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89 Cards in this Set
- Front
- Back
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As opposed to other psychotherapeutic approaches, CBT:
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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 |
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CBT assumes that how a person handles him/herself is based on a _______ which he/she acquired through ______
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a person's way of thinking, perceiving, & evaluating
the interaction of temperament, genetic endowment, & environmental experience |
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What is a Mediational Model?
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It states that if the thoughts can be ID'd and modified, then the behaviors will also change, & vice versa
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What is the empirical component in CBT? That is, what does CBT emphasize a therapist do to ensure that their client is progressing?
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focus on ID-ing measurable differences in Bx.
clearly & objectively defining goals assessing/monitoring/evaluating behavioral change. |
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Does CBT deny the existence of the unconcious?
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No...it just sees no need to create an entity of an unconscious.
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Coping Skills Training
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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
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Problem-Solving Therapies
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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 |
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Cognitive Restructuring
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Focuses on internal, implicit, or personally created problems which have produced maladaptive behavioral styles.
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What are the three modes of CBT?
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Coping Skills Training
Problem Solving Therapies Cognitive Restructuring |
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Early behavioral theorists were ____ concerned with actual clinical application of their theories and ____ focused on the academic/theoretical understanding of human Bx
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Less w/clinical application
MORE w/academic/theoretical understanding |
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Name some Behavioral Theorists
What was their focus? |
Skinner, Watson, Wolpe, Beck, Paul
Human motivations, societal change, nature of the human mind & pathology |
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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 |
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What did Cognitive Theorists focus on?
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manifest problems
cognitive distortions underlying schema |
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Social Learning Theory
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by Bandura; expanded the scope of strict behaviorists and intro'd the ideas of a person's social perceptual set into motivating behaviors
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A mediational Model proposes that:
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if a thought is changed, behaviors are then changed (and vice versa)
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What was the first journal to define CBT and who created it?
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Cognitive Therapy & Research (1978)
Mahoney |
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What are some advantages of CBT
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-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 |
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What question is rarely asked in CBT?
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WHY
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What is so unique about CBT's explicit & intentional use of hypothesizing, treatment implementation, testing & rehypothesizing until a satisfactory solution is reached?
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All other forms imply this, but it is only explicit/intentional in CBT
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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
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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 |
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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
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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 |
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Basic tenents of CBT
6. Long-term "cures" do not require long-term therapy |
brings us back to the basis of the mediational model
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What is a Schema?
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an implicit assumption of cognitive organizations that underlie thinking, problem solving, decision making, judgment, priorities, and beliefs
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Where are dysfunctional schema reflected?
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in cognitive distortions
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Dysfunctional Schema - Emotional Deprivation
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Belief/expectation that your primary needs will never be met.
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Dysfunctional Schema - Abandonment
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Belief/expectation that others will leave, are unreliable, that relationships are fragile, loss is inevitable, and that you will ultimately wind up alone
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Dysfunctional Schema - Mistrust/Abuse
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Belief that others are abusive, manipulative, selfish, or looking to hurt/use you.
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Which dysfunctional schema are likely to show up when you see intense interpersonal issues?
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Emotional Deprivation
Abandonment Mistrust/Abuse Defectiveness |
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Dysfunctional Schema - Defectiveness
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Belief that you are flawed, damaged, or unlovable, and will thereby be rejected
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Dysfunctional Schema - Social Isolation
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Pervasive sense of aloneness, coupled w/a feeling of alienation. This is the sense that connection w/others doesn't exist for you
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Dysfunctional Schema - Vulnerability
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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
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Dysfunctional Schema - Dependence/Incompetence
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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
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What are the basic components of CBT (Hint: ABCDE)
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Antecedents
Behaviors Consequences Debate/decision Excitation |
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Operationalization
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process of defining a concept in specific, measurable "operations," such as actions, effects, or other observable behaviors
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What does operationalizing something do in therapy?
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It "pins down" what ppl mean when they say.... it requires ppl to define their terms
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What are the advantages to operationalizing something?
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makes it specific so that you can determine whether there is evi for/against a given hypothesis
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What are the disadvantages to operationalizing something?
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-interpretation can mean accidentally misdirecting the client (be OBJECTIVE!)
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What do cognitive distortions tell you?
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What dysfunctional schema are at work
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What is "All or nothing thinking?"
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A cognitive distortion
Look for terms like "either - or," "unless," and extremist statements |
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What is "overgeneralization?"
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Cognitive distortion
Look for terms like "always," "never," and "every" |
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What is "mental filter?"
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Cognitive Distortion
"selective attention" Underlies a host of Axis II reactions to criticism |
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What is "discounting the positive?"
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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 |
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What is "Jumping to conclusions?"
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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 |
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Jumping to Conclusions: Mind reading error
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cognitive distortion
w/o checking it out you arbitrarily conclude someone is reacting neg to you |
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Jumping to Conclusions: Fortune telling error
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cognitive distortion
predict that things will turn out badly |
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What is "magnification?"
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cognitive distortion
"binocular trick" Look for signs of narcissistic perspective. Statemetns that suggest person's perspective is the ONLY perspective |
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What is "emotional reasoning?"
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cognitive distortion
look for any statement that carries emotional content, or that emph the emotional quality (not facts) of a situation |
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What are "should statements?"
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cognitive distortions
Look for terms like "should," "must," "have to" and "need" |
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What is "labeling" a form of?
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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 |
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What are "personalization and blame" indicative of?
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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 |
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Structural Analysis
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Form of case formulation focusing on relations between antecedents, schemata, resulting behaviors & thoughts, & consequences of those behaviors and thoughts
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Functional Analysis
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Unlike structural analysis it also offers a probabilistic functional interpretation to the behaviors
-more popular for those w/a psychodynamic |
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Case Conceptualization using Structural Analysis
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1. Case Level
2. Problem Level 3. Situational Level |
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Structural Analysis: Case Level
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most general & inclusive & involves client's entire context
-most comprehensive level for generalized problems |
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Structural Analysis: Problem Level
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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 |
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Structural Analysis: Situational Level
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-most specific focus
-most structured therapeutic work using details of a specific problem situation, client's Bx, thoughts, feelings & perceptions |
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What are the steps to challenging irrational ideas?
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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. |
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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 |
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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 |
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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 |
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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) |
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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 |
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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 |
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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) |
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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 |
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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 |
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What does PRISM stand for?
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Potency (efficacy)
Relatedness Identity Spirit (energy) Meaning (Sense of purpose) All together --> Self Worth |
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What part of a case report involves the most detail?
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the history
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What is the goal of Socratic Dialogue/Guided Discovery?
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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.
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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 |
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What is the attitude of a CBT therapist like?
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-straight forward (keep language basic!)
-non pathologizing (use terms like effective, adaptive, & efficient) -matter-of-fact |
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What is Guided Discovery?
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How the therapist guides the client to understand the real issues at hand
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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 |
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When is Guided Discovery used?
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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 |
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What are some things you need to keep in mind when doing guided discovery?
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-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 |
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What is the purpose of guided discovery?
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-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 |
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What are 3 types of guided discovery?
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Spontaneous or unplanned
Exploratory Focused |
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What is spontaneous/unplanned guided discovery?
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-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 |
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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) |
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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 |
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What is one risk involved in socratic questioning?
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prompting "recovered" memories that never actually happened
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What are the 4 ways you can help a client clarify their distortions with Socratic questioning?
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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?) |
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What is the Activating Stimuli?
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the common, sometimes daily events, ppl, places, times of day, that reliably occur w/the problem Bx
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What is the Precipitating Event?
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-the last straw that finally led them to seek help
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T/F Schemata are inferred cognitive structures, beliefs, values, priorities, etc that produce cognitive distortions & lead to problem behaviors?
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TRUE
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What should the working hypothesis always include?
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ALL 4 sets of schema
-Self -Other -The world -Future |
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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
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