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What is "following images to conception"?
- The therapist encouraging the client to continue imagining until:
- 1.) The client imagines getting through the cisis and feel better OR
- 2.) The client imagines an ultimate catastrophe, such as death. The therapist questions the client to determine the special significance of the catastrophe
What is "Jumping ahead in time"?
The therapist helps the client imagine him or herself at some point in the near future when they are past the obstacle or distressing event.
What is "coping in the image"?
Guiding the client to imagine that he or she is coping with a difficult situation
What is "changing the image"?
Teaching the client to reimagine the image, changing the ending. This helps the client imagine what might be possible, and th client and therapist could work to try to realize these possibilities
What is "reality testing the image"?
treating the image like a verbal automatic thoughts using standard Socratic questioning
What is "repeating the image"?
Helpful when the client is imagining an exaggerated, though not catastrophic, outcome.
What are intermediate beliefs?
not as changeable as automatic thoughts, but are still more changeable than core beliefs
What are examples of asumptions?
What are examples of attitudes?
broad negative evaluations
What are examples of rules?
rigid imperatives usually containing a "must" or "should"
What are compensatory strategies?
- behaviors the client developed to cope with the painful core belief
- "If I do [compensatory strategy], then [core belief] may NOT come true."
What are some common compensatory strategies?
Avoid negative emotion, try to be perfect, be overly responsible, avoide intimacy, seek recognition, avoid confrontation, purposely appear incompetent, avoid responsibility
What is the Downward Arrow technique?
- 1.) Therapist identifies key automatic thought
- 2.) Therapist asks the client for the meaning of this thought
- 3.) Therapist continues this until one or more important beliefs are uncovered
- 4.) Asking what thought means TO the client often uncovers intermediate belief
- 5.) Asking what thought means ABOUT the client often uncovers a core belief
When is it clear that the client has uncovered a negative belief?
when the client shows a negative shift in affect or begins to state the belief in the same or similar words
What is the cognitive conceptualization diagram?
- Charts the relationship between core beliefs, intermediate beliefs and the automatic thoughts
- A cognitive map of the client's psychopathology
- Helps organized the data the client presents
What are relevant childhood data that should be included in the the case conceptualization diagram?
- Arguing between parents or other family members
- Negative interactions with parents, siblings, peers or teachers where the child felt blamed or devalued
What is socratic questioning
Therapist helps client evaluate the belief in the context of specific situations. The questions are more persuasive and leading
What goes in to modifying beliefs?
Socratic questions, behavioral experiments, cognitive continuum, rational-emotional role play
What is a "Cognitive Continuum"?
Correcting polarized thinking, helping the client see that there is a middle ground
What are examples of negative core beliefs?
- Dangerous environment or other people
- Hopeless future
How do core beliefs develop?
in childhood as a person interacts with significant others and encounters a series of situations
What are self-concept core beliefs?
- Unlovable: unworthy, undesirable, defective
- Incompetent: failure, inferior, not good enough, loser, disrespected
What are self-efficacy core beliefs?
Personally helpless - powerless, vulnerable, trapped, out of control, weak, needy
How do you identify core beliefs?
- Downward arrow technique
- Watching for central themes in the client's automatic thoughts
- watching core beliefs expressed as automatic thoughts
What does the core belief worksheet do?
encourages the client to look for evidence that supports a new belief, and to reframe evidence that seemed to support the old belief
What do historical of the core beliefs do?
helps the client reframe developmental history
What does restructuring early memories using Gestalt Techniques do?
helps the client restructure the meaning of an earlier event related to the current distressing situation
What is the cognitive model
people's emotions and behaviors are influenced by their perception of events, not by the event directly
What are intermediate beliefs
rules, attitudes, and assumptions where the person applies their core beliefs to the demands of everyday life
What are cognitive distortions
consistent logical errors in thinking
What are automatic thoughts?
quick, evaluative situation-specific thoughts that come from deeper beliefs; not deliberative
What is the main CBT technique
attend to shift in affect and ask, "What went through your mind just then?"
