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PSYCH LEC
[9] COGNITION AND BELIEF
| Term | Definition 1 | Definition 2 |
|---|---|---|
| COGNITION | ● Your drive of doing something ● Involves processes that are associated with perceiving, making sense of, and using information ● Best understood by examining its components | |
| COGNITION & PSYCHIATRIC DISABILITIES | ● DEMENTIA ● ADHD ● SCHIZOPHRENIA ● ATTENTION PROBLEMS ● BIPOLAR DISORDER ● DEPRESSION | |
| DEMENTIA | ○ Progressive ○ Alzheimer’s Dementia | |
| Alzheimer’s Dementia | ■ Impaired recall memory | |
| ADHD | ○ Executive Dysfunction ■ Contributes to academic difficulties of patients | |
| DEPRESSION | ○ Problems in cognition happens in acute stage, as the disease progresses, the cognitive state stays the same | |
| COMPONENTS OF COGNITION | ● Memory ● Attention ● Executive Function | |
| Memory | ○ One of the most basic cognitive functions | |
| Attention | ○ Efficiently using cognitive resources to take in the information needed to accomplish a task ○ If you try to comprehend everything, this would lead to cognitive overload. You need to choose important factors you should focus on. | |
| Other factors contribute to deficits in attention, such as | preoccupied mind, sleep deprivation, etc. | |
| Executive Function | ○ High-level thinking skills that help a person plan, think flexibly, regulate behavior, and manage complex tasks | |
| AUTOMATIC PROCESSING | ● It is unintentional. ● Activity or task is done without conscious awareness ● Automatic tasks are highly familiar and practiced ● It does not interfere with other mental activity | ● Adaptive and allows you to perform more tasks more efficiently and it facilitates the development of order and routine in life. |
| CONTROLLED PROCESSING | ● Intentional, effortful, and conscious. ● Requires individual to deliberately allocate cognitive resources ● Highly unstable or irregular tasks such as social interaction can never fully be automatic | |
| SELECTIVE ATTENTION | ● Sorting out and focusing on the relevant sensory stimuli in the environment ● This is important because you will get easily overwhelmed with all the stimulus in your environment | |
| Filter theory by Broadbent: | There is a limit to the amount of information a person can attend to at any one point in time (not lifetime). | |
| Attenuation Theory by Treisman: | Alin sa mga stimulus yung bibigyan mo ng attention ○ This states that unattended information is not totally blocked, but is turned down. Some unattended information is weaker, but is turned down. | |
| DIVIDED ATTENTION | ● Move back and forth between the two tasks ● One of the two tasks is automatic and does not require conscious cognitive effort ● Specific practice performing the two tasks together | |
| VIGILANCE | ● Ability to sustain attention over time ● Requires that the individual maintain a readiness to respond to a target stimulus ● Always on guard ● You are looking for specific cues | |
| VIGILANCE Strategies: | take frequent breaks, limit area to a certain portion of the workspace, increase contrast/make stimulus more observable | |
| SHORT TERM MEMORY | ● Held for only a matter of seconds to minutes ● Capacity for about 7 (+/-2) by Miller ● If not rehearsed, information in short term memory is lost in about 20 seconds ○ Can turn into long term memory when repeatedly rehearsed | |
| SHORT TERM MEMORY Strategies: | Mental rehearsal, chunking | |
| LONG TERM MEMORY | ● Capacity is unknown, unquantifiable through minutes ● Accumulation of knowledge throughout your lifetime ● Repeatedly applied | |
| SEMANTIC MEMORY | ● General knowledge, facts, lessons, etc. ● Should be applied to make it long term memory ● Tends to be created and forgotten relatively easy. | |
| Deep processing | is a strategy that involves finding meaning in facts, resulting in better remembering. | |
| EPISODIC MEMORY | ● Events that happened to you ● Portrayed by sequence of how the task happened to you | |
| PROCEDURAL MEMORY | ● Memory about how to do something → process ● Takes longer to be created and is less susceptible to errors. ○ Important to incorporate repeated practice to establish new procedural memories ● More implicit = less consciously accessible | |
