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Studieboek - Wider applications of CBT

36 important questions on Studieboek - Wider applications of CBT

What does research say about CBT for EDs?

Due to gains not remaining stable over time, the focus shifted from behavioral techniques to modifying cognitions. There is reasonable evidence that CBT is a defensible treatment. Due to some differences in the presentations of different EDs, there are differences in understanding and treatment

What are the different eating disorders? (8 + 1)

1. Anorexia
2. Bulimia
3. Binge eating disorder
4. Pica
5. Rumination disorder
6. Avoidant/restrictive food intake disorder
7. Other specified feeding or ED
8. Unspecified feeding or ED
(9. Obesity - medical condition)

What are common core themes in eating disorders? (2)

1. Social and interpersonal issues (fear of being abandoned, social evaluation, shame, and low self-esteem)
2. Control (over-controlling and at risk of losing control)

What are common cognitive processes in EDs? (2)

1. Dichotomous thinking (often expressed as perfectionism)
2. Dissociation (can be induced by self-starvation or over-eating. Leads to failing to learn that emotions can be tolerated)

What is common for affects in EDs? (3)

1. Mood or affect intolerance ((not) eating to moderate intolerable emotions)
2. Emotions overriding the sensations of hunger or satiation
3. Emotions being mistaken for hunger, which is maintained by the soothing effect of eating

What is common for motivation for treatment in EDs?

That there is often an ambivalence about or resistance to chage. Therapists must acknowledge this and focus on enhancing motivation.

What are common cognitions in EDs? (3)

1. 'If I eat this, I'll lose control, I'll get fat and disgusting'
2. 'I've over-eaten. I can't stand the feeling. I'm repugnant and fat'
3. 'I feel bad. Eating will comfort me'

What are common emotions caused by the common cognitions in EDs?

1. Fear and disgust
2. Despair and anticipatory calm

What is common behavior caused by the common emotions in EDs? (3)

1. Starvation or extreme under-eating
2. Extreme compensation (can cause the urge to over-eat afterward, which can turn into a trigger for the common cognitions)
3. Comfort eating or binge-eating

What are the maintenance cycles in EDs?

The behavior enhances the temporary belief in the effectiveness of the behavior, which causes the belief in the importance of shape and weight to be unchallenged, which is partially mediated by self-loathing. This reinforces the cognition, partially mediated through the self-loathing causing a new trigger. Triggers can also be reinforced by the urge to over-eat after extreme compensation.

What needs to be considered in the treatment of BN, binge eating, and obesity?

The medical risks of extreme compensation for perceived over-eating (BN) and the medical risks of over-eating and being overweight (binge eating and obesity)

What is the difference between type 1 and type 2 trauma?

Type 1 trauma victims have experienced a single traumatic event, while type 2 trauma victims have repeatedly been traumatized.

What are the key issues when working with survivors of trauma? (4)

1. Memory of trauma
2. Sense of self
3. Interpersonal and systemic issues
4. Complexity of presentations

What are the problems regarding the memory of trauma in working with trauma survivors (3)

1. Lack of memory of trauma (either the memory was never consolidated or it is repressed. Recall should not be forced)
2. Intrusive memories
3. False memory (detail is unreliable, but general memories are not. Therefore, focus on the meaning that the client is left with)

What are the problems in the sense of self of trauma survivors? (2)

1. Childhood trauma can impact the fundamental sense of self, others, and the future, leading to rigid and unhelpful schemata
2. Consequences of developmental trauma can be a fragmented or absent sense of selve

What are things to consider regarding interpersonal and systemic issues in working with trauma survivors? (2)

1. Regularly keep the client's real-life relationships in mind and check up on these
2. Repeated early life trauma has often been linked to personality disorders

How can a therapist deal with the complexity of presentations in working with trauma survivors?

Consider the 'bigger picture' when working with survivors of complex or chronic trauma by asking questions that elicit more information

For what patients with trauma might compassionate mind therapy (CMT) be helpful?

It may be effective for those left with fixed self-blaming and self-attacking beliefs

What is the evidence for the usage of CBT for trauma survivors?

Most research was on survivors with PTSD, so clear evidence is lacking a bit. There are however some guidelines from experts on working with survivors with personality disorders. Cognitive techniques have support for specific aspects of a client's presentation and particular categories of trauma.

What are the aspects on which there is a focus in the stabilization phase in the treatment of trauma survivors?

Learning basic mood and stress management skills, working with (unhelpful) schemata, and developing interpersonal skills.

What are some recommendable guidelines for the treatment of trauma survivors? (6)

1. Formulate the big picture, and think interpersonally/systemically/culturally to appreciate the full impact of trauma
2. Remember the qualities of memories and do not force recollections
3. Focus on the accessible DSM problems as far as possible, using treatment protocols where appropriate
4. Keep the possibility of having to accommodate interpersonal difficulties, schema-driven problems, and multi-problem presentations in mind
5. Consider a stepped approach
6. Keep risk assessment on your agenda

What are the important aspects of the Beckian approach to anger management? (3)

1. Posits that anger arises when people feel that important 'rules' have been violated
2. If guilt and shame are prominently linked to angry outbursts, a compassionate focus could be incorporated into CBT
3. Assertiveness training can supplement CBT in managing anger

What are the stages of anger control? (3)

1. Preparation (help the client to identify patterns of anger, including triggers and typical thoughts, feelings, and behaviors)
2. Skills acquisition (the client learn techniques to help lower arousal when provoked)
3. Application training (the clients rehearse the techniques in progressively more difficult situations, perhaps starting with the imagination and working up to in vivo).

What are the steps in the management of different stages of a potentially anger-provoking situation? (4)

1. Preparing for the provocation (recognize a difficult situation and reduce excessive expectations of other people)
2. Coping with physical arousal
3. Coping with cognitive arousal
4. Post-confrontation reflection

What are the potential difficulties in working with clients in therapy for anger? (4)

1. Some clients may be reluctant to give up anger if it helps them feel safe/strong/confident (work towards other means of achieving these feelings)
2. Some clients are referred because others think they have a problem (may help to begin with a positive formulation of the cycles of anger management to illustrate the advantages to motivate them)
3. Losing the Rogerian stance and cognitive curiosity can cause engagement difficulties (figure out a response before the therapeutic impasse is established)
4. Important to consider the risks

In what disorders are psychoses common?

Particularly in schizophrenia and bipolar disorder. A lot of earlier work on CBTp focused on medication-resistant symptoms in schizophrenia, after which the interest in bipolar disorder increased.

Why are appraisals of actual experiences key in the treatment of psychosis?

As an anomalous experience in itself does not indicate psychosis or bipolar disorder. It is the appraisals alongside the associated levels of distress or dysfunctions, and the behavioral consequences that are important.

What are other factors in psychosis that may require special care? (4)

1. Clients may be suspicious and might see themselves as having been abused by psychiatric systems
2. The pleasurable experience of mild mania
3. Idiosyncratic thought processes making it difficult to keep track of the client's thinking
4. The sometimes neediness of the client's family

What are important things about the treatment of relationship problems? (2)

1. Relationship can be the main problem, or caused by another disorder
2. Cognitive-behavioral formulations allow issues to be approached by looking at the interlinkages between cognition, emotions, behaviors and physical state

How can relationship difficulties be treated? (3)

1. The therapeutic setting can allow relationship problems to be viewed as they ovvur, using interactions to invalidate unhelpful beliefs
2. DBT for clients with BPD promises significant impact on interpersonal and social adjustment
3. CBCT and systemix CBT have a wealth of theory and research

What is the distinction between substance abuse and substance dependence that was used in the DSM-IV?

Substance abuse is a maladaptive pattern of use leading to significant impairment or destress, while substance dependence is more severe and includes increased tolerance, withdrawal symptoms and persistent desire to use despite awareness of the negative consequences. In DSM-V it can be added as a specifier.

What are reasons for people to engage in substance abuse or addictive and harmful behaviors? (4)

1. Mood regulation
2. Manage cravings (physiological or psychological)
3. Coping with adverse circumstances
4. Contain severe psychiatric symptoms

Why is long-term input required instead of short-term treatment?

Even though short-term treatment can help, long-term input is required as it should address associated problems. Many programmes involve more than one treatment modality.

What is part of the cognitive behavioral approach to substance misuse and addictive behaviors? (6)

1. Emphasises additional role of unhelpful thinking in the maintenance of the behavior
2. Strong emphasis on building a non-blaming conceptualisation, whilst encouraging the development of a sense of autonomy and responsibility
3. Helpful to emphasize asssets such as adaptive coping styles or strong social supports
4. Collaborative therapeutic alliance is imported and relates to compliance
5. Preparedness for change can fluctuate and goes hand in hand with motivational work (worth taking the risk of changing)
6. Decide whether to encourage control of the problem behavior or total abstinence (the latter in case of more severe problems)

What are common problems in working with people compelled to engage in harmful behaviors? (3)

1. Marked ambivalence about change
2. Difficult behaviors such as non-compliance and dishonesty
3. Some problem behaviors are difficult to identify as manisfestations may be hard to recognize

What does the developmental model of substance misuse include?

Exposure to and experimentation with addictive behaviors and consequent development of drug-related beliefs

The question on the page originate from the summary of the following study material:

Positive Clinical Psychology

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