What are the 4 types of factors in therapy outcome?
- Extra-therapeutic factors (40%): larger culture, SES, career, events, family, social support
- Common factors (30%): core conditions of therapy, therapeutic alliance
- Expectancy factors (15%): therapists's social influence on client, placebo effect.
- Specific therapy techniques (15%): CBT
What is the primary curative component of therapy?
The development and maintenance of the therapeutic relationship.
What are the core conditions of Carl Rogers' Person-Centered Therapy
- Empathic Understanding
- Positive Regard
- Therapeutic Alliance
What is empathic understanding?
the degree to which the therapist is successful in communicating personal comprehension of the client's experience
What is positive regard?
the extent to which the therapist communicates non-evaluative caring and respect
What is congruence?
the extent to which the therapist is non-defensive, real, and "non-phony"
What is therapeutic alliance?
- typically easy to form with Axis I disorders and hard with Axis II
- Involves goals that both the client and the therapist endorse
- Collaborative tasks and behaviors and processes within the therapy session that constitute the actual work of therapy
- The positive interpersonal attachment between therapist and client of mutual trust, confidence, and acceptance (bonds)
What is physical attending?
face the client squarely, provide and open posture, at times lean toward the client, maintain eye contact, and relax
What is active listening?
Minimal encouragers and restatements of client's behavior, cognition, and affect?
What is passive listening?
using silence in a counseling session. It demonstrates the therapist's concern unwillingness to let the client assume control of their part in the therapeutic process.
What are some expectancy factors?
What is expertise?
visible evidence such as diplomas; professional dress; reputation of yourself or your institution; acting like you have experience, education and training; having confidence in your theoretical model
What is attractiveness?
the client's perception of your similarity and compatibility with them, an dhow much they like you.
Describe the cognitive model of both Ellis and Beck?
- Dysfunctional thinking is common to all psychopathology
- A change in thinking improves mood and behavior
- Long-lasting improvement comes from changing underlying dysfunctional beliefs
What are the 10 CBT Principles?
- 1. Based on an evolving formulation of clients and their problems in cognitive terms
- 2. Requires a good therapeutic alliance
- 3. Emphasizes collaboration and active participation
- 4. Goal oriented and problem focused
- 5. Initially emphasizes the present
- 6. Teaches clients to be their own therapists
- 7. Tries to be time-limited
- 8. Sessions are structured
- 9. Teach patients to identify evaluate and respond to their dysfunctional thoughts and beliefs
- 10. Uses a variety of techniques to change thinking, mood, and behavior
What are the characteristics of automatic thoughts
- ATs exist with the general stream of consciousness, and are not based on reflection or deliberation
- May be verbal, visual, or both
- Are usually brief and the client more aware of the resulting emotion, which is logically connected to the AT
- ATs are fairly predictable once the clients underlying beliefs are identified
What are dysfunctional ATs?
- Often distort reality
- Emotionally distressing
- Interfere with clients' ability to reach their goals
What are hot cognitions?
- ATs that arise in the therapy session
- Associated with a change in emotion
- May be about the client, the therapist, or the topic of discussion
- The most important ATs to work with
What are relevant AT's usually paired with?
When is an intense negative emotion dysfunctional to a client?
- When it hinders a client from:
- Thinking clearly
- solving problems
- act effectively
- Gain satisfaction
All or nothing thinking
polarized; viewing a situation in only two categories instead of on a continuum, which is usually more realistic
evaluating a problem as being awful, horrible, unbearable, and uncontrollable rather than something manageable
disqualifying the positive: unreasonably telling yourself that positive experiences, deeds, or qualities do not count
thinking something must be tru because you"feel" believe it so strongly, ignoring or discounting evidence to the contrary
predicting the future negatively without considering other, equally (or more) likely outcomes
putting a fixed, global label on yourself or others without considering that the evidence might more reasonably lead to a less disastrous conclusion
Evaluating yourself, another person, or situation, and unreasonably magnifying the negative and/or minimizing the positive
- (selective abstraction)
- Paying undue attention to one negative detail instead of seeing the whole picture
believing you know what others are thinking, failing to consider other, more likely possibilities
making sweeping negative conclusions that go far beyond the current situation
believing others are behaving negatively because of you, without considering more plausible explanations for their behavior
having a precise, fixed idea of how you or others should behave and overestimating how bad it is when these expectations are not met
Only seeing the negative aspects of the situation
What are some 1st session goals of CBT?