| WORKING MEMORY | ● Short-term memory storage and active manipulation of new information ● Actively using the information you need to remember ● Remembering rules/information necessary while performing a task | ● All these three must be present in the task for it to be working memory (active recall is not enough to be called working memory) - Phonological Loop - Visuospatial Sketchpad - Central Executive |
| PHONOLOGICAL LOOP | ● Analogous to inner speech or what you do when you talk to yourself through task | |
| VISUOSPATIAL SKETCHPAD | ● Involves visual input around the objects you’re locating and yourself ● Spatial Orientation and Problem solving within the task through a mental map | |
| CENTRAL EXECUTIVE | ● Oversees the whole process, choosing, and directing the flow of information ● Moves information in and out of short-term memory and integrates new information that is coming in with long-term memory stores. | |
| EXECUTIVE FUNCTIONS | ● Require a level of awareness and conscious effort ● Depends on the context | |
| concept | Basic unit of knowledge | |
| CONCEPT FORMATION AND CATEGORIZATION | ● Established to cover a person’s knowledge base ● When creating categories, people define the features of the category around prototype | ● E.g., Clothing is categorized when it is cold or hot and appropriate to wear to works vs. going out on friday night. |
| Schema: | Mental representations that create structure out of related concepts | |
| Script: | type of schema that describes the sequence of events that would that occur in a familiar activity | |
| SCHEMA AND SCRIPT | ● This is important to people because this helps us integrate information. However, it can fool our memory because it happens all the time. | |
| PROBLEM SOLVING | ● What a person use to reach a certain goal, but one cannot immediately figure out the best pathway to the goal ● Involves overcoming obstacles that interfere with goal attainment ● Must be exact with what you want them to learn | |
| PROBLEM SOLVING TUA: | Must innately have a problem | |
| 6 STEPS OF PROBLEM SOLVING | 1. Recognizing that there is a problem 2. Understanding the problem 3. Identifying strategies or solutions to resolve the problem 4. Evaluating the strategies 5. Selecting and carrying out a strategy 6. Evaluating the outcome | |
| STEPS OF PROBLEM SOLVING Evaluating the outcome | ● In this scenario, you are employing a facilitative leadership to challenge the client’s problem-solving skills | |
| DECISION MAKING | ● Activity full of choices | |
| Heuristics: | Simple rules of thumb that help people make decisions quickly. Can also lead to be biased or incorrect decisions. | |
| REPRESENTATIVENESS HEURISTIC | ● Heuristic ● People make decisions when something looks like a prototype or model you have come to expect ● People believe that random outcomes are more likely than orderly outcomes | |
| AVAILABILITY HEURISTIC | ● People estimate frequency or make decisions based on how easy it is to think of an example ● Familiarity influences decisions | ● E.g.: If you are sick recently after eating a food, you wouldn’t eat it again for the next few days but you might make a different decision in another 5 years. |
| ANCHORING AND ADJUSTMENT HEURISTIC | ● People start w/ an anchor, then make adjustments with additional information | ● E.g.: You estimated that you’ll be able to finish your output in 4 hours, but once 3 hours have passed and you still haven’t reached 50% of your work, you make an adjustment. |
| METACOGNITION | ● Awareness of what you know and what you don’t know ● Important regulatory mechanism because it helps you match your abilities with the task at hand | |
| ACL 1 | ● Awareness - Automatic Actions | Respond to pain 1.4 Locate Stimuli 1.6 Roll in Bed 1.8 Raise body parts |
| ACL 2 | ● Gross Body Movement - Postural Actions | 24-hr care for: Transfer ADLs |
| ACL 3 | ● Manual Actions - Repetitive Actions | Simple Tasks Self Care Tactile Cues Distracted |
| ACL 4 | ● Familiar Activity - Goal-Oriented | Visual Cues Supervision for Safety Fix cold meal/snack Walk to familiar places Reminders for chores Live alone - Daily |
| ACL 5 | ● Learning New Activity - Exploratory | New Learning Trial & Error Poor Judgement Impulsive Live Alone - Weekly |
