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cbt > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Why do we want to elicit positive emotions?

A

-Promote Well-being & resilience
-Increase scope of attention, cognitions, and lower arousal
-Improve coping

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2
Q

How to elicit positive emotions?

A

-Discuss Interests
-Positive Memories
-Encourage pleasant actions
-Help client draw adaptive conclusions about their experiences

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3
Q

If the client is having trouble identifying positive emotions, you can:

A

-Provide multiple choice options
-Imaginal exposure
-Listing emotions

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4
Q

When might you want to increase negative emotions?

A

-Increase intensity of ATs
-Exposure
-Change cognitions on an emotional level
-Evaluate maladaptive behaviour

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5
Q

List activities for regulating negative emotions

A

-Problem Solving
-Evaluating and responding to negative thoughts
-Engaging in (and being fully mindful of) social, pleasurable, or productive activities)
-Exercising
-Accepting negative emotion nonjudgmentally
-Mindfulness (for detaching from thoughts)
-Relaxation
-Engaging in self-soothing
-Focusing on positive qualities of oneself

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6
Q

What are the different kinds of ATs in CBT?

A

Inaccurate thoughts that lead to distress and/or maladaptive behavior

Accurate but unhelpful thoughts

Thoughts that are part of a dysfunctional thought process (rumination, obsession, self-criticism)

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7
Q

How do you address a client’s unhelpful, yet accurate, thoughts?

A

-Problem-solve,
-Evaluate inaccurate conclusion,
-Work towards acceptance,
-Change focus of attention

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8
Q

How do you address a client’s distressing and inaccurate ATs?

A

-Behavioural Experiments
-Verbal evaluation

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9
Q

How do you address thoughts that are part of a dysfunction thought process (rumination, obsession, self-criticism)?

A

-Evaluate beliefs about thought process
-Use mindfulness,
-Emphasize valued action

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10
Q

How do you select key ATs?

A

-Is it currently causing significant distress? Or is it unhelpful and likely to reoccur?
-Does it pose itself as an obstacle to the client’s goals?
-Is it likely to cause the client distress again?

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11
Q

Do you directly challenge ATs and why?

A

-No. As therapist, we do not know the validity of the AT.
-It can invalidate the client’s feelings and perspective.
-Non-collaborative

Instead, apply gentle Socratic questioning.

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12
Q

How do you use Socratic questioning? (List out of 6)

A
  1. Evidence questions
    * Help to identify evidence to the contrary (which they often fail to identify)
  2. Alternative explanation questions
    * “Is there another way to look at this/an alternative explanation?”
  3. “Decatastrophizing” questions
    * Ask them how they could cope if the worst does happen
    * Help to think of more realistic outcomes and ask for the best outcome
  4. “Impact of the automatic thought” question
    * “What is the effect of you thinking…?”
    * “And what could happen if you changed your thinking?”
  5. “distancing” questions
    * “What would be good to do now?”
    * Ask how likely Abe is to text him and respond to obstacles that could get in the way
    * Ask if he wants to text him right then in my office
  6. Problem-Solving Questions
    -“What would you like to DO about this situation?”

Assess the outcome of the evaluation process by asking how much they still believe their thought (in %)

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13
Q

Reasons for cognitive restructuring being ineffective: (list 6)

A
  1. There more central automatic thoughts not yet identified
  2. Evaluation of automatic thoughts is implausible, superficial or inadequate
  3. Client hasn’t sufficiently expressed the evidence that support automatic thought
  4. Automatic thought is broad, overgeneralized cognition (=core belief)
  5. Client understands intellectually that automatic thought is distorted but not on an emotional level
  6. Automatic thought is part of a dysfunctional thought pattern
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14
Q

How can you identify when cognitive restructuring is ineffective?

