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89 Cards in this Set

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As opposed to other psychotherapeutic approaches, CBT:
1. has considerable empirical support
2. has good outcome data
3. has working assumptions based on demonstrable learning theory
4. has interventions & theory that change in light of new data
5. Is guided by client's context & issues w/in the framework of "normality" for the particular client's culture
CBT assumes that how a person handles him/herself is based on a _______ which he/she acquired through ______
a person's way of thinking, perceiving, & evaluating

the interaction of temperament, genetic endowment, & environmental experience
What is a Mediational Model?
It states that if the thoughts can be ID'd and modified, then the behaviors will also change, & vice versa
What is the empirical component in CBT? That is, what does CBT emphasize a therapist do to ensure that their client is progressing?
focus on ID-ing measurable differences in Bx.
clearly & objectively defining goals
assessing/monitoring/evaluating behavioral change.
Does CBT deny the existence of the unconcious?
No...it just sees no need to create an entity of an unconscious.
Coping Skills Training
a mode of CBT that focuses on teaching skills that will help the client with problems they currently have working w/others or managing themselves in some external context
Problem-Solving Therapies
Focus is on personal & social competence

Involves finding effective solutions to the problem & carrying out the solution. Can be external or internal & usually involves multiple steps
Cognitive Restructuring
Focuses on internal, implicit, or personally created problems which have produced maladaptive behavioral styles.
What are the three modes of CBT?
Coping Skills Training
Problem Solving Therapies
Cognitive Restructuring
Early behavioral theorists were ____ concerned with actual clinical application of their theories and ____ focused on the academic/theoretical understanding of human Bx
Less w/clinical application

MORE w/academic/theoretical understanding
Name some Behavioral Theorists

What was their focus?
Skinner, Watson, Wolpe, Beck, Paul

Human motivations, societal change, nature of the human mind & pathology
Name some Cognitive theorists

What was their focus?
Beck, Frank, Ingram, Koenigsberg

developmental processes, learning history, & other experiences are what produce sets of "core" beliefs & perceptual sets
What did Cognitive Theorists focus on?
manifest problems
cognitive distortions
underlying schema
Social Learning Theory
by Bandura; expanded the scope of strict behaviorists and intro'd the ideas of a person's social perceptual set into motivating behaviors
A mediational Model proposes that:
if a thought is changed, behaviors are then changed (and vice versa)
What was the first journal to define CBT and who created it?
Cognitive Therapy & Research (1978)

Mahoney
What are some advantages of CBT
-works well in adjunction to longer-term therapy
-can be effective in short or Very short term treatment
-direct & active client involvement
-empirically verifiable so treatment can improve
-widely adaptable & applicable
-open to change & can work w/other models
-adaptable to diverse clientele
-focuses on direct, practical solutions
- suitable for circumscribed, situational problems
What question is rarely asked in CBT?
WHY
What is so unique about CBT's explicit & intentional use of hypothesizing, treatment implementation, testing & rehypothesizing until a satisfactory solution is reached?
All other forms imply this, but it is only explicit/intentional in CBT
Basic tenants of CBT:

2. CBT includes the assumption that simple insights can form the basis of major, enduring psych (cog, affective, & behavioral) change
The only thing we can do with the past is reframe it in the present; client makes insights and therapist just facilitates
Basic tenants of CBT

3. change DOES NOT have to result from understanding and re-organizing "unconscious" or deep, underlying psych processes
Mediational Model

These underlying cog processes can change on their own when current Bx and thought patterns change b/c they are no longer relevant to current behavior
Basic tenants of CBT

4. CBT assumes some degree of universality in ways of thinking, feeling, & acting among humans
The nature or process of distorting & forming schema occur in all forms of ppl; manifestations may bary in form & content, but processes are essentially the same
Basic tenents of CBT

5. A substantial portion of therapeutic progress occurs w/active involvement of the client
This can vary depending on cultural background of client or nature of their problems; Sometimes you may need to tell them what to do, but other times it's better to let them lead

Psychoeducation & objectification of the problem are key
Basic tenents of CBT

6. Long-term "cures" do not require long-term therapy
brings us back to the basis of the mediational model
What is a Schema?
an implicit assumption of cognitive organizations that underlie thinking, problem solving, decision making, judgment, priorities, and beliefs
Where are dysfunctional schema reflected?
in cognitive distortions
Dysfunctional Schema - Emotional Deprivation
Belief/expectation that your primary needs will never be met.
Dysfunctional Schema - Abandonment
Belief/expectation that others will leave, are unreliable, that relationships are fragile, loss is inevitable, and that you will ultimately wind up alone
Dysfunctional Schema - Mistrust/Abuse
Belief that others are abusive, manipulative, selfish, or looking to hurt/use you.
Which dysfunctional schema are likely to show up when you see intense interpersonal issues?
Emotional Deprivation
Abandonment
Mistrust/Abuse
Defectiveness
Dysfunctional Schema - Defectiveness
Belief that you are flawed, damaged, or unlovable, and will thereby be rejected
Dysfunctional Schema - Social Isolation
Pervasive sense of aloneness, coupled w/a feeling of alienation. This is the sense that connection w/others doesn't exist for you
Dysfunctional Schema - Vulnerability
Sense that the world is a dangerous place, disaster can happen at any time, and that you will be overwhelmed by the challenges that lie ahead
Dysfunctional Schema - Dependence/Incompetence
Belief that you are unable to effectively make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day to day responsibilities
What are the basic components of CBT (Hint: ABCDE)
Antecedents
Behaviors
Consequences
Debate/decision
Excitation
Operationalization
process of defining a concept in specific, measurable "operations," such as actions, effects, or other observable behaviors
What does operationalizing something do in therapy?
It "pins down" what ppl mean when they say.... it requires ppl to define their terms
What are the advantages to operationalizing something?
makes it specific so that you can determine whether there is evi for/against a given hypothesis
What are the disadvantages to operationalizing something?
-interpretation can mean accidentally misdirecting the client (be OBJECTIVE!)
What do cognitive distortions tell you?
What dysfunctional schema are at work
What is "All or nothing thinking?"
A cognitive distortion

