CBT skills

CBT skills

CBT top tips for clinicians!

I'd love to pass on reviews of workshops, books, research, and focus on the material that's clinically useful. It would be great if you could take away a new idea or technique that you could use straight away with your patients.

Update on exposure. Michel Craske lecture

This might help your patients.Posted by Philip Kinsella Wed, February 03, 2016 16:00:04

https://www.youtube.com/watch?v=pKPgFVKVFLA

She has done a lot of research on mechanisms of fear reduction

Fear will return over time. The fear is not eradicated after exposure, but there is a competing memory based on the safety that has been learnt during the exposure.

If a distressing unexpected trigger occurs later then the fear will occur.

Anxious people are not good at inhibiting fear i.e. in the amygdala.

Extinction learning unlike original fear learning, is context specific, so can easily return in adifferent context.

Maximizing exposure:

Duration of exposure is not so important.

Need to violate expectancies e.g. ask the patient what they need to do for the bad thing to happen, then do exposure.

Add extra triggers during exposure. E.g. add interceptive to driving exposure, add in social rejections to social exposure.

Cognitive restructuring is not good before exposure as it is shifting expectancy: should be done afterwards.

Variability is good e.g. triggering object and duration:different spiders, different height situations. this is a slight effect.

Good to enhance tolerance of fear.

Throw in many contexts in exposure: familiar/unfamiliar, accompanied/not, on or off medication.

New rules of exposure:

Mixed in level of difficulty not graded (if possible), does not have to be prolonged, add in extra stimuli, repeated exposure especially to a variety of triggers, ensure focused attention to stimuli, cognitive restructuring after exposure.Can try to enhance positive mood towards stimuli. Use affect labeling ‘I’m feeling anxious…’

Behavioural experiments:

BE do not focus on duration and they do focus on violating experiments, so this is good. BE needs to be better at facing a more variable range of exposures. BE need to ensure patient is focused on stimuli. Do CT afterwards not before. Can try to enhance positive mood towards stimuli. Use affect labeling ‘I’m feeling anxious…’



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