Core Beliefs on Trial -...

Handout for the Neuroscience Education Institute (NEI) online activity:

Core Beliefs on Trial: A Cognitive Therapy Approach for

Psychopharmacologists

Irismar Reis de Oliveira, MD Department of Neurosciences and Mental Health

Post-Graduation Program, Federal University of Bahia, Brazil

Copyright © 2011 Irismar Reis de Oliveira. All rights reserved.


Learning Objectives

After participating in this webinar, participants

should be able to:

• Explain the cognitive model to the patient according to

the Trial-Based Cognitive Therapy (TBCT)

conceptualization diagram

• Describe the role of the Trial-Based Thought Record

(TBTR) in changing patients' core beliefs

• Describe the main research findings supporting the

efficacy of TBTR


1. Important definitions • Automatic thoughts, underlying assumptions, and core

beliefs

2. Conceptualization diagram • Circuits hypothesis

3. Trial-Based Thought Record • Obsessive-Compulsive Disorder

• Panic disorder

4. Research • Trial-Based Thought Record

o First use

o Social anxiety disorder

Trial-Based Cognitive Therapy


• A generally short-term psychotherapy model

o Developed by Aaron Beck at the University of Pennsylvania

o Goal-directed

o Present-oriented

o Based on the cognitive model of psychopathology and learning

theory

• Emphasis on:

o Current thoughts, emotions, and behaviors

o Undoing old learning and teaching new behaviors

What is cognitive therapy?


Important Definitions

• Automatic thoughts

• Underlying assumptions

• Core beliefs


Automatic Thoughts

• Perceptions that occur rapidly in response

to a situation

• Are not subjected to systematic, logical

analysis

• A person may be unaware of their presence

or significance

• May or may not be distorted


Cognitive Distortion Definition Example

1 Dichotomous thinking (also

called “all-or-nothing” or

“black and white”)

I view a situation, a person, or an event

only in all- or-nothing terms, fitting them

into only 2 extreme categories instead of

on a continuum.

“I made a mistake, therefore I’m a failure.” “I ate

more than I planned, so I blew my diet completely.”

2 Fortune telling (also called

“catastrophizing”)

I predict the future in negative terms and

believe that what will happen will be so

awful that I will not be able to stand it.

“I will fail, and this will be unbearable.” “I’ll be so

upset that I won’t be able to concentrate for the

exam.”

3 Discounting or

disqualifying the positive

I disqualify and discount positive

experiences or events, insisting that they

do not count.

“I passed the exam, but I was just lucky.” “Going to

college is not a big deal; anyone can do it.”

4 Emotional reasoning I believe my emotions reflect reality and let

them guide my attitudes and judgments.

“I feel she loves me, so it must be true.” “I am

terrified of airplanes, so flying must be dangerous.”

5 Labeling I put a fixed, global label, usually negative,

on myself or others.

“I’m a loser.” “He’s a rotten person.” “She’s a

complete jerk.”

6 Magnification/minimization I evaluate myself, others, and situations,

magnifying the negatives and/or

minimizing the positives.

“I got a B. This proves how inferior I am.” “I got an A.

It doesn’t mean I’m smart.”

7 Selective abstraction (also

called “mental filter” and

“tunnel vision”)

I pay attention to one or a few details and

fail to see the whole picture.

“My boss said he liked my presentation, but since he

corrected a slide, I know he did not mean it.” “Even

though the group said my work was good, one

person pointed out an error so I know I will be fired.”

Definitions and Examples of 15 Cognitive Distortions


Underlying Assumptions

• Conditional rules or “should” statements used

to guide our behavior, emotional expression,

and understanding of how the world operates

(Padesky & Greenberger, 1995)

• Usually expressed as “if… then…” statements

o “If I go to the party, then people will know I am

awkward.”


