KHA714 Lecture Notes - Lecture 2: Plans, Panic Attack, Body Awareness
24 Jun 2018
School
Department
Course
Professor
Behaviour Change:
Week 2
CBT Assessment and Formulation
Case formulation
- Central to CBT
- Road map for treatment
- Tying together all the information you have received
oPersonalized based on the NOW
Touch on the past but font focus on it overly
oNo longer manualized depending on the diagnosis
oA useful way to start to get ideas
- Need to know diagnosis information
oPsychopathologies
oPresentations
- Literature
oWhat is the literature saying is helpful in helping this presentation
- Different terminologies used in literature
oFind a case formulation tool that works for you
oDiagram; table…
- Problems never happen in isolation
o“The problem isn’t the problem”
oWhy is the coping mechanism used, is it maintaining not helping
- Based on the CBT model:
oDescription of the current problem
oAccount of why and how problems may have developed
oAnalysis of key maintaining processes
- Acts to bridge:
oIndividual experiences
oCBT theories
oLiterature
- Shared rationale and guide for therapy that is to follow
oDon’t tell them exactly how it is
oThey wont retain this information
oTheir brain hasn’t gone through that process of putting all the pieces
together themselves
oFocus on the current maintenance processes
Starting problems not the same that maintain it necessarily
- Briefly touch on the sensitive issues
oIn the intake interview
oSave for later
oInclude in case formulation
oBut don’t go into detail with it; don’t open a can of worms and then
leave them
oIf it does come up- pause for a moment, and ask if it okay to ask a few
more questions about it, or shall we move on
- Process of assessment:
oRead your client
find more resources at oneclass.com
find more resources at oneclass.com
To know whether you have got all the information you require
on a topic
Be at the client’s pace
oActive and flexible process of repeatedly building and testing
hypothesis
oDeciding which processes are important and need to be included in the
formation
Process of questioning and reformulating continues until
hypothesis is refined
oPreliminary discussions
So when you get anxious, you get light headed and this makes
you even more anxious?
oMirror your client positioning
If they up regulate- we need to give them space and ask
“I’ve noticed… would you like some time to take a break”
Use client’s language
Begin client’s journey in challenging their thoughts
“So you then have the thought that, they will think you
are a fool”
Get use to using the client’s words
oDo I have enough information to know what I want to do next time
they come back?
oRefining your hypothesis:
Clarifying
Summarizing
In the process he is refining for himself
Client starts to relax and nod once they realize that the
psychologist got it
Challenging in a gentle way
Normalizing avoidance and safety behaviours
And then later explain that they aren’t that helpful
- Assessing current problems:
oProblem description
Description of each aspect of presenting problem
Where and when does this problem occur
How do they think about it
How do they react?
oEmotion
oBody
oBehaviour
Looking to get an image for ourselves- how would this fit in
our CBT model
Clear picture of its nature
A problem is not a diagnostic label
oFour internal systems
Cognitions
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find more resources at oneclass.com
oWhat goes through your mind when you …
oAsk at each stage of the situation
oE.g. what do you think: arriving, being there,
leave
oThoughts can occur in words or images
Emotions or affect
Need to differentiate with thoughts
Don’t push it- just take a notes that they need to develop
their understanding of thoughts vs. feelings
Behaviour
Whether there are any coping behaviours
oPositive
oNegative
Safety
Avoidance
What have they stopped doing- what has changed in life
because of these things
Often this is part of case conceptualization
We want them to return to the ones that were adaptive
Strengths:
oFind something to feed back to the client
o“Despite everything you’ve told me, you’ve got
here today”
oRecognize AND ACKNOWLEDGE
oUsing recent episode to father information
For a case formulation
CBT = mini formulation
Use this to build up bigger formulation
How long ago the episode was
NORMALISE
What was the first thing you noticed when you experienced
this:
What did she pick up on first as being wrong
The first thing was a:
oThought?
oFeeling?
oBody?
Talking about the reaction in terms of the thought
oWhen you had that thought, what did you
noticed happening?
oRather than the situation
oIn her own words
oEach thought has a corresponding
reaction/emotion
Different thoughts can have the same
reaction
oWe only have one reaction per thought
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Tying together all the information you have received: personalized based on the now. Touch on the past but font focus on it overly: no longer manualized depending on the diagnosis, a useful way to start to get ideas. Need to know diagnosis information: psychopathologies, presentations. Literature: what is the literature saying is helpful in helping this presentation. Different terminologies used in literature: find a case formulation tool that works for you, diagram; table . Problems never happen in isolation: the problem isn"t the problem , why is the coping mechanism used, is it maintaining not helping. Based on the cbt model: description of the current problem, account of why and how problems may have developed, analysis of key maintaining processes. Acts to bridge: individual experiences, cbt theories, literature. Starting problems not the same that maintain it necessarily. To know whether you have got all the information you require on a topic.
