Working with cognitions Flashcards
What facets make up Beck’s model of emotional distress?
Early experience(s): Events, relationships, social and cultural context
Core beliefs: Conclusions about the self, others and the world
Dysfunctional assumptions: Rules for living, evolving from core beliefs; often compensatory
Critical incident(s): Events impacting on (e.g. activating, shattering) beliefs / assumptions
Activation of beliefs/assumptions
Negative automatic thought(s): thoughts, images, meanings
Maintenance: Emotions, behaviour, body state, attentional processes
What are the characteristics of negative automatic thoughts?
-Spontaneous (just seem to happen – not based on reason or fact)
-Habitual
-Involuntary, difficult to ‘turn off’
-Often ruminative
-Affect-laden (can make you feel very emotional)
-Plausible BUT often distorted and unrealistic (i.e. not based on real facts) despite patient being convinced that they are true/valid e.g. “I will never be able to trust anyone again”
-Continue to occur despite evidence to the contrary
Zoom in on affect laden thoughts.
What are some of the ways of identifying negative automatic thoughts?
-Ask patient for a recent example of when they felt particularly low or anxious
-Ask “what was going through your mind just before you noticed the change in your mood?”
-Ask the patient to complete a thought record (TR) between sessions
What is a hot thought?
The thought that is believed highly and that related to an intense emotion.
What are the various cognitive distortions?
Catastrophising
Expecting the worst possible outcome
E.g. “What if a make a blunder in this lecture and my boss finds out and I love my job and never work again?”
Personalisation
Taking personal responsibility for things that are outside your control
E.g. My son behaved badly today, I must be a bad mother”
Black-and-white/ All-or-nothing thinking
Things are either this way or that way
E.g. “If I’m not perfect, I’m a failure”
Overgeneralisation:
Seeing a single event as a never ending pattern of defeat
E.g. “These things always happen to me!” or “I made a mistake – I can never do anything right”
Jumping to conclusions:
Assuming something negative when there are no facts to justify your conclusion – mind-reading or fortune-telling
E.g. “He thinks I’m making a hash of this lecture” and “I’m never going to get through this training”
Selective abstraction:
Discounting positive evidence that does not support your belief
E.g. “I did manage to get onto training, but anyone could have got on”
What’s the chain of events for challenging thoughts?
-Establish the cognitive bias for a specific thought
-Establish evidence for and against for a thought
-Explore alternative explanations for the thought (How would a friend think about this, what would someone else say).
Whare are some of the ways we can challenge NATS?
Decatastrophising Questions:
What is the worst that could happen?
If it happened, how could I cope?
What is the best that could happen?
What is the most realistic outcome?
Impact Questions:
What is the effect of my believing the automatic thought?
What could be the effect of changing my thinking?
Distancing Questions:
What would I tell a friend or family member if he/she were in the same situation?
How are underlying assumptions/rules for living classified?
-Intermediate beliefs > response to Core Beliefs
–Also called ‘dysfunctional’,‘unhelpful’, etc.
-May not seem problematic when things are going well
Rules for living:
-Attitudes (e.g. “It’s terrible to fail”)
-Rules (e.g. “I should give up if a challenge seems too great”)
-Assumptions (e.g. “If I try doing something difficult, then I will fail”)
What characteristics are representative of the nature of underlying thoughts?
Often conditional
Exaggerated, unrealistic and unreasonable
Learned from (usually early) experience
May be culturally reinforced
Part of social heritage
Not as easily accessible as NATs and often not directly articulated
What is the typical thought structure of an underlying thought structure?
If…then…
Unless… then…
Should…must…ought…
It’s terrible when?
What questions can we ask to get at underlying assumptions?
- What does that mean about you/ others/ the world?
2.What’s so bad about that?
3.What would others think about you? - What does that say about you as a person?
5.What would that say about your life/ the future?
Under what circumstances should we modify unhelpful assumptions?
1) How strongly does the patient believe it? How intensely does it feel true?
2) How broadly and how strongly does it affect the patient’s life?
3) Does it fit with the formulation? Does it fit with the treatment plan?
4) Would they be able to evaluate it at this point?
Do we have enough time in the session to begin working on it?
What are some of the questions we can ask to explore the origins of someone’s underlying assumptions?
Where did the UA come from?
What life experiences contributed to it?
What kept it going?
Does it really still make sense now?
What questions can we ask to help a person assess whether their rules for life are unreasonable/unrealistic?
In what ways is the UA unreasonable?
How does it fail to reflect ‘real life’?
In what ways are its demands excessive?
What questions might we ask to help someone gather information to construct new meaning/assumptions?
- What is the current assumption
-What cues tell you it is operating?
-What effect does it have in your life?
-How do other people operate? (e.g. surveys, direct observation)
-Do other people have the same assumption as you? If not, what is the difference? What do you make of that?
-Do other people have the same assumption as you? If not, what is the difference? What do you make of that
