cbt chapter 7 - psychoanalytic diagnosis book

8/17/2019 CBT Chapter 7 - Psychoanalytic Diagnosis Book

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Chapter 7: Behavorial Methods IIReducing Anxiety and Breaking

Patterns of Avoidance

Mehak Chopra


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Behavorial Analysis of Anxiety

Disorders

Report intense subjective experiences of fear with physical symarousal when exposed to a threatening stimulus

Ex. Man climbing up a tall ladder

Feared object stimulus! " reaction of anxiety response!

#C$ unconditioned stimulus! #CR unconditioned respons

$timulus generation% triggering of anxiety by associated remind

Reminders% conditioned response CR!

C$ CR

&nxiety disorders arise from people trying to avoid experiencing

that will adverse emotional " physiological responses


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Behaviors…

'eople will avoid going to places b(c it provides emotional

&voidance reinforces feeling of relief from anxiety

Example of )ina

&goraphobia related panic attacks

Fear of elevators

*herapy worked on using elevators again

+C,

+bsessional thoughts occurs in people with +C,

Compulsive rituals used to stop the thoughts


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-ey features

/. an initial unconditioned! stimulus causes a fearful

unconditioned! response and is generali0ed to

conditioned stimuli that in turn produce conditioned

response

1. pattern of avoidance of the feared stimuli serves to

reinforce the patient2s belief that he cannot face the

object(cope with the situation

3. pattern of avoidance must be broken for the patient

to overcome the anxiety


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$tudies

&utomatic thoughts are irrational(illogical

Exaggerated

Fearful conditioned shaped by life experiences

'arents or other influential people

&nxiety disorders cannot be traced back to single

stimuli


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+verview of 4ehavorial *reatment Methods 5ink between

/! stimulus C$( #C$! " 1! fear response CR(#CR!

&voidance must be replaced with a more adaptive behavior

4reaking the $timulus6Response Connection

Reciprocal inhibition(exposure'rocess of reducing emotional arousal by helping the patient experience a positive or healthy emotion

dysphoric response

Example% 7nduce deep relaxation of voluntary musculature state of calm which is incompatible w

anxiety(arousal

'ractice method regularly

Example% exposure

Repeated exposure allows person to reali0e that the stimulus can be faced and managed

'hysiological response cannot be sustained

Cognitive restructuring techni8ues

Methods that reduce(turn off negative thoughts can lower tension levels

Replace fearful cognitions with more pleasant(calming thoughts ex. relaxing mental images!

,ecatastrophi0ing helps the patient

/! systemically evaluate the likelihood of an imagine catastrophic outcome occurring on ex

1! develop a plan to reduce the probability that such an outcome will occur

3! create a strategy to cope with the catastrophe


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$e8uencing 4ehavorial 7nterventions for

&nxiety $ymptoms

First%

&ssess symptoms anxiety triggers9 existing coping strategies!

,efine course of therapy

$econd%

*aught basic skills for coping withthoughts(feelings(behaviors

*hird%

#se skills to assist patients in exposing themselves to anxiety

provoking situations


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$tep /% &ssessment of $ymptoms9

*riggers9 Coping $trategies,elineate

/. Events memories of events(streams of cognition! that serve as trigger

1. &utomatic thoughts9 cognitive errors9 underlying schemas involved in the overreaction to t

3. emotional and physiological responses

:. habitual behaviors such as panic(avoidance symptoms

$cales used% 4EC-9 Fear of ;egative Evaluation $cale9 $tate6*rait &nxiety 7nventory9


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$tep 1% 7dentifying *argets for

7ntervention

*herapist and patient decide to

4egin by attacking the most difficult situation or ease

the patient into exposure therapy in a step6by6step

fashion


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$tep 3% 4asic $kills *rainingFive methods described

/. Relaxation *raining

&chieve relaxation response

Mental and physical calmness

Muscle relaxation

$een in table >6/

Explain rationale for relaxation training

*each patients to rate their level of muscle tension and anxiety

Explore the range of muscle tension

*each the patient methods for reducing muscle tension

?elp the patient systematically relax each of the major muscle groups of

$uggest mental images that may assist in relaxation

&sk the patient to practice the relaxation induction method regularly

5isten to an audiotape(read


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1. *hought $topping

$top the process of negative thinking and replace it with more positive(adaptive thoughts

May or may not be useful

+C, may worsen intensification of obsessions!

