CBT TX

Question 1

BEHAVIOURAL ACTIVATION

Answer 1

• help clients become more physically active and to engage in more pleasant events in their daily lives
• breaks reliance on mood-dependent beh. w/ use of plans
• Uses activity scheduling

Question 2

ACTIVITY SCHEDULING

Answer 2

• Help them see link between activity and mood
• Clients rate mood on 10pt scale, then engage in physical activity (e.g., pacing up and down the room) until mood improves by 1 pt.
• keep a diary for a week and note down each day on an hourly basis the activity they did and their mood rating out of 10pt. Examining dairy = evidence for a link between activity level and mood.
• AFTER link discovered: schedule brief daily physical activity and keep a diary of mood ratings before and after activity. Review and use evidence from them to reinforce link between activity and mood and their motivation to exercise daily.
• =core technique for depression
• Addresses reduction of activity as a maintenance factor

Question 3

PLEASANT EVENT/ACTIVITY SCHEDULING

Answer 3

• list activities they used to or might enjoy/ gives a sense of mastery (“activities did you engage in when you were not depressed?”) If they can’t think of any, can provide them with a list - Rate out of 10
• Schedule to do these (time, place, etc)
• Keep dairy of mood rating before and after pleasant events (use diary to reinforce link)

Question 4

GRADED TASKS

Answer 4

• start with small tasks and gradually increase more demanding and challenging task
• Can be going to mailbox / getting out of bed

Question 5

SYSTEMATIC DESENSITIZATOIN/ GRADUAL EXPOSURE

Answer 5

• Previously conditioned response is gradually extinguished
• Three phases:
  1) Learn deep muscle relaxation
  2) Develop hierarchy
  3) Gradual exposure (IN VIVO OR IMAGAINAL) – confront feared situations gradually from least to most fearsome
  4) check in during exposure to see monitor anxiety

relaxation skills or other coping strategies are only important insofar as they help the person tolerate remaining in the presence of the feared object.

Question 6

BEHAVIOURAL CONTRACTING:

Answer 6

• Agreement with client usually in written signed form
• specify the goals of treatment
• Specify short term as well as long term goals (shaping)
• Identify specific target behaviours for change
• a monitoring system to ensure the client is meeting his or her goals
• reward contingencies for compliance and consequences for non-compliance

USED WHEN:
* Helping parents manage adolescent behaviour
* Working with procrastination
* Increase motivation and the likelihood of behavioural change – make goals specific, measurable, and associated with rewards
* Use of Premack’s Principle in order to motivate oneself – e.g. go to the movies after studying for the afternoon
* A safety plan or behaviour management plan to manage challenging clients feq. Suicide threats, aggressive and abusive clients.

Question 7

Premack’s principle:

Answer 7

can use a preferred behaviour to reinforce less preferred behaviour (Vegetables before dessert, HW before TV)

Question 8

UNDERSTAND AND IDENTIFY COGNITIONS - HOT COGNITIONS

Answer 8

• Identify link between thoughts, behaviours, feelings etc
• Use (friend say hi example)
• Analyse personal situation that resulted in a drop in mood, discuss the situation, then to guess what they must have told themselves for it to lead to the drop in mood
• imagery and role play if needed (recount a recent example “see it in your minds eye”)
  o Use mood shift in session (change in face, tone, etc) to find hot cognitions
  o Elicit by Qs: what was going tough your mind?, were you remembering something?
• Using self-monitoring (dairy): situation, feelings/mood, thought
• Other kinds of records tailored to the individual:
• • E.g: the urge to self-harm exceeding 5 on a 10-point scale; a mood rating of fewer than 4 on a 10-point scale; a binge-eating episode (where the term ‘binge’ has been defined).
    Can add on
• cognitive distortion

Question 9

COGNITIVE EVALUATION

Answer 9

Learn to appraise NATS a pessimistic interpretation of an activating event is only one possible interpretation of the situation, not a true fact.
- Once able to recognise thoughts
- list evidence for and against a NAT (quality of evidence – camera looking, judge scenario)
- Use cognitive distortion QS and “advice to a friend” to create distance from them and NAT
- Reframing: adjusting the language of the thought to better reflect reality Rate belief in thought and strength in emotion before and after the disputation
Other:
- What is the worst that could happen (could I live with it), - take power out of catastrophizing and name the ultimate fear
- what is the best that could happen, what is the most realistic?
- Effect of believing NAT/changing NAT (weigh up short and long-term pros and cons)

Question 10

BEHAVIOURAL EXPERIMENTS

Answer 10

• Test validity of NAT
  Consideration:
  1) gradually work up towards more challenging experiments
  2) specific times and places
  3) help the client design the experiment to test out whether a particular belief is true or false and write down the possible outcomes or predictions
  4) anticipate possible problems in doing the experiment and collaborate on developing a list of strategies to overcome possible problems or setbacks
  5) client to write down the outcome of the experiment and whether it supported their negative or positive predictions.

