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72 Cards in this Set
- Front
- Back
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What are the 3 levels of thought?
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- Automatic Thoughts (ruminations)
- Intermediate Beliefs/Underlying Assumptions - Core Beliefs |
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Describe Automatic Thoughts
Discuss 3 aspects. |
They are unplanned - come from moment to moment.
They are the most accessible thoughts - they're Suface Thoughts. They are situation specific |
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Discuss aspects of Intermediate Beliefs
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They are the guiding rules, attitudes, assumptions.
They move across situations. They organise our perceptions and guide our lives. They're not necessarily articulated. They are the root of automatic thoughts. Involve 'shoulds' or if-then statements. |
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If I was talking about Unconditional statements about ourselves, others, or the world, what level of thought would I be operating at?
E.g. 'I'm a failure' |
Core Beliefs
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List 11 Common Thinking Mistakes
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- All or Nothing, Dichotomous
- Over-generalising - Mental Filter/Selective Abstraction - Jumping to Conclusions/Catastrophising - a) Mind Reading - b) Fortune Telling - Magnifying or Minimising - Emotional Reasoning - Shoulds and Musts - Labelling - Personalising - Tunnel Vision - Disqualifying/Discounting the Positive |
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What are two sub-types of Jumping to Conclusions/Catastrophising in terms of Thinking Errors
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- Mind Reading
- Fortune Telling |
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In terms of Thinking Errors, what is Personalising?
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When we take personal responsibility for things that were not or not entirely in our control. This can lead to a huge amount of suffering.
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Outline 4 Aspects that Highlight the Importance of Emotions in CBT.
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1 - Shifts in mood signal something important is happening.
2 - Identifying Specific Emotions helps to shape/choose specific Interventions. 3 - Mood Intensity can be used to track therapy effectiveness. 4 - Awareness of increase in positive emotions is important - helps identify things that support positive emotion. |
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What is the arrangement of capillaries?
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they are surrounded by alveolar gas
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What are the Guiding Principles of CBT?
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- Centrality of the Cognitive Conceptualisation
- Phenomenological Emphasis - Collaborative nature of the Therapeutic Relationship - The Active Involvement of the Client - Use of Socratic Questioning and Guided Discovery - Expliciteness of the Therapist - Emphasis on Empiricism - The Outward Focus |
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What are Four Components of Guided Discovery?
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- Asking Informational Questions
- Empathic Listening - Frequent Summarizing - Asking synthesizing and analytical questions (socratic) |
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What is the purpose of Guided Discovery?
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It helps the client to discover data, information for themselves. It is more powerful when they discover and identify, thoughts, feelings, behaviours and links themselves. Gives them a sense of ownership. Makes them an active participant, and helps them to become 'their own therapist'. It fosters 'collaborative empiricism'.
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What are the benefits of the Therapist being Explicit?
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It helps the client to understand the process of therapy. Enhances the therapeutic relationship and collaboration.
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Why is there an Outward Focus in CBT?
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Because CBT wants to be able to generalise the change of in-session therapy to the greater life experience of the individual. The therapist wants the client to become their own therapist.
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Why is Structure Important?
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- It clarifies expectations for the therapist and client.
- It increases the understandability for the client. - It increases efficiency, helping to keep therapy focused. - Increased structure in CBT has been shown to lead to better outcomes for therapy. |
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What would a session of CBT look like.
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It would start with a REVIEW of the clients state (mental). This may help to prompt targets for that session. It would then move into setting the AGENDA for the session. Then there would be a HOMEWORK REVIEW then work on the SESSION TARGETS, then assigning, etc, of further HOMEWORK, and then the session would provide an opportunity for the client to give FEEDBACK to the therapist on any issues, etc.
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Identify 4 structural areas that help to achieve collaborative relationship between the therapist and client.
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A - Providing a Rationale for use of Techniques.
B - Setting an Agenda C - Listening and Summarizing D - Eliciting Feedback |
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What are the benefits of working collaboratively?
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Ensures:
- Co-operation, exploration, and discovery. - Better learning situation for client and therapist - a good working alliance is established - that goals are shared and agreed upon, as well as responsibility being shared, etc. - Resistance and Competition possibilities are reduced - Communication is clear and direct. |
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How does Providing a Rationale help the Collaborative Process?
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- It helps the client see a scientific and therapeutic basis for techniques.
- encourages the clients buy in of the techniques used, helping them to see their import. - Increases the likelihood of clients completing tasks and gives them opportunity to voice objections to anything. |
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What are some reasons a session would depart from the set agenda?
