CBT Model Flashcards
(172 cards)
1
Q
What is labelled “The Black Box”: perennial puzzle?
A
The human mind - stimuli goes into the ‘black box’, something happens which then produces a reaction.
2
Q
When were the earliest attempts at clinical interventions?
A
1880 - 1900, Wilhelm Wundt and Gall’s Phrenology
3
Q
Which years were the cognitive revolution?
A
1960-1970
4
Q
What were the two main influences, in many ways, revolutions in history of psychology?
A
-Learning theory and behavioural therapy
-Cognitive therapy
5
Q
What are the three levels of cognition?
A
-Deep level: core beliefs or schemas
-Intermediate level: intermediate beliefs, conditional/dysfunctional/underlying assumptions
-Peripheral: thoughts/images (negative automatic thoughts)
6
Q
What year did Ellis implement reason and emotion in psychotherapy?
A
1962
7
Q
What are some processing biases
A
Cognitive distortions, logical errors, thinking biases, information processing errors/biases
8
Q
What was the big realisation in the history of CBT?
A
That everything is both cognitive AND behavioural. In fact, it is often impossible to separate the two.
9
Q
Give an example of how behavioural interventions have cognitive elements:
A
Clients want to know rationale, evidence that it works, what to do should they experience symptoms
10
Q
What is the ABC in the ABD model of cognitive therapy?
A
- Event antecedent
- Belief
- Consequence
11
Q
Describe the relationship between beliefs, biases and automatic thoughts, using depression as an example.
A
- Core beliefs and thinking biases influence each other (e.g., I am unlovable/overgeneralisation)
- A situation/event occurs (e.g., I yelled at my kids) which leads to
- Automatic thoughts (e.g., I don’t love my kids) which leads to
- Emotions, physiological, behaviours, other thoughts (e.g., sadness, withdrawing)
12
Q
How are Ellis’ and Beck’s version of CBT different to one another?
A
Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. In contrast, Beck stresses the quality of a therapeutic relationship.
13
Q
What are some factors that distinguish core beliefs from intermediate beliefs?
A
-they are deeper cognitive level
-are more stable and enduring
-are more likely to be linked to early childhood experiences
-explain, influence and subsume several intermediate beliefs
14
Q
What are some factors that distinguish intermediate beliefs from core beliefs?
A
-are at a more superficial level
-are less stable, less pervasive and more easily changeable
-may be influenced by stressors as well as early experiences
15
Q
How do core beliefs differ from intermediate beliefs in terms of therapy?
A
- patients with different psychological disorders may share the same belief
-may be targeted for change later in therapy
-change can produce lasting effects and prevent relapses
16
Q
How do intermediate beliefs differ from core beliefs in terms of therapy?
A
-patients with different disorders have different beliefs
-are often targeted for change in early or middle stages of therapy
-changes can produce significant symptom relief
17
Q
What are negative automatic thoughts?
A
-End-products or beliefs and distortions that emerge into consciousness
-Single thought can be the result of several cognitive distortions
-Frequent and familiar, believable
-Not attention grabbing, unnoticed and implicit
-Despite the term, may be visual images
-The kind of negative automatic thought often but not always reveals the type of cognitive biases
18
Q
What did D’Zurilla and Goldfried develop in 1971?
A
Problem solving therapy
19
Q
What are three factors relative to thinking biases?
A
-They are frequent and familiar
-They’re often unnoticed and implicit
-Discovery may evoke surprise, but often believable
20
Q
There are many different lists and descriptions, what what is one way that thinking biases can be categorised as?
A
- Filter Biases/errors
- Evaluative or interpretive biases/errors
- Memory biases/errors
21
Q
What are filter biases?
A
-They derive from selective attention to some aspects of a situation and ignoring of others
-Selection abstraction, discounting the positive, binocular error
22
Q
What are evaluative or interpretative biases?
A
-They derive from inaccurate evaluation or judgement of the attended event
-Negative conclusions without any justification
- Overgeneralisation
-Probability estimation
-Flexibility of thinking
-Emotional reasoning
23
Q
What are memory biases?
A
Fascinating aspects of human memory. Vulnerable to distortions as one retrieves and restores memories. (memories don’t always tell the truth the whole truth and nothing but the truth).
