psychotherapy - cbt assessment and conceptualization

how is a CBT assessment structured?

involves structured questions to obtain detailed information

what might a client be asked to do during assessment?

to detail a recent occasion when problem symptoms were experienced

what four internal systems are presenting problems broken down into during assessment?

cognitions, emotions, behavior, and physiology

triggers

what factors make problem more or less likely to occur

modifiers

contextual factors that impact how severe the problem is when it occurs

consequences

what has happened as a result of current problems?

what can consequences tell us during assessment?

often give clues about maintaining processes

maintaining processes

the vicious cycles that keep the problem going

can maintaining processes be identified based on diagnosis?

no, disorders have different common ones but individuals will be different

what is included in past history and problem development?

vulnerability factors, precipitants, and modifiers

vulnerability factors

things that set the stage for a problem to develop, but are neither necessary nor sufficient

precipitants

events or situations that provoke onset of symptoms

what are precipitants likely to activate?

a pre-existing vulnerability belief

core beliefs

enduring cognitive phenomena that are deeply rooted, global, rigid, overgeneralized

how are core beliefs maintained?

people focus selectively on information that confirms core beliefs and disregard information that doesn’t

intermediate beliefs

attitudes, rules, and assumptions, fall in between core beliefs and automatic thoughts

what are the three main core beliefs?

incompetent, unlovable, and worthless

attitude

generalized statement about perceived reality, ex: asking for help means you’re weak

rule

I should statement

assumption

if then statement

how can you identify intermediate and core beliefs from automatic thoughts?

downward arrow technique

downward arrow technique

ask client about meaning of key automatic thoughts that you suspect stem from core beliefs

what questions might be asked with the downward arrow technique?

if the thought is true: what does that mean about you? what is so bad about that? what is the worst part about the situation?

what is the CBT conceptualization?

road map to therapy, series of hypotheses about client that are refined based on incoming data

is the client privy to the conceptualization?

yes, will present conceptualization to client to see if it “rings true”, modified based on client feedback

what do you want to answer when creating a case conceptualization?

disorder development, big life events, basic beliefs, coping strategies, disorder-maintaining automatic thoughts and behaviors, how was client vulnerable, current events and perceptions in client’s life