7) Chapter 12: Psychodynamic and Cognitive Behavioral Skills (read only “Cognitive behavioral Theories” and “Core Skills of Cognitive Behavioral Practice”) (Harms & Pierce, 2020)

Cognitive behavioural therapy (CBT)

Therapy based on the understanding that a person's difficulties emerge as a result of the interaction of thoughts, feelings, and behaviours. This therapeutic approach focuses on creating change in any of these domains, particularly cognitions, so that change in the other domains will follow.

CBT focuses on an individual's thought process and how their thoughts can trigger certain emotional and behavioral responses.

True

Cognitive behavioural therapy (CBT)

Therapy based on the understanding that a person's difficulties emerge as a result of the interaction of thoughts, feelings, and behaviours. This therapeutic approach focuses on creating change in any of these domains, particularly cognitions, so that change in the other domains will follow.

CBT focuses on an individual's thought process and how their thoughts can trigger certain emotional and behavioral responses.

True

Rational thoughts

Are considered helpful in that they are reality-based and enable appropriate behaviour and feelings to follow.

Irrational thoughts

Are considered unhealthy or unhelpful because they distort reality or focus on irrelevant dimensions of experience.

The CBT model focuses on negative automatic thought (thoughts) and how the thought process influences emotions (anger, guilt, sadness, etc.), physical sensations (anxiety, stress, etc.), and the resulting behaviours.

True

Engagement is usually a short-term, time-limited, client-worker relationship.

True

What are specific skills needed within CBT?

Challenging the client's self-defeating or unhelpful beliefs so the client learns to control and monitor their thoughts.

Decision making

A process of coming to a decision about a particular course of action. In counselling work, this involves a series of steps: brainstorming all the options, considering the pros and cons of each course of action, and deciding on the most manageable, realistic, and achievable option.

Challenging

In counselling work, the process of calling into question a particular view, behaviour, or feeling. For example, challenging a self-defeating belief that someone may hold about himself or herself.

Why are challenging beliefs important?

Challenging beliefs establishes a middle ground that can be reached through a reality check. Beliefs that are considered irrational or unhelpful can be challenged or neutralized by more rational or helpful beliefs.

What are the skills required to reframe challenging or self-defeating behaviours?

- Challenging their helpful or unhelpful characteristics
- Include more information into the picture of understanding
- Hearing another point of view

In CBT approaches, thoughts are controllable.

True

What is thought-stopping?

The worker can interrupt the client's unhelpful thoughts during a conversation by saying "stop," and then the client is encouraged to stop their negative thoughts with a corrective thought.

What is this an example of... "I should be working harder, I am a failure" (STOP). "I work heard and it is healthy to have time off."

Thought-stopping

What are the specific interventions for CBT?

- Challenging self-defeating or unhelpful beliefs
- Controlling thoughts and thought stopping
- Monitoring thoughts

What is CBT helpful for treating?

Mental health disorders like anxiety, stress, depression, social phobias, PTSD, and ED's.

Personalization

- You believe others are behaving negatively because of you, without considering more plausible explanations for their behaviour.
- ex. The repairman was rude to me because I did something wrong.

"Should" and "must" statements (ie. imperatives)

- You have a precise, fixed idea of how you or others should behave, and you overestimate how bas it is that these expectations are unmet.
- ex. It is terrible that I made a mistake. I should always do my best.

All-or-nothing thinking (ie. black-and-white, polarized, or dichotomous thinking)

- You view a situation in only 2 categories instead of a continuum.
- ex. If I am not a total success, I'm a failure.

Catastrophizing (ie. fortune telling)

- You predict the future negatively without considering other, more likely outcomes (jumping to conclusions).
- ex. I am so upset, I won't be able to function at all.

Formulation

Summation and integration of the knowledge acquired by the assessment process.

Formulation: The 5 P's

- Presenting problem
- Predisposing factors
- Precipitating factors
- Perpetuating factors
- Protective factors

Presenting problem

What is the client's problem list? What are DSM diagnoses?

Predisposing factors

Over the person's lifetime, what factors contributed to the development of the problem? Think bio-psycho-social?

Precipitating factors

Why now? What are triggers or events that exacerbated the problem?

Perpetuating factors

What factors are likely to maintain the problem?

Protective factors

What are client strengths that can be drawn upon?

How does formulation connect with the cognitive model?

- Early experiences
- Core beliefs
- Hopelessness, worthlessness, unlovability
- Dysfunctional assumptions (DA) or rules for living
- Negative automatic thoughts (NATs)

Strategies/Intervention

- Downward arrow technique
- Socratic questioning
- Modifying NAT (thought challenge)
- Pie chart