24
Q
The last few decades in psychology have been described as being marked by the increasing rise of CBT. There are several reasons for this, name a few:
A
- It is a simple and parsimonious theory
- Wide applications: can be used to explain how several disorders are maintained
- Extensive empirical support for the efficacy of therapy
25
Why does CBT have clinical appeal?
Because it has predictive power within an individual once patterns of beliefs and responses are known. AND, funding in the health systems around the world tend to support empirically validated therapies.
26
What is by far the most researched psychotherapy?
CBT
27
_____ ____ by themselves have been shown to be effective for several conditions, particularly for anxiety disorders?
Behavioural strategies
28
What are three disorders which still have only some limited support for efficacy when it comes to CBT?
1. Anorexia
2. Schizophrenia
3. Bipolar disorder
29
Cognitive therapies (without behavioural interventions) have been shown to be ____ for some disorders
effective
30
What is the treatment of choice for all anxiety disorders, with medication often being recommended as the 2nd choice?
CBT
31
Despite similar effects, CBT is often used in lieu of or in combination with medication because it helps reduce what?
-Symptom relapses after drug cessation
-This patterns applied to depression, OCD, social phobia, PDA and other disorders
32
Which disorders have preliminary support for positive effects for CBT (modified) ?
-Personality disorders
-Psychotic conditions
33
What are some things to be aware of when it comes to the credibility of evidence?
-Transparency and replicability
-Independence vs. conflicts of interest (pharma funded research)
-Independent teams
34
What are the first three levels of evidence according to the NHMRC?
1. Meta analysis
2. A study or test, blinded comparison
3. Pseudo-randomised controlled trial
35
What is the cognitive principle of CBT?
Interpretation of events is important
36
What is the behavioural principle of CBT?
Behaviour has impact on thoughts and appraisal
37
What is the continuum principle of CBT?
Psychopathology is on a continuum- (not categorical) from normal to deviance/dysfunction
38
What is the here and now principle of CBT?
Commence from present problems; may not be necessary to delve into past to resolve current problem
39
What is the empirical principle of CBT?
Important to evaluate theory and therapy
40
What is the interpersonal principle of CBT?
Therapist as informed, engaged and active
41
What are the 4 interacting systems which result from a situation in CBT?
-Thought
-Physical reactions
-Emotions
-Behaviour
42
What is the approach to the client when it comes to cognitive therapy?
Collaborative empiricism
43
Cognitive therapy is ___ and promotes ___ ___
structured
active engagement
44
Cognitive therapy is time limited and brief. Outline how many sessions are needed depending on complexity.
Mild: up to 6 sessions
Mild to moderate: 12 sessions
Moderate to severe or co-existing personality disorders: 12-20
Severe problems co-existing with axis 2: >20
45
Cognitive therapy requires regular use of ___ exercises
homework
46
Cognitive therapy uses guided discovery. Relate this back to Beckian therapies vs. Ellis' therapy
-Characteristic of Beckian therapies
-Disputation was a characteristic of Ellis' rational therapy
47
What are some myths about CBT (1-6)
1. Therapeutic relationship is not important
2. CBT is mechanistic
3. CBT is about positive thinking
4. CBT disregards the past
5. CBT deals with superficial problems, hence symptoms substitution is likely
6. CBT is adversarial
48
What are some myths about CBT (7-12)
1. CBT is for simple problems
2. CBT is interested in thoughts not emotions
3. CBT is only for clients who are psychologically minded/high intelligence
4. CBT is quick to learn and easy to practice
5. CBT is not interested in the unconscious
49
What is the current subject focus in CBT research?
standard cbt
50
What are some newer therapies in recent developments?
-mindfulness and mindfulness based approaches
-schema therapy
- acceptance and commitment therapy
-dialectical behaviour therapy
-metacognitive therapies
51
What are the six features of competency-based approaches?
1. Begin with the end in mind
2. Molecular approach to the conceptualisation of competence
3. Outcome determined; not input focused
4. Criterion based standards of competence
5. Systematic, objective, ecologically valid assessment
6. Developmental approach to attainment of competence
52
There are many domains of psychology practitioner competence. What are 3 examples (the ones taught in masters this semester)
1. Interventions: knowledge and knowledge application
2. Individual culture and diversity
3. Effective and skillful assessment and intervention
53
What are some differences between the diagnostic assessment as opposed to the cognitive behavioural assessment when it comes to info about aetiology, maintenance?
