Cbt Final

Front 1

If behavioral principles are generally applicable, why is it necessary to understand cultural diversity?

Back 1

It makes us more efficient and gives us a source for our hypotheses.

It also helps focus the search for the source of our client’s problems.

It helps us understand the function of the behavior for that individual. It helps us give the client more effective treatment (i.e., should family be brought in, etc.) Helps increase credibility and rapport. Helps therapist understand how client will interpret therapist

Front 2

What are ways to effectively facilitate emotional engagement with imaginal exposure?

Back 2

activate schema

introduce incompatible information

create a balance of the client speaking, the therapist speaking, and contributing to imagery. It should be vivid and emotionally evocative with a lot of detail.

With imaginal exposure, any situation can be created and with in-vivo exposure the same is not true

get them to articulate details in 1st person present tense prompt for rich detail using all 5 senses add and embellish sensory stimuli to recreate situation (train whistle, foot steps, door slams, etc.)

Front 3

Why do some clients emotionally engage in imaginal exposure, but fail to habituate? What can you do to help your client habituate?

Back 3

Exposure is too briefOver-engagement in exposure.Difficulty/failure to identify and integrate disconfirming information

pull for detailshave them speak in first person, present tenseprompt them for rich sensory detailsembellish specific stimuli, sometimes using prompts for various sensory modalities

Front 4

List specific ways you can increase compliance with exposure therapy.

Back 4

Motivational Interviewing

Validation-their struggle makes sense

Articulate their long term goals and have them do the same

Highlight choice and options (illusion of choice in absence of alternatives; don’t be forceful; just make it clear that if they continue what they are doing what consequences will result)

Orient them to tasks-give them specific instructionsHave them “try it out,” even just “a little bit”- graded exposure

Front 5

What is spontaneous recovery/ renewal and why does it occur following exposure therapy?

Back 5

Spontaneous recovery is the fear (or other emotion/behavior that you were trying to extinguish) coming back after it has been exterminated. It is expected that the fear will come back. Fear extinction/ emotional extinction is context specific so it may not generalize to all situations. Generally speaking fear generalizes well and extinction does not. Variability reduces spontaneous recovery.

Front 6

What is the principle of how to promote generalization of extinction when doing exposure? What can be done to limit spontaneous recovery and renewal?

Back 6

Multiple days, multiple settings over time. Different weather, inside, outside, a lot of variability! Repetition with multiple contexts. “Repetition is the best way to learn...repetition is the best way to learn... repetition is the best way to learn…”

Front 7

Is EMDR and effective treatment for PTSD? If so a) how effective is it, b) what role do eye movements have its effectiveness, and c) what therapeutic process accounts for its effectiveness (according to empirical evidence)?

Back 7

There is no evidence that EMDR is effective. The effective active ingredients are exposure, response prevention, and cognitive restructuring. Eye movements, according to the research, have little to nothing to do with improvements in symptoms.

Front 8

Name the best CBT strategy for eliminating nightmares?

Back 8

Imaginal exposure to the feared imagery content that may be occurring in dreams

Front 9

What are four primary strategies for helping a client who is afraid of making mistakes? What determines which strategies to use?

Back 9

problem solving

exposure

cognitive restructuring

The key distinction that needs to be considered is whether the fears are justified or unjustified.If the fear is justified, then problem solving is best. If the fear is unjustified, then exposure with cognitive restructuring is best.

Front 10

In the treatment of GAD, for what types of worries is problem solving not recommended?

Back 10

unjustified fears.

Front 11

GAD patients should be prevented from engaging in problem solving during the implementation of which other CBT strategy?

Back 11

exposure (they are opposites)

Front 12

What is the primary reason for using imaginal exposure in the treatment of GAD?

Back 12

Because intrusive imagery controls us. Better option if in-vivo exposure is not possible or ethical.

Front 13

What is the primary theoretical and practical reasons for using imaginal exposure in the treatment of OCD? What advantage does addition of imaginal exposure have over in-vivo exposure alone?

Back 13

Imaginal exposure is flexible- you can imagine anythingEmpirical studies show that adding imagery to in-vivo exposure is powerful for anxiety disorders and improves outcomes.In OCD, often the feared stimulus is a thought or belief that something bad will happen. Makes more sense to use imaginal exposure to that thought/belief.

Front 14

What are the three ways to reduce dysfunctional shame? What determines which strategies to use?

Back 14

Exposure or problem solving are the two primary ways. If the shame is justified, use problem solving. If the shame is unjustified, use exposure.

Front 15

List the six levels of validation according to Linehan

Back 15

Be present (listening and observing)

Use Accurate Reflection

Guessing about unstated feelings. (Try to read the person's behavior, imagine what they could be feeling, thinking and wishing for)

Validate in terms of past learning or biological dysfunction

Validate in terms of present event and the way most people would react(normative function)

Radical genuineness.

Front 16

What are the main ways in which DBT is “dialectical”?

Back 16

Therapist balances CBT with Rogerian acceptance strategies including validation

strategies to help client respond differently, accept and tolerate as well as change and problem-solve (balancing acceptance and change), I.e., teach and model how to accept and tolerate

Balancing therapist style: which involves balance of a warm and nurturing style with confrontational style when necessary

Front 17

What are the first two stages of DBT for BPD and what is the rationale for having the second stage? What problem could result from a therapist doing Stage 2 work too early in treatment?

Back 17

skills training-learning to inhibit problem behaviors (ie: self-harm) (behavioral control)trauma exposure/experiencing emotionsIf trauma exposure is started before the client has learned to inhibit problem behaviors (ie: self-harm) there is likely to be an increase in the problem behaviors which could be very dangerous to the client’s health and safety

Front 18

List the four primary behavioral targets in Stage 1 DBT individual therapy session (i.e. the target hierarchy)?

Back 18

Reducing life-threatening behaviors

Reducing therapy interfering behavior

Addressing behaviors that interfere with the client's quality of life

extinguishing bxs that reduce quality of life

increasing bxs that improve quality of life Skills acquisition, strengthening and generalization.

controlling attention or mindfulness relationship skills

understanding emotions

Front 19

What are the three main ways to prevent or reduce therapist burnout in DBT?

Back 19

Meet as a team of therapists to promote strategies and provide support

Utilize biosocial theory in your head; blame biology and upbringing instead of the client’ engender compassion not judgment

Observe your own limits, the therapist should be assertive in his/her limits because it is important to be available to the client and at the same time to avoid getting taken advantage of. Focus on directing the client to more effective behavior.