Cognitive Distortions
What is a cognitive distortion?
An unrealistic or biased way of thinking
DBT was developed for individuals who struggle with....
Intense emotions
What is Attention Bias?
Attention bias is the tendency to focus on certain types of information, particularly negative or threatening stimuli, while ignoring neutral or positive information.
Which type of distorted thinking would say: "I either get 100% on this exam or I am a complete failure!" ?
All or nothing thinking
What is the primary goal when using "mindfulness" in DBT?
How can attention bias influence the maintenance of anxiety?
People are likely to focus on potential threats and dangers in their environment, leading them to interpret neutral or ambiguous situations as threatening. Due to this constant perception of threats, individuals may feel very fearful and avoid situations they perceive as dangerous. This avoidance results in a remaining fear as the threat can never be disproved.
"I should have passed my drivers test first try, I always have to be perfect." - Is an example of what?
Should Statements
What is the Wise Mind?
Wise Mind occurs when you can use both emotional awareness and logical reasoning together. It's the part of you that recognizes your emotions but doesn't let them dominate, and it uses reason while still acknowledging your feelings. It holds two things to be true at one time.
Wise Mind is an integral skill for making thoughtful decisions, managing intense emotions, and improving emotional regulation.
What is a core belief?
A core belief refers to the deeply held and fundamental thoughts or assumptions that we have about ourselves, others, and the world. These beliefs often form the basis for how a person perceives and reacts to various situations. These beliefs are often formed early in life and may be influenced by past experiences, particularly those that were traumatic or emotionally significant.
"I'm a failure at everything I do" is an example of what kind of distorted thinking?
Over-generalizing
What is the purpose of distress tolerance in DBT?
Distress Tolerance focuses on managing and surviving overwhelming emotional experiences in the short term without engaging in harmful behaviours.
How can attention bias influence the maintenance of depression?
Individuals with depression may pay more attention to negative or self-critical thoughts and information. They may focus on perceived failures or negative aspects of their life. This constant rumination on negative aspects can deepen feelings of sadness or hopelessness.
"My brother is a total slob!" - is an example of what kind of distorted thinking?
Labelling
Emotional Mind vs. Reasonable Mind
Emotion Mind is when a person is overwhelmed by intense emotions, which can cloud judgment and lead to impulsive behaviour.
Reasonable Mind is when a person relies purely on logic and facts, often without considering emotions.
Why is it important to explore thoughts, feelings, behaviours, and perception in CBT?
By examining all four quadrants, a therapist gains a full understanding of how different aspects of a person's experience influence one another.
Many mental health issues, like anxiety or depression, involve negative feedback loops where one quadrant influences the others.
Focusing on just one quadrant may overlook other contributing factors.
By helping clients recognize how their thoughts, feelings, behaviours, and physical sensations interact, CBT provides them with greater insight and control over their experiences.
Each individual may experience their symptoms differently, and one quadrant may be more prominent in some people’s experience than others.
What is mind reading?
A cognitive distortion in which you are assuming others are constantly thinking negatively about you.
Can you give some examples of distress tolerance techniques?
Distraction / Self-soothing / Improving the moment using imagery and relaxation / Radical acceptance of reality in the moment
Your client says "My coworker I have been training keeps doing all the tasks wrong! I must be a failure as a trainer. I should have brushed up on my own training and adjusted my approach to help them better. I bet if I wasn't so awful they would do better." - Explain how and why CBT would support this client.
CBT is short-term, finding a solution to the issue quickly. This client also appears to be experiencing a lot of guilt, shame, and anxiety that are all contributing to some heavy cognitive distortions that CBT is equipped to untwist. CBT helps to illuminate a client’s cognitive distortions and core beliefs, in addition to providing methods to update thinking that is more accurate and useful.
"I only got the job because my mom knows the owner, not because of my skills or education." - is an example of what cognitive distortion?
Disqualifying the positive
Your client comes in with this presenting topic: "During arguments or intense emotions I'm prone to getting overly emotional and exploding at others. I say things I don't mean, cry, can't think clearly, and tend to storm away or avoid others." Explain why DBT may be supportive for this client.
DBT would be suitable based on the client’s goal to regulate emotions, to respond versus react during conflicts, and to improve their relationships.
DBT is developed specifically to work with clients struggling with intense emotions and use specific skills/techniques to work on emotion dysregulation, reactivity, and interpersonal conflicts.
What are the 3 key pieces needed in a CBT session outline?
• Counselling Techniques
• Psycho-education
• Action Plan / Homework
What is an example of personalization?
Example: "You don't like the dinner I made, I guess I'm just the worst mom in the world." (There could be lots of different correct answers here)
Your client is struggling to regulate their emotions, communicate with their partner, respond rather than react to others, and have a very avoidant attachment style. What are some DBT skills you would use to work with them?
Mindfulness:
Helping the client to become more self-aware and skillful in their relationships by mindfully observing their thoughts, feelings, and physical sensations before, during, and after conflicts.
Emotion Regulation:
Teaching the client about their Window of Tolerance helps them to identify habitual patterns and build strategies to manage dysregulation moving forward. (e.g. grounding and opposite attraction)
Distress Tolerance:
Exploring effective distress tolerance skills would help the client learn to cope with uncomfortable feelings and reduce impulsive, reactive behaviours which create negative consequences in their relationship.
Distraction activities:
Engage in activities that require thought and concentration. This could be a hobby, a project, work, or school.
Interpersonal Effectiveness:
DBT would be a good fit to help the client acquire more effective interpersonal skills, and help to minimize reactive behaviours or say things they will later regret.
Hypothetically, you have completed the intake and first 2 sessions with a client. This includes a PSA, rapport building, and identifying the goal of counselling. The goal for session 3 is to understand cognitive distortions, emotions, and thinking patterns. What could this session outline look like? (Ex. Techniques, Psycho-ed, Homework?)
• Psycho-education:
Explain the relationship between thoughts, emotions, behaviours. Define cognitive distortions
• Counselling Techniques:
Help the client identify their automatic thoughts, emotions, and behaviours related to their challenge. Explore some of their cognitive distortions. Discuss the impact of those cognitive distortions on their feelings and behaviour.
• Action Plan / Homework:
Provide client with a tracking sheet where they can document their automatic thoughts, emotions, and behaviours this week in relation to the challenge they brought to therapy.
What is the purpose of a "thought record"?
To monitor and challenge negative or unhelpful thoughts
What does DEARMAN stand for?
Describe, Express, Assert, Reinforce, Mindful, Appear, Negotiate
What are the three categories core beliefs are often divided into?
Beliefs about oneself
Beliefs about others
Beliefs about the world
What is emotional reasoning?
Emotional reasoning is a cognitive distortion where individuals believe that their emotions reflect objective reality
What does GIVE stand for?
Gentle, Interested, Validate, Easy
What are the four quadrants of CBT?
thoughts, feelings, behaviors, and physical sensations
"I made a small mistake today, I know I'm going to get fired and become homeless when I go in tomorrow!" - Is an example of what?
Catastrophizing
What does FAST stand for?
Fair, Apologies, Stick to Values, Truthful
Bonus Narrative Therapy Question: What does narrative therapy primarily challenge in people's lives?
Their Dominant Stories