| ACL 6 | ● Planning New Activity - Conceptual | Anticipates Error Plans Actions Desires & Priorities |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 1 | ● Subliminal cues (interoceptive functions such as thirst, hunger, pain, temperature) ○ No goal since you want sensory stimulation for arousal | |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 2 | ● Can perform Procedural Memory ● Demonstration is one movement at a time | |
| Procedural Memory | Automatic actions but needs cueing | |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 3 | ● They can be independent at their self-care tasks ● Unable to learn new skills/tasks, only performs familiar tasks | ● Teach what has only been taught and practiced before ○ Simple and repetitive tasks only ○ Familiar and procedural activities only (ADLs) ● Can demonstrate one full step at a time |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 4 | ● New learning and problem solving is still not possible ● Materials placed on where it is usually seen ● Cannot be left alone ● Demo 2 steps | ● No problem-solving components ● Activity compliance is sufficient ● Basta may visual cues, kaya niya gawin |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 5 | ● Can follow instructions already but not if it’s solely written (should have verbal cues as well) ● Can problem solve but still trial and error (cannot know and plan ahead) | ● Inductive Reasoning (Specific to General) ● Should have a tangible end product ● Exploration: Trial and Error, spontaneous, impulsive = accident prone |
| ALLEN’S COGNITIVE DISABILITY MODEL LEVEL 6 | ● Deductive Reasoning (Abstract Thinking) ● Our current level! | |
| BELIEF | ● Cognitive content held as true by or about the client ● Among the most primitive and central of mental construct ● Basic to learning, health, and overall psychological well-being | ● Beliefs and their dynamic interaction with emotions, physiologic reactions, behavior, and environment comprise human functioning ● “Paniniwala” ● You cannot correct this ● You do CBT, because you want to correct irrational beliefs |
| LAYERS OF BELIEF AUTOMATIC THOUGHTS | ● Surface, peripheral | |
| LAYERS OF BELIEF RULES FOR LIVING | ● Intermediate assumptions, values, conditional "if-then" rules, easier to test | |
| LAYERS OF BELIEF CORE BELIEFS OR SCHEMA | ● Template of absolutes about self, others, world; | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● Depression: | constitutes negative views about self, the world, and future | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● Anxiety Disorders: | explanation for chronic worrying seen in GAD | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● OCD: | intrusive thoughts and engagement in rituals or compulsions | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● Eating Disorders: | Assumptions about self and distortions related to eating | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● Conduct Disorders: | More likely to interpret the social environment as hostile | |
| IMPACT OF BELIEFS ON MENTAL HEALTH AND ILLNESS ● SRD, PD gf schizophrenia | ○ Substance-related disorders: I need to take this substance to feel good about myself ○ Schizophrenia: What I’m seeing is true so I need to do this ○ Negative belief about self, the world and the future | |
| STROOP TEST | ● Assesses attention and processing speed. Individuals read color words or name the color of the ink in which XXXs are printed | |
| TOWER OF LONDON | ● An executive function test that involves moving objects on a peg with the fewest moves to reach a desired goal. Requires planning and strategy use | |
| WECHSLER MEMORY SCALE | ● Eighteen subtests of immediate and delayed recall and recognition memory. ● Includes verbal and non-verbal tasks. | |
| WECHSLER ADULT INTELLIGENCE SCALE AND WECHSLER INTELLIGENCE SCALE FOR CHILDREN | ● includes multiple subtests that result in summary measures of full scale, verbal, and performance IQ ● Done by Psychometricians | |
| TEST OF EVERYDAY ATTENTION | ● Includes eight tasks, such as locating items on a map and searching a telephone directory ● Designed to measure selective, sustained, alternating, and divided attention ● Not available in the PH | |
| TEST OF EVERYDAY ATTENTION ● Test-retest reliability | adequate | |
| TEST OF EVERYDAY ATTENTION ● Target Population | ● The measure has norms for adults aged 18 to 80 | |
| MULTIPLE ERRANDS TEST ● Errands: | shopping – mostly western context | |