- Establish trust and rapport
- Assess suicidality
- Socialize the client into cognitive therapy
- Educate the client about his/her disorder/diagnosis
- Normalize the client's difficulties and instill hope
- Make sure the client has realistic expectations for therapy
- Gather information about the client's difficulties
- Use this information to develop a list of goals
the social context of intervention research that has been applied to behavior modification
What is treatment acceptability?
judgments by laypersons, clients, and others of whether treatment procedures are appropriate, fair, and reasonable for the problem that is to be treated
What is the least restrictive alternative doctrine?
guides the use of interventions that might be aversive. In some situations restrictions might be required, for example to protect children from seriously injuring themselves
What is the primary task and challenge of behavior modification?
to develop prosocial and adaptive behaviors
What is positive reinforcement?
an increase in the probability or likelihood of a response following the presentation of a positive reinforcer
What are social reinforcers?
verbal praise, attention, physical contact, and facial expressions
What is the Premack Principle?
- High probability behaviors;
- of any pair of response or activities in which an individual engages, the more frequent one can reinforce the less frequent one.
What is feedback?
- the knowledge of results of one's performance;
- does not necessarily include additional events that may be reinforcing in their own right.
What is token economy?
tokens function in the same way that money does in national economies, they are earned and then used to purchase more primary reinforcers such as food and other consumables, activities, and privileges.
What is negative reinforcement?
a behavior is increased or strengthened when it results in escape from or avoidance of an aversive event
What is punishment?
the presentation or removal of events that reduces the possibility or likelihood of the response in the future.
What are primary aversive stimuli?
inherently aversive events, unlearned
What are secondary aversive (conditioned) stimuli?
stimuli that acquire their aversive properties by being paired with events that are already of aversive
What are verbal statements?
reprimands, warnings, disapproval, saying "no" and threats
What is electric shock?
rarely used, and restricted to persons who engage in behaviors dangerous to themselves or to others and who have not responded to other procedures
What is timeout from reinforcement?
the removal of a positive reinforcer for certain period of time as a punishment procedure.
What is the response cost?
the loss of a positive reinforcer, typically a penalty that comes after a behavior
What is overcorrection?
the penalty for engaging in an undesirable behavior, performing some other behaviors in this situation
What is restitution?
correcting the environmental effects of the inappropriate behavior
What is positive practice?
repeatedly practicing the appropriate behavior
Factors that influence the effectiveness of punishment?
- Social Reinforcement
What is extinction?
withholding reinforcement from a previously reinforced response
What is an extinction burst?
an increase in responding at the beginning of the extinction
What is spontaneous recovery?
the temporary reoccurrence of the unreinforced response during extinction
behaviors that a person deliberately undertakes to acheive self-selected outcomes
What is self-assessment?
Assessment of mental health, screening
What is self-monitoring?
systematically observing one's own behavior over time.
What is stimulus control?
behaviors are performed in the presence of specific stimuli.
What is self-reinforcement?
the individual is free to reward him or herself at any time, regardless of whether a particular response is performed
What is alternate response training?
training a person to engage in response to interfere with or replace an undesirable response?
What is Biofeedback?
providing info to people about their ongoing physiological processes
What is rational emotive psychotherapy?
- Developed by Albert Ellis
- based on view that psychological problems arise from faulty or irrational thought patterns
What is the purpose of REBT?
to examine the implicit self-verbalizations people make, challenge them and point out the irrationality, and to substitute more adaptive self-verbalizations