Diagnostic:
- little info about aetiology, maintenance
CB:
-informative about aetiological and maintenance
54
What are some differences between the diagnostic assessment as opposed to the cognitive behavioural assessment when it comes to treatment?
Diagnostic:
-Often, no more than broad guidelines about treatment
CB:
-Clear implications for treatment
55
What are some differences between the diagnostic assessment as opposed to the cognitive behavioural assessment when it comes to assumptions?
Diagnostic:
-medical model
CB:
-cognitive behavioural theory
56
What are some differences between the diagnostic assessment as opposed to the cognitive behavioural assessment when it comes to what's focused on?
Diagnostic:
-focus on WHAT: what features (signs and symptoms) are present/absent
CB:
-focus on HOW: how features arise and are perpetuated. How linked to others
57
What is critical to the conceptualisation of a case?
Cognitive behavioural assessment
58
What is cognitive behavioural assessment directly linked to?
Choice of treatment strategies
59
An inaccurate cognitive behavioural assessment leads to what?
Unproductive therapy
60
What should you do to case conceptualisation if therapy is not progressing well?
Re-examine it
61
Like all other behaviours, problem behaviours are influenced by principles of learning. What a person ___ with regard to a problem influences the way a person ___ and ___, and vice versa.
thinks, feels, behaves
62
It is useful to conceptualise problems as being related to antecedents and consequences. For what purposes? (2)
1. of assessment and understanding
2. for planning and implementing treatment
63
What is the 5-stage model of CB assessment and formulation?
1. Identify the problem behaviours
2. Identify antecedents of the problem behaviours
3. Identify consequences of the problem behaviours
4. Identify strengths and resources that influence stage 2 or 3
5. Integrate the information into a formulation
64
What is the ABC model of assessment, and how does this differ from the ABC model of rational emotive therapy? Outline the two
Assessment:
A - Antecedents
B - Problem Behaviour
C - Consequences
Rational Emotive Therapy:
A - antecedents
B - Beliefs
C - Consequences
65
How do antecedents exert influence on B?
By increasing or decreasing frequency, duration, likelihood of occurrence
66
Give an example of how an antecedent might be a stimulus event (proximal)
Dinner as an antecedent to smoking behaviour, Binge as antecedent to vomiting behaviour
67
Can an antecedent be a precipitating event?
Yes
68
What does the BASICP acronym stand for, that we can use when clarifying antecedents?
B: behaviour
A: affect
S: situations
I: interpersonal
C: cognitions
P: physiological
69
Apart from clarifying the antecedents, where else can we use the BASIC-P acronym?
To clarify consequences
70
What are some tips to clarify unclear and vague answers in the A and C of the ABC model:
- "Tell me more about this "funny" feeling in your head"
- "Tell me a little more about the sequence..what immediately precedes the funny feeling and what follows it?"
-Move from open to closed-end questions: is this funny feeling something that's just unusual or something that is dangerous? How dangerous?
71
What are three examples of modifiers that can exert positive influences in the ABC model?
-Self
-Others
-Protective factors
72
How do we integrate information into formulation during the advanced stage?
-Build up conceptualisation
-Draw flow-chart to indicate which aspects lead to what
-Use arrows to indicate direction of effects
-CB models of disorders may help, although specific aspects for the individual concerned may require mention
-An adequate formulation enables making and testing predictions
73
What does the escape/avoidance cycle look like in the maintenance of fear?
Fear --> escape/avoidance --> no change to fear beliefs --> fear
74
What are the negative thoughts and reduced activity cycle maintaining depressed mood?
depressed mood --> negative thoughts --> reduced activity --> loss of positive rewards --> depressed mood
75
What are some useful tips about getting to specifics when it comes to cognitive behavioural assessment?
-Don't be general, adequate assessment is individualistic
-Clarify vague and general statements until they are clear and specific
-Elicit the underlying (unsaid) feared consequences or catastrophe
-Focus on proximal events
76
What are some useful tips when it comes to CBT assessment methods?
Vary your assessment methods - use self-monitoring, observation in-vivo, observation in stimulated contexts, physiological recording
77
Often there are several problematic behaviours a client has, antecedent factors and consequences that interact in a complex way, in a manner that resembles circular rather than linear causality. In such instances, what should you do?
Identify the elements linked together in this circular fashion, identify weak link(s) between elements and then choose one or more points of intervention. Prioritise problems and focus your CB assessment on the main or pivotal problem.