| MULTIPLE ERRANDS TEST | ● A measure of executive function that is administered in a shopping mall ● Designed to test strategy used in an ecologically valid setting ● More sensitive in neurological disorders ● Specific rules are established | ● Simple tasks are assigned, such as getting information about the times a particular service is available, purchasing items on a store, and getting oneself to identified location on pre-specified time |
| LOEWENSTEIN OCCUPATIONAL THERAPY COGNITIVE ASSESSMENT (LOTCA) | ● Assesses orientation, visual and spatial perception, visuomotor organization, and thinking operations | |
| LOTCA SCORING | ● Includes 26 subtests and takes 30 to 45 minutes to administer ● Each subtest is scored from 1 to 4 or 1 to 5 ● A higher score represents better functioning | |
| EXECUTIVE FUNCTION PERFORMANCE TEST (EFPT) | ● Performance-based standardized assessment of cognition and executive function ● Includes four-standardized instrument activity of daily living tasks (IADL) that the client perform with graded cues | ● You can only administer this test if the Cx has enough ability to understand and comprehend the instructions. You can do functional observation as an alternative. |
| EFPT ● Four-standardized instrument activity of daily living tasks (IADL) that the client perform with graded cues | ○ Cooking ○ Telephone use ○ Medication management ○ Bill paying | |
| EFPT ● Serves three purposes: | ○ To determine an individual's capacity for independent functioning ○ To determine which executive functions are impaired ○ To determine the amount of assistance necessary for task completion. | |
| CUEING HIERARCHY ● No Cues: | The participant completes the task independently. | |
| CUEING HIERARCHY ● Indirect Verbal Guidance: | Open-ended questions or reminders that encourage the person to think about the next step (e.g., "What do you need to do next?", "Is there anything you forgot?"). | |
| CUEING HIERARCHY ● Gestural Guidance: | Pointing or gesturing toward materials to guide the person. | |
| CUEING HIERARCHY ● Direct Verbal Assistance: | Specific, direct instructions on what action to perform (e.g., "Turn on the stove"). | |
| CUEING HIERARCHY ● Physical Assistance: | Hand-over-hand or light physical guiding to assist with movement. | |
| CUEING HIERARCHY ● Do for the Participant: | The evaluator completes the step because the participant cannot | |
| CONTEXTUAL MEMORY TEST (CMT) | ● Includes a subjective assessment of the individual's awareness of his or her memory ability and objective assessment of memory ● Discriminate Individuals with Alzheimer's disease and children with brain injury | |
| CONTEXTUAL MEMORY TEST (CMT) ● PART 1: | ○ Uses 20 drawings with either a restaurant or morning routine theme to assess recall memory ○ Each picture is presented for 90 seconds | ○ Individual is asked to recall as many items as possible ○ After 15 to 20 minutes, individual is asked to recall the items again |
| CONTEXTUAL MEMORY TEST (CMT) ● PART 2: | ○ Alternate theme of either restaurant or morning routine is presented ○ Instructed to analyze the overall context before attending to the specifics of the picture | |
| TOGLIA CATEGORY ASSESSMENT | ● Uses a dynamic approach to assess categorization and conceptualization using everyday objects ● Plastic utensils are sorted according to size (small or large), color (red, yellow, green), and utensil type (knife, fork, spoon) | ● If the individual has difficulty with sorting, cues are provided |
| ALLEN COGNITIVE LEVEL TEST (ACL) 1 | ● Uses a leather lacing task as a screening tool to determine cognitive level based on Allen’s Cognitive Disability Practice Model ● Has verbatim instructions, demonstrations, and questions to estimate the cognitive level and mode of the client | |
| ALLEN COGNITIVE LEVEL TEST (ACL) 2 | ● Comprised of 24 standardized craft projects with ACL ratings of 3.0 to 5.8 ● Craft activities can both be used for evaluation and treatment ● Specific observational criteria are established for each item | ● Limited in terms of psychometric reliability ● Assesses functional cognition associated with cognitive disability models ● Standardized assessment ● Performance-based ● 15-30 minutes to administer |
| ALLEN COGNITIVE LEVEL TEST (ACL) ● 3 Components | ○ Running Stitch ○ Whip Stitch ○ Single Cordovan Stitch | |