Like good science experiment:
- Hypothesis ((make clear e.g., blushing how red on this scale?)
- Validity (will this measure what we want?)
- reliability (need to repeat?)

o Different to exposure because they are about fact finding not habituation
o Can be hypothesis or discovery-driven
o Can be surveys, observations, researching, behaving in vivo

For Safety behaviours
- identify the safety behaviours
- experiment = give up using safety behaviours and notice the impact of this (OR once safety behaviour once no behaviour) (can use video tape for objective measures)
- usually provides evidence that the feared consequence clients were avoiding with the safety behaviour does not occur which weakens their anxious beliefs.

Question 11

EXPOSURE WITH RESPONSES PREVENTION:

Answer 11

• The aim is to expose himself to the feared situation without engaging in his usual safety behaviour
• A cognitive approach (BE) the client learns that his obsessional predictions of disaster are not justified and that he can tolerate distress.
• Rituals are essentially SBs and therefore ERP is exactly analogous to reducing SBs in any other anxiety disorder.

STEPS TO DELIVERING ERP
1. formulation
2. ERP rational to reduce symptoms
3. Introduce SUDS (Fear Thermometer)
4. Hierarchy of triggering stimuli based on SUDS
5. Design exposure tasks to confront stimuli and “ban” rituals
6. Ascend up the hierarchy, altering as necessary for generalizability

OTHER ERP TO CONSIDER:
- Do the task with them (if possible/practical)
- Rapport is key
- Check in every 5 minutes to see where their distress/discomfort level is at (0-100); record
- During/after the exposure, discuss with the client how they interpret the reduction in distress/ discomfort (processing), the outcome of their predictions, and help them elaborate this learning.

Question 12

DISTRACTION

Answer 12

• theory: can only concentrate on one thing at a time so active focus on something pleasant replaces negative
• See them as just thoughts rather than caught up in it
• Example get them to identify situation leading to NAT/distressing mood then ask to focus on other aspect of situation – distract through attention on something else (e.g, singing song, focus on external object like true, saying “stop”, snapping band on wrist, postponing worry till later in the day).
  Learning distraction for short-term coping:
• 4 main types: Physical exercise, refocusing on the external, mental exercise, neutral focus on the internal
• Come up with collaboratively based on client interests, strengths, and needs across settings
• Grounding: elaboration of distraction that helps someone ground themselves in the present (if dissociated) or the pleasant (if distressed). Uses sensory cues and imagery

Question 13

SOCRATIC QUESTIONING

Answer 13

• better to ask the client about such evidence than tell them what you think the evidence is
• Asking questions that allow attention to possibilities previously outside client awareness- encourages a personal review so conclusions have more credibility
• Can be used for gaining data in assessment, in providing psychoeducation, for evaluating thoughts, debriefing experiential activities, problem solving, devising behavioural interventions/homework

Question 14

PSYCHOEDUCATION

Answer 14

• Link situations, thoughts, feelings, physiology
• general information about the problem and a specific three-column formulation
• Insitll hope, simple to understand, strengths

Question 15

PROBLEM-SOLVING

Answer 15

*Teach how to identify problems, brainstorm solutions, weigh up solutions, pick solution, break it down, action it and then evaluate it
*If thought true: can still be distorted, problem solving, skill to improve if they can do something…

Question 16

RELAPSE MANAGEMENT:

Answer 16

GOAL: become independent of the therapist, remember the techniques of CBT and use them in difficult situations
-introduced early and developed as a skill - 3 qs after set back: how can I make sense of this? what have I learnt from this? With hindsight, what would I do differently?’
- Asking after setbacks: how can you make sense of this, what have you learnt, what would you do differently?

Question 17

Relaxation

Answer 17

• Use to manage high arousal; anxiety, anger, urges/cravings, as aid to BE, to begin/end intense sessions, as scheduled pleasant events etc
• Instructoins: 20min a day, same time same place, comfortable eyes shut, breathe deeply engage in exercises below
• “Close your hands into fists. Then allow them to open slowly. Notice the change from tension to relaxation in your hands and allow this change to continue further and further still so the muscles of your hands become more and more relaxed. – do with all body then breathe then visualise e.g sun on body”

Question 18

Imagery

Answer 18

• Where imagery is the primary determinant of mood do the below:
  1. Use relaxation skills
  2. bring to mind an agreed distressing image.
  3. imagine the “movie” of the image progressing and having a positive rather than a negative outcome
  4. repeat process with each negative image until cues that once called the negative image to mind now call the modified image to mind.

Question 19

OTHER PHYSICAL TECHNIQUES

Answer 19

• Controlled breathing
• Exercise: great research for effect on low mood, also good for chronic fatigue, self esteem, anxiety, sleep, anger
• Applied Tension for blood and injection phobias; prevents fainting when phobic
• Meditation