Cognitive Behavioral/Cognitive Disabilities (Allen's Cog Levels)

Cognitive Behavioral FOR believes that thinking is…

an intervening factor influencing behavior

Thoughts are impacted by…

• beliefs

• culture

• perceptions

• emotions

• attitudes

Theoretical Foundations of Cog Behavioral

• Psychology

• Social learning

• Cognitive Therapy

• Rational Emotive Therapy

Psychology

• behaviorism

• cognition has impact on behaviors

• systems oriented are the factors that influence a person

Social Learning

• observational learning

• models

• reinforcement

• self control/regulation

• self-efficacy: belief in themselves

• self-awareness: self and affect on others

• insight changes

Cognitive Therapy

• ABC method

  • A - stimulus

  • B - beliefs/thoughts

  • C - response

• Cognitive distortions: exaggerations or misinterpretations that are automatic

  • ex. everyone is out to get you

• Socratic method: walking person through their thoughts

Rational Emotive Therapy

• adds on to ABC

• D - disrupting beliefs via cognitive restructuring

  • reshaping how we think

Function/Dysfunction of Cog Behavioral

• Function: use cognitive processes to reason, test hypotheses, and develop accurate self-awareness and realistic perceptions of others and the environment

• Dysfunction: by the presence of maladaptive behaviors, which are presumed to have been caused by maladaptive learning

  • distorted views

Postulates of Change - Cog Behavioral

• reinforcement

• relaxation training

• decatastraphizing

• challenging absolutes

• thought stopping

• visualization

• self-instruction

Reinforcement

• external - impacted by others

• internal - how we see ourselves

Relaxation training

help them use different methods that are more adaptive to handle stress/anxiety

Decatastrophizing

when somebody jumps to a worst case scenario, you help them break down the scenario and how they can handle it differently

Challenging Absolutes

black and white thinking → create alternative assumptions in a situation

Thought stopping

stop and recognize instead of automatic process, engaging in an activity to stop initial thoughts

Visualization

mental imagery → what can occur?

Self-Instruction

talking steps through steps for success

Eval of Cog behavioral

• Occ profile: learn peoples perceptions about emotions, abilities, and concerns

• self-report measures

Interventions for Cog Behavioral

• Psychoeducational groups

• social and life skills groups

• self-regulation programs

• coping model of pediatric OT

• cognitive orientation to occupational performance model CO-OP

Psychoeducational groups

use rational thinking to apply new knowledge and skills through group problem solving

ex. med management, healthy living, household safety

Social and life skills groups

skill training programs that support problem solving

used for those that have MH impairments

Self-regulation groups

combination of ones cognition and emotions to determine how to respond to emotions and different internal states and stress

Coping Model of Pediatric OT

emphasis on childs use of cognitive resources to meet challenges posed by the environment

• grading activities

• promote self-efficacy

• provide feedback to support coping skills

Co-OP

views cognition ad bridging the gap between inherent ability and actual performance

• client identifies goal

• analysis

• cognitive strategies for problem solving

Principles of Allens Cog Levels

• task demand: physical/cognitive demands

• task environment: physical/social environment of activity

• just-right challenge: matching clients skill with demands

• functional cognition: strength v. deficit oriented

• brain conservation: use of brain processes only necessary for task

• task equivalence and analysis: physical and cognitive demands are equal to task

Sensory perceptual memory

automatic, unconscious use of info from environment

ex. fire alarm → you leave

Working memory

memory used during a task

Long term memory

• explicit

  • semantic: remembering something from anatomy

  • episodic: memories you have from an event

• implicit

  • procedural: skills/habits that come naturally

  • perceptual: prior exposure to stimulus activities association networks

  • conditioning: classical conditioning

Function/Dysfunction of Allens

1. Automatic

2. Postural

3. Manual

4. Goal-directed

5. Exploratory

6. Planned

Automatic

• responds to internal sensory info; reflexive motor

  • profoundly impaired

  • in coma

  • respond and withdraw from noxious stimuli

Postural

• respond to proprioceptive info; imitation; comfort based actions

  • gross body movements

  • severe impaired

  • need max assistance

Manual

• imitate actions, respond to proprioceptive and tactile cues; repetitive steps of task

  • able to imitate actions

  • able to do cause/effect but can’t understand why they are doing it

  • attention span short

Goal-directed

• can perform steps; addition of visual cues; can becomes distracted

  • able to do familiar tasks

    • brushing hair when given hairbrush

  • can’t learn new tasks

  • can’t invent new motor actions

    • can brush hair, but don’t know when to stop

Exploratory

• trial & error; benefit from all types of cues; except written; lack prior planning

  • can learn new activiites

  • may be impulsive and have poor judgement

Planned

• abstract thinking, planning, anticipate problems

  • typical cog functioning

Intervention for Allens

• assistance: providing best style/type of assistance

  • cueing, probing, rescuing

• environment: modifying environment to support functional and safe performance