Methods%

Recogni0e that a dysfunctional thought process is active

)ive a self6command to stop the thought

$top@

Auit thinking that way@

Evoke a visual image to reinforce the command

$top sign (red traffic light( gloved hand

$witch the image

From stop sign to a pleasant(relaxing scene

Bacation spot9 pleasant person9 photograph

&sk patient how the experience was and feedback regarding the session


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,istraction

4reathing retraining

#sing images to help the patient generate positive9 calmi

can be used to relax

Reading9 going to a movie9 working on a hobby(craft proj

sociali0ing with friends9 spending time on the 7nternet

Effective distraction facilitates participating in exposu

behavorial interventions by reducing the fre8uency(inten

automatic thoughts " lowering physical tension and emot

, hi i


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,ecatastrophi0ing Refers to Bideo 1

/. Estimate the likelihood that the catastrophic outcome will occur by asking patients to rate their

from = to /== absolute!

1. Evalute the evidence for and against the likelihood that a catastrophic event will occur

Fears vs facts

3. Review the evidence list and ask patients to re6estimate the likelihood of the catastrophe occurr

$hould have reduced from step /

:. &ssess perceived control by asking patients to rate the extent to which they believe they have co

occurrence of the event (outcome

D. Create an action plan

$trategies that will reduce the likelihood that the catastrophe will occur

. ,evelop a plan for coping

7f the event should occur

>. Reassess the perceived likelihood of the catastrophic outcome

&s well as the degree of control over the outcome

. ,ebrief

&sk what it was to talk about the catastrophic event


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4reathing Retraining

+ften used in treatment of panic attack(disorder

4reath rapidly and deeply for a short time max of

/.D mins!

4reath slowly until regaining normal control over his

respiration


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$tep :% Exposure $ome situations(phobias can be treated in a single session

Flooding therapy directly face the stimulus while the therapist mode

the situation! $ystematic desensiti0ation

$tep by at step protocol

,eveloping a ?ierarchy for )raded Exposure

4e specific

Rate the steps for degree of difficulty or amount of expected anxiety

,evelop a hierarchy that has multiple steps of varying degrees of diff

Range of difficulty low to high!

Choose steps collaboratively

Gork as a team with the patient to select the order of the steps


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7maginal Exposure vs 7n6vivo Exposure

7maginal

/! use environmental cues to create vivid imagines of the

1! use cognitive restructuring9 relaxation9 thought stoppi

C4* methods to decrease anxiety and dispel the negative

3! present the images in a hierarchical fashion take the

specific targets!

:! coach the patient on ways to cope with the anxiety

D! repeat the imaginal exposure until anxiety is extinguis


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7n Bivo Exposure

,irect confrontation with the stimulus that arouses fear in

the patient

'resence of therapist positive b(c

Model effective anxiety management techni8ues

Encourage patient to confront their fears 'rovide timely psychoeducation

Modify catastrophic cognitions

)ive constructive feedback


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Response 'revention

Methods used to help patients stop behaviors that are perpetuat

disorder

*herapist and patient work on specific goals for response respon

prevention'atient keeps a log

Rewards

'ositive reinforcement by friends(family(therapist

)oing out to eat

*rips

'acing Exposure *herapy

Ranges from single visits simple phobias! to lengthy protocols

-eep in mind patient2s diagnosis9 comorbid conditions9 strengths

intelligence9 resilience9 motivation9 readiness for change9 patien

response to therapy

cbt chapter 7 - psychoanalytic diagnosis book

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