Q

Overvigilance and Inhibition meaning

A

patient suppresses her spontaneous feelings and needs and follows her own set of strict rules and values at the cost of self-expression and relaxation. Family emphasized achievement, perfection and repression of feelings. Caregivers were critical.

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15
Q

emotional inhibition

A

patient always hold in her emotions and impulses as she thinks that expressing these will damage others or lead to feelings of shame, abandonment or loss of self-worth. Involves suppressing all spontaneous expression: anger, joy, as well as discussing problems. She emphasizes rationalization.

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16
Q

punitiveness meaning

A

patient feels that individuals should be severely punished for their mistakes. She is aggressive, intolerant and impatient. Completely unforgiving of mistakes. She does not take an individual’s circumstances or feelings into account.

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17
Q

clarification-oriented psychotherapy characteristics of therapeutic relationship 4

A
  • nondirective as to content, directive with regard to process
  • no focus on meeting the patients unmet childhood needs but on helping patient become aware of dysfunctional ways in which basic needs are expressed
  • no psychoeducation
  • Rogerian therapy conditions are necessary
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18
Q

schema therapy for personality disorder findings

A

revealed consistently that schema therapy is superior to treatment as usual and clarification-oriented psychotherapy.

exercise-based schema therapy training was superior to lecture-based training

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19
Q

exposure optimization strategies

3

A

expectancy violation
deepened extinction
occasional reinforced extinction
and others…

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20
Q

pavlovian conditioning model

A

neutral stimulus (conditional stimulus, CS) is followed by an aversive stimulus (the unconditional stimulus, US)

after pairings, the neutral CS will elicit fear reactions (conditional response, CR)

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21
Q

powerful way to reduce conditional fear reactions is through…

A

extinction

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22
Q

conditional fear shows spontaneous recovery, meaning…

A

strength of CR increases in proportion to the amount of time since end of extinction.

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23
Q

how to offset negative effects of spontaneous recovery of CR

A

an exposure model that takes elements of inhibitory learning into account

goal is to enhance inhibitory learning

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24
Q

expectancy violation

A

exposures that maximally violate expectancies regarding the frequency or intensity of aversive outcomes

the more expectancy can be violated the greater the inhibitory learning

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25
Q

deepened extinction

A

multiple fear CSs are first extinguished separately before being combined during extinction, or a previously extinguished cue is paired with a novel CS

e.g. exposure to one type of spider, then a second type of spider, then exposure to both at same time.

25
Q

deepened extinction

A

multiple fear CSs are first extinguished separately before being combined during extinction, or a previously extinguished cue is paired with a novel CS

e.g. exposure to one type of spider, then a second type of spider, then exposure to both at same time.

26
Q

occasional reinforced extinction

A

involves occasional CS-US pairings during extinction training

participant is less likely to expect the next CS presentation to predict the US because CS-US pairings have been associated with both further CS-US pairings and CS-no US pairings

27
Q

another 5 exposure optimization strategies

(RVRMR)

A

removal of safety signals
variability
retrieval cues
multiple contexts
reconsolidation

28
Q

variability strategy for exposure

A

stimulus variability

varying the to-be-learned task enhances retention of learned non-emotional material

29
Q

retrieval cues

A

they retrieve the CS-no US relationship during extinction training so it can be used in other contexts once extinction is over

Retrieval cues are aspects of an individual’s physical and cognitive environment which aid the recall process

e.g. therapists office where previous exposure sessions were conducted can act as a retrieval cue for new exposure.

30
Q

reconsolidation

A

the process of replacing or disrupting a stored memory with a new version of the memory.

extinction during reconsolidation may weaken fear memory

31
Q

habituation

A

describes the progressive decrease of the amplitude or frequency of a motor response to repeated sensory stimulation that is not caused by sensory receptor adaptation or motor fatigue.

32
Q

vivo exposure

A

directly facing a feared object, situation, etc in real life

33
Q

extinction learning to exposure therapy for anxiety disorders involves

3

A

directly targeting initial acquisition,

consolidation, and

later retrieval of new learning

34
Q

general elements of exposure therapy

A
  1. therapist and client decide on specific goal
  2. the therapist elicits from the client the particular feared outcome of engaging in the task. Exposures are then designed in such a way and proceed until a given anticipation or expectation is violated.
  3. recognition and consolidation of the non-occurrence of the anticipated event - following completion of an exposure practice, therapists aid clients in discussing the non-occurrence of the feared event. This reflects consolidating the new learning regarding the non-contingent relationship between the conditional stimulus and the unconditional stimulus.
35
Q

Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

method

A

Qualitative data were collected through in-depth semi-structured interviews with 15 patients and a focus group of 8 therapists. A thematic analysis was performed.

36
Q

helpful aspects from results of Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

3

A

highly committed therapeutic relationship,
the transparent and clear theoretical model,
and the specific schema therapy techniques.

