CBT Final Exam

3 YES rules

1. Do my goals involve changing myself rather than expecting others to change?

2. Do my goals involve changing things that are within my control?

3. Are my goals realistic

Emotional mind vs. Wellness mind

Emotional: automatic negative thoughts

Ex: “I am a failure. I don’t care. “

Wellness: automatic positive thoughts

Ex: “It’s ok to ask for help. I am good at some things.”

Characteristics of automatic thoughts

• “coexist” with more explicit, conscious thoughts

• typically brief, often outside awareness

• “shorthand” but can be more easily delineated if we ask for the meaning of the thought

• not just verbal form, sometimes in visual form (images) or both

Characteristics of the emotional mind

• Generates automatic, self-defeating thoughts

• Wants you to believe negative things about yourself, future, and your world

• Fast & furious

• Likely to trick you

• Key words: “never”, “should”, “always”, “if/then”, and “everything”

• Often gives you same interpretation of different trigger that, overtime, causes core beliefs to develop

Action plan

1. Actions to take

2. Time to begin

3. Possible problems

4. Strategies to overcome problems

5. Progress

How are core beliefs developed? What are the 4 areas?

• Typically develop early in life through repeated experiences and messages from important people

  1. Interpretation of major events (ex: child fails test might start believing “I’m stupid”, especially if idea is reinforced by others or repeated struggles)

  2. Modeling (ex: parent constantly worries about danger, child might develop belief that “the world is unsafe”)

  3. Cultural and societal influence (ex: messages from media, school, religion, or boarder cultural norms can shape core beliefs)—> form as part of how we make sense of the world and our place in it

  4. Genetics and biological vulnerability (ex: intelligence, temperament, specific skills or ack thereof)—> overtime beliefs become internal filters (automatically coloring how we percieve things even in adulthood)

What is cognitive therapy (CT)?

Type of psychotherapy in which negative patterns of thought are challenged to alter unwanted behavior/treat mood disorders.

What is REBT?

• Rational Emotive Behavioral Therapy

• Changing ones thinking leads to emotional and behavioral change

Who developed REBT?

Albert Ellis

What are the fundamentals of REBT?

• Beliefs and irrational thoughts causing emotional reactions—> not event itself

• Psychological problems maintained by interpretations people make events in their lives

What is the REBT ABC model?

A- activating event: something happens in environment around you

B- beliefs: hold beliefs about event/situation

C- consequence: have emotional response to belief

Describe a person participating in REBT

• Strong tendency to think irrationally

• Ability to choose to work toward changing irrational thinking

• Hedonistic (major goals are to stay alive & pursue happiness)

What are the basic principles of REBT?

• Responsible for own emotions and actions

• Irrationality is somewhat innate

• Irrational thinking results in harmful emotion and dysfunctional behavior

• Rationality aids people in achieving basic goals

• Need to make changes in beliefs, not situations/past events

What are the goals of REBT?

• Replacing thoughts based on irrational beliefs with thoughts based on rational beliefs

• Realistic views

• Deeper acceptance of self and greater satisfaction in life

• Focus on shifting absolutistic musts to desires or preferences

What is the role of the therapist in REBT?

• Therapist as educator

• Therapist strives to accept client unconditionally

• Informal, humorous, active, directive, flexible

• Little warmth but show emotional and philosophical empathy

What are the three types of acceptance?

1. Unconditional self-acceptance

2. Unconditional other acceptance

3. Unconditional life-acceptance

What are the components of REBT?

• Identify thoughts based on irratinal beliefs (self-talk)

• Challenging irrational beliefs (90% of session)

• Dispute irrational thoughts/ beliefs
  (socratic method w/ homework and experiments)

What are the types of musts?

• Demand on yourself

• Demand on others

• Demand on situations

What are some emotive techniques utilized in REBT?

• Teach clients differences in emotions

• Humor

• Model rational philosophy (self-disclosure)

• Role reversal

What are some behavioral techniques utilized in REBT?