| ALLEN COGNITIVE LEVEL TEST (ACL) PROTOCOL 1 | 1. Persons may take as much time as they need to complete the stitching tasks. 2. Persons' requests to end the assessment at any time during the assessment are honored. | 3. Administrators encourage persons to progress through all stitching tasks, whether or not they complete three correct stitches in the preceding task. 4. Administrators provide no more than two demonstrations in each stitching task. |
| ALLEN COGNITIVE LEVEL TEST (ACL) PROTOCOL 2 | 5. Administrators may ask persons questions beyond those specified in the protocol to clarify inferences related to factors influencing the person's performance. | 6. Assessments that must be rescheduled due to interruptions should begin with Task 1: Running Stitch |
| ACL TASK 1: RUNNING STITCH | ● Introduction ● 1st demonstration ● 2nd demonstration | |
| TASK 1: RUNNING STITCH ● 1st demonstration | ○ Position tool ○ Read and demonstrate running stitch ○ Allow client to complete task ○ If completed, proceed to Task 2: Whipstitch | ○ Proceed to 2nd demonstration if client does not make an attempt to make a stitch. stops before completing 3 stitches, or makes errors and does not correct them |
| TASK 1: RUNNING STITCH ● 2nd demonstration | ○ Repeat same instructions in 1st demonstration ○ Whether client completes stitches or not, proceed to task 2 whipstitch | |
| TASK 2: WHIPSTITCH ● Criteria: | Person completes three correct | |
| TASK 2: WHIPSTITCH | ● Whipstitches in consecutive holes including recognizing and correcting (a) one Cross-in-back Error and (b) one visible Twisted Lace Error without removing the lace from the hole. | ● Introduction and position tool ● Check if client can tell difference between shiny and rough side |
| TASK 2: WHIPSTITCH ● 1st demonstration | ○ Position tool ○ Orient client to not twist the lace ○ Read and demonstrate whipingstitch ○ Allow client to complete task ○ If completed, proceed to introducing errors | ○ Proceed to 2' demonstration if client does not make an attempt to make a stitch, stops before completing 3 stitches, or makes errors and does not correct them |
| TASK 2: WHIPSTITCH ● Errors | ○ If during the 1* demonstration the client makes an error (skipping hole, making a running stitch cross-in-back error, or twisted lace error), allow them to recognize and correct the errors | |
| TASK 2: WHIPSTITCH ● Inserting Errors | ○ Cross-in-back Error ○ Twisted Lace Error | |
| Cross-in-back Error | ■ Insert the error out of sight of the client ■ Ask client to identify error and fix it ■ Do not provide additional problem solving cues | |
| Twisted Lace Error | ■ Insert the error in two whipstiches out of sight of the client ■ Ask client to identify the error and fix it ■ If they remove the laces, ask them to attempt to fix it without remove the laces | |
| TASK 3: SINGLE CORDOVAN STICH ● Criteria: | Person completes three correct | |
| TASK 3: SINGLE CORDOVAN STICH | ● Single Cordovan Stitches in consecutive holes. | |
| TASK 3: SINGLE CORDOVAN STICH ● Introduction and position tool | ○ Ask client to make three stitches without showing them ○ Do not provide problem-solving cues ○ If client makes mistakes and does not recognize error, ask them if they want help. | ○ If client says, "Yes". proceed with providing 1 verbal cue ○ If client says, "No", and completes 3 stitches, end the screening test ○ If client says, "No," and does not correct errors, proceed with 1st demonstration |
| TASK 3: SINGLE CORDOVAN STICH ● Verbal Cue | ○ Direct attention to error but do not provide a solution or non-verbal cue ○ Allow client time to recognize and correct error | |
| TASK 3: SINGLE CORDOVAN STICH ● 1st demonstration | ○ Read and demonstrate single cordovan stitch ○ Do not provide problem-solving cues ○ If no attempts are made even after encouragements, end the screening test | ○ If client makes mistakes and does not recognize error, ask them if they want help ○ If client says. "Yes", proceed with 2nd demonstration ○ If client says, "No", end the screening test |
| TASK 3: SINGLE CORDOVAN STICH ● 2nd demonstration | ○ Repeat same instructions in 1st demonstration ○ Do not provide problem-solving cues | |
| ROUTINE TASK INVENTORY (RTI-2) | ● Rates clients cognitive levels in ADLs using three perspectives to validate scores: self-report, therapist observation, and caregiver report | ● Scores are estimates of the cognitive level which are interpreted by the therapist according to specific guidelines |