78
What should you do with the client once you have completed their formulation?
Share it with the client and get their feedback, examine client's perceptions of problems and solutions, educate, reassure, set goals.
79
What are some reasons as to why the therapeutic-client relationship was not seen as important in CBT historically?
-Psychoanalysis vs. BT (client was conceptualised as fragile and exposure therapy considered naive and potentially dangerous)
-counselling vs. BT/CBT (relationship variables were considered essential and sufficient)
80
What are the characteristics of the therapeutic relationship in classical psychoanalysis?
Objective and neutral, ....'distant'
81
What are the characteristics of the therapeutic relationship in some counselling approaches?
Supportive, non-directive, reflective
82
What are the characteristics of the therapeutic relationship in cognitive therapy, Beckian approach?
Collaborative empiricism, guided discovery
83
What are the characteristics of the therapeutic relationship in behavioural therapy?
Expert and coach
84
What are the characteristics of the therapist-client relationship in CBT?
-Establish a good therapeutic relationship early in therapy
-Maintain relationship throughout therapy
-Attend to any problems (disrupt, ruptures)
-Key features of CBT (collaboration, active participation, guided discovery) contribute to good alliance
85
What is resistance in the T-C relationship in CBT?
Analysed as a consequence of client beliefs about therapist or therapist actions. If persistent/pattern, examine schemas
86
What are the characteristics of the therapist - client relationship in CBT today?
- shift roles based on needs of situation
- reflective and insight orientation to change beliefs and schemas
-skills training (coach) when required
-Teach (expert) - data, research and facts
-Supportive and validating of client's emotions and experience
87
What are some cultural factors to be aware of when it comes to the T-C relationship in CBT?
-awareness that own beliefs and perceptions are grounded in "dominant" or "own" culture
-aware of blind spots
-greater effort/time in engagement if different cultures
-CBT translates well to different belief systems
-aware of different perceptions
-aware of language/translation difficulties
88
What are some principles in psycho-education
-Deliver information in bite-sized chunks
-Use verbal and visual information, adapt information to style of reader
-Check the client has understood the information
-Check whether the client finds the information credible now and when distressed
-Use analogies from disorders other than client's to illustrate points
89
Why is it important to examine the cilent's beliefs about their diagnosis?
They may have encountered someone else with a similar diagnosis and have assumptions attached to that
90
What is size mismatch as a common block in beliefs about therapy?
"I'm not going to feel better by these simple strategies! It's too big to be fixed, period."
91
What is causal mismatch as a common block in beliefs about therapy?
"I don't need psychotherapy, I have a biochemical problem"
92
What is 'solution is too hard for me' as a common block in beliefs about therapy?
"I don't think I'll be able to do this. I'm not that strong or motivated enough or capable enough for this solution"
93
What is 'sequence mismatched' as a common block in beliefs about therapy?
Cart before the horse: reduce my anxiety first, then I'll do exposure therapy, or, get rid of my depression first, then I'll do all of these activities you want me to do.
94
What is 'solution is unfair' as a common block in beliefs about therapy?
I thought therapy was about someone else fixing my problems, but you seem to be saying that I've got to do all the hard work.
95
Relationship competencies are ____ but not ___ to effect change.
Important, sufficient
96
What are the main steps in imaginal desensitisation?
1. Explain rationale for procedure
2. Hierarchy construction: initial stage
3. Selection of coping response to exposure
4. Scene presentation
5. Debriefing and cognitive appraisal
6. Homework and follow-up
97
What should you do if outcomes are not expected in imaginal desensitisation?
Reassess and trouble-shoot
98
What are some things that are involved in the preparation: rationale and reassurance section of imagined exposure therapy?
-explain rationale in lay terms
-examine expectations of client: some anxiety is expected
-reassure client that they can terminate exposure if it becomes excessive
99
What is the objective of the initial stage of imagined exposure therapy?
1. Identify a few scenarios (triggers) that can raise anxiety levels
2. Identify 2 positive imagery scenes as coping resources
100
What are some common coping responses you can use whilst doing imagined exposure therapy?
-slow breathing and instructions to "relax" during exhalation
-brief muscle relaxation
-body scan and relax exercise
101
During the second scene presentation in exposure therapy, the scene is repeated until SUDS drop to what?