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- The client is too upset around a particular issue and wants more time to discuss
- New topic may come up that is especially relevant for the client/goals - Clients mood may change for the worse in the session to it is unable to continue. |
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What are some things/questions to consider when setting the agenda?
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- Which problem looks liek the most productive one?
- Which is the most important to the client (ask them) - Which is the most resolvable? - Which could possibly provide relief to symptoms today? - Which could be used to teach/reinforce a needed skill? - Is there any item that may be counter-productive? - The client may not be ready for it yet (e.g. core belief stuff)? |
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What are some reasons a session would depart from the set agenda?
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- The client is too upset around a particular issue and wants more time to discuss
- New topic may come up that is especially relevant for the client/goals - Clients mood may change for the worse in the session to it is unable to continue. |
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What are some things/questions to consider when setting the agenda?
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- Which problem looks liek the most productive one?
- Which is the most important to the client (ask them) - Which is the most resolvable? - Which could possibly provide relief to symptoms today? - Which could be used to teach/reinforce a needed skill? - Is there any item that may be counter-productive? - The client may not be ready for it yet (e.g. core belief stuff)? |
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What are some reasons a session would depart from the set agenda?
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- The client is too upset around a particular issue and wants more time to discuss
- New topic may come up that is especially relevant for the client/goals - Clients mood may change for the worse in the session to it is unable to continue. |
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What are some things/questions to consider when setting the agenda?
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- Which problem looks liek the most productive one?
- Which is the most important to the client (ask them) - Which is the most resolvable? - Which could possibly provide relief to symptoms today? - Which could be used to teach/reinforce a needed skill? - Is there any item that may be counter-productive? - The client may not be ready for it yet (e.g. core belief stuff)? |
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What are some benefits of setting an agenda?
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- It enhances therapeutic collaboration by making things more understandable to the client
- it elicits active participation from the client - Provides guidance to the session, makes sure the important things are dealt with - enhances efficiency - an agreed-upon agenda seems to facilitate sponteneity and involvement on the part of the client. - Allows for prioritization of problems - helps deal with the most important/beneficial issues first. |
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What are some things listening should try and not generally do in CBT
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Guessing, interpreting, or interrupting.
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What are two types of Summarizing?
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- Periodic Summaries
- Final Summary |
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What is one form of a Periodic Summary?
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A brief summary after a section of the session is completed to ensure the therapist and client both understand what's been accomplished and what they will next move on to.
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What are 3 very important things a Periodic Summarizing of what the client has said should generally cover?
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- Most troublesome bit
- Present it in a more concise, clear way - subtly demonstrate the cognitive model |
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What is one way that you would make sure you understand what the client has told you, and to see if you have things correctly?
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By providing a periodic summary, summarizing the content of what the client has just told me. To do this I would try focus on what was the most problematic part of what they told me, I would try present it in a more clear and concise manner, and I would endeavour to subtly demonstrate the CBT model.
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What is a Final Summary?
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This is a summary at the end of the session.
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What does a Final Summary try and cover, or not?
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It tries to make clear to the client the major points covered in the session.
It tries to avoid activating anything that is distressing to the client - trying to close the session to reopen topics. It could be possible to get the client to try summarize at later sessions. You could do a cue card review with the client hear, and get them to note the important aspects down, as well as anythng they learnt, observed, etc. |
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Discuss the benefits of Eliciting Feedback.
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- It enhances the therapeutic relationship by enabling the therapist to understand how they are coming across - empathic, competent, caring?
- It allows correction from the client if something has been missed or misunderstood. - It allows, in the first session especially, the client to give feedback on what they think of the therapist and of therapy. - Reciprocal feedback allows the therapist and client to assess whether they are understanding each other. |
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When would you want to receive feedback?
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Preferably during the session, but definately at the beginning and end.
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How would you go about obtaining feedback?
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- Through giving the client opportunity to correct/add to any summaries the therapist makes in session.
- By asking the client to share what they abstract from what the therapist has said. This identifies if the client has really tuned in to what the therapist has said. - By watching covert reactions (behaviour, body language, etc) to identify areas where the therapist can ask what is going on with the client, through their mind, etc. - Asking for their reaction at the end of therapy. - Getting feedback on Homework assignments - do they like it, can they do it, understand it, etc, etc. - Asking about how the previous homework went and the previous session. Reactions, thoughts, issues, etc. |
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What are the goals of the First CBT session (note - not the Initial Assessment)
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1 - Establishing trust and rapport
2 - Socialize client into CBT 3 - Educate - disorder, Cog. Model, process of therapy 4 - Normalize their problems - instill hope 5 - Elicit expectations - possibly correct them 6 - Gather further information about problems - define them 7 - Use information gathered to develop a goal list |
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If you had completed your initial assessment, and this was your second meeting with the client, what would the format look like?