| ROUTINE TASK INVENTORY (RTI-2) | ● Widely used screening tool for assessing cognitive function in older adults ● Assesses orientation, registration, attention, recall, and language | ● Quick measure that takes approximately 10- minutes to administer ● A score below 25 (out of 30) is generally considered indicative of cognitive impairment |
| CLOCK DRAWING TEST | ● Procedures instruct individuals to mark 1:00, 3:00, 9:15, and 7:30 on four pre-drawn clock faces ● One point is awarded for each correct placement of hand, and one point is given for drawing the different lengths of the minute and hour hand | |
| MONTREAL COGNITIVE ASSESSMENT (MOCA) | ● Designed as a RAPID SCREENING instrument for mild cognitive dysfunction. | |
| MONTREAL COGNITIVE ASSESSMENT (MOCA) ● It assesses: | attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. | |
| MONTREAL COGNITIVE ASSESSMENT (MOCA) ● Time to administer: | 10 minutes | |
| MONTREAL COGNITIVE ASSESSMENT (MOCA) ● Total possible score: | 30 points | ● A score of 26 or above is considered normal |
| DEMENTIA RATING SCALE-2 | ● Provides an easily administered and objectively scored measure of general cognitive ability for individuals suffering from brain dysfunction | |
| DEMENTIA RATING SCALE-2 population: | ● Norms are based on a sample of healthy adults ranging from 56 to 105 years of age | |
| DEMENTIA RATING SCALE-2 test: | ● Measures deficits in a wide range of higher cortical functions and differentiates varying levels of severity ● Tasks includes attention, initiation/perseveration, construction, conceptualization, and memory | |
| COGNITIVE PERFORMANCE TEST population: | ● Standardized functional assessment designed for the evaluation of Allen Cognitive Levels in persons having Alzheimer ’ s disease | |
| COGNITIVE PERFORMANCE TEST test: | ● Task on CPT are identified as dress, shop, toast, phone, wash, and travel ● Each specific task specifies standard equipment and procedures | |
| ROSS INFORMATION PROCESSING-GERIATRIC (RIPA-G) population: | ● Individually administered test assesses cognitive LINGUISTIC deficits in geriatric clients in skilled nursing facility | |
| ROSS INFORMATION PROCESSING-GERIATRIC (RIPA-G) test: | ● Completed in 45 to 60 minutes, supplement subtests in 10 to 20 minutes | |
| BECK DEPRESSION INVENTORY | ● 21-item self-report rating inventory that measures characteristic attitudes and symptoms of depression (Beck, et al., 1961) ● Interpreted through the use of cut-off scores | |
| BECK DEPRESSION INVENTORY Raw Scores: 0-13 | Depression Severity: Indicates minimal depression | |
| BECK DEPRESSION INVENTORY Raw Scores: 14-19 | Depression Severity: Indicates mild depression | |
| BECK DEPRESSION INVENTORY Raw Scores: 20-28 | Depression Severity: Indicates moderate depression | |
| BECK DEPRESSION INVENTORY Raw Scores: 29-63 | Depression Severity: Indicates severe depression | |
| STRESS MANAGEMENT QUESTIONNAIRES (SMQ) | ● Identify the symptoms, stressors, and coping activities that a person chooses to describe his or her ways of managing stress ● Helps the person consider physiological, cognitive, emotional, and behavioral symptoms of stress | ● Questions can identify the source of stress |
| SMQ FIRST SET OF DESCRIPTORS | ● Describes the symptoms that individual experience while under stress ○ 1. Physiological ○ 2. Cognitive ○ 3. Emotional ○ 4. Behavioral | |
| 1. Physiological: | headaches, tremors, neck/low back pain | |
| 2. Cognitive: | difficulty concentrating, remembering, decision making | |
| 3. Emotional: | feeling angry, hopeless, tense, and sad | |
| 4. Behavioral: | difficulty sleeping, eating, and speaking | |
| SMQ SECOND SET OF DESCRIPTORS | ● Identifies situations that cause the stress response ○ interpersonal: arguments with family members ○ Intrapersonal: low self-esteem ○ Time Demands: meeting a deadline at work ○ Mechanical Breakdown: dealing w/ a broken household appliance | ○ Performance: taking a test ○ Financial Pressures: loss of income ○ Illness: having a flu ○ Environmental disturbance: excessive noise ○ Complex situations: raising a child alone |