20% or below, or drops by 50% of original level
102
In exposure therapy, scene presentation (imagined), the new session should begin with what?
The last item that the subject coped with
103
What are some guidelines when it comes to scene presentation during exposure therapy?
- keep SUDS within manageable limits at all times
-most clients happily tolerate SUDS in the 40-60 window (exposure cues) and 40 or below (when no cues/relaxing)
104
What can high levels of distress do when it comes to exposure therapy?
Lead to panic --> negative consequences on motivation, confidence
105
What is systematic desensitisation?
A combination of graded exposure and relaxation
106
Recorded audio tapes of a ____ _____ is a good home task
desensitisation session
107
Supervision of one or more desensitisation sessions has advantages such as:
-to prevent unexpected adverse consequences
-to understand individual patterns of anxiety experience, appraisal and coping (including safety behaviours)
108
What might be happening if imagery in systematic desensitisation fails to provoke anxiety?
Mental blocking - may be deliberate or automatic
109
What are some tips for when systematic desensitisation imagery fails to provoke anxiety?
Use escalation strategies
-move up the hierarchy
-switch/push additional anxiety buttons (add negative cognitions, physiological sensations)
You might be pressing the wrong anxiety buttons
-switch modalities, use multi-sensory modalities
110
What are some things to remember when setting a systematic desensitisation task for homework?
-negotiate a desensitisation home work task if appropriate (record session x daily use)
-discuss client's confidence in carrying it out
-discuss potential blocks. Be pro-active about compliance and motivation problems
-Reassure, empathise, empower the client
111
What are some things to note when preparing for flooding sessions:imagery
-panic attacks may occur during session
-allow for longer sessions (often 2+ hours - may go to 4 hours)
-start high (80+)
-graduated features may be incorporated (e.g., 80 at initial step before 90, 100, or exposure for shorter time)
-coping responses (slow breathing, + imagery), may be used to drop sustained, high anxiety levels
-Can use relaxation to deal with residual anxiety after exposure session is over
112
What does cBT or CbT mean?
Clinicians differ in the emphasis they place on the 'C' or the 'B' (cognitive heavy or behavioural heavy)
113
What did Beck (1960) summarise about the cognitive therapy model?
Maladaptive states are underpinned and/or maintained by biased ways of thinking.
114
CT provides a method for:
testing thoughts against reality (probability rather than certainty)
115
Cognitive therapy aims to develop ___- thoughts, not ___ ones
Realistic, positive
116
What are the three layers of cognition (from most accessible to least)
-Automatic thoughts
-Assumptions
-Schemas (or core beliefs)
117
The Panic Disorder model was developed by Clark in 1986. What are the two key learning we can take from this model to apply to CT?
-Core maintaining factors is a catastrophic misinterpretation of bodily sensations
-We intervene cognitively by helping clients to re-appraise the symptoms as non-threatening.
118
What are the 6 main cognitive biases in OCD that maintain symptoms?
1. Inflated responsibility
2. Over importance of thoughts
3. Over importance of controlling ones thoughts
4. Over estimation of threat
5. Intolerance of uncertainty
6. Perfectionism
We intervene cognitively by helping clients to re-appraise these biases.
119
In a social situation, people with social anxiety disorder make evaluations on their own performance and judge what two main factors?
1. The possibility of negative evaluation
2. Consequences of negative evaluation
We intervene cognitively by helping clients to re-evaluate the probability and consequences of negative evaluation.
120
In examining the evidence for cognitive therapy, patients with MDD took part in a randomised control trial where there was a cognitive therapy group, an antidepressant group and a placebo group. What was found?
58% of both the cognitive therapy and antidepressant groups were classified as responders.
121
In examining the evidence for cognitive therapy, patients with panic disorder took part in a randomised control trial where there was a cognitive therapy group, a relaxation group and a control group. What was found?
82% of CT patients met criteria for response
68% of relaxation patients met criteria for response
36% of control patients met criteria for response
122
What are the 5 steps in cognitive therapy?
1. Education on thoughts
2. Elicit thoughts and assumptions (identify cognitive distortions)
3. Evaluate and challenge automatic thoughts
4. Evaluate and challenge underlying rules and assumptions
5. Identify and challenge core beliefs (if required)
123
What are the two key concepts that must be understood regarding thoughts in cognitive therapy?
