Evidence Based Midterm

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Evidence Based Midterm
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2012-05-04 17:20:53
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Evidence Based Midterm
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  1. common characteristics of anx pts
    • HIGH degree of self focused attention
    • personal perfectionism
    • emotional perfectionism
    • strong desire to please others
    • fear of failure
    • impressionistic cognitive style
    • focus on predictability, permanence, order and routine
  2. GAD-forms of emotional avoidance
    • procrastination-behavioral
    • reassurance-cognitive
    • talisman, good luck charm-safety signal
  3. ALL Anx d/o's-forms of emotional avoidance
    thought suppression-cognitive
  4. Depression-forms of emotional avoidance
    trying to think positive
  5. Social phobia-forms of emotional avoidance
    • avoiding eye contact-behavioral
    • overuse of sunglasses-safety signal
  6. PDA-forms of emotional avoidance
    avoiding exercise/physiological arousal-behavioral
  7. cognitive content-specificity
    • central concept to theory and practice
    • diff mood states associated w/ distinct cog content
    • enables clinician to see whether you have "hot cognitions"
  8. content specificity-depression
    • negative view of self
    • neg, view of others/experiences
    • neg view of future
    • critical attention directed INWARD
  9. content specificity-anger
    • hostile attributional bias toward others
    • labeling others
    • otehrs' intent is deliberate
    • sense of unfairness
    • others' violation of personal imperativeness
    • critical attention is directed OUTWARD
  10. content specificity-anxiety
    • overestimation of magnitude of danger
    • neglect coping strategies
    • overestimation of probability of danger
    • ignore rescue factors
    • social anxiety-feer of neg. eval
  11. content specificity-panic
    catastrophic misinterpretation of normal bodily sensations
  12. Relationship is a VIP
    • want to avoid thinking of relationship in "either-or" terms
    • both tx relationship and procedures are important
    • they are contemporaneous
  13. Anx session structure
    • Socratic Dialogue
    • Empathy
    • Psychoeducation
    • Daily Thought Diaries
    • SUDS ratings
    • Scaling
    • Contingency Management
    • Self-instruction
    • Cognitive restructuring
    • Test of Evidence
  14. SLIDE 12
  15. Anxiety techniques.....???
    • collaborative empiricism
    • guided discovery
  16. collaborative empiricism
    • clinician and pt work as partners
    • not only equal partners
    • may be a therapeutic goal
  17. empiricism
    therapy is observable, quantifiable and transparent
  18. guided discovery
    • clinician is coach and shepherds pt through data collection using empathy, questioning and beh experimentation
    • transcends refutation and disputation
    • goal is to create doubt where there was once certainty of belief
  19. broad conceptual areas for anx intervention
    • increase coping skills
    • increase thinking
    • decrease avoidance and increase self efficacy
  20. increase coping skills-anx
    • relaxation
    • stress management
    • assertiveness
  21. increase thinking-anx
    • cog restructuring
    • rational analysis
  22. structure
    Components of session, relationship; assessment measures, DTRs; homework assignment, exposure trials, social skills practice, etc.
  23. content
    • the WHAT
    • material produced from structure elements
    • ex. thoughts, feeling, beh, etc
  24. Process
    • the HOW
    • way the pt reacts to structure and content
    • ex. avoidance, irritation, smugness, etc
  25. skill acquisition-anx
    • accomplished through psychoeducation
    • direct or vicarious isntruction
    • utilizes generic material and template
  26. skill application-anx
    • accomplished through psychotherapy
    • skills are used to modulate and cope with distress
    • very individualized
  27. self monitoring
    • first keystone for self-directed change
    • objective
    • idiographic measures
  28. subjectives units of distress (SUDs)
    • making the emotional quantifiable
    • can be 1-100, 1-10, etc
    • scaling device which titrates level of distress
  29. climbing the ladder
    • adaptation of hierarchy
    • each rung is a diff level
    • provides another metaphor
    • climbing is a nice active way to communicate progress through the hierarchy
  30. thought diaries
    • situation
    • feeling
    • thought
  31. thought diaries-situation
    • objective description of what is going on
    • be careful that there are no automatic thoughts embedded in the situation
  32. thought diaries-feeling
    • emotional label
    • keep it simple-mad, sad, angry, scared, worried
    • be carreful-no confusion bw thought and feeling
  33. thought diaries-thought
    • what is going through their mind?
    • remember the content-specificity hypothesis
  34. anx behavioral intentions-relaxation
    • deep/controlled breathing
    • progressive muscle relaxation
  35. Explanation of relaxation procedure
    • Relaxation is a skill (like driving a car)
    • Tell client they may experience unusual sensations
    • Important to emphasize that the client feels in control & can stop the process at any time
    • Explain relaxation with “floating analogy”
    • May want to encourage client to keep eyes open
  36. PMR
    • Instruction on focused breathing
    • Instruction on how to tense muscles
    • Client starts to tense muscle groups at cue word (“tense”)
    • Maintain tension for about 5-7 sec.
