Psychotherapy Exam 3

What causes distress according to mindfulness and contemplative theory?

• Our usual waking state is not optimal, and more effective and functional states are available to us through contemplative training

• We are all prone to numerous erroneous thoughts that easily become unrecognized erroneous assumptions and beliefs, a process that acceptance and commitment therapy calls fusion.

How do mindfulness and contemplative theories view identity?

• We suffer from a case of mistaken identity

• We think we know who we are, but we’re wrong

• We incorrectly assume that we have a permanent/consistent self

• True identity is a fluctuating state

• Our identity/self is impermanent but we believe that it is permanent

• We are victims of our own creation

Describe the differences between prepersonal, personal, and transpersonal stages. What are the other terms used for each stage?

• Prepersonal stage: no coherent sense of self or of special conventions

• Personal stage: More coherent sense of seld and largely accept the conventional cultural assumptions about ourselves and the world

• Transpersonal: further development; shift in the way people think. Achievement of a new level of consciousness that allows people to be extremely focused and very well in control of their attention

Describe the differences between basic needs, hedonic needs, and metamotives

• Basic needs: keep us alive (food, water, shelter)

• Hedonic needs: chasing pleasure/happiness; brings a good feeling for a little while but eventually stops; hedonic treadmill (money)

• Metamotives: key to move from personal to transpersonal or conventional to postconventional; higher motives beyond ourselfs, include transcendence, altruism, if we overlook this it causes pain and suffering.

• If we only satisfy basic and hedonic needs we are likely to experience anxiety

What is the hedonic treadmill and how can we get off it?

• The hedonic treadmill is when we believe that lower-order goals are the only means to attain happiness, we become addicted to them and then when we don’t have them, we suffer. To get the same high the goals need to become bigger and bigger – the hedonic treadmill. Obsession with wealth and possessions can tranquilize us with trivia and distract us from what is truly important in life. 

Describe what the three poisons are and how they can hold us in iron chains or golden chains.

• The three poisons are delusion, craving, and aversion. Our craving for these hedonic pleasures holds us in our iron chains. They cause distress

• Delusion: sets us searching in the wrong place→ searching causes distress; delusion leads us to stay on hedonic treadmill; nothing is ever good enough

• Craving: compulsive necessity; we can become addicted to almost anything; unable to distinguish from wanting and needing; hold craving/demanding feeling for satisfaction

• Golden chains: engaging in behaviors that are consistent with metamotives, but are doing it for the wrong reasons. Being someone that is always good, never angry, always pleasant. Doing it for their own gains, responding to a craving (crave to feel like, wanted, needed) not understanding altruism.

What is the meaning of pain in mindfulness? How can one handle it?

• Pain is a signal that the mind needs growth

• Goal is to recognize when we experience pain/discomfort/distress: the mind tells us there is growth to be done

What is meant by the good news and the bad news in mindfulness and contemplative theory?

• Contemplative psychologies are based on a “good news, bad news” understanding of the mind.

• The bad news is that our ordinary state of mind is considerably less controlled, developed, and functional than we usually recognize. The result is significant unnecessary suffering.

• The good news is that we can train and develop our minds, even far beyond conventional levels. The results include enhanced mental capacities, well-being, and maturity. 

What are the goals of mindfulness and contemplative based therapies?

• Rigorous scrutiny of own perceptual-cognitive processes

• Ability to awaken from the waking dream

• Recognize and reduce distortions (the way we distort what we think is reality)

• Improve concentration, perceptual clarity, insight, compassion (intro of metamotives, improve things beyond ourselves)

• Goal to develop and move towards ethical behavior, to be motivated by ethics

• Refining awareness

• Emotional transformation

• Redirecting motivation towards metamotives

• Training attention

What are the primary methods of psychotherapy in mindfulness and contemplative theories?

• There are three main types of methods of psychotherapy: metaphorical, process, and mechanistic. Traditional explanations are usually metaphorical. 