Core Beliefs

• Also sometimes called “schemas”

• Are global, rigid, and fundamental beliefs that people

have about themselves, the world, and/or the future

• Influence the types of thoughts (cognitions) that people

experience in specific situations

o “I am incompetent” will likely predict that he will be unable to

function adequately during a job interview

o “I am unlikable” will likely predict that others will not be interested

in what she has to say at a social gathering

o As a result, both of these people would likely experience a great

deal of social anxiety


Cognitive Model

Situation Automatic thoughts

Underlying assumptions

Emotions

Behaviors

Physiological

responses

Core beliefs

(Schemas)


Situation Automatic thoughts

Underlying assumptions

Emotions

Behaviors

Physiological

responses

Core beliefs

(Schemas)

1st level

2nd level

3rd level

A More Complex Cognitive Model




beliefs



• Panic disorder


o First use



TBCT Conceptualization Diagram

Same components as standard cognitive therapy, but…


TBCT Conceptualization Diagram Phase 1: Before Treatment

Negative core beliefs predominantly activated

Situation

Automatic thought

Emotional reaction

Behavioral and/or

physiological response

Activated negative core belief

1st level

-

Schema activation


TBCT Conceptualization Diagram Phase 1

Situation

Automatic thought

Emotional reaction

Behavioral and/or


1st level

Circuit 1

Circuit 1

Automatic Thought → Emotion→

Behavior and/or Physiological Response

→ Automatic Thought



Situation

I am invited to a party

I will be criticized

Anxious

I do not go to the

party

Automatic thought

Emotional reaction

Behavioral and/or


1st level


John’s TBCT Conceptualization Diagram Phase 1

Situation


I will be criticized People will find me awkward

Anxious More anxious I do not go to the

party I avoid people

Automatic thought

Emotional reaction

Behavioral and/or


1st level



Situation

I am not invited to a new party

People really find me awkward

Anxious

I continue to avoid people

Automatic thought

Emotional reaction

Behavioral and/or


1st level



Situation

I am not invited to a new party

People really find me awkward

Anxious I continue to avoid

people

Automatic thought

Emotional reaction

Behavioral and/or


I am awkward


1st level



Situation

Automatic thought

Emotional reaction

Behavioral and/or


1st level

2nd level Modulation by underlying

assumptions Circuit 2

Circuit 2

Underlying Assumption → Safety Behavior →

[Automatic Thought]* → Emotion → Behavior and/or

Physiological Response → Underlying Assumption

*May not exist or may be implicit

Underlying assumptions/rules: Compensatory strategies/safety behaviors:



Situation


I will be criticized People think I am awkward Anxious

I do not go to the

party I avoid people

Automatic thought

Emotional reaction

Behavioral and/or


1st level

2nd level


Avoidance



Situation



I do not go to

parties I avoid people

Automatic thought

Emotional reaction

Behavioral and/or


1st level

2nd level Modulation by underlying

assumptions

Underlying assumptions/rules:

If I do not avoid people, then they will criticize me Compensatory strategies/safety behaviors:

Avoidance



Situation

Automatic thought

Emotional reaction

Behavioral and/or



Inactive positive

core belief

1st level

2nd level

3rd level

Modulation by underlying assumptions

Circuit 3


Relevant childhood data for: 1) Negative core belief 2) Positive core belief




Inactive positive

core belief

1st level

2nd level

3rd level


Circuit 3

Circuit 3

Underlying Assumption → Safety

Behavior → Core Belief → Underlying

Assumption





Situation



I do not go to


Automatic thought

Emotional reaction

Behavioral and/or


I am awkward


Inactive positive

core belief

1st level

2nd level

3rd level


Circuit 3



Avoidance




Situation



I do not go to


Automatic thought

Emotional reaction

Behavioral and/or


I am awkward


Inactive positive

core belief

1st level

2nd level

3rd level




Avoidance




Phase 2: During Treatment

Positive core belief activation with TBCT


Situation

Automatic thought

Emotional reaction

Modulation by underlying

assumptions

Behavioral and/or


1st level

2nd level

3rd level

Inactive negative core belief

Activated positive

core belief

Circuit 3



Trial I Trial II.1

RG



Phase 3: After Treatment

Balance between positive and negative core belief activation


Situation

Automatic thought

Emotional reaction

I am

normal

Modulation by underlying

assumptions

Trial I and II

Behavioral and/or


1st level

2nd level

3rd level


Activated positive

core belief

CD-Quest IntraDTR InterDTR

CRP and behavioral experiments Underlying assumptions/rules: Compensatory strategies/safety behaviors:







beliefs



• Panic disorder


o First use



Literary Work


Trial-Based Thought Record (Trial I)

• Designed to change core beliefs or schemas

• Inspiration from Franz Kafka’s surreal novel The Trial

o Self-accusation as a universal principle?