37
Q

4 unhelpful aspects from results of Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

A
  • several patients and some therapists shared the opinion that 50 sessions was not enough.
  • patients lacked clear advance information about the possibility that they might temporarily experience stronger emotions during therapy and the possibility of having telephone contact outside session hours.
  • With regard to imagery, patients experienced time pressure and they missed a proper link between the past and the present.
  • For therapists, it was hard to manage the therapeutic relation, to get used to a new kind of therapy and to keep the treatment focused on personality problems.
38
Q

conclusion of Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

A

Patients and therapists found some aspects of the schema therapy protocol helpful. Their views about which aspects are unhelpful and their recommendations need to be taken into consideration when adjusting the protocol and implementing schema therapy.

39
Q

recommendations to improve Schema Therapy for Personality Disorders

3

A
  • clear information in advance
  • more responsibility for patients in final phases of therapy
  • experiential training for therapists
40
Q

Young’s understanding of borderliners

A

they were flipping through clusters of schemas and coping styles and that it would be more useful to envision patients personality as consisting of various modes or different aspects of the self

41
Q

3-factor origin of BPD

A
  1. genetics and temperament
  2. childhood experiences in the family and outside world
  3. interaction between child’s temperament and parenting style and reactions of caregivers
42
Q

family environmental situations that may contribute to development of BPD

4

A

family environment is:
- unsafe and unstable
- depriving
- harshly punitive and rejecting
- subjugating

43
Q

inner world of borderliner is characterized by

A

five modes or aspects of self that interact in destructive ways

44
Q

the 3 groups of modes

A

child, parent, coping modes

45
Q

5 central modes in the borderline constellation

(AADPH)

A
  1. abandoned / abused child mode
  2. angry and impulsive child mode
  3. detached protector mode
  4. punitive parent mode
  5. healthy adult mode
46
Q

detached protector mode characteristics (3)

A

patients may feel numb or empty

avoid investing emotionally in people

interferes with therapeutic progress

47
Q

punitive parent mode

A

harsh part of self that punishes the patient for being bad

48
Q

healthy adult mode serve 3 basic functions

A
  1. nurtures affirms and protects vulnerable child
  2. sets limits for the angry child and impulsive child,
  3. battles the maladaptive coping and dysfunctional parent modes
49
Q

4 mechanisms of healing and change for schema treatment in borderliners

A
  1. limited reparenting
  2. experiential techniques
  3. cognitive techniques
  4. behavioral pattern breaking
50
Q

limited reparenting

A

therapist compensates for deficits from lack of emotional needs met by parents. Patients are still very young children. This takes place in interactions, dialogues and emotion-focused work between the two.

51
Q

experiential techniques

A

emotion-focused techniques, consists of imagery work, dialogues, letter writing. Gives therapists a sense of the kind of early experience patients went through and what contributed to their situation

52
Q

cognitive techniques primary goals

A

education (teaching patients about normal needs and normal emotions)

cognitive restructuring (centered on the idea that parent had problems and that is why it turned out bad for them)

53
Q

behavioral pattern breaking

A

last phase and longest.

goal is to guide patients in generalizing what they have learned in the therapy session to relationships outside. To do so, the work often “incorporates other schema strategies, such as flash cards, imagery, and dialogues. Other techniques are relaxation training, assertiveness training, anger management, self-control strategies.

54
Q

3 stages of treatment of BPD schema therapy

A
  1. bonding and emotional regulation
  2. schema mode change
  3. autonomy
55
Q

bonding and emotional regulation stage of BPD ST

A

centered on developing a relationship
between the therapist and the patient that is a contrast and an antidote to the abusive or punitive one
that the patient experienced as a child.

The therapy situation becomes a “holding environment”, a safe
place in which the patient is affirmed and the expression of needs, desires, and feelings is encouraged

56
Q

schema mode change stage of BPD ST

A

Mode work involves maintaining a relationship with the abandoned/abused child while working to
reorganize the inner mode constellation of the patient

57
Q

4 steps involved in processing anger in sessions at therapist or someone else

A
  1. ventilate (patient encouraged to express anger)
  2. empathize
  3. reality testing (acknowledge aspects of situation that was accurate)
  4. rehearsal of appropriate assertiveness (explore how they could have expressed their needs in an assertive rather than an angry manner)
58
Q

3 arenas in which the angry and impulsive child can come into play

A

therapeutic relationship

reworking of traumatic experiences through imagery and chair work

interpersonal relationships outside the session

59
Q

autonomy stage of BPD ST

A

the therapy focus shifts from reparenting within the therapy
relationship to developing independence outside sessions.

hope is that patient will be able to develop relationships in which she is neither oppressed nor deprived

60
Q

a core sense of self is missing in Borderliners. The result is…

A

a lack of identity, a lack of a clear sense of self, which means that patients often do not know what they like, feel, or believe in.

The therapist and patient can work together to explore the world, to find out what resonates with the patient.

CBT (8 decks)

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