• Calming the mind, enhanced awareness, disidentification, and rebalancing mental element 

• Meditation and Yoga

• Meditation: process of developing voluntary control over attention

• Yoga: involved ethics, wisdom, intellectual study, skill

What are the six stages of practice in mindfulness and contemplative theories?

• First stage: can be humbling; recognizing how little control we have over our own mental processes and how much time is spent lost in thoughts and fantasies.

• Second stage: involved recognizing habitual patterns. One identifies repetitive mental and behavioral patterns similar to those that insight-oriented psychotherapy unveils. 

• Third stage: begins as refined awareness unveils still deeper cognitive insights. One can microscopically investigate subtle psychological processes such as thought, motivation, and perception.

• Fourth stage: marked by the emergence of a variety of exceptional abilities, which are discussed in detail in the research section.

• Fifth stage: transpersonal experiences emerge, producing identification with others and compassionate concern for them.

• Sixth stage: stabilization; here peak experiences extend into plateau experiences and transient capacities mature into permanent abilities. 

How do we train our attention?

• Do one thing at a time, stop multitasking

How do we develop wisdom?

Examine regrets and carefully reflect on our lives

Who is a good candidate for mindfulness and contemplative therapies?

• Those with anxiety disorders, depression, cardiovascular or hormonal/immune issues, illnesses

What variables explain behavior according to the theory of personality (behavior therapy)?

• Behavior is explained in terms of variables in the environment: learning, situational cues, and temperament

• Distress is determined by our behaviors

Explain the difference between operant conditioning and classical conditioning

• Operant conditioning assumes behavior is controlled by the environment, and utilizes reinforcement and punishment. 

• Classical conditioning is when a neutral stimulus comes to elicit a response through repeated pairing with another stimulus and it also assumes behavior is controlled by the environment, but we respond to cues that environment gives us.

What are the goals of behavior therapy?

• The goals of behavior therapy is to correct maladaptive learning experiences and introduce adaptive learning.

Where are adaptive behaviors learned?

• All behaviors serve a function and make sense in the context they are in. 

• What function behavior serves, and what factor is maintaining that behavior.

What are maladaptive behaviors? Give an example.

• Maladaptive learned behaviors include procrastination and tantrums. 

• Ex: Learn over time that procrastination might not be maladaptive at first, but once you get into your upper level classes, it is maladaptive and will not work  

• Ex: Kids learn that tantrums work to get what they want.

Define discrimination learning and give an example

• Learning that remains context specific 

• Child learns something in a specific environment, and doesn’t generalize in other places

• Ex: A baby who reacts differently to their mother’s voice than to a stranger’s voice.

Define generalization

• Behavior can occur in multiple contexts, not just the context it was learned

Define vicarious learning and give an example

• Awareness of the contingencies in the environment because you’ve seen it happen to someone else 

• Ex: Child learns there is a punishment for disruptive behavior

Define rule-governed behavior/instructional learning and give an example

• Don't have to see contingency to know it

• Learn rules without seeing the consequence

• Ex: Don’t have to see someone run a red and get in a car accident to know that you have to stop at a red light

Define stimulus control and give an example

• Change environment so that we don’t have the stimulus at all or change as much as possible

• People who are tobacco-dependent smoke when they drive, can’t tell them to never drive but tell them to change the routes that they do

• Avoiding or getting rid of triggers for a behavior

• Ex: in an office, stop rebooting computer, mute sound

Define reinforcement

• Increases likelihood of behavior

• Positive reinforcement is behavior followed by rewarding stimulus

• Negative reinforcement is behavior followed by the removal of an aversive stimulus

Define punishment and give an example

• Decreases responding/behavior

• Positive punishment is behavior that is followed by an aversive consequence (ex. Being hit or yelled at)

• Negative punishment is behavior that is followed by the removal of desired stimulus (ex. Don’t get dessert if you don’t eat your vegetables)

Define differential reinforcement and give an example

• Put unwanted behavior on extinction (no longer being reinforced)

• Instead, reinforce an alternative desired behavior

• These occur at the same time; ignore unwanted behavior (tantrum) and reinforce other behavior

How is the therapeutic relationship viewed in behavior therapy?