• Analogy or metaphor to a judicial process

o Inquiry (downward arrow)

o Prosecutor’s plea (evidence supporting the core belief)

o Defense attorney’s plea (evidence not supporting the core belief)

o Prosecutor’s response to the defendant’s plea (discounting the evidence)

o Defense attorney’s response to the prosecutor’s plea (sentence reversal)

o Jurors’ verdict (debriefing)

o Preparation for the appeal (upward arrow and positive self-statements log) as homework

Where is the defense attorney?


I believe in the accusation: Emotion:

1. Inquiry

2. Prosecutor’s

plea

3. Defense

attorney’s plea

4. Prosecutor’s

response (but…)

5. Defense

attorney’s response (Sentence reversal)

6. Meaning of the

response: “It means

that…”

7. Juror

Who was more convincing? Who presented more evidence? Whose

evidence was more based on facts? Who made fewer

(cognitive) distortions?

Downward arrow

(core belief)

I am...

Automatic thoughts:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

Verdict:

Upward arrow

(new core belief)

I am...



I believe in the accusation: Emotion:

1. Inquiry

2. Prosecutor’s

plea

3. Defense

attorney’s plea

4. Prosecutor’s

response (but…)

5. Defense

attorney’s response (Sentence reversal)

6. Meaning of the

response: “It means

that…”

7. Juror

Who was more convincing? Who presented more evidence? Whose

evidence was more based on facts? Who made fewer

(cognitive) distortions?

Downward arrow

(negative core belief)

I am...

Automatic thoughts:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

I believe: Emotion:

Verdict:

Upward arrow

(positive core belief)

I am...

Deconstructive language

Constructive language



Defense Attorney’s Preparation for the Appeal (Positive Self-Statements Log)

I am... (positive belief derived from the upward arrow technique)

Date (90%) 1.

2.

3.

Date ( %) 1.

2.

3.

Date ( %) 1.

2.

3.

Homework Assignment


Case Report

Obsessive Compulsive Disorder and Borderline Personality Disorder

Described in the Common Language for Psychotherapy Procedures

http://www.commonlanguagepsychotherapy.org/



Case Illustration

Ida, married and in her 30s, had been anxious,

angry, and aggressive for 3 years. She had

difficulty dealing with subordinates (she was a

manager in a company) and went on sick leave.

Her depression worsened. Ida could not resume

work and stopped her master’s degree studies.

She mutilated herself and attempted suicide due

to severe anxiety, which did not reduce with

antidepressants and high doses of

benzodiazepines.

Her benzodiazepines were tapered and

replaced with quetiapine. She also had weekly

cognitive restructuring of beliefs such as “I’m a

failure, incompetent, and inadequate” by

examining evidence for and against them.

Though her anxiety decreased, external events

reactivated her beliefs, and she mutilated

herself again.


Case Illustration (cont.)

Six months before the session yielding the Trial

session described in this presentation, Ida

started to repeatedly verify her wallet for hours

daily, checking 13 items by touching and reading

each word in the documents and cards.

Intensive exposure, ritual prevention, and

cognitive restructuring therapy (2‒3 weekly

sessions to a total of 18 sessions) stopped her

checking within 2 months.



INQUIRY

(downward

arrow

technique)

PROSECUTOR

(evidence

supporting the

accusation)

DEFENSE

ATTORNEY

(evidence not

supporting)

PROSECUTOR’S

RESPONSE

(yes, but...)

DEFENSE ATTORNEY’S

RESPONSE

(sentence reversal)

IT MEANS

THAT...

JUROR

(debriefing)

I am not

succeeding in

studying

I am too anxious

I will not finish

my master’s

degree course

ACCUSATION:

I AM

IMPERFECT

EMOTION:

ANXIETY

Initial Final

100%

100%

I’ve lost control

of my whole life

I can’t absorb

information

quickly

I’m slow at

reasoning

I don’t do well

when interacting

with people and

controlling my

environment

100%

100%

1. I don’t check my

driver’s license,

and I haven’t lost

control

2. My OCD score fell

today

3. I can remember

some techniques

without having to

reread the book

4. I’m completing the

evidence chart

80%

80%

1. I check on other

items

2. I’m not cured

3. I can’t remember

them all.