    • Direct focus of attention to the “tension”
    • Client releases the tension and implements focused breathing on cue “Relax”
    • Focus on feelings of relaxation for about 30-40 Sec
  37. PMR cont.
    • Continue thru the muscle groups
    • Be sure they are only tensing 1 muscle group
    • To terminate process, count backwards slowly from 5 with instruction that client become more alert with each number
  38. Relaxation induced anxiety (RIA)
    • Relaxation may be associated with cognitive, physiological or sensory sensations that some chronically tense individuals find unpleasant
    • May be related to fears of loss of control
    • Fear that focusing on the sensation is dangerous
  39. anx-basic cog. interventions
    • (from increasing difficulty and complexity)
    • cognitive restructure (changing self-talk)
    • advantages and disadvantages
    • problem solving
    • de-catastrophizing
    • reattribution
    • test of evidence
  40. cognitive restructuring
    • focuses on "changing habits of thought"
    • translates unproductive internal dialouge into a lang for coping
  41. elements of cog. restructuring
    • hlps ppl prepare for stressor
    • refocusing attention
    • direct adaptive beh
    • emphasize persistence despite challenge and discomfort
    • facilitates accurate appraisals (new messages do not have to be 100% positive)
    • should include strategies and action plan
  42. advantanges/disadvantages of cognitive restructuring
    • very basic intervention
    • cog, cost-benefit analysis
    • clients see what they lose and gain by holding onto certain behaviors
  43. Problem Solving
    • basic staple of CB spectrum approaches
    • many rubrics use it
    • RIBEYE taken from TADS protocol
  44. RIBEYE
    • R-relax in face of stressor
    • I-identify stressors
    • B-brainstorm
    • E-evaluate each solution
    • Y-Yes! to the best solution
    • E-encourage self for active problem solving
  45. socratic method
    • curious, inquisitive, gentle
    • ex. helping child do puzzle, dont keep handing child wrong piece, give them other pieces/options to try
  46. decatastrophizing-anx
    • tests predictions of doom
    • not a full logical test but rather adds perspective to narrow beliefs by adding context
    • works to modify overestimations of the magnitude and probability of dangers as well as maximize attention to rescue and coping factors
  47. 9 pillars of decatastrophizing-anx
    • Record the catastrophic cognition from DTR
    • Lists that are worse than the catastrophic thought
    • Rate the likelihood of these new catastrophes
    • List the best things that can happen in the situation
    • Rate the likelihood of these best things happening
    • Make a problem solving plan for worst things
    • If you have a plan, how catastrophic can it be?
    • List the most likely things to happen
    • Make a conclusion based on the evaluation of the most likely, worst, and best outcomes
    • Re-rate the mood
  48. reattribution-anx
    • does not focus on the facts themselves but rather the explanation of facts
    • teaching clients to view experiences from diff angles
  49. 5 steps of reattribution-anx
    • 1. Identify misattribution from DTR
    • 2. Engage in search for alternative explanations
    • What’s another way to see this?
    • What else could ____ mean?
    • What a fresh way to look at this?
    • What’s another conclusion we can make?
    • What’s another explanation for?
    • 3. Rate the plausibility of each alternative
    • 4. Make a conclusion
    • 5. Re-rate mood
  50. test of evidence-anx
    • evaluates whether conclusions are factually based and logically sound
    • need to take a deliberate and mindful approach
    • patience is key
  51. 6 steps in conducting a test of evidence
    • Identify the thought from the DTR
    • Rate the degree of belief
    • Create two columns labeling one “facts that support the belief 100%” and the other one labeled “facts that do not support the conclusion”
    • Check for alternate explanations of the facts that support the conclusion
    • Review the facts supporting the belief, facts not supporting the belief, alternative explanations, and come to a conclusion
    • Re-rate the mood based on a new conclusion
  52. performance attainment
    • All forms of psychotherapy, when successful, arouse the patient emotionally
    • Change occurs and endures in the context of negative affective arousal
    • Helps the head and heart reach consensus
    • The art of cognitive behavioral psychotherapy is like sculpting iron
    • What matters most in psychotherapy is helping clients face, experience, and cope with what they avoid
  53. experiential tradition in CBT and BT
    • action oriented, making changes rather than "talking" about change
    • experiential approach exposes pt to experiences that are themselves powerful enough to change misconceptions
    • theoretically founded on state-dependent learning hypothesis
    • info and skills are best learned in the emo context in which they are likely to be applied
  54. experiential foundations of CBT
    • actions speak louder than words
    • cts remember what they "experience" more than what they talk about
    • experimental interventions avoid the flaws inherent in purely verbal methods
    • first thoughts that ppl think of in times of misfortune are experiential
    • must convince experiential mind of new beliefs
  55. exposure is a "common factor"
    • Designed to help pts face the situations they fear
    • True “ Experiential” approach
    • Pts remain in control and “engaged”
    • Pts learn to habituate, reinterpret, and often extinguish the fear
    • Promotes a genuine sense of self-efficacy
  56. exposures and experiments
    • perf. accomplishments provide the most dependable source of efficacy expectations bc they are based on one's own personal experiences
    • help clts show they can apply their acquired skills in emo evocative contexts
  57. exposures and experiments cont.
    • present-oriented
    • increase perceived sense of control
    • “Fosters the belief that one can continue to meet life’s demands in the presence of aversive internal experiences” Adds order to clt’s chaotic inner worlds
    • This increases sense of control becomes a “safety signal” reflecting the sense they are in charge of their emotional experiences rather than the experiences being in charge of them
  58. exposures and experiments-emotion processing opportunities
    • ‘We cannot talk about emotion without reason or conversely about reason without emotion; the former is chaos, the later pure abstraction”
    • Explicit processing is key
    • “Experience can be wasted if patients do not take time to consider what they have observed.
  59. Exposures and Experiments are collaborative
    • They are done WITH rather than to clts
    • “Therapists should assure the patient that he/she would not force the exposure without their consent
  60. what is required from clinician in experiential procedure
    • Psychological presence on the part of the clinician which allows for attention to be directed to the moment to moment actions in therapy
    • Direct, clear communication with the pt.
    • Collaboration
    • Accurate & effective data collection
    • “Good clinical skills”
    • Welcoming the patient’s and therapist’s negative emotional arousal
    • Harvesting open and flexible attitudes in both the therapist and patient
    • Tolerating ambiguity in both the patient and therapist
    • Creativity

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