• Shame-attacking & risk- taking exercises

• Encourage client to act in ways consistent with new rational thinking

Who is considered the “father of cognitive therapy”?

Aron Beck

What is Aron Beck best known for?

• CBT

• Beck depression inventory

• Beck hopelessness scale

• Beck anxiety inventory (BAI)

What are key predecessors for Beck?

• Epictetus (to him all external events are beyond our control)

• Should calmly and dispassionately accept whatever happens

• Individuals responsible for their own actions, which they can examine and control through rigorous self-discipline

What is the Social Cognitive Theory?

Interplay of cognitive, environmental, and behavioral factors determines human behavior

What is CBT?

• Way of thinking about psychological problems and their treatment

• Approach to case conceptualization that guides understanding of why someone is suffering and how to help them

How was CBT developed?

• Beck developed key ideas (explaining different disorders)

• Distorted thinking has a negative effect on person’s behavior no matter what type of disorder they had

• Discovered frequent negative automatic thoughts reveal a person’s core beliefs

What are unique characteristics of CBT?

• Empathy

• Genuineness

• Unconditional positive regard

• Facilitating positive expectations and hope

What are the 10 basic principles of CBT?

1. Based on ever-evolving formulation of patient’s problems and an individual conceptualization of each patient in cognitive terms

2. Requires sound therapeutic alliance

3. Emphasizes collaboration and active participation

4. Goal oriented and problem focused

5. Initially emphasizes present

6. Educative, aims to teach the patient to be his/her own therapist and emphasizes relapse prevention

7. Time limited

8. Structured sessions

9. Teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs

10. Uses variety of techniques to change thinking, mood, and behavior

What are the underlying theories of CBT?

• Cognitive model (dysfunctional thought patterns, which influence mood and behavior, are common to all psychological disturbances

• Lasting improvement (examining and challenging basic beliefs that lie deeper than more surface level thought)

What is the ABCDE model of CBT?

A- activating event

B- beliefs about event

C- emotional consequence

D- disputations to challenge irrational beliefs

E- effective new beliefs replace the irrational ones

How is CBT structured?

Beginning: ensure therapeutic alliance, check patients moods/emotion, collect info on problem, cognitive conceptualization, plan strategy, evaluate negative thinking associated with problem/behavior change

Problem-solving: collect data, cognitively conceptualize, collaboratively plan strategy, evaluate negative thinking associated with problem or behavior change

End: review important points from sessions, reinforce homework and self-help activities, elicit feedback about sessions, plan to incorporate feedback for future sessions

What does IMAGE stand for?

I do care

Managing problems effectively is a plus

Awareness is important

Go for it

Emotions

What are distinctive characteristics of CBT?

• Collaboration

• Structure and active engagement

• Time-limited and brief

• Empirical approach

• Problem-oriented in approach

• Guided discovery

• Behavioral methods

• In vivo work

• Summaries and feedback

What are 6 questions used to evaluate automatic thoughts?

1. What is the evidence that supports/against this idea?

2. Is there an alternative explanation or viewpoint?

3. What is the worst that could happen? If it happened, how would I cope? What is the best that could happen? What is the most realistic outcome?

4. What is the effect of my believing the automatic though? What could be the effort of changing in my thinking?

5. What would I tell a friend/family member in the same situation? (distancing questions)

6. What should i do? (problem solving questions)

What are some (at least 5) of the questions to help identify automatic thoughts?

1. What was going through my mind just before I started to feel this way?

2. What am i afraid might happen?

3. What is the worst that could happen?

4. What do I think?

5. What images/memories do I have in this situation?

What are the possible reasons for the evaluation of the automatic thought to be INEFFECTIVE? Give an example each.