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Similar to all other sessions with a few differences.
- Review assessment/bridge from assessment - Mood Check - Set Agenda - Problem List - Expectations of Therapy - Education about CBT and Model - Educate about Disorder - Summary - Set Homework - Feedback |
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What do you want to do before each session with a client?
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A Pre-Session Review
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What do you wanna look at in a pre-session review?
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- Diagnoses as it informs the model, structure and style of the therapy
- Formulation as it informs the content of therapy - individualized - Monitors has they inform the pacing - Hopelessnes as this alerts you to any need of an emergency response (e.g. possible suicide) |
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What could you use to plot and track a clients mood, etc?
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VAS - Visual Analogue Scale
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What does a Visual Analogue Scale do?
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It is a subjective measure of a clients mood that they plot themselves. It is useful for showing how mood fluctuates, and for showing links between situations and moods. They are always UNIDIRECTIONAL.
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What kind of interventions would you most likely use towards the beginning of therapy with a client? Why?
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Behavioural Interventions.
Because they are often the best way of dealing with the most stressful problems, they are quick and simple to implement and master. It is easier to see progress and so can boost the clients view of therapy and of their possibility for change. |
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What factors would influence your decision to go with a more Behavioural or a Cognitive Intervention?
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The more severe the problem is, the more I would lean towards a Behavioural Intervention. And the more intense they are - Behavioral.
Also the lower the intellectual ability (or less accessible cognitions), lean towards Behavioural interventions. |
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Out line the three factors that influence the speed of therapy.
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- What's going on in the therapists head (conceptualizing, what questions to ask, etc)
- What is happening interactively between the client and therapist - determined by the capability of the client (faster with higher functioning clients) - What the client is doing independently outside of the session. This is the most important aspect in terms of outcomes. Usually this aspect moves slower than the others - and has the most impact on clients life. |
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What are 3 questions you could ask yourself to help determine the speed in-session and in terms of homework?
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- What does the client know?
- What does the client need to know/do? - How can I help the client to take the next learning step? |
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What is a Problem List?
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A comprehensive list of all the difficulties a client is facing.
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What are the 3 stages of making a Problem List?
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- Eliciting a Problem List
- Clarifying the Problem List - Deciding which Problems to address/Prioritizing. |
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What is a question that could be used to start eliciting a Problem List, and what are some factors to consider?
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Q: Can you tell me about the difficulties you are currently having?
- Should be comprehensive and exhaustive - May need more than one session - possibly homework assignment - It is an ongoing process - All the problems may not be worked with, but work on some may affect others. |
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Discuss aspects of how a therapist would probably go about Clarifying the Problem List.
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By doing a functional analysis of the problems on the list, and a behavioural assessment.
- You would want to quantify and define the problems - may involve homework (e.g. journal, etc). - Observation of how the client behaves in-session may reveal other issues the client is not aware of. - Talking to others E.g. 'When you say your life is a mess, what's going on?' - Look at Predisposing, Precipitating, Perpetuating - ABCs, Five Part Model - Course of the Problem - Current Features: SITUATIONS, MOODS, BEHAVIOURS, COGNITIVE ASPECTS - Look at Severity - Frequency, Duration - Look at what the client is avoiding as a result of the problem (Summarize all through this process) |
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What factors would influence the decision around which Problems to focus on/Prioritization?
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Prioritize problems in terms of the most manageable/distressing/recurrent/ongoing.
- Danger/Threat - PRIORITY - What problem could possibly destabalize the patient - Pervasiveness This would be a COLLABORATIVE decision. |
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Once a Problem List is Elicited, Clarified, and Prioritized, what would be the next step?
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Setting Goals
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Why would we want to set goals in Therapy?
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Identifies what client wants to change, guides plans.
Allows measurement. Emphasizes the possiblity of change. Reinforces clients active participation. Give structure Allows for evaluation of effectiveness |
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How would one go about setting goals
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- Start with the problem list - "From this list, what would you like to accomplish in therapy?"