| SMQ THIRD SET OF DESCRIPTORS | ● List of coping responses ○ Creative: writing a poem ○ Construction: knitting a sweater ○ Exercise: walking ○ Appreciation: listening to music | ○ Self-care: taking a bath ○ Social: talking to friends ○ Plant and animal care: having a pet ○ Performance: singing in a choir ○ Sports: swimming |
| ROTTER’S INTERNAL-EXTERNAL SCALE | ● Self-report forced-choice questionnaire that measures a person ’ s perception of control; whether he or she is controlled by variables in the environment or in control of his own behavior ● Can be completed in 15 to 20 minutes | |
| INFORMAL OR SEMI-STRUCTURED ASSESSMENTS 1 | ● Offer valuable method for identifying beliefs that contribute to occupational performance problems ● Structured or Semi-structured interviews ● What does the person identify as his or her occupational performance strengths and limitations? | ● What beliefs or thoughts does the person have that facilitate or hinder occupational performance in general? ● What are the client’ s belief about his or her ability to successfully address these intervention priorities? |
| INFORMAL OR SEMI-STRUCTURED ASSESSMENTS 2 | ● What are the person’s beliefs and expectations about intervention outcomes? Are they realistic or unrealistic? ● What physiological and emotional reactions trigger dysfunctional beliefs? | |
| Structured or Semi-structured interviews | - provide a more informal collaborative interaction with clients | |
| TECHNIQUES FOR COGNITIVE IMPAIRMENT ● REMEDIATION APPROACH | ● Repetition and Rehearsal ● Therapist should always consider the importance of generalizing the improvements of cognitive skills to occupational performance | |
| Repetition and Rehearsal | - essential characteristics of cognitive remediation | |
| Area of Cognitive Impairment ● Memory | Intervention Strategy ● Chunk items together ● Create mnemonics ● Ask questions about the information ● Use memory aids such as calendars, checklists, and alarm | |
| Area of Cognitive Impairment ● Selective attention | Intervention Strategy ● Remove irrelevant stimuli ● Enhance and intensify important information ● Address internal distractions such as anxiety and auditory hallucinations | |
| Area of Cognitive Impairment ● Divided attention | Intervention Strategy ● If possible, separate tasks so that the individual does not need to divide attention ● Work toward making one or more tasks automatic ● Practice doing the tasks together | |
| Area of Cognitive Impairment ● Sustained attention (vigilance) | Intervention Strategy ● Slow down the rate at which information is presented ● Make stimulus easy to detect ● Schedule difficult task when individual is well-rested and during preferred time of a day | |
| Area of Cognitive Impairment ● Problem-solving | Intervention Strategy ● Provide and practice problem-solving heuristics ● Prevent or eliminate common problems that occur with specific tasks | |
| Area of Cognitive Impairment ● Decision-making | Intervention Strategy ● Limit the number of options (activity gradation) ● Teach individual to step back and think through important decisions | ● Ask other individuals for input when making important decisions ● Teach individual about potential biases in decision-making |
| Area of Cognitive Impairment ● Metacognition | Intervention Strategy ● Create questions for individual to ask self before engaging in task ● Have individual evaluate performance after completing a task | |
| Area of Cognitive Impairment ● Automatic processing | Intervention Strategy ● Target tasks that have potential for automatic processing ● Simplify tasks and incorporate opportunities for consistent repeated practice | |
| Area of Cognitive Impairment ● Schemas and scripts | Intervention Strategy ● Write out or use pictures to show the steps of the task ● Order objects in the sequence in which task is carried out ● Repeatedly practice the sequence of a task | |
| DYNAMIC INTERACTIONAL APPROACH (TOGLIA, 2011) | ● Focuses on processing strategies and self-monitoring skills ● Facilitates on generalization by working on a strategy across different activities and situations that gradually change | |
