Psychopathology (Final) CBT for Panic Dx and Personality Dx

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1

Common catastrophic thoughts

  • Fear of death or disability
  • Fear of losing control/ insanity
  • Fears of humiliation or embarrassment
2

Cbt techniques for panic dx

  1. Interoceptive exposure
  2. cognitive restructuring
  3. exposure interventions
  4. situational exposure
3

Interoceptive (internal) exposure

  • one CBT treatment for panic disorder
  • Rationale: provides opportunities to examine negative predictions about internal sensations and
  • Rationale: provide opportunities to increase tolerance and acceptance to internal sensations thru repeated exposure
  • Method:
    • engage in systematic exercises that induce feared internal sensations (dizziness, increased heart rate)
      • head rolling
      • hyperventilation
      • stair running
      • full body tension
      • chair spinning
  • interoceptive exposure makes the feared sensations more safe- at home or in office w therapist
4

Cognitive restructuring

  • one cbt tx for panic dx
  • ID nature of thoughts (they don’t have to be true to affect emotions)
  • Learn about common biases in thoughts
  • Treat thoughts as “guesses” or “hypotheses” about the world
  • Specifically:
    1. Increase awareness of thinking patterns
    2. Monitor relationship between thinking and panic episodes
    3. Challenge thinking
    4. Establish adaptive thinking patterns
5

Exposure Interventions

  • one cbt tx for panic dx
  • Provide rationale for confronting feared situations
  • Establish a hierarchy of feared situations
  • Provide accurate expectations
  • Repeat exposure until fear diminishes
  • Attend to the disconfirmation of fears (“What was learned from the exposure?”)
6

Situational exposures

  • another method of tx panic dx
  • Provides a new learning opportunity to examine negative predictions about feared outcomes
  • Increases tolerance to internal sensations in feared situations
  • Fear hierarchy to be completed
  • ID safety behaviors
7

Five factor model of personality

  • Openness (to experience)
  • Conscientiousness (constraint)
  • Extroversion
  • Agreeableness
  • Neuroticism (negative affect)
8

List of personality dx

  • Antisocial PD
  • Narcissistic PD
  • Borderline PD
  • Schizotypal PD
  • Dependent PD
9

Antisocial PD

  • Psychopathy is a severe variant of this
  • Disregard for and violation of the rights of others
  • Recklessness, impulsivity, aggressiveness, irritability, indifference to mistreatment of others
  • Differential diagnosis
    • narcissistic personality traits; substance dependence disorders
  • Low conscientiousness
10

Narcissistic Personality Dx

  • Pervasive pattern of grandiosity, need for admiration, or adulation, and lack of empathy
  • Differential dx
    • Antisocial personality disorder
11

Borderline Personality Dx

  • Pervasive pattern of impulsivity and instability in interpersonal relationships, affect, and self-image
  • Most frequently diagnosed and studied personality disorder
  • Efforts to avoid abandonment; engaged in reckless activity (impulsive); episode of rage or anger; self-mutilation
  • Differential diagnosis:
    • Mood disorders
    • Dissociative fx
    • Eating dx
    • Substance use dx
    • Anxiety dx
12

Schizotypal Personality Dx

  • Pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships, eccentricities of behavior, and cognitive- perceptual aberrations
  • Odd beliefs, magical thinking, social withdrawal, unusual perceptual experiences
  • Differential diagnosis:
    • Schizophrenia (people with schizotypal might appear to have prodromal symptoms of schizophrenia)
13

Dependent Personality Dx

  • Pervasive and excessive need to be taken care of that leads to submissiveness, clinging, and fears of separation
  • Difficulty making decisions without others’ input, need for others to assume responsibility, difficulty disagreeing with others, lack of self confidence
  • Differential dx
    • Agoraphobia, schizophrenia, severe injuries, dementia
14

what are the broad goals of DBT?

  • Dialectical (two things that can seem like opposites but can both be true at the same time)
  • People are doing the best they can but need to try harder
  • Balance acceptance and change at the same time
  • really helpful for BPD
15

four components of DBT treatment

  1. Structured individual therapy (focus on dialectics and behaviors)
  2. Skills group (weekly, 2 hours, learn new behavioral skill to develop interpersonal skills and coping skills)
  3. Skills coaching (call therapist 24/7 to get help; helps reaction at difficult times)
  4. Consultation team (dbt therapists work on teams)
16

The 5 Steps of Dialectical Behavior Therapy

  1. Mindfulness (be aware of present, rather than focused on past or being worried about future)
  2. The middle path (how to compromise with peers and take new POV)
  3. Distress tolerance (ID and developing coping skills for times of crisis w/o turning to harmful behaviors)
  4. Emotion regulation (skills to maintain stable mood. Connection between physical and emotional health)
  5. Interpersonal effectiveness (develop healthy relationships, develop boundaries, and assert themselves)