- GENERAL goals need to be broken in SPECIFIC ones E.g. Less Controlling-----Don't tell my children what to do so much. |
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What do goals need to be?
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Me-focused
Achievable Realistic Specific (SMART) |
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What would you look at to identify problems that may not have been reported?
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- Observation in Therapy
- Family & Social History - Collateral information - Mental State exam - Comprehensive assessment |
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What are some guidelines for setting goals?
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- Relate to presenting issue
- Short, Medium, Long term goals - Specify what would constitute change (use conceptualization) - Realistic? - Achievable in early therapy - Dependant on others? - Measurable - Do they build resilience? |
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What are Graded Task Assignments? What problems are they particularly helpful for?
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Tasks are broken down into smaller manageable chunks, from simple to more manageable. They help expose clients to successful completion of a series of tasks, helping to increase their mood.
- Particularly helpful with Depression, low motivation, poor concentration, inactivity |
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What are some potential problems with Graded Task Assignments?
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- Poorly designed, it could lead to failure reinforcing the clients negative issues. They may magnify the negative.
- Clients can minimize/dismiss their accomplishments |
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What is Graded Exposure?
What problems is it helpful for? |
- It often overlaps with Graded Task Assignment
- It involves systematic desensitization to a stimulus/situation, etc. - Aims to counter avoidance - Helps to check whether feared thing actually occurs - It is particularly useful for anxiety disorders, phobias, avoidance, etc |
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What are some principles in designing and reviewing Graded Exposure?
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- A system of steps, to help client build up to fully feared experience
- Need to try stay in the situation until anxiety diminishes - Should face alone (or with someone else/therapist if unable at first) - Repeptition - everyday, or multiple times a day if possible until anxiety has abated. - Start with least anxiety provoking step - may need creativity. |
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What is Cognitive Rehearsal and what problems is it particularly useful for?
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- A process of getting a client to imagine a situation or task in their head to get them to deal with potential barriers and get used to the idea before actually meeting it in real life. They can also practice coping techniques.
- Particularly useful for Depressed clients, problem situations (assertiveness, anger control, phobias, avoidance, etc) |
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What are some of the Principles of Cognitive Rehearsal?
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- Imagine each step in sequence leading to completion
- Pay attention to essential details - helps prevent mind wandering - Identify the obstacles - Think about ways of overcoming obstacles - come up with solutions |
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What are Role Plays and what problems are they useful for?
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- Role Plays are where the client practices/acts out with the therapist in session a certain situation.
- they are particularly good for clients with social skill problems, bolster confidence, uncover automatic thoughts, Fears, Assertiveness, etc |
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What are some of the Principles of the Role Play?
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- First assess skill level. Problems to do with faulty thinking instead of skills would probably not be appropriate for role plays.
- However, you could use a role play to identify these problems. - Make sure goals are reasonable - Practice is thoroughly - May swap roles, depending on the purpose - Therpist may often need to overplay to highlight clients worst fears coming true - If sufficiently successful, should set the rehearsed task for homework. |
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What two questions does Assessment mainly what to answer?
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- What are the problems for the client?
- Why does this person have these problems at this time? |
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What kind of things do you wanna watch for when making an assessment?
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Body language
What is said What is unsaid Your own response |
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What are the two parts (sources) of assessment
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The client
Other sources (e.g. family, doctor, previous mental health care, etc) |
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What are the 12 areas of a Diagnositc Assessment Outline? (PDW)
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1 -Mode of Referral
2- Problems/complaints 3- History of presenting illness 4- Assessment of psychiatric symptoms 5- Past history of psychiatric disorder 6- Past Medical History 7- Family History 8- Personal History 9- Psychosexual History 10- Personality Before Illness 11- Mental Status Exam 12- Insight |
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Outline a Behavioural model of depression
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Stimulus - - - Response
E.g. The loss of contingent positive reinforcement leads to the extinction of active behaviour - E.g. removal of Pleasure leads to stopping of seeking pleasure |
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Outline a Cognitive model of Depression
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Stimulus---Cognitive Mediation----Response
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What are some Objective Monitors that can be used?
Say whether they measure severity or cognitive components. |
- Hamilton Rating Scale for Depression (HRSD) - Severity
- BDI - Severity - State Trait Anxiety Inventory (STAI) - Severity - Dysfunctional Attitude Scale (DAS) - Cog Com - Automatic Thought Questionnaire (ATQ) - Cog Com - Hopelessness Scale (HS) - Cog Com - Cognitive Styles Test (CST) - Cog.Com |