4. I still believe I’m

imperfect

90%

90%

1. I check on other items, BUT

I don’t check my driver’s

license and haven’t lost

control

2. I’m not cured, BUT my OCD

score fell today

3. I can’t remember them all,

BUT I can remember some

of the techniques without

having to reread the book

4. I still believe I’m imperfect,

BUT I’m completing the

evidence chart

1. I can stop

myself

checking

2. I can cure

myself

3. I can learn

4. I see the

other side of

my

imperfection

(that I am

normal)

70%

70%

___________

VERDICT:

TBTR: Described in the Common Language for Psychotherapy Procedures


INQUIRY

(downward

arrow

technique)

PROSECUTOR

(evidence

supporting the

accusation)

DEFENSE

ATTORNEY

(evidence not

supporting)

PROSECUTOR’S

RESPONSE

(yes, but...)


RESPONSE

(sentence reversal)

IT MEANS

THAT...

JUROR

(debriefing)

I am not

succeeding in

studying

I am too anxious

I will not finish

my master’s

degree course

ACCUSATION:

I AM

IMPERFECT

EMOTION:

ANXIETY

Initial Final

100%

100%

I’ve lost control

of my whole life

(A)

I can’t absorb

information

quickly (C)

I’m slow at

reasoning (C)

I don’t do well

when interacting

with people and

controlling my

environment (B,

C)

100%

100%


driver’s license


control


today

3. I can remember

some techniques

without having to

reread the book


evidence chart

80%

80%

1. I check on other

items (B)

2. I’m not cured (B)

3. I can’t remember

them all (B)


imperfect (B)

90%

90%

1. I check on other items, BUT

I don’t check my driver’s


control


score fell today


BUT I can remember some

of the techniques without

having to reread the book



evidence chart

1. I can stop

myself

checking

2. I can cure

myself

3. I can learn

4. I see the

other side of

my

imperfection

(that I am

normal)

70%

70%

The prosecutor

made errors:

overgeneraliza

tion (A),

discounting

positives (B),

and all-or-

nothing

thinking (C)

The defense

attorney

made no

distortions and

gave fairer and

more

consistent

arguments

___________

VERDICT:

55%

55%

Innocent




Upward Arrow Technique

T: If the defense attorney’s statements

are right, what do they mean about

you?

P: I AM NORMAL!

De-Oliveira IR (2007) Sentence-reversion-based thought record (SRBTR): a new strategy to deal with “yes,

but...” dysfunctional thoughts in cognitive therapy. European Review of Applied Psychology, 57:17-22.

Date (60%)

1. I succeeded in

conquering the

driver’s license

2. I managed to

conquer the student

card

3.

Date ( %)

1.

2.

3.

Date ( %)

1.

2.

3.

Homework Assignment Defense Attorney’s Preparation for the Appeal (Positive Self-Statements Logs)

I am normal (positive belief derived from the upward arrow technique)



INQUIRY

(downward

arrow

technique)

PROSECUTOR

(evidence

supporting the

accusation)

DEFENSE

ATTORNEY

(evidence not

supporting)

PROSECUTOR’S

RESPONSE

(yes, but...)


RESPONSE

(sentence reversal)

IT MEANS

THAT...

JUROR

(debriefing)

I am not

succeeding in

studying

I am too anxious

I will not finish

my master’s

degree course

ACCUSATION:

I AM

IMPERFECT

EMOTION:

ANXIETY

Initial Final

100% 40%

100% 40%

I’ve lost control

of my whole life

(A)

I can’t absorb

information

quickly (C)

I’m slow at

reasoning (C)

I don’t do well

when interacting

with people and

controlling my

environment (B,

C)

100%

100%


driver’s license,


control


today

3. I can remember

some techniques

without having to

reread the book


evidence chart

80%

80%

1. I check on other

items (B)

2. I’m not cured

(B)

3. I can’t

remember them

all (B)


imperfect (B)

90%

90%

1. I check on other items, BUT I

don’t check my driver’s


control


score fell today


BUT I can remember some of

the techniques without having

to reread the book



evidence chart

1. I can stop

myself

checking

2. I can cure

myself

3. I can learn

4. I see the

other side of

my

imperfection

(that I am

normal)

70%

70%

The prosecutor

made errors:

overgeneralization

(A), discounting

positives (B), and

all-or-nothing

thinking (C)

The defense

attorney

made no

distortions and

gave fairer and

more consistent

arguments

___________

VERDICT:

55%

55%

Innocent


I am a capable person

I am normal I am assertive

I am a truthful person

I am lovable I am a reasonable person

11/10 – 40%

1. I sent comments to my supervisor

2. I reviewed a thesis

11/10 – 60%

11/10 – 40%

1. I sent comments to my supervisor

2. I reviewed a thesis

11/10 – 50% 11/10 – 60%

1. My husband told me I was the most important person for him

11/10 – 50%

1. I gave a telephone call to R

12/10 – 45%

12/10 – 60%

1. I woke up feeling well

12/10 – 45%

1. I sent a card to my goddaughter

12/10 – 55%

1. I told my mother I would not have lunch with her today

12/10 – 60%

12/10 – 55%

1. I sent a card to my goddaughter

13/10 – 50%

1. I got to limit my OCD rituals

2. I was able to leave the bedroom this morning

13/10 – 60%

13/10 – 50%

1. I got to limit my OCD rituals

13/10 – 55%

13/10 – 60%

1. My husband gave me support while I was feeling pain

13/10 – 60%


Homework Assignment


Case Report

Panic Disorder

Described in the Common Language for Psychotherapy Procedures

http://www.commonlanguagepsychotherapy.org/


Case Illustration

Two weeks before consulting a psychiatrist, Karen,

age 28, developed panic attacks and stopped

going out alone for fear of further panics. Panic

attacks vanished for a whole year within weeks of

starting escitalopram and clonazepam, but

returned after drug discontinuation; resuming

those medications no longer helped.

Karen’s panic attacks improved dramatically with 2

sessions of cognitive restructuring and

interoceptive exposure, and she was able to

resume normal activities.

Karen remained well during a year, even not taking

any medication. Then, during a stressful period,

Karen started fearing new panic attacks, and

worrying about health problems and dying. She

was no longer able to go out alone.



INQUIRY

(downward

arrow

technique)

PROSECUTOR

(evidence

supporting the

accusation)

DEFENSE

ATTORNEY

(evidence not

supporting)

PROSECUTOR’S

RESPONSE

(yes, but...)


RESPONSE

(sentence reversal)

IT MEANS

THAT...

JUROR

(debriefing)

I have several

chronic diseases

that can lead to

sudden death.

A psychological

disorder may

evolve into a

physical

disease.

ACCUSATION:

I AM

VULNERABLE

EMOTION:

SAD

Initial Final

70%

50%

My grandfather

died suddenly.

I have a genetic

predisposition,

and I can also

die.

My sister had an

infarction when

she was 13, due

to a viral

infection.

I have panic

disorder.

90%

80%

1) I have gone

through many

difficult situations,

and I always

survived.

2) I have never had

a serious disease; to

the contrary, I am

always the last to

become ill.

3) My eating habits

are healthy, I do

physical exercises,

and I visit the doctor

regularly.

50%

20%

1) … BUT I can go

through a worse

situation and not

survive.

2) ... BUT I may

have a physical

disease.

3) ... BUT I may

have a genetic

predisposition to a

physical disease.

90%

80%

1) I can go through a worse

situation and not survive, BUT

I have gone through many

difficult situations and I

always survived.

2) I may have a physical

disease, BUT I have never

had a serious disease; to the

contrary, I am always the last

to become ill.

3) I may have a genetic

predisposition to a physical

disease, BUT my eating

habits are healthy, I do

physical exercises, and I visit

the doctor regularly.

1)... the

expression “I can”

is abstract.

Indeed, I always

survived.

2) ... the

expression “I may”

is just an

assumption and,

in fact, I have

never had a

serious disease.

3) ... I have

always behaved in

the most careful

and preventive

way. 0%

0%

The defense

attorney

seems more

convincing and

presented

more evidence

based on facts.

The prosecutor

tends to make

more

distortions as

discounting

positives and

catastrophic

thinking.

___________

VERDICT:

0%

0%

Innocent




Upward Arrow Technique

54

T: If the defense attorney’s statements

are right, what do they mean about

you?

P: I AM NORMAL!

De-Oliveira IR (2007) Sentence-reversion-based thought record (SRBTR): a new strategy to deal with “yes,

but...” dysfunctional thoughts in cognitive therapy. European Review of Applied Psychology, 57:17-22.

Date.... (90%)

1. I came to therapy

by myself.

2. I took care of my

children this morning.

3.

Date ( %)

1.

2.

3.

Date ( %)

1.

2.

3.

