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Chapter 13 Cognitive -behavioral techniques

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cognitive behavioral therapy
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psycho therapy focused on identifying, analyzing, and ultimatley changing th habitually inflexible and negative cognitions about oneself, others and the world that contribute to distress and problematic behaviors
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What can CBT do for a patient?
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can help a person change unhelathy behaviors, overcome avoidance behaviors and deal with stress and anxiety but also health promototion
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What is the interconnection in CBT (cognitive model) 3 influences
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thoughts emotions and behaviors
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What kind of disorders does CBT help
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General anxiety disorder, ptsd, bulimia nervosa, panic dosrder, depression, pathological gambling
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Benifits of using CBT
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cost effective and can do it from home
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Where did CB T origonate?
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ancient times and the stoic philospher epictetus, psychiatrist Aaron Beck and psychologitst Alvert Ellis.
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what can be learned using CBT
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life skills for coping with distress and problem solving can be leanred using this model
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What is the Cognitive model
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forms the foundation of CBT teh essence of which is that humans respond primarily to cognitive representatins of the environment and that conition mediates affect and behavior the way we think about situaltins influences our emotions and behavior
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how does perception play a role in CBT
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cognitive theory suggests that ones perceptions of situaltins and events is salient in guiding emotional and behaviroal repsonses
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what are the levels of cognition
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core beliefs intermediate beliefs autmatic thoughts relationship between levels of cognition
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core beliefs
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there are existence of core knowledge structures that hold organize, and interpret all information about ones view of self, others and the world also known as cognitive shcema or core beliefs
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Core beliefs or cognitive shema
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comprise basic beliefs so fundamental that they are often not articulated in explicit words but rather are accepted as absolute truths core beliefs assist in evaluating and assigning meaning to events and influencing the subsequent range of affective and behavioral repsonses example (i am inadequate) hold general and specific information about the self others and theworld and influence the maner in one negotiates throughlife
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intermediate beliefs
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attitutes, rules or expectatins and assumptions that influence ones perceptions affect and behavors. they take the form of if.. then should or must that are rigid and unrealistic. has risent from direct teaching or observations of important others ealry in life cultural background
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what are two cognitive products
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intermediate beliefs and automatic thoughts
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Autmatic thoughts
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more superficial than intermediate beliefs knee jerk in the moment words and images generatged in a particular situaltion. may not be logical and are difficult to shut off usually the first to be targeted in therapy we are not always consiously aware of their presence when a car cuts you off you get angry instead of thinking about the htough CBT brings automatic thoughts into awareness and helps us evaluate the process
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Relationships between levels of cognition
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situation: standing in line and someone steps in front Automatic thoughts: person must not have realized they did it so ill tells them Immediate beliefs: people do not intend to be rude Core belief: i am a valuable person worthy of repsect.
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10 principles of CBT
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1. based on an evolving CB formulation of the patient 2. requires a sound therapeutic alliance 3. emphasizes collaboration and active participation 4. is goal oriented and problem focused 5. initially emphasizes the present 6. is educative and emphasizes on relapse prevention 7. aims to be time limited 8. sessions are structured 9. teaches how to identify evaluate and respond toe syfunctional thoughts and beliefs 10. uses a variety of techniques to change thinking mood and behavior.
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Cognitive behavioral formulation
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begins during patients initial assessment and is reviewd and reviesed over the course of therapy adresses typical thoughts and problematic behaviors that contrubute to the current distress next is collecting info on the factors that precipitated the onset of the current problem also looks at developmental issues that contribute to and continue to reinforce the current problem is shared with the paiteine and modified
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strong therapeutic alliance
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needs a strong therapeutic relationship consisting of trust, mutual respect, safety, empathy, warmth and acceptance patient must feel free to disclose anxieties and take risks
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time limited and brief
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CBT is a short term treatment the therapist will transfer knowledge and skills to theperson and then further therapy becomes unessasry one session per week for 10-15 weeks for panic disorder
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SRS
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suitablility for short term cognitive therapy rating scale, predicts value regarding potential for CBT to be successful for a particular patient
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Goal oriented , proglem focusted and change oriented
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with therapist set realistic, mesurable goals to be attained during a treatment period distortions are detected and replaced with accurate and flexible ways of evaluating self others and theworld barriers to goal attainment are considered and methods are used
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Structured and directive
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all sessions follow a simular structure structure of CBT provides clarity reassurance and a sense of control to the patint, it maintians focus and maximizes the ability to use the session effectvly. prepares the patient to be his or her own therapist by the end of the session mood check collaberativly decides which problem areas will be adressed requests feedback from previous session self reflective exersises therapist offers summaries of key areas as session progresses the paitent takes responsiblity of providing these summaries and managing the structure in general
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Educative
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initial sessions are therapist directed and later include eduation about the patients problems and cognitive model teaches patients how to engage in cognitive restructuring info on nature and course of behavior helps assist with self therapy
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theraputic collaberation
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CBT is a collaberative effort with patient and therapist equal parnter to solve problems there is no authoritative stance
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inductive reasoning
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patients think at first that their thoughts are facts goal is to assist patients in attending to all available facts and informtion in their hypothesis testing patients are encouraged to think a scientist and search for objective facts find validity and accuracy of their thoughts
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Socratic questioning
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CB adops a questioning stance of socratic questioning when the therapist asks questions possible answers are generated patient reveiws these as a hypothesis capable of being examined and tested in therapy reasoned idalogue the intention is not for the patinet to feel interrogated
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Self reflective excersises
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practice nely developed skills and monitor progress
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Treatment strategies
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both cognative and behaviroual techniques are used to effect change
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cognitive techniques
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revolve primalrly around cognitive restrucutring a process that follows a particular path of identifyling analyzing and modifying the three levels of cognition begining with automatic thoughts and working through to core beliefs
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cognitive restructuring
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process inwhich congitions (automatic thoughts and intermediate and core bleifs) are identified analyzed and modified to effect psoitive change in mood and behavior
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identifying automatic thoughts
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awareness causes change to get a patient to do this, the patient attends to shifts or intesification of their emotions, when a strong emotion is felt or a new emotion is experienced the question is asked ” what is going thorugh your mind” or to ask thepatient to recount a stressfull recent event “what is bothering you the most”
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evaluating automatic thoughts
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examine thoughts to examine in detail to dertermine accuracy objective facts what experiences have i had that show this thought is not always true? evaluating cognitive distortion thinking errors
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10 thinking errors
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all or nothing thinking overgeneralization mental filter magnification /minimization jumping to conclusions.. mind reading.. fortune telling labelling personilzation and blame should/must staements disoucnting the positives emothinal reasoning
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Modifying automatic thoughts
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patient uses what they learned about identifying and evaluating automatic thoughts to move toward modificaiton wighing evidence for and against an automatic thought in an effort to generate new ones the new way of thinking considers all apsects of ones edxperince so they can arrive at a more broadened way of viewing ones self others an dthe world
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thought record
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tool in CBT worksheept that records all teh info about problematic and distressing situations that helps patients to make sense of why they feel and react in a certain way puts into seven columns situation, moods , autmatic thoughts, evidence ant supports the thoughts , evidence that doesnt, formation of alternative thoughts and rerating of moods
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identifying and modifying intermediate beliefs
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the same as automatic thoughts, attending to patterns of negative thoughts that emarge ofver the course of therepy these may reveal a core belief
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identifying and modifying core beliefs
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downward arrow additional advanced strategies include discussing the early lfie experiences, core beliefs are found where they are develped painful early experiences
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Behavioral techniques
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behavioral strategies ar eused in CBT, to test and challenge both old ways and new ways of thinking can be used to modify symptoms when conducted in a manner that supports a change in cognition
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Behavioral strategies to test beliefs
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creating experiences to test and challenge core beliefs is essental in CBT BEHAVORIAL EXPERIMENTS tested in real life situaltions, increasing the believablitly of alternative thoughts can be challenging can produce anxiety test drive new thoughts see what really happens
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Behavioural strategies to modify symptoms
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exposure techniques, relaxation trainign and activlty monitoring. used in PSTD, panic disorder, agorpahobia, put paitent in contact with feared situation controlled breathing progressive muscle relaxation depressed patients would schedule dailiy activitys and recording moods
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mindfullness
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trained self observation based on meditation practices learning to be present to what is happeneind in the immediate moment pushign away negative thoughts automatic pilot