1.    There are other/more central automatic thoughts not identified/evaluated

-       “If I try out for the team, I probably will not make it”—> “What if they think I’m a lousy player?” (more trivial need to be explored)

2.    Evaluation of automatic thought is implausible, superficial, or inadequate

-       “I won’t finish all my work… there’s too much”—> “No I’ll probably get it done” (need further evaluation

3.    Patient has not sufficiently expressed the evidence that he/she believes supports the automatic thought

-       Therapist can/should probe more for evidence that patients believe supports the automatic thoughts being true—> uncovering additional evidence can lead to further evaluation/problem solving

4.    Automatic thought itself is also a core belief

-       “I’m incompetent”—> No single evaluation is going to alter perception and associated affect—> this type of thinking will necessitate multiple techniques and extended time to alter

5.    Patients understand intellectually that the automatic thought is distorted, but does believe it on an emotional level

-       Therapist asks, “how much do you believe that is is not your fault if you get laid off?”—> uncover underlying assumptions which requires further evaluation

What is a hot thought?

Automatic thoughts strongly connected with intense emotions

Identify the hot thought in the following scenario:

Scenario:

Marissa was working at her desk when her supervisor came in to say hello. While they were talking, her supervisor said, “By the way, I want to compliment you on the nice report you wrote yesterday.” As soon as her supervisor said this, Marissa became nervous and scared. She couldn’t shake this mood the rest of the morning.

Situation: supervisor read her monthly report in office on Tuesday at 4:30pm

Moods: Nervous (90%) Irritated (60%)

Automatic thoughts: she’s (manger) looking for problems and will criticize me, memory of dad criticizing how i mowed the lawn, shell be unhappy with my sales, I bet there are other people who did better this month, Ill get fired or get a pay cut

What are questions to help arrive at alternative or balanced thinking?

• Is there an alternative/balanced way of understanding this situation?

• Does combining the 2 summary points (of evidence) with the word “and” create a balanced thought that considers all the info I have gathered?

• If someone I cared about was in this situation, what alternative views of the situation would be suggested?

• If someone who cares about me and knew what I was thinking what might this person say is another way of understanding this situation?

• If a hot thought is supported, what is the worst outcome? What is the best outcome? What is the likely outcome?

What does acceptance mean in CBT? Give an example.

• Acknowledge difficulties in life and come to our own understanding and figure out how to live with them in ways consistent with our values and what is important to us

  Ex: Wake up early for school and dwell on how we’re tired—> likely to be in bad mood (I’m tires but grateful I get to go to school because it will help get me a good job)

Mike constantly thinks that others do not like him. Unsing downward arrow technique identify his core belief

Doesn’t think she likes him—> whenever I get close people end up disliking me—>I’ll never have a close relationship—> I’m unlikable

How do you challenge core beliefs?

1. Identify

2. Find evidence that supports it

3. Find evidence against it

4. make alternate belief

5. Rate that new belief

6. Reflect

How do you test assumptions?

1. Experiment

2. Prediction

3. Possible problems

4. Strategies to overcome problems

5. Outcome

6. What have I learned?

What are underlying assumptions?

• Rules we live by

• Each of us have hundreds of underlying assumptions

• Can be stated as “if… then…” statement

SCENARIO: Linda and Tom had been married for one year and were deeply in love. But despite their affection for each other, there was a great deal of tension, and they frequently argued when they were getting ready for parties. Tom was always ready 10 minutes before it was time to leave and would stand at the door, tapping his foot. Every few minutes he would text her, asking Linda if she knew what time it was and reminding her that it was time to go. Linda was equally upset and frustrated by Tom’s reminders and could not understand why he was always in such a hurry.

 

What were the underlying assumptions of Tom and Linda and how they developed these assumptions?

• Tom: family believed arriving late was disrespectful= “if we don’t arrive on time, then it will be disrespectful and others will be upset with us”

• Linda: family saw time as a suggestion= “if we arrive on time, then it will pressure the hosts”

What are the guidelines for planning behavioral experiments?

1. write down assumption to be tested

2. make specific predictions

3. break up experiment into smaller steps

4. do a number of experiments

5. problem solve

6. write down outcomes

What are the 7 steps to testing a core belief?

1. Identify core belief

2. What supports this belief (specific situations/memories)

3. Evidence against belief

4. Alternative balanced belief (i’ve failed before but also succeeded i’m learning)

5. Emotional check in

6. Behavior experiment

7. Reflection