Look for terms like "either - or," "unless," and extremist statements
What is "overgeneralization?"
Cognitive distortion

Look for terms like "always," "never," and "every"
What is "mental filter?"
Cognitive Distortion

"selective attention"
Underlies a host of Axis II reactions to criticism
What is "discounting the positive?"
A Cognitive Distortion

Can be a form of minimization but has quality of a defense mechanism

Look for: more examples of selective attention or preoccupation w/the negative
What is "Jumping to conclusions?"
A cognitive distortion

Mind reading error & fortune telling error

Look for "if-then" statements/any statement about the future that aren't supported by data or are idiosyncratic to the person
Jumping to Conclusions: Mind reading error
cognitive distortion

w/o checking it out you arbitrarily conclude someone is reacting neg to you
Jumping to Conclusions: Fortune telling error
cognitive distortion

predict that things will turn out badly
What is "magnification?"
cognitive distortion

"binocular trick"
Look for signs of narcissistic perspective. Statemetns that suggest person's perspective is the ONLY perspective
What is "emotional reasoning?"
cognitive distortion

look for any statement that carries emotional content, or that emph the emotional quality (not facts) of a situation
What are "should statements?"
cognitive distortions

Look for terms like "should," "must," "have to" and "need"
What is "labeling" a form of?
cognitive distortion

it is an extreme form of all-or-nothing thinking or generalization

Look for: condensation of a person/situation into a single term
What are "personalization and blame" indicative of?
cognitive distortion

may take on the blame or use others as a scapegoat

Look for: statements that continually refer back to the person or that make the person the center of the situation
Structural Analysis
Form of case formulation focusing on relations between antecedents, schemata, resulting behaviors & thoughts, & consequences of those behaviors and thoughts
Functional Analysis
Unlike structural analysis it also offers a probabilistic functional interpretation to the behaviors
-more popular for those w/a psychodynamic
Case Conceptualization using Structural Analysis
1. Case Level
2. Problem Level
3. Situational Level
Structural Analysis: Case Level
most general & inclusive & involves client's entire context
-most comprehensive level for generalized problems
Structural Analysis: Problem Level
more specific & less comprehensive
-focuses on particular element of the client's dysfunction that appears to be primary difficulty
-guides a specific, well-defined theoretical conceptualization
-for clients who have a good idea of what is wrong w/them
Structural Analysis: Situational Level
-most specific focus
-most structured therapeutic work using details of a specific problem situation, client's Bx, thoughts, feelings & perceptions
What are the steps to challenging irrational ideas?
1. ID the beliefs
2. ID more rational sentences to replace
3. ID feelings & circs in which unwanted emotions are experienced
4. Explore underlying ir/rational ideas in each sit (Cognitive restructuring)
5. Role playing
6. Anticipate emotional reactions & reframe
5.
Methods of challenging irrational ideas:

Risk Appraisal
-challenges the degree to which an event can/will have an effect on the person
-in-line, conversational approach w/therapist reflecting back to the client in probabilistic terms
Methods of challenging irrational ideas:

Using Determinism
-accepting all Bx, thoughts, & feelings as being the inevitable, lawful outcome of complex psych laws describing cause/effect relationships in human bx
1. Take a deterministic approach
2. Build off of reactions to step 1
Methods of challenging irrational ideas:

Trying a New Lifestyle
Fixed Role Therapy
1. Write a description of a new way of being/interacting
2. Live in that way for 2 weeks
3. Decide which parts of thta lifestyle were helpful and explore things learned
Methods of challenging irrational ideas:

Paradoxical Intention - techniques
-Paradoxical Intention
-Symptom prescription
-Sublimation
1. Paradoxical Intention (do opp of what you fear; focus on underlying fear)
2. Symptom Prescription (doing the unwanted habit to get rid of it; reveals pointlessness of problem bx)
3. Sublimation (taking a diff view; make undesirable bx more adaptive by exploring other ways of challenging irrational ideas)
Challenging irrational ideas/ CBT techniques:
Paradoxical Intention - steps
1. Choose a paradoxical approach
2. put it into effect w/zeal
3. follow plan until goal is achieved
CBT techniques/Challenging irrational ideas:

Increasing Motivation
-necessary for change to happen
1. deal w/early distractions/own resistance
2. Skill building
3. make changes in the environ, learn self-instructions, reward successes
4. Enrich your self concept; envision successes and ways you might fail
5. avoid continuing distractions
6. enjoy fruits of your labor
CBT Techniques/Methods of challenging irrational thinking:

Straight thinking/common sense/good arguments
1.Recog common errors in thinking/args
2. ID-ing the cognitive factors affecting your ability to cope w/problems and manage emotions
3. Become a good thinker (make decisions/args based off good thinking skills/evi)
CBT Techniques/Methods of challenging irrational thinking:

Developing Attitudes that help you cope
1. Self observation of/assessment of your attitudes
2. Adopt new attitudes to replace maladaptive ones
3. Embrace new attitude in order to embody it cognitively, emotionally, & behaviorally
CBT Techniques/Challenging irrational ideas:

Thought Stopping
When a client recog they've started a bad/neg thought, have them say "STOP" & engage in relaxation exercises

STOP disrupts recall process & distraction aborts the rest of the scenario
What does PRISM stand for?
Potency (efficacy)
Relatedness
Identity
Spirit (energy)
Meaning (Sense of purpose)

All together --> Self Worth
What part of a case report involves the most detail?
the history
What is the goal of Socratic Dialogue/Guided Discovery?
That the client is able to understand the nature, extent, and manner in which distortions interfere. From this they can learn how to change them.
CBT -
What is the client-therapist relationship like?

How does the client see the therapist?
Relationship is collegial & cooperative, w/the therapist viewed as having some confidence/knowledge

Therapist = Explorer
Non judgmental, engaged, caring
What is the attitude of a CBT therapist like?
-straight forward (keep language basic!)
-non pathologizing (use terms like effective, adaptive, & efficient)
-matter-of-fact
What is Guided Discovery?
How the therapist guides the client to understand the real issues at hand
If a hard-core psychoanalyst were to adopt any CBT intervention, what would it be?

Why?
Guided Discovery

B/c it can help the client uncover the real issues underlying the problem
When is Guided Discovery used?
ie: when the client says anything that might reflect an agenda

AKA when the client says something:
-with more meaning than they might realize (auto thinking),
-signals distorted thinking,
-"loaded" w/unintended meaning (racism, etc),
-has a causal conclusion, or is dismissed quickly/defensively
What are some things you need to keep in mind when doing guided discovery?
-Chop down long statements into smaller ones
-create contexts that they perceive as valuable to the change process
-rephrase/ re-contextualize to clarify thoughts/issues/probs
-provoke new/diff thoughts in spite of "stuck" thoughts
- Don't let them derail from the issue at hand
-encourage ongoing self-questioning
-encourage them to challenge/q what they say to others/themselves
-encourage openness & willingness to hear others out
What is the purpose of guided discovery?
-raise & define basic issues
-probe the meaning/logic behind the issues
-find/reveal the logic/irrationality behind the issues
-discover the structure/logic of thoughts, attributions, & assumptions
-use objective reasoning to develop sensitivity & awareness of thought processes
-Sensitize client to their assumptions, beliefs, implications, conseqs, interps
What are 3 types of guided discovery?
Spontaneous or unplanned
Exploratory
Focused
What is spontaneous/unplanned guided discovery?
-begin whenever a potential clarifying issue, statement, or problem arises.
-can be anxiety provoking at first but is a good way to get client to start to change how they see life outside of therapy
Types of Guided Discovery

What is Exploratory guided discovery?
When is it used?
- used to discover the value system, priorities,/ meaning client's put into statements, beliefs,/elements of their lives
-when you see a value-hvy comment /issue appear rptdly (look for "fuzzy" logic, auto thoughts, stereotypes, obvious biases)
Types of Guided Discovery

What is Focused guided discovery?
- used when you see a particular (often rptd) issue that appears to relate directly to the prob
- use this when you sense a countertransference issue
-can be a mutually ID'd problem in reasoning
-use clarification, eval, trace the logic, & uncover knowns/unknowns
What is one risk involved in socratic questioning?
prompting "recovered" memories that never actually happened
What are the 4 ways you can help a client clarify their distortions with Socratic questioning?
1. Ask for conflicting views (what?)
2. Ask for the source of the view (who?)
3. Ask for the consequences & implications of the view (what then?)
4. Ask for evidence, reasoning, & assumptions of the view (How? Because?)
What is the Activating Stimuli?
the common, sometimes daily events, ppl, places, times of day, that reliably occur w/the problem Bx
What is the Precipitating Event?
-the last straw that finally led them to seek help
T/F Schemata are inferred cognitive structures, beliefs, values, priorities, etc that produce cognitive distortions & lead to problem behaviors?
TRUE
What should the working hypothesis always include?
ALL 4 sets of schema
-Self
-Other
-The world
-Future
Which of the below is NOT appropriate for the Treatment Plans section?
a. Reduce anxiety
b. Increase involvement in relaxing activities
c. Meditate for 20minutes 3 x/week
a