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Project: CBT Lecture 3
I have the 24-lecture series from The Teaching Company on Cognitive-Behavioral Therapy. I'll take notes here, for the amusement and interest of anyone who is curious.
The entry about Lecture 2
Lecture 3: what I learned
This is titled Setting Therapeutic Goals but it was all about making what they call a case formulation.
A case formulation = an individualized theory that explains a particular patient's symptoms and problems, serves as a basis for an individual treatment plan, and guides the therapy process.
- To make this, gather all the data they talked about in lecture 2.
- Try to understand causes so you can come up with a treatment.
- Take the individual's specific goals into account.
Elements of a case formulation:
1. Problem list.
- Include other factors such as comorbidities (both psychiatric and medical)
- Rank the problems: urgent things such as suicidal ideation are high, as are any "therapy-interfering behaviors" because treatment will also depend on working on those
2. Hypotheses about causes.
- Cognition: what caused as well as what maintains the issue
- Behaviors: triggers, antecedents, punishments and rewards
- Early Origins: first time something happened, family of origin issues, etc
- - Here may be some of the reasons for the "automatic thoughts" that pop up
- Summary: tie it together
3. Focus on individual strengths and assets
4. Form a treatment plan, with goals, measures, and interventions.
Hypotheses - Cognition:
- "Automatic thoughts": what pop up when an event happens
- - Anger is often triggered by thoughts that one is being mistreated
- - Depression is often triggered by thoughts about loss
- "Beliefs" or "schemas" driving those automatic thoughts: can often be phrased as "conditional assumptions", if-thens
- - IF I am doing my best, THEN people should recognize that
- - IF people don't honor their word, THEN there should be some kind of negative that happens
- "Core beliefs" about ourselves and the world, driving the schemas: there are two big buckets here
- - Beliefs about one's own lovability (relationships, connection, etc)
- - - Example: many depressed people feel they aren't lovable
- - - At the end of the day, do you like/love yourself? Are you happy with who you are?
- - Beliefs about one's own success, defined however the individual defines success
Hypotheses - Behaviors:
- More on this in a future lecture
- Include all sorts of activities: mundane, daily, big, small, alone, with people, work, leisure
- Lots of little activities can add up to a big effect
- Our environment gives us a lot of small rewards and punishments for various behaviors, and that can shape some functional and some dysfunctional results
Here is an example of a narrative from a case formulation for an individual with anger management issues.
"Michael is a fifty-year-old married man with one teenage son, educated and gainfully employed. He is motivated to address his anger, and sees how it will help himself and others. He is uncertain if treatment can help, but he is willing to try. His anger has a quick onset and high intensity but often a short duration. His pattern of angry arousal has been mostly lifelong and is similar to the pattern displayed by his own father, much to Michael's chagrin. His anger is triggered by any number of environmental events, usually involving a perceived transgression. The combination of his perfectionism and his hyper-responsibility (must be the enforcer) further fuels his anger and his sense of self-righteousness, all in accord with the traditional cognitive model of anger. Michael doubts his own power and influence and often underestimates the effect he has on others. He worries that he and others won't learn or improve as human beings unless a punitive force keeps us in line. He clearly possesses some self-regulatory capacity, as he has been in a successful marriage and has been promoted and successful at work. His anger has damaged and sometimes ended relationships and damaged his reputation. He is currently using exercise and self help as a means to improve his anger control. He is interested in somatic quieting, deepening his empathy, and using classic cognitive behavioral therapy."
The entry about Lecture 4
The entry about Lecture 2
Lecture 3: what I learned
This is titled Setting Therapeutic Goals but it was all about making what they call a case formulation.
A case formulation = an individualized theory that explains a particular patient's symptoms and problems, serves as a basis for an individual treatment plan, and guides the therapy process.
- To make this, gather all the data they talked about in lecture 2.
- Try to understand causes so you can come up with a treatment.
- Take the individual's specific goals into account.
Elements of a case formulation:
1. Problem list.
- Include other factors such as comorbidities (both psychiatric and medical)
- Rank the problems: urgent things such as suicidal ideation are high, as are any "therapy-interfering behaviors" because treatment will also depend on working on those
2. Hypotheses about causes.
- Cognition: what caused as well as what maintains the issue
- Behaviors: triggers, antecedents, punishments and rewards
- Early Origins: first time something happened, family of origin issues, etc
- - Here may be some of the reasons for the "automatic thoughts" that pop up
- Summary: tie it together
3. Focus on individual strengths and assets
4. Form a treatment plan, with goals, measures, and interventions.
Hypotheses - Cognition:
- "Automatic thoughts": what pop up when an event happens
- - Anger is often triggered by thoughts that one is being mistreated
- - Depression is often triggered by thoughts about loss
- "Beliefs" or "schemas" driving those automatic thoughts: can often be phrased as "conditional assumptions", if-thens
- - IF I am doing my best, THEN people should recognize that
- - IF people don't honor their word, THEN there should be some kind of negative that happens
- "Core beliefs" about ourselves and the world, driving the schemas: there are two big buckets here
- - Beliefs about one's own lovability (relationships, connection, etc)
- - - Example: many depressed people feel they aren't lovable
- - - At the end of the day, do you like/love yourself? Are you happy with who you are?
- - Beliefs about one's own success, defined however the individual defines success
Hypotheses - Behaviors:
- More on this in a future lecture
- Include all sorts of activities: mundane, daily, big, small, alone, with people, work, leisure
- Lots of little activities can add up to a big effect
- Our environment gives us a lot of small rewards and punishments for various behaviors, and that can shape some functional and some dysfunctional results
Here is an example of a narrative from a case formulation for an individual with anger management issues.
"Michael is a fifty-year-old married man with one teenage son, educated and gainfully employed. He is motivated to address his anger, and sees how it will help himself and others. He is uncertain if treatment can help, but he is willing to try. His anger has a quick onset and high intensity but often a short duration. His pattern of angry arousal has been mostly lifelong and is similar to the pattern displayed by his own father, much to Michael's chagrin. His anger is triggered by any number of environmental events, usually involving a perceived transgression. The combination of his perfectionism and his hyper-responsibility (must be the enforcer) further fuels his anger and his sense of self-righteousness, all in accord with the traditional cognitive model of anger. Michael doubts his own power and influence and often underestimates the effect he has on others. He worries that he and others won't learn or improve as human beings unless a punitive force keeps us in line. He clearly possesses some self-regulatory capacity, as he has been in a successful marriage and has been promoted and successful at work. His anger has damaged and sometimes ended relationships and damaged his reputation. He is currently using exercise and self help as a means to improve his anger control. He is interested in somatic quieting, deepening his empathy, and using classic cognitive behavioral therapy."
The entry about Lecture 4
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