KHA714 Lecture Notes - Lecture 12: Cognitive Restructuring, Socratic Questioning, Patient Health Questionnaire
24 Jun 2018
School
Department
Course
Professor
Behaviour Change
Week 12
Putting it all together
- Critical questions to consider
oWhat circumstances does the problem occur
oDepression- treatment plan
oBehavioural elements
oCognitive elements
oCore emotional components
Subjective feelings reported
Physiological sensations
Classical conditioned emotional responses
- Jim
oLongitudinal information for depression
Early life experiences
Assumptions
Core beleifs
oReinforcement cycles
Comparisons
More layers of context added
Not just parental relationship fed in and influence sibling
relationships
oCase conceptualization
Lists
But are there relationships between these points
oIs loneliness about
Adaptive coping strategy that is no longer working
Or because of avoidance due to the case information
oBeliefs:
I am not good enough
Achievement
And life ability
Start looking for all pieces of information that supports the
schema/frame of reference
Keeps it activated
oConditional assumptions
Intermediate beliefs- sole purpose is to prevent the core belief
being activated
If I work very hard, maybe I will be okay. If I don’t, I’ll fail.
Now he has lost his job.. activated his core belief of being a
failure
oCoping strategies
Set high expectations for self
Work very hard
When I thought I’ve worked hard, it wasn’t enough
Whatever I’m doing is never quite going to be enough
find more resources at oneclass.com
find more resources at oneclass.com
Setting himself up for failure- the standard will get too
high to attain
Remain vigilant for signs of failure
Is prepared if teased or criticized
And reminds him to keep in place his conditional
assumptions
oPrecipitating events
Losing his job- couldn’t find comparable job, cut off from
former work friends (I must be doing okay because these peers
are the same)
Now he is below
More evidence that the core belief is accurate
New job below capacities
Reinforces that he is not good enough
Everyone knows this
Very likely that he won’t maintain contact with his
former work colleagues
Wife moved out with children, started divorce proceedings,
stressful custody
Financial problems, house gone
Basement of parents house
Difficulty sleeping and feel exhausted all the time
oActivation of core beliefs
I am a loser. I am a worthless failure. I am helpless
I am not good enough to be liked or loved
Wife and kids gone
Multiple layers of reinforcement
oNegative cognitions (triad)
I cant believe
Automatic thoughts can be in the form of images. In picture
format, there is a stronger reaction to it. Doesn’t necessarily
mean that this AT becomes a core belief, but the
physiological response is stronger
Image of self weighed down, living with parents forever
I cant prove for my kids. I’m letting them down
Ill lose my children and there’s nothing I’ve an do to prevent
that
My friends wont want to hear from me
My life will just keep getting worse and worse
oValues are different to core beliefs
If we view core beliefs as values, we get in true
We start to think that core beliefs are what makes a valued and
meaningful life
Values do this… not core beliefs
Stable vs. unstable core beliefs
Stable- if a piece of information comes that contradicts your
core belief, it doesn’t hurt or rattle you (outer layer of an onion)
find more resources at oneclass.com
find more resources at oneclass.com
Unstable-if a small thing rocks the perception, it is unstable
(pierces the heart of the onion)
Core belief, and make decisions in life that make this true and
purpose (a value- when they are the same, this is easy)
Pain or discomfort illustrates it is a core belief
Is this core belief helping the person achieve the life that
they want to have
All on a continuum
- Longitudinal information: depressive symptoms
oAffective
Feels sad, hopeless, anxious, guilty
oBehavioural
Isolates himself socially
Withdrawn from non-work activities
Gives up easily
Not self medicating with alcohol
oCognitive
Concentration difficulties
oPhysical
Eating sleeping, libido difficulties
oMotivational
Feel apathetic, difficult to do things
- Pervasive persistent depression vs. a situational, episodic
oSelf medication shoots this up
oHealth
oFinancial
oRelationships
oFamily
oProtective- children, hard working
- Starting CBT with Jim
oIdentify initial target problem list
Depending on client and intake information
Client-focused: what do we know about Jim
Specific problems
What skills can help Jim
Not a general description of depression
oComponents:
Fundamental behavioural strategies
Graded manner with depression
Self monitoring
Activity scheduling
Early stage cognitive strategies include, distraction and
counting thoughts
CB work like monitoring and testing ATs
Relapse management – always some form of this
- Treatment
oCognitive restructuring
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Critical questions to consider: what circumstances does the problem occur, depression- treatment plan, behavioural elements, cognitive elements, core emotional components. Not just parental relationship fed in and influence sibling relationships: case conceptualization. But are there relationships between these points: is loneliness about. Adaptive coping strategy that is no longer working. Or because of avoidance due to the case information: beliefs: Start looking for all pieces of information that supports the schema/frame of reference. Intermediate beliefs- sole purpose is to prevent the core belief being activated. If i work very hard, maybe i will be okay. Now he has lost his job activated his core belief of being a failure: coping strategies. When i thought i"ve worked hard, it wasn"t enough. Whatever i"m doing is never quite going to be enough. Setting himself up for failure- the standard will get too high to attain. And reminds him to keep in place his conditional: precipitating events assumptions.