A

Ask client to rate how much they believe in their adaptive response & how they feel

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15
Q

Alternative ways to address ATs (list 5)

A
  1. Using alternative questions
    * “What makes you think you should/not …?”
    * “Is it reasonable to …?”
  2. Identifying cognitive distortions (see appendix)
    * Give them a list
    * Can help to gain distance from their thoughts
    * Explain how to use it and then label it as part of action plan
  3. Designing behavioral experiments
    * If possible, suggest to do the experiment right in the session (otherwise outside of session)
    * Help client draw adaptive conclusion after having done successful
    ® “What did you learn/conclude?”
    ® “What does this experience mean for the future?”
  4. Using self-disclosure
    * To demonstrate how you were able to change similar automatic thoughts of your own
  5. Asking clients for a helpful response
    * Ask how clients would like to respond to an automatic thought
    * “Can you think of a more helpful way to view this?”
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16
Q

What can you do when the ATs are true? (List 3)

A
  1. Focus on problem solving
    * Investigate whether the problem can be solved at least to some degree
  2. Investigate invalid conclusions
    * Examine underlying belief or conclusion
    * “What does it mean about you?” or “What are you afraid will happen?”
  3. Work toward acceptance & valued action
    * Help them learning to focus on core values, pursue valued action, emphasize the more rewarding parts of live & enrich experience in new ways
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17
Q

After helping a client respond to an AT, you should…

A

encourage the client to record their responses.

18
Q

Having evaluated an automatic thought with clients ask them to summarize:

A
  • “What do you think would be important for you to remember this week?”
  • “If the situation comes up again, what do you want to tell yourself?”
  • “Would you like to write it down? I want to make sure you remember it this week?”

–Read therapy notes every morning & every time needed throughout the day

19
Q

Clients can respond to ATs with:

A

-“Testing Your Thoughts” worksheet
-Thought Records
-Evaluative questioning

20
Q

What should you do if a worksheet isn’t helpful enough?

A

Check for obstacles/ limiting thoughts before giving it as homework

Emphasize that it’s a skill they build over time, that it’s okay to make mistakes

You can also skip many steps in the worksheets and just do two columns: “automatic thought” and “response/ what I can remind myself of”

21
Q

How can mindfulness be helpful in CBT?

A

-Focus on the present, internal and external

-Change relationship to thoughts

-Improve acceptance of internal experience

22
Q

TECHNIQUE FOR INRTODUCING A MINDFULNESS INTERVENTION FOR RUMINATION (6 steps)

A
  1. Educate about cognitive model
  2. Apply Socratic questioning
  3. Do pros and cons of rumination vs. focusing on present moment
  4. Educate how mindfulness can be helpful
  5. Have them start the thought process right in the session
  6. Ask them to rate intensity
23
Q

Two reasons why we want clients to engage in unhelpful thought process before starting an exercise:

A
  1. Can serve as behavioral experiment to test dysfunctional beliefs: “Rumination is uncontrollable”
  2. Important to replicate the conditions clients will experience when using this strategy outside of session
24
Q

What is the AWARE technique? What are the 6 steps?

A

Mindfulness technique designed to be used when clients worry excessively or experience excessive anxiety

  1. Accept anxiety (or other emotion)
  2. Watch it
  3. Act constructively with it
  4. Repeat the steps
  5. Expect the best
25
Q

How is CBTp different from CBT?

A

A lot of experiential learning

Patient’s view is respected and stimulated

Reduce distress and enhance freedom

Do NOT discuss what is real and what is not, don’t be judgmental and try to convince them their wrong

26
Q

What types of goals does CBTp serve?

A

Reducing current distress
Being free,
Having to avoid less,
Being less alert all the time

27
Q

What types of goals does CBTp not serve?

A

Improving illness insight
Taking away voices (we can’t)
Treating a former psychosis that is not present now

28
Q

What is & when do you use a historical test and how to you do it?

A

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

  1. Ask client to remember time when they had belief x (e.g. aged 6-11)
  2. Ask for relevant memories when they were an adolescent
  3. Use Socratic questioning to reframe the meaning they put to each of these experiences
  4. Ask them to record a summary of their new understanding of themselves from the most salient time – ask them to read it everyday
29
Q

When do you use a probability (chance) calculation?

