9: CBT Specific techniques

Question 1

When should the patient ask themselves about their automatic thoughts?

Answer 1

Need to ask when
- Notice a change in emotion
- Notice a change in mind/body
- Feel the urge to engage in a dysfunctional way

Question 2

What are the three types of automatic thoughts?

Answer 2

Distorted thought→ occurring despite objective evidence to the contrary
- ex→ thinking that going to fail the exam but are a A student

Accurate thought but distorted conclusion
- ex→ “I didn’t meet the deadline; thus, I am a horrible student”

Thought is accurate, but not helpful
- ex→ “It is going to take me hours to finish this assignment. I will be
up all night!
- more about letting go of the thoughts

Question 3

When are dysfunctional automatic thoughts most bad?

Answer 3

• the client is manic or hypomanic (“It’s a great idea to see how fast
  my car can go”)
• the client has narcissistic traits (“I’m superior to everyone”)
• the client is giving themselves the permission to engage in maladaptive behavior (“It’s okay to binge drink because all my friends are doing the same thing”)

Question 4

What are the different techniques to address automatic thoughts?

Answer 4

Reviewing evidence for and against the thought
- which evidences support the thoughts→ validate the patient’s feelings
- try to find a more balanced way of looking at things
- alternative explanation questions

Worst case, best case, more realistic case
- good for anxiety and GAD
- imagine the worst scenario and how would they cope
- decatastrophizing questions

Advantages and disadvantages of having the thought
- how do you behave ?
- is it useful for you
- assess the consequences of responding and not responding to his distorted thinking

Distancing self from thought
- imagine that advising a family member or friend

Problem-solving
- what could you do differently next time

Question 5

How can we help the patient to elicit automatic thoughts?

Answer 5

If patient have difficulties
- Heighten the client’s response→ try to increase their emotional and physiological arousal
- Have the client visualize the distressing situation
- If the situation involves another person, suggest the client re- create it in a role play with you
- Inquire about images
- Supply thoughts you believe are probably opposite to the client’s thoughts
- Ask for the meaning of the situation

Question 6

What should we do if the automatic thoughts are true?

Answer 6

Problem solving
- should focus on finding concrete solutions
- ex with abe being jobless→ put looking for a part time job in the action plan of the week

Investigate invalid conclusions

Work toward acceptance
- focus on core values
- emphasize rewarding parts of their life

Question 7

What are some common types of cognitive distortions?

Answer 7

All-or nothing→ only see extremes as possibility
- identify the relevant extremes
- explore the stages of steps between

Mental filter→ only select info that fit with what you think
- pay attention to all instances of an event
- note both good and bad
- more scientific approach

LOOK AT TABLE

Question 8

How should we do behavioural experiments during sessions?

Answer 8

Planned experiential activities undertaken to test validity of patient’s beliefs and construct more adaptive beliefs
- Hypothesis testing VS discovery (just gathering info
- different from exposure
- Active VS observational

Planning behavioural experiments
- can be spontaneous
- do not want to do too much too soon BUT still push the patient
- design experiment so learn either way

Implementing behavioural experiments
- patient should fully engage so that had no excuse
- Monitor thoughts/feelings throughout
- Be flexible and respond to the unexpected

After the experiment
- Save time to debrief
- What actually happened? How did outcome fit with predictions?
- What did you learn? What might you do differently next time based on results

Question 9

What are some others CBT techniques?

Answer 9

Making decisions
- advantages and disadvantages analysis
- rate importance of each qualities from 1-10

Refocusing
- evaluating is not always desirable or feasible in urgent situation (public talk)
- Label automatic thought as such
- Deliberately refocus attention on task at hand

Graded task assignment
- Break goal down into smaller pieces
- Focus on one step at a time
- Success encourages further action

Pie technique
- pie graphs
- treatment for ED→ how do people evaluate themselves
- Useful for setting goals or determining relative responsibility

Self-comparisons and credit lists
- Are you comparing yourself to you at your best or your worst?
- Give yourself credit when its due
- not fair to compare yourself to your best when you’re at your worst