List the various types of avoidance behaviours (5)
-Social withdrawal
-Non-social avoidance (not taking on challenging tasks)
-Cognitive avoidance (not thinking)
-Avoidance by distraction
-Emotional avoidance (use of substance to numb feelings)
Activity Scheduling is especially effective for which diagnosis?
Depression
How do you conceptualize inactivity?
- Situation (Thinking about initiating an activity)
- Common Automatic Thought: “Im too tired”
- Common Behaviour (Remain Inactive)
and; - Common Emotional Reactions (Sadness, Anxiety, Hopelessness)
T/F
The ATs of depressed clients only occur before initiating an activity.
False. Clients can have negative thoughts during or after an activity
“I am not enjoying this”
What is an activity chart?
Clients write down the activities they do each hour and, if they’re willing, rating their sense of mastery and pleasure
Useful for:
-Activity Scheduling
-Eliciting potential activities
How to use predictions to help clients who are skeptical about activity charts:
- Ask them to predict levels of mastery and pleasure and connection, or overall mood will be on a chart.
- Then record their actual ratings
- If they find their predictions are inaccurate, they usually become more motivated to continue scheduling activities.
- If their predictions turn out to be accurate, you’ll ask questions to conceptualize the problem, and then likely do problem solving and respond to unhelpful thinking.
What to ask yourself when reviewing the typical day of the client? (3)
Which activities is client doing too much?
Which activities is he doing too little or avoiding?
Which new activities is client most likely to engage in?
What is ACT?
Acceptance and Commitment Therapy describes useful metaphors for accepting negative emotion and turning one’s attention to valued action.
For whom would Relaxation most benefit?
Those experiencing bodily tension
3 methods for relaxation
Progressive muscle relaxation = alternately tense and then relax muscle groups in a systematic way
Imagery = having clients create a vision in their minds of feeling relaxed, calm & safe in a particular environment,
such as lying on the beach
Deep breathing
What is the “Oh well” technique?
“I don’t like this situation or problem. But there’s nothing I can do to change it, not if I want to reach my goal. So, I might as well stop struggling, accept it, and change my attention to something else”
What you can do when client is having difficulty with problem-solving, via direct-instruction:
*Offer own solutions, though least ideal
*Guided self-discovery:
- Ask client how they solved similar problems in the past
*Some problems facilitated by change in environment
- E.g., excess junk food consumption being solved by more frequent supermarket trips
*Some problem solving may involve significant life changes.
- After careful evaluation of a situation, you might encourage battered spouses to seek refuge or take legal action.
*Help clients identify dysfunctional cognitions which interfere with problem solving
When to use Graded Task Assignments?
Clients tend to become overwhelmed when they focus
on how far they are from a goal, instead of focusing on
their current step.
What is a Graded Task Assignment?
The process of helping the client break their goal down into more manageable parts
When is exposure most applicable?
When the client engages in avoidance
What are safety behaviours?
A behaviour used while encountering stimulus, which produces a sense of safety without disconfirming the CS = US link
What is a major consequence of avoidance? According to CBT
Clients don’t get opportunity to test their automatic thoughts & receive disconformity evidence
Step to introducing exposure to client: (6)
- Provide strong rational (Research has shown that the way to get over fear is to expose in gradual steps)
- Create hierarchy of avoided situations & rate anxiety from 0-10
- Link exposure to client’s values (need to drive to car to visit family)
- Ask client to engage in activity every day
- Ask to monitor automatic thoughts after exposure to alert for unhelpful cognitions
- Draw helpful conclusion
What is ‘in vivo’ exposure?
Directly facing a feared object, situation or activity in real life
What is Interoceptive exposure?
The practice of strategically inducing the somatic symptoms associated with a threat appraisal and encouraging the patient to maintain contact with the feared sensations
In what areas can Role-Play enhance CBT? (3)
-Uncover automatic thoughts
-Develop adaptive response & modify intermediate & core
beliefs.
-Useful in learning & practicing social skills
How are self-comparisons relevant to CBT?
-Clients TEND to compare themselves to an ideal point in the past (prior to the disorder)
-Therapist can propose a more helpful comparison (prior to beginning treatment)
What are the 3 theoretical explanations of exposure therapy?
-Habituation
-Extinction
-Inhibitory Learning Theory
Reasons for inducing positive images (5)
- Focusing on positive memories
= recall memories, relevant to a current or upcoming situation, in which they solved problems, coped well
with difficult situations or experienced success - Rehearsing adaptative coping techniques
= help clients practice using coping strategies in imagination à boots their confidence & their mood &
motivates them to use these adaptive behaviors - Distancing
= reduce distress & help clients to view problem in greater perspective
* E.g. visualize day in future when mood & functioning have improved - Substituting positive images
= regularly practiced for the client to experience relief from distressing spontaneous images
* Image that distressing image is a picture on TV & change channel to different one e.g. lying on a
beach - Focusing on positive aspects of a situation
= induced image is designed to allow clients to view a situation more positively