A

It is used when patients overestimate the probability for negative events and/or have limited awareness of the many prerequisites that need to be fulfilled for the event to actually happen.

Often concerns beliefs with a ‘if …. then’ structure

30
Q

How do you use a probability (chance) calculation? (7 steps)

A
  1. Explain rational: multiple things need to happen before x can happen
  2. Formulate negative expectancy and probability
  3. Write down all necessary previous steps and rate probability
  4. Explain that even if one step doesn’t happen, the feared event will not happen  all probabilities need to be cumulated
  5. Calculate cumulated probability for each step – multiply cumulated probability of step 1 with that of step 2 and so on
  6. Discuss results, check with initial probability rating, write down conclusion
  7. Rate belief again and see if it has changed
31
Q

When do you use the pie chart technique?

A

When patients tend to jump to conclusions and have difficulty formulating alternative explanations for events.

Patients tend to stick to only one explanation and this technique addresses that.

32
Q

When and how do you use a cost-benefit analysis?

A

To examine the effects of behavior, beliefs about a behavior or other beliefs; behavior/ belief emerged because of a reason, but now it probably has a very high cost; determine if it’s worth it and find alternative

Steps:
1. Take a form + describe behavior/ belief
2. Ask patient how useful behavior is
3. Write down all pros and cons
4. Discuss results (2 options):
More cons: talk about where this behavior comes from, what its function is but also how it relates to safety behaviors, coping and avoidance
More pros: emphasize that behavior has a lot of benefits; try to find other behavior that have the same benefits but less costs
5. Review the usefulness of behavior
6. Formulate alternative behaviors/ beliefs

33
Q

When do you use the cognitive continuum?

A

-Patients that think black/ white or that have very high standards,
-Perfectionism,
-Core beliefs and automatic thinking
-To help illustrate a middle ground between success and failure

34
Q

How do you use the cognitive continuum? (7 steps)

A
  1. make a scale, define 0 and 100, ask client to rate themselves on the scale
  2. ask for real life examples: does anyone come to mind when you think of a really good/ bad x?  ask them to rate themselves again now
  3. start defining each extreme of the scale: what are the characteristics of being a really bad x or a really great x?
    * really go into detail - what does x mean to you? can you describe that more? (write it down, use client’s words)
  4. ask client to rate themselves on each of the named qualities/ characteristics on the scale
  5. add up all the points and divide by number of items/ characteristics
  6. new score on scale -> look at difference between initial and final rating; how does it feel? What did they learn?
35
Q

7 ways to strengthen adaptive beliefs:

A
  1. Eliciting positive data and drawing conclusions
  2. Examining advantages of adaptive belief
  3. Pointing out the meaning of positive data
  4. Referencing other people
  5. Use a chart to collect evidence
  6. Inducing images of current & historical experiences
  7. Acting “as if”
36
Q

When might you use intellectual-emotional role plays?

A

When clients get it intellectually but not emotionally

37
Q

The video for socratic questioning identifies 4 types of questions:

A
  1. Questions for clarification
  2. Questions that probe reasons & evidence
  3. Questions about viewpoints and perspectives
  4. Questions that probe consequences
38
Q

Describe the evidence technique (4 types of evidence)

A

“things will never change”

Evidence for: assign % on how much this evidence proofs that things will never change

  1. statistics that prove it
    -e.g. unemployment rate (%)
  2. tensional objects
    -something physical that you can look at (e.g. journal) (%)
  3. testimony
    -things that people said to him
  4. social consensus
    -e.g. experts making negative predictions about economy in future

Evidence against: go through all steps again

39
Q

When do you use the ‘Pie Chart’?

A

-When patients tend to jump to conclusions and have difficulty formulating alternative explanations for events
e.g., Responsibility in a tragic event, Hypochondria

40
Q

What is ‘personalization’?

A

A thought distortion

Believing that others are behaving negatively because of you, without considering more plausible explanations for their behaviour.

41
Q

What is ‘tunnel vision’?

A

A thought distortion

Only seeing the negative aspects of a situation

cbt (3 decks)

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