Homework Assignment Defense Attorney’s Preparation for the Appeal (Positive Self-Statements Logs)

I am normal (positive belief derived from the upward arrow technique)



beliefs



• Panic disorder


o First use




Revista Brasileira de Psiquiatria, 30(1):12-18, 2008

Impact factor: 1.25

Trial-Based Thought Record: Preliminary data on a strategy to deal with

core beliefs by combining sentence reversion and the use of analogy

with a judicial process

Irismar Reis de Oliveira

Department of Neurosciences and Mental Health

Federal University of Bahia

http://www.scielo.br/scielo.php?pid=1516-4446&script=sci_serial





TBTR Applied to 30 Patients With Different Psychiatric Diagnoses

40,7

26,8

32,8

67,8

80,276,1

30,5

58,2

72,867,5

39,3

25,8

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

T1 T2 T3 T4 T5 T6

(%)

Belief

Emotion

Results: T1 – Inquiry T2 – Prosecutor T3 – Defense attorney T4 – Prosecutor’s response T5 – Defense attorney’s response T6 – Verdict by the juror T1-T3, p < 0,001 (B and E) T1-T6, p < 0,001 (B and E) T1-T6, p < 0,001 (B and E) T3-T5, p = 0,009 (B and E) T5-T6, p = 0,005 (B) T5-T6, p = 0,02 (E) Kruskal-Wallis and Wilcoxon’s Signed Rank Test B= Belief E= Emotion


Efficacy of the Trial-Based Thought Record,

a New Cognitive Therapy Strategy Designed To

Change Core Beliefs, in Social Phobia:

A Randomized Controlled Study

De Oliveira et al. (2011)

Journal of Clinical Pharmacy and Therapeutics (in press)


Results Assessed for eligibility: n = 77

Randomized: n = 47

Excluded: n = 30 Not meeting inclusion criteria or meeting exclusion criteria

Allocated to TBTR: n = 25 Allocated to conventional: n = 22

Dropouts before intervention: n=3

Received allocated intervention: n = 19 (intention-to-treat analysis) Completers analysis: n = 14

Dropouts before intervention: n = 8

Received allocated intervention: n = 17 (intention-to-treat analysis) Completers analysis: n = 16


Social phobia scale, social avoidance and distress scale, fear of negative evaluation scale, Beck anxiety

inventory, and clinical global impression-improvement at baseline and week 14 in the groups*

TBTR (n= 17) Conventional (n= 19) P**

Social phobia scale (Liebowitz, 1987) Baseline Final P***

86.82 (28.23) 54.94 (32.17)

0.000

82.58 (24.31) 61.63 (25.37)

0.000

0.64 0.49

Social avoidance and distress scale Baseline Final P***

21.88 (6.32) 12.18 (8.43)

0.000

22.05 (4.22) 17.47 (6.57)

0.000

0.92 0.04

Fear of negative evaluation Baseline Final P***

23.76 (5.87) 17.41 (7.08)

0.003

26.16 (4.27) 24.95 (5.65)

0.19

0.17

0.001

Beck anxiety inventory Baseline Final P***

18.76 (9.40) 7.12 (5.66)

0.000

21.21 (12.53) 11.32 (11.22)

0.000

0.52 0.17

CGI-I Baseline Final P***

4.06 (1.09) 1.82 (1.13)

0.000

4.11 (1.15) 2.21 (1.08)

0.000

0.90 0.30

*Intention-to-treat analysis **Independent-samples t-test ***Paired-samples t-test


Conclusion

• In this study, TBTR seemed to be:

o as efficacious as conventional CBT regarding Liebowitz Social Anxiety Scale and Beck Anxiety Inventory scores;

o more efficacious than conventional CBT regarding Fear of Negative Evaluation and Social Avoidance and Distress Scale scores

• Results support other studies of TBTR in social anxiety disorder and other psychiatric disorders




Techniques/Diagrams/Forms Session

TBCT Conceptualization Diagram All sessions

Cognitive Distortions Questionnaire (CD-Quest) All from session 2 on

Intrapersonal Thought Record (IntraTR) Any from session 2 or 3 as needed

Interpersonal Thought Record (InterTR) Any from session 2 or 3 as needed

Consensus Role-Play (CRP) Any from session 3 or 4 as needed

Responsibility Grid (RG) Any session (as needed) for guilt/shame

Trial-Based Thought Record (TBTR or “Trial I”) Usually from session 5 on

Trial II.1 Usually from session 7 on

Trial II.2 (Trial-Based Empty Chair) Usually from session 8 on

Core Beliefs on Trial -...

Documents

Transcript of Core Beliefs on Trial -...