week 1: case formulation and functional analysis

what are the 3 different types of case formulations?

1. behavioural

2. cognitive

3. cog-beh

what are the two steps between problem and treatment plan?

info gathering and individual analyses

why is problem described by patient not linked to treatment plan?

because two people could have the same problem for two different reasons (people drink excessively for different reasons)

what are the 3 steps after info gathering/individual analyses?

3. treatment plan

4. therapeutical methods

5. evaluation

4 reasonys why to use case formulation

1. combines client experience, CBT theaory and research

2. helps catch when therapy is not working and why

3. can be used when there is more than one problem

4. individualized treatment

what psychological concept is FA/IA based on?

operant conditioning

other names for an Antecedent

• Activating event

• Sd = discriminating stimulus

what does Sd, R, and Sr mean in FA

• Sd = discriminating stimulus/ antecedent

• R = respondent (behaviour)

• Sr = reinforcing consequence (maintanance factor

what is the role of FA in treatment?

it’s a hypothesis that informs and guides treatment

what is topographical analysis?

detailed procedure where you talk about one recent event with your client, and go through it step by step - the goal is to get info for ABC

in FA how should you differentiate the consequences?

short and long term

what are the 4 different models that describe kind of the same process when it comes to FA?

1. ABC model by Ellis

2. Operant conditioning skinner

3. 5 Gs schema (dutch)

4. cognitive model by beck

3 objectives of the intake session

1. gather info for diagnosis

2. determine if you’re a suitable therapist

3. start forming the therapeutic alliance

what is Beck's principle of guided discovery?

The therapist uses collaborative empiricism/socratic questioning: clients review the evidence for their ideas, supported by cognitive restructuring rather than direct challenging - people learn better from their own conclusions

Define a case formulation. Use the James/Pete example to explain why "the problem the patient presents" does not directly determine the treatment plan, and say what you do if the evaluation phase shows no symptom reduction.

A case formulation is a hypothesis about the psychological mechanisms that cause and maintain a client's symptoms and problems (1 pt). It focuses on why (e.g., why keep drinking despite negative consequences) and develops hypotheses (1 pt). James and Pete show the same behavior but different antecedents and functions (coping with trauma vs. socializing), so treatment differs (1 pt). If evaluation shows no symptom reduction, the therapist goes back to information gathering and individual analyses to check the hypotheses, and considers other methods (1 pt).

Give one realistic example for each of the four consequence types: +S+, -S-, +S-, -S+. State for each whether the behavior will increase or decrease. Then explain what ~S+ and ~S- mean.

+S+: praise after a presentation (increase). -S-: taking a pill to remove panic (increase). +S-: arguments after smoking, or being scolded (decrease). -S+: time-out, phone taken away (decrease) ~S- = something negative that was expected does not happen (negative reinforcement, behavior increases, e.g., avoiding shops and no panic). ~S+ = something positive that was expected does not happen (negative punishment, e.g., no expected promotion).

why should an FA separate short-term from long-term consequences? What are -S+ and ~S+ here, and why do they matter for the vicious circle of being unable to change?

Separating short and long term often shows that wins are short term (relief, calm) while losses are long term or permanent (1 pt). -S+ and ~S+ are positive learning opportunities lost or never experienced (e.g., letting kids clean up, learning others make you happy) (1 pt). By acting the same way, we prevent ourselves from finding out that other behavior brings a better outcome, which closes the vicious circle (1 pt). They are often what maintains the problem and what you want to tackle (1 pt).

(a) What is a topographical analysis and why do we use it?

(b) Name two guidelines for introducing it to a client.

(c) Give two example questions each for the antecedent and behavior phases.

(d) Explain how it relates to the functional analysis.

(a) A very detailed, step-by-step conversation about one recent event, like slowly replaying a film, used to get input for the FA; it zooms in on situations that have become habits ("that's so typical me") (1 pt).

(b) explain what you are doing; explain why it matters; it should aid your analysis; consider analytical and introspective level; be aware it may elicit negative emotions (1 pt).

(c) Antecedent: Where were you? Who was with you? What happened? Behaviour: What did you feel? What did you think? What did you do? How bad was it? (1 pt).

(d) The topographical analysis supplies the Sd, R and consequences from which you build the FA hypothesis (1 pt).

Distinguish automatic thoughts, intermediate beliefs and core beliefs. Describe how the downward arrow technique moves from one level to the next, and name one precaution during it.

Automatic thoughts: the stream of thoughts in the moment, hard to recall, can be positive, negative or neutral (e.g., "Why isn't he calling?"). Intermediate beliefs: unspoken attitudes, rules, assumptions, often if–then ("If he doesn't call, he doesn't love me"). Core beliefs: how we see ourselves, others and the world, the "thoughts of the heart" ("I am unlovable") (3 pts).

Downward arrow: start from the AT and keep asking "If that were true, what would it mean to you?", "What would be so bad about that?" until the underlying core belief appears (1 pt). Precaution: it increases arousal, so be prepared to use a calming or safe-spot exercise and watch affect (1 pt).

A client says "I'm not sure what was going through my mind." Name four techniques to elicit the automatic thought and give an example prompt for two of them.

1. heightening the client's response (ask about feelings and where in the body),

2. visualizing the situation,

3. role play,

4. inquiring about images,

5. suggesting an opposite thought,

6. eliciting the meaning of the situation

Name four of Beck's 14 principles of CBT (Chapter 2) and explain in one sentence each how they show up in practice.

1. ever-evolving conceptualization (revise as data arrive),

2. sound therapeutic relationship,

3. monitoring progress (weekly checklists),

4. emphasis on the positive and hope,

5. collaboration,

6. aspirations and values,

7. present focus,

8. educative,

9. time sensitive,

10. structured sessions,

11. guided discovery,

12. action plans,

13. variety of techniques

what is a registration assignment in CBT?

a structured homework task where clients record specific thoughts, behaviors, or situations to track patterns and progress between sessions