1. Thoughts and feelings are distinct phenomena
2. Thoughts create feelings and behaviours
124
What is thought monitoring in cognitive therapy?
-essential technique in CBT
-generally used as a homework task
-worksheets and apps available
125
What are two tools you can use to elicit thoughts in cognitive therapy?
-You can use checklists. There are many available to use (e.g., automatic thoughts questionnaire)
-You can take a guess (e.g., If you had to take your best guess, what do you think was going through your head at that time?)
- therapist experience (if you've tried everything else) "A lot of people with similar symptoms say they have X, Y and Z. DO any of those sound like thoughts you might have had?)
126
What are 9 common cognitive distortions?
1. Black and white thinking
2. Mind reading
3. Catastrophising
4. Fortune telling
5. Shoulds
6. Labelling
7. Personalising
8. Emotional reasoning
9. Blaming
127
What is socratic questioning?
-A process of 'guided discovery'
-Questions are asked that help the client challenge assumptions and discover new ideas and perspectives
128
Challenging cognitions are most effective when it is what?
Client led
129
What are the 4 steps to socratic dialogue?
1. Informational questions
2. Empathic listening
3. More complex summarising
4. Asking analytic synthesising questions that are genuinely curious in how they are asked
130
What are the most commonly used techniques in cognitive therapy?
-Examining the evidence
-Double standard
-Likelihood/probability
-Alternative explanations
131
What are some key points to remember with cognitive therapy? (4)
1. It can be done in multiple ways
2. Track level of conviction over time (%)
3. Some thoughts may have to be challenged multiple times (but always ask yourself why)
4. Both within and between session practice is imperative (CT sheets can be useful to provide for homework)
132
____ exposure is better than _____ exposure in systematic densitisation
prolonged, brief
133
When might in-vivo and imaginal exposure need to be used in combination?
For disorders with physical and mental rituals (e.g., OCD)
134
What are four different variants of exposure therapy?
1. Interoceptive exposure
2. Simulations
3. Blood-injury phobia
4. Exposure with response prevention
135
What is interoceptive exposure?
Strategically inducing the somatic symptoms associated with a threat appraisal and encouraging the patient to sit with this.
136
Who was the first to formally suggest that interoceptive exposure may be an effective way of reducing fear of physical sensations in panic disorder?
Goldstein and Chambless (1978)
137
What did Barlow and Craske et al (2000) add with multiple research studies, regarding interoceptive exposure?
That there is an essential component when learned alarms are involved.
138
Elevated fear of arousal sensations mean what in terms of anxiety?
A high anxiety sensitivity
139
What are the three main clusters of panic disorder, and therefore changes the procedures of interoceptive exposure?
1. Heart cluster
2. Head cluster
3. Anxious symptoms abdominal cluster
140
What is one example of the panic symptoms, exposure task, and fears of those in the heart cluster, as used for panic disorder during interoceptive exposure
Panic symptoms: palpitations
Exposure task: aerobic exercise
Fear: heart attack
141
What is one example of the panic symptoms, exposure task, and fears of those in the head cluster, as used for panic disorder during interoceptive exposure
Panic symptoms: dizziness, derealisation
Exposure task: spinning on chair, hyperventilation
Fear: going crazy, fainting, losing control
141
What is one example of the panic symptoms, exposure task, and fears of those in the abdominal cluster, as used for panic disorder during interoceptive exposure
Panic symptoms: abdominal discomfort, nausea
Exposure task: certain foods and drink followed by progressive toilet delays
Fear: bowel accident
142
What is one thing you must rule out in panic disorder
Ensure there are no medical contradictions
143
What are some key points to remember during interoceptive exposure for panic disorder:
-Provoke the anxiety sensation by the appropriate activity
-Have a method for client to signal anxiety levels
-Try and keep anxiety to tolerable levels
-Remember very brief exposure can trigger high levels of anxiety
144
What is a validity check, to be conducted during interoceptive exposure for panic disorder?
How similar is the feeling to panicky feelings in real life
145
What is a severity check, to be conducted during interoceptive exposure for panic disorder?
How high was the anxiety? Would it increase with prolonged exposure
146
What is a cognitions check, to be conducted during interoceptive exposure for panic disorder?
Automatic thoughts and conditional beliefs, (what if...)
147
What should you do in the intervening period of desensitisation?