| COGNITIVE ADAPTATION ● Global four-step strategy: GOAL-PLAN-DO-CHECK | 1. Goal: What do you want to do? 2. Plan: How will you go about doing it? 3. Do: Carry out the plan 4. Check: Did the plan work? Does it need to be modified? | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Basis for intervention: | modifications to the activity and environment | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Focus: | creating the best fit for the individual to promote participation in valued occupations ( McCraith et al, 2011) | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Emphasis: | interventions aimed at modifying occupations and environments | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 1: | Self, internal cues | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 2: | Body | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 3: | Arm’s Reach | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 4: | Visual field | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 5: | Immediate task environment | |
| COGNITIVE DISABILITY FOR: HIERARCHAL LEVELS OF COGNITIVE FUNCTIONING ● Level 6: | Potential task environment | |
| ERRORLESS LEARNING APPROACH | ● Compensates for self-monitoring problems and prevents intrusive or perseverative errors. ● Easily applied to discrimination tasks | |
| ERRORLESS LEARNING APPROACH ● Training process: | ○ The task is broken down into simple components. ○ The training starts with simple tasks with a high likelihood of success | ○ Increasingly difficult tasks are added, but prompts, cues, and guided instruction are used at each level ○ Performance at each level is overlearned using repetition, successful practice, and positive reinforcement. |
| ERRORLESS LEARNING APPROACH ● Target(s) of Intervention: | Distorted beliefs in the context of occupational performance | |
| ERRORLESS LEARNING APPROACH ● Description: | Distorted beliefs are identified by providing evidence to the contrary | |
| CBT | is effective for reducing depression, and combined CBT and medication is more effective than medication alone (Cuijpers et al, 2013). | |
| COGNITIVE RESTRUCTURING WITH CBT METHODS | ● Directly target cognitive beliefs for persons with psychiatric conditions and other psychological problems | ● Involve identifying, reframing, and replacing cognitive distortions, perceptions, and appraisals of life events with more realistic and adaptive appraisals, automatic thoughts, attitudes, and core beliefs |
| A1. SOCRATIC QUESTIONING | ● Involves the strategic use or open-ended, guiding questions that avoid interpretation | |
| A1. SOCRATIC QUESTIONING phase 1. Asking informational questions that the cx can answer to help make concerns explicit and for the client to feel heard | What are you thinking/feeling when you do __? Could you give me an example? Elaborate? What do you mean when you say __? How long have you felt/believed this way? | |
| A1. SOCRATIC QUESTIONING phase 2. Asking questions that reflect empathetic listening and summarize issues related to the problem. | Let me see if I understand; do you mean __? When you say __, are you implying __? Let me summarize; are you thinking __? Or feeling __? | |
| A1. SOCRATIC QUESTIONING phase 3. Asking questions that draw the client’s attention to information relevant to the issue being discussed, but which may be outside the client’s current focus. | What evidence do you have that support or refute the view? In a similar situation, what did you do? How did that turn out? What might someone who disagrees say? | |
| A1. SOCRATIC QUESTIONING phase 4. Asking analytic/synthesizing questions that guide the client toward new information to reevaluate a previous conclusion. | How could you find out if it is true or not? How does this information fit with __? Are there alternative explanations? | |
| A2. GUIDED DISCOVERY | ● Involves the strategic and collaborative process between client and therapist that leads to uncovering information relevant to an issue being discussed and alternative options for addressing the issue. | ● What is evidence for and against the belief? ● What are the alternative explanations of the event or situation? ● What are the real implications if the belief is correct? |
| B. THOUGHT RECORDS | ● A worksheet that helps persons organize and evaluate their thoughts, beliefs, and emotional responses when they feel distressed by a situation they encountered (J. Beck, 2011) | |
| B. THOUGHT RECORDS ● Fortune Telling: | You predict the worst case scenario | |
| B. THOUGHT RECORDS ● Magnifying: | Exaggerating the situation | |
| Thought Record - Date/Time | 7/13/2008 7:00 AM | |
| Thought Record - Situation | