Which of the following terms refer to beliefs that thoughts and behaviours have reciprocal and equivalent effects?
C. TAF is a cognitive distortion. It is thought to have two forms: ‘probability TAF’ in which the intrusive thought is believed to increase the probability that a specific negative event will occur. This is prominent in those with violent obsessions. ‘Morality TAF’ in which experiencing the intrusive thoughts is morally equivalent to carrying out a prohibited action. This distortion is especially prominent in obsessions, is closely related to guilt, and is associated with subsequent attempts at neutralization. A comparable cognitive distortion termed ‘thought–shape fusion’ is thought to be present in a minority of people with eating problems and occurs when the thought of eating induces feelings of fatness, moral unacceptability, and weight gain. These cognitive distortions can be manipulated experimentally and have clinical implications that include improvement in understanding the nature of the disorder and its treatment.
Reference:
Which of the following is a technique for automatic thought modification?
E. Examining the evidence is a technique in which the therapist and patient collaboratively explore the evidence for and the evidence against a specific distorted thought or belief. When working through the exercise, the therapist asks the patient to write the thought or belief at the top of a piece of paper and then label two columns with ‘evidence for’ and ‘evidence against’ the thought. The patient is then guided to explore methodically and write down each piece of evidence. At the end of this procedure, the evidence for and against the cognition is quantified and estimated. Guided discovery is the most frequently used technique to help patients articulate automatic thoughts in sessions. The specific technique used is called Socratic questioning. One of the most powerful ways of teaching patients to detect automatic thoughts is to fi nd a real-life example of how automatic thoughts influence their emotional responses. A shift in mood during the therapy session can be an opportune time for the therapist to facilitate the identification of automatic thoughts. The Automatic Thoughts Questionnaire devised by Hollon and Kendall is a comprehensive list of dysfunctional thoughts that has been used primarily in research studies. Similar lists can be used in clinical settings when patients are having difficulty detecting their automatic thoughts. Imagery and role-play are two methods for uncovering cognitions when direct questions are unsuccessful (or partially successful) in generating suspected automatic thinking.
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A woman comes to your outpatient clinic. She has recurrent thoughts of contamination with germs and has to wash her hands up to 20 times every time she touches wooden surfaces. This prevents her from looking after her 2-year-old child. She is worried that the child may not be gaining the required weight. She has also started to lose the skin of her palms due to the excessive washing.
The treatment you would recommend would be:
B. According to NICE guidelines, in the initial treatment of adults with OCD, low-intensity psychological treatments (including exposure and response prevention (ERP)) (up to 10 therapist hours per patient) should be offered if the patient’s degree of functional impairment is mild and/ or the patient expresses a preference for a low-intensity approach. These include brief individual CBT (including ERP) using structured self-help materials; brief individual CBT (including ERP) by telephone; group CBT (including ERP) (note, the patient may receive more than 10 hours of therapy in this format). Those with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low-intensity treatment has proved to be inadequate, should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient). Adults with OCD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient). Adults with OCD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP).
Jack has certain core beliefs about being unlovable. He thinks that this characteristic makes people abandon him. In order to avoid this, he turns out to be excessively self-sacrificing to his family.
From a schema-based therapy point of view, what is the underlying cognitive process that is maintaining the schema?
B. Schema-based approaches in cognitive therapy are based on the original ideas of Beck. Early life experiences produce a number of thought patterns or schemata. These thought patterns are like ‘block moulds’ into which thoughts fi t in when evaluating events. They are otherwise called core beliefs. These result in underlying ‘assumptions’ which reinforce the core beliefs and from these arise the negative automatic thoughts. Schemata are thought to be dormant, and get activated during a depressive episode. Schemata are patterns of unconditional beliefs that are hard to access and are self-maintaining. There are thought to be three main processes that maintain schemata. Schema surrender is the process where the person seeks evidence that supports the beliefs and dismisses any evidence to the contrary. Schema compensation refers to compensating for the core belief by doing the exact opposite, but, ultimately, this action acts as a reinforcer that maintains the schema, as in the case described in the question. Ultimately, the person believes that the family loves him only because he is self-sacrificing, and if he was not, he would still remain unlovable. Schema avoidance is a group of blocking behaviours that help avoid emotional arousal – e.g. comfort eating.
Maria has obsessive thoughts of a violent nature towards her mother.
Which of the following is the least characteristic of dysfunctional assumptions likely to be seen in Maria?
E. Salkovskis described fi ve characteristic dysfunctional assumptions in patients with obsessive compulsive disorder (OCD). The first option refers to thought–action fusion, i.e. having a thought equates to performing the action. This is consistent with the thoughts of patients with OCD, especially those who have ‘violent’ obsessions. The second statement that a person should (and can) exercise control over one’s thoughts is also consistent with thoughts in OCD. Responsibility is not attenuated by other factors (e.g. the low probability of occurrence) is a typical assumption in patients with OCD. The fourth option is also typical of an obsessive cognition. The fi nal option is an assumption that is not typical of OCD. This is probably more typical of a depressive assumption that reinforces the core belief ‘I am a failure’. As a corollary, there may be another secondary assumption – ‘If I please everyone, I am considered successful’.
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