-Use an appropriate coping strategy or just rest in the intervening period
-Several exposure-relaxation/rest cycles are administered during the same session
-Number of cycles depend on client motivation and likely outcomes
148
What is a good range to keep the clients SUDS at for beginners?
20-60
149
What are some simulations that we can use in therapy (4)
1. Imaginal
2. Specially designed simulations (e.g., flight simulations)
3. Virtual reality
4. Role plays
150
What are some advantages of doing individual sessions for social phobia?
-Tailored to the individual
-Less distressing for client initially
151
What are some advantages for group sessions for clients who have social phobia?
-Enables simulations exercises which can be a powerful intervention
-Friendships form
-Economical
-Enhances motivation
-Sense of being understood
152
What are the therapy of Heimberg's group therapy programme for social anxiety disorder?
-Assessment and preliminary interview
-Acute treatment phase
-Intensive continuation phase
-Maintenance phase
153
What are two specific issues that you find in exposure group programs for clients with social phobia? (2)
-distress levels are less predictable because they depend on others responses
-durations are dependent on others so not controllable; often limited to brief interactions
154
What is an essential component in treating OCD with exposure therapy?
Homework
155
What two things should you combine in treating obsessional thoughts?
Exposure and response prevention
156
What are the 3 common procedures for treating obsessional thoughts for OCD?
1. Patient is exposed to obsessive thoughts/images AND instructed to prevent neutralising behaviours
2. Exposure is by loop-tape or repeated writing down of obsessive thoughts
3. Exposure to imagery if this is associated with thought (via instructions to client)
157
What are 3 challenges in exposure response prevention when treating obsessions in OCD patients?
1. Higher levels of defensiveness/secrecy and distress, more subtle avoidance behaviours so challenges to enforce response prevention
2. Ethical and religious values may interfere with initial readiness to comply with intervention
3. Treatment may take longer and often involves others (family, other professionals)
158
Is pharmacotherapy an evidence based treatment for OCD? If so, what kind of medications?
Yes - high doses of SSRI's
159
What is homework?
Any therapeutic activity that a client may complete outside treatment sessions (e.g., engaging in a specific behaviour or the daily recording of cognitions). It should be purposeful and be related to therapeutic goals.
160
Where does support for the use of homework in psychotherapy stem from?
The behavioural principle of generalisation where the effects of reinforcement in one environment is spread to another environment.
161
What are some benefits of doing homework during cognitive therapy?
Increased feelings of self-efficacy, the sense that the client can actually do something to promote successful outcome.
162
What are three examples of the benefits of homework during therapy?
-Makes therapy more concrete and specific
-Continues application and use of skills
-Provides data which can disconfirm negative thoughts and beliefs
163
We know that homework is effective, but what are some of the research caveats?
-Restricted to involving patients with depression and anxiety
-of 719 related studies, only 27 met inclusion criteria and reported sufficient data
164
What is a significant predictor of therapy outcome
Homework compliance
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What did the 2000 study by Burns and Spangler on homework and depression patients find?
A causal effect between homework and measures of depression. Effects on improvement was due to homework assignments and not some other variable.
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What were some of the conclusions from the practitioner survey on homework?
-Almost all practitioners use homework assignments
-Most clinicians do not consistently follow systematic procedures for prescribing homework
-Practitioners appears to believe that homework is more important for some problems than for others
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What are some tips when designing homework assignments for clients?
-Start small
-Start with assignments that ask the clients to do what they already do 30% of the time
-Anticipate obstacles
-Written instructions have been shown to improve compliance
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Outline what happens in the 10/40/10 model split of the therapy hour:
-First 10 minutes of therapy are involved in homework review
-40 minutes allocated for therapy proper
-Last 10 minutes in the design and assign of new homework
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What should you refrain from saying so that you don't reinforce noncompliance in the homework tasks?
"No that's okay" or "better luck next time"
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What are the 4 key components in reviewing systematic homework administration?
1. Discuss homework completion (amount and quality)
2. Reinforce/praise for attempts
3. Examine reasons for any homework not completed
4. Problem solve to overcome barriers to homework completion
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What are some important things to remember in the ASSIGN part of systematic homework administration?
-Write a description of homework on homework prescription form
-Consider alternative activities for potential difficulties
-Elicit the clients confidence rating of their ability to carry our each activity and use ratings to negotiate each homework task
-Write down when, where, how often and how long homework should be practised
-Obtain final confidence rating on homework form