• It is viewed as collaborative (teach people to dispute their own automatic thoughts, but the therapist does not actively dispute it for them).

• Therapists as a guide and catalyst for change (socratic method: ask questions that are designed to lead you to the answer you’re looking for)

• Warmth, empathy, genuineness, curiosity 

• Emphasizes patient responsibility 

• Very important in order to get patient on board for treatment

• Not emphasized in traditional behaviorism

• Can bolster motivation

According to behavior therapy, why do people become distressed?

• Learning is the basis of our distress

• Distress is determined by our behaviors: whether they are adaptive or maladaptive

What are the different types of exposure and how do they differ?

• Gold standard treatment for anxiety, phobia, PTSD 

• Flooding (exposing someone to a fear stimulus)

• Want habituation (long-lasting in fear)

• In-Vivo (exposed to the stimulus in real life)

• Imaginal (exposed through mental imagery)

• Interoceptive (thinking about feared bodily sensations)

What is response prevention and why is it an important aspect of exposure therapy?

• Safety behaviors undermine exposure

• Trying to imagine yourself somewhere else, do anything you can to avoid it

• Safety behaviors → avoidance

• Therapist tries to stop safety behaviors, talk about why they are scared/have anxiety

What are the key differences between contingency management and token economy?

• Token economy sets up a reinforcement system based on tokens. Receive tokens for desirable behaviors, once they reach a certain amount, they can redeem for a reinforcement. Over time, the token becomes a reinforcer in itself. Intermittent/variable schedules are more effective bc you don’t know when they’re coming

• Contingency management provides a directed reinforcement for the wanted behavior and reinforcement is given right away.

How could a therapist apply classical conditioning principles as a form of treatment? How could they apply operant conditioning?

• Classical: Expose them to a stimulus, but prevent the conditioned response from happening. Over time, new learning takes place to say this learning does not elicit this response anymore.

• Operant: Extinction: behavior stops bc it is no longer being reinforced. Remove reinforcer, but does not have to be punishment. We do not need punishment, it doesn’t work as well as reinforcement or last as long. Shaping: slow, progressive adjustments to the behavior over time. Choose to reinforce a behavior that might not be the final target behavior, but it is closer.

What might a therapist consider when conducting a behavioral assessment?

• Identify target behaviors to be treated and decide what treatment is best.

• Look for behavioral excesses: behaviors that are present that we want to reduce or eliminate

• Consider information sources

• Functional analysis: process by which we determine what function this behavior is serving. 

• Antecedence: what’s triggering the behavior? What’s the behavior itself? What’s the consequence? Look for both types of conditioning

Why did Aaron Beck find psychoanalysis to be insufficient in describing the development of distress? (cognitive therapy)

• It focused too much on unconscious processes and not present cognitive processes

• Lack of empirical evidence

• It takes too long and it is not focused on solutions

How is personality shaped according to cognitive theory?

• Personality = temperament + cognitive schemas

• Personality dimensions are made up of clusters of attributes about us and styles of responding so how do I respond to certain situations?

What’s a schema?

•  a fundamental belief or assumption that you have about self, others, world

What are the types of cognitive distortions?

Catastrophizing, overgeneralizing, personalization, emotional reasoning, shoulding and musting, magnification and minimization

Catastrophizing

• Tendency to blow circumstances out of proportion, making it a way bigger deal than it is

• Making problems larger than life

Personalization

• Tendency to take blame for everything that goes wrong

• Feel like everything is your fault even when you have no control over the situation

• When something goes wrong, they feel really guilty

Over Generalizing

• Tendency to make broad generalizations on single event (and minimal evidence)

• Take a small piece of bad info and overgeneralize to the whole experience

Emotional Reasoning

• Tendency to interpret your experience based on how you are feeling in the moment

• I feel bad therefore it is bad

• You made me feel bad, therefore you are a bad person

Shoulding and Musting

• Tendency to make unrealistic and unreasonable demands on yourself or others

Magnification and Minimization

• Tendency to magnify the positive attributes of others while minimizing our own

• Look at others in such a positive light, look at ourselves and our experiences negatively (especially in comparison)

Core beliefs

• Foundation of maladaptive schemas

• What are things that I believe wholly and fully

• About ourselves, others, world, future (follow common themes and apply to everything you do

• Pessimists may believe nothing good will ever happen to them, making an underlying assumption that something bad will happen in every situation

• Your worth is tied to something (ex. productivity)

Underlying assumptions

• Assumptions made on the world based upon our core beliefs. They give rise to automatic thoughts/shape perceptions and provide meaning.

• We think we know what is going on, and we do this without any evidence that our core belief is correct

• Distort info you are taking in based on core beliefs

Automatic thoughts

• Spontaneous thoughts triggered by circumstance which leads to automatic thought and leads to emotion and behavior. These can occur because of underlying assumptions. 

• Stimulus → automatic thought → emotion and behavior

• Maladaptive assumptions give rise to automatic thoughts which cause our emotions and behaviors

Voluntary thoughts

• Most accessible and stable thoughts

• Choose to think about it

• Key to breaking through the cycle bc the only way to feel better is to change the way we think voluntarily

What is the cognitive triad of depression?

• Self: decreased sense of self-worth

• World: daily tasks of living in world are too much

• Future: hopeless 

Outline the mechanisms that cause anxiety in cognitive models?

• Exaggerated perception of danger (ambiguous info leads us to think there is danger)

• Difficulty recognizing cues of safety

• Minimize ability to cope

• Maximum threat, minimal safety, minimal coping 

What are the important aspects of the therapeutic relationship in cognitive therapy?

• Collaborative: teach people to dispute their own automatic thoughts, but the therapist does not actively dispute it for them

• Therapists as a guide and catalyst for change: socratic method

• Warmth, empathy, genuineness, curiosity

• Emphasizes patient responsibility and homework (10,080 minutes)

What is the goal of cognitive therapy?

• Correct faulty information processing

• It is filtered through our core beliefs and make maladaptive assumptions

• Goal is to start correcting at the bottom of the pyramid (core beliefs) so that these assumptions aren’t happening

• Identify when they make an assumption

• Treat thoughts as testable hypothesis

Why do therapists often assign homework to their clients in cognitive therapy?

• Because there are 10,080 hours out of the therapy room, and they want the rest of the week to be more adaptive

Identify and explain the parts of the structure of treatment in cognitive therapy.

• Set the agenda: guides the session, do collaboratively with patient

• Review previous material: always a teaching component, consistently provide psychoeducation about disorders, symptoms, strategies, teach patient what is causing them distress 

• Review HW: usually provides info on what will be happening in that session

• Cover new material

• Summarize and assign homework: HW will be used in the next session

• Elicit feedback

Describe techniques for challenging cognitive distortions

• Decatastrophizing: recognize where their catastrophizing isn’t helpful for them; drill in on the specifics

• Reattribution: consider alternative causes so we don’t make automatic assumptions; we believe we know the cause, but we have to look at entire body of evidence and consider other reasons

• Redefining: see when there is a problem and put it in terms of things that they can control

• Decentering: changing the idea that people are so concerned with us; people don’t pay attention/judge us as much as we think they do

Who are the best candidates for cognitive therapy?

• Large effects have been found for people with depression, generalized anxiety disorder, panic disorder, social phobia, and childhood depression or anxiety

• Mid effects for marital distress, anger, chronic pain, childhood somatic disorders

Danny was recently dumped by his boyfriend, who cheated on him. While in session, Danny explains that he has been very upset since the breakup and that he’s been feeling depressed. Additionally, Danny states that he has been ruminating on two thoughts: 1. That he will be cheated on in all his future relationships and 2. That if he was a better boyfriend, he would not have been dumped. Deep down, Danny believes he is not worth very much, despite evidence to the contrary, and relies on others for positive evaluations

of himself.

1. From a cognitive therapy perspective, identify Danny’s automatic thoughts and cognitive distortions.

• Cognitive distortions: overgeneralizing – he thinks he will be cheated on in all future situations

• Catastrophizing – he thinks he will be cheated on in all future relationshups

• Personalization – he is taking the blame for things out of his control

• His automatic thoughts are that he will be cheated on in all future situations and that if he were a better boyfriend he would not have been dumped.

Danny was recently dumped by his boyfriend, who cheated on him. While in session, Danny explains that he has been very upset since the breakup and that he’s been feeling depressed. Additionally, Danny states that he has been ruminating on two thoughts: 1. That he will be cheated on in all his future relationships and 2. That if he was a better boyfriend, he would not have been dumped. Deep down, Danny believes he is not worth very much, despite evidence to the contrary, and relies on others for positive evaluations of himself.

1. What do you think some of Danny’s underlying assumptions might be?

• Some of his underlying assumptions might be that he needs to please his boyfriend or that if he isn’t perfect, he will be cheated on

What is the education for the oppressed model?

• Paulo Friere identified dominant models of education as instruments of oppression that reinforce and maintain the status quo and social inequities.

• Critical consciousness was coined as a process of personal and social liberation. Involved asking questions like what, who, for who etc, to help oppressed individuals author their own reality.

• Education for the oppressed teaches individuals to become aware of their circumstances and change them through a dialectical conversation with their world.

Critical Consciousness

• coined as a process of personal and social liberation. Involved asking questions like what, who, for who etc, to help oppressed individuals author their own reality.

What is co-counseling?

• Peers learning from each other

• Ex: reevaluation counseling: individuals listen to each other to recover from effects of racism, classism, sexism, and other types of oppression

What are some reasons we consider culture?

• Cultural convention is that you can’t share that you’re going to therapy

• Importance of masculinity, belief that you should get over things on your own

• Therapies were made for white people 

• Distrust in medical system → unethical experimentation of black people

How does cultural adaptation occur?

• By involving diverse people in development

• Including collectivistic values

• Attend to religion

• Paying attention to relevance of acculturation - the process of losing touch with culture which is particularly impactful for immigrants

• Generations can lose touch with culture or individuals who immigrated can also

• Acknowledging effects of oppression

What is cultural competence and what are the steps to it?

• Cultural competence involves a set of congruent behaviors, attitudes, and policies that reflect an understanding of how cultural and sociopolitical influences shape individuals’ worldviews and related health behaviors. 

• 1) Cultural destructiveness- attitudes, policies, and practices that are destructive to cultures and to individuals within cultures (e.g., English-only mandates). 2) Cultural incapacity- individuals believe in the racial superiority of the dominant group and try to parent the culture diverse groups with their way of thinking 3) cultural Blindness- where people believe that culture makes no difference and the values of the dominant culture and universal and beneficial 4) cultural pre-competence- individuals desire to provide an equitable and fair treatment with cultural sensitivity but do not know exactly how to proceed 5) Cultural competenceIndividuals respect cultural differences, continually self-assess, acknowledge dynamics of difference, expand their knowledge and resources, and support various adaptations in beliefs, policies, and practices. They know how to proceed. 

What are the features of therapists who are culturally competent?

• Value diversity

• Manage dynamics of difference

• Navigating interpersonal discomfort, disagreement

• Acquire and incorporate cultural knowledge into their inventions

• Increase their multicultural skills

• Conduct self-reflection and assessment 

• Adapt to diversity and cultural context of their clients

What’s the difference between ethnorelative and ethnocentric?

• Ethnorelative: thinking about cultural differences; goal to think flexibly about cultural beliefs; adapt to different situations, fully integrate these values into our sense of self

• Ethnocentric: Puts your own culture as central

What are the goals of multicultural therapy?

• Address cultural trauma (being in an environment where your identity/values aren’t accepted causes distress)

• Experience is valuable knowledge 

• Healing results from empowerment, sharing multiple perspectives, anchored in meaningful and relevant contexts

What are some of the possible dynamics that can arise between therapist and client with transference and countertransference?

• Interethnic transference: overcompliance, mistrust, denial, ambivalence

• Intraethnic transference: views therapist as omniscient or omnipotent, traitor (betrayal of culture), autoracist

• Interethnic countertransference: deny cultural differences, become overly curious about differences at the expense of psychological need, guilt, or pity. Over complies with therapist, puts therapist as authority, high level of mistrust

• Intraethnic countertransference: overidentification, shared victimization, distancing, survivor’s guilt, cultural myopia (can’t see clearly)

Explain the stages of minority identity

• Stage 1: Conformity: internalized racism, goals, beliefs from dominant culture is what someone is trying to follow

• Stage 2: Dissonance: start to identify that something isn’t sitting right with you, dominants groups and cultures may not be applicable to you, there is something wrong with it

• Stage 3: Resistance-immersion: start to think more in line with minority held views, endorse some as their own

• Stage 4: Interoception: someone starts to think about how the cultural norms that they are being exposed to actually fit with their own personal identity

• Stage 5: Synergistic: self fulfillment that is not tied to feeling that we have to choose one culture over another without questioning whether or not we agree with that culture or if it agree with our identity. Can see things we disagree with.

Explain the stages of white american identity development

• Stage 1: Contact (we perceive ourselves as being not necessary racial, “I don’t see color,” I am trying not to look at racial differences and perceive myself as a racial being, in denial about race, being a racial being

• Stage 2: Disintegration: have to start realizing that prejudice and discrimination exists

• Stage 3:Reintegration: victim blaming, reverse discrimination, acknowledge that you see discrimination but blame the person that is being, common reaction to disintegration

• Stage 4: Pseudo-independence: genuine curiosity and interest about other cultures

• Stage 5: Autonomy: Acceptance and respect and appreciation for other cultures

Explain the stages of sexual orientation identity development

• Stage 1: Confusion (starting to question)

• Stage 2: Comparison (it is a possibility that I belong to a sexual minority)

• Stage 3: Tolerance (I have an identity or orientation as a sexual minority; can admit but not feel good about it)

• Stage 4: Acceptance (increase contact with other sexual minorities)

• Stage 5: Pride

• Stage 6: Synthesis: desire towards outreach towards other sexual orientations; provide education/bridge for people to think differently about sexual orientation 

How do worldviews play a role in therapy?

• Collectivistic: selflessness, priority places on group rather than individual; personal identity defined according to relationships; leads to a culture that prioritizes interdependence

• Individualistic: focused on ourselves, independence, only responsible for yourself, more emphasis on internal attributes

Explain the multicultural assessment

• Explanatory model of distress: wanting to know the clients own perspective on why they’re having the experience that they’re having 

• Cultural formulation and analysis

• Cultural genogram

• Ethnocultural assessment: recognizing that there are multiple domains to culture

What do multicultural therapists emphasize and why?

• They emphasize empathy towards culture (empathetic witness) and believing and respecting cultural diversity. They recognize the client’s expectation for the therapist's role. They respond according to the clients needs and work towards cultural congruence in worldviews. 

• Should be able to have a dialogue on cultural differences and similarities- 1) suspend preconceptions 2) recognize that clients may be different than others in their group 3) they should consider how client therapist differences may affect therapy and acknowledge that power privilege and oppression may affect interactions