Cbt Case Conceptualization and Treatment

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  • Topic: Cognitive therapy, Psychology, Cognitive behavioral therapy
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CBT Case Conceptualization and Treatment

Case Conceptualization

The basic premises of all CBT models are
• that cognition, emotion and behavior are reciprocally related; • that perceiving and experiencing are active processes that involve both experiencing the world as it is (sensory input, essentially) and interpreting the world (meaning-making); • that meaning-making is related to prior learning – often social learning; • that a person can learn to become aware of the interaction of cognition, emotion, and behavior; and that altering the ones that may be more directly under our control or influence – cognition and behavior – will impact the person’s responses on all levels. • Further, CBT models uniformly propose that basic or core beliefs acquired early in childhood evolve into a cognitive map of the world (schema or apperceptive mass or phenomenal field) that affects not only the information the person pays attention to (a cognitive filter, creating expectancies) but also how they explain what happens to them and others (their attributions).

Core beliefs or schema are usually unquestioned underlying assumptions about the world which the person takes as givens, and may be fairly accurate, flexibly responsive to incoming information, varying with time and situation, and thus adaptive. However, maladaptive schema tend to be irrational (unscientific, illogical), to be based on incomplete or incompletely understood information, to be rigidly adhered to across situations, and to be resistant to change despite conflicting information or experience.

Basic beliefs or schema are revealed by consistent patterns of cognition, behavior, and emotional response across situations. Long-standing maladaptive/irrational beliefs are evident in automatic thoughts/intermediary beliefs that form the stream of consciousness of the individual. When a person is seriously distressed, these automatic thoughts are likely to be characterized by predictable errors in interpreting experience.

CBT approaches attempt to reduce the occurrence of the fundamental attribution error – erroneously attributing events to global, stable, internal dispositions when they might more accurately be attributed to specific, temporary, external factors in the situation itself – as well as other errors of appraisal and prediction, using cognitive interventions, and to alter maladaptive or impractical behaviors using various behavioral interventions. What each variety of CBT attends to, and how it attempts to bring about change, varies mildly to moderately within this general description.

A case conceptualization based on Beck’s Cognitive Therapy approach would focus on cognitions about self, world, and future, and address common cognitive errors made by individuals with the patient’s particular disorder/diagnosis. A formulation from this perspective should describe the patient’s negative cognitive triad composed of dysfunctional cognitive schema or core beliefs about self, world/others, and future along the lines of Self: I'm worthless.

I’m not good enough.
I am damaged.
World: I must not disappoint my family.
People can’t be trusted.
The world is a threatening place.
The world is unfair (and should be fair).
Men are dangerous.
Women will betray you.
Future: It’s hopeless.
I will never be loved.
I will never be happy.
My whole life is ruined.
I’m stuck; it’s impossible to solve my dilemma. It will always be this way

Intermediate beliefs may be couched as if-then statements, such as: Self: I must be perfect in order to be accepted.
If something goes wrong, it’s all my fault.
World/Others: If you don’t respond to me, you must hate me.
If you are not for me, you are against me.
If you are angry, I cannot stand it.
Future: If I don’t get into...
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