KHA714 Lecture Notes - Lecture 5: Mental Representation, Panic Disorder, Adaptive Learning
24 Jun 2018
School
Department
Course
Professor
Behaviour Change
Week 5
For both GP letter and case formulation- due 14 days after the OSCE
-Write the letter that evening
oNot references
-Good practice
-And start case formulation too
-First draft
-From Tuesday 11am
Behavioural Techniques:
- No longer activating and motivating our clients
- Looking at avoidance and safety behaviors
- Types of interventions that we may look at to tackle these
- Developing a basic theoretical understanding
Avoidance:
- We want to know internal and external forms of avoidance
oCovert and incovert
- External avoidance is usually easy to identify
- Behaviours:
oAvoidance
Usually report these
oSafety behaviours
These are usually more covert
I can’t not go/do this thing, so I become consumed by doing
this behavior
Convinced self it will help
Doesn’t make a difference
- Clients can be aware, but many times they are unaware of them
oRitualistic often – doesn’t have any impact on the outcome/skill
- Avoidance of internal stimuli:
oMore difficult to identify
oThings client are doing internally
oEasily become learnt behaviours- so they start not to recognize
themselves as doing them
oDifficult when it comes to treatment
oNeed to rpobe and ask
oWhat helped you stay at the party
What did you do
What did you think
Did you do anything specific to change how your body was
feeling
Need to draw it out
oIf client is still doing them, this isn’t effective therapy
Need to remove all safety behaviours while doing behaviour
experiment
- Eliminating safety behaviours:
find more resources at oneclass.com
find more resources at oneclass.com
oDon’t get to learn that their interpretation of the disaster is wrong
They still think its linked to what they did
oFour categories of safety behaviours:
Distraction
Deliberately doing this
Some forms of therapy
GAD- allocated worry timevacuuming or another
boring task
oNot a safety behaviour because it is very
structured
An issue when they attribute their ability to cope with
the safety behaviour
oStill using the language
oStill saying that HE doesn’t have the
resources/ability to cope
During and after exposure, I will not do the things that
distract me from my discomfort
Increasing a sense of safety
During and after exposure, I will not do the things that
increase my sense of safety
Difficult because clients keep on adding to the safety
behaviour
Affirms that the fear is true/there
Safety behaviours keep telling us that our automatic
thoughts are true
Relaxing and feeling better
During and after exposure, I will not do something to
try and relax and feel better
Trying to teach client that they don’t have any evidence
for my automatic thought
Bringing things or people
Re-assurance seeking is a major safety behaviour
Hardest one to break because of the involvement of
loved ones
Temporary decrease in anxiety, but it doesn’t last
The reassurance is external to you
Still telling you that you don’t have the resources to
cope
oSo I better go and check again with my loved
one
oAnd get more reassurance
Need to have time with parents or loved ones
oBring them in
oEspecially if kids
oAsk them to respond with “what do you think?
What have you and Leesa been talking about?”
find more resources at oneclass.com
find more resources at oneclass.com
During and after exposure, I will not use the following
things or people
oAnxiety:
Over estimation of threat
And an underestimation of their ability to cope
State of up-regulation
Teaching them to down-regulate
Teaching them to be in the window of tolerance
I can have an increase HR etc. but I can tolerate it
-Video notes:
oUsing avoidance as a coping strategy
When they over estimate threat and their ability to cope
oSafety behaviours: Subtle things people do to get through the threat
Prevent them from finding out how threatening the situation
was
They think of them as a good thing
Impacts on the evidence gathering for the AT
oDiscomfort is natural
Learning to manage with the distress or discomfort
Learning to manage or cope with the idea that this might
happen, but it is okay
In terms of my values and ideas for life..
Over-protiective parents
Problematic because of:
Parents overestimating threat and their child’s ability to
cope…
And because child doesn’t learn what to do if parents
aren’t there or telling them what to do
oOr if the threat does occur
oExamples:
Panic attack- always driving in the right lane, putting the visor
down, stare at the number plate
Panic symptoms is feeling hot- AC, windows down,
distractions with music
Grabbing steering wheel very tightly
Fear of forgetting something
Repeating information over and over in her head
Mental ritual
Fear of vomiting of public
Carrying ginger ale, and other medications etc.
Not eating before going to an event
Supermarket:
Going slowly through the isles
oWhen you feel anxious, is there something that you do or don’t do to
try and feel better in the moment
oWhat kind of things did you do to try and keep from
FAINTING/VOMITTING/FORGETTING?
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
For both gp letter and case formulation- due 14 days after the osce. Write the letter that evening: not references. No longer activating and motivating our clients. Types of interventions that we may look at to tackle these. We want to know internal and external forms of avoidance: covert and incovert. External avoidance is usually easy to identify. I can"t not go/do this thing, so i become consumed by doing this behavior. Clients can be aware, but many times they are unaware of them: ritualistic often doesn"t have any impact on the outcome/skill. Did you do anything specific to change how your body was feeling. Need to draw it out: if client is still doing them, this isn"t effective therapy. Need to remove all safety behaviours while doing behaviour. Eliminating safety behaviours: experiment: don"t get to learn that their interpretation of the disaster is wrong. They still think its linked to what they did: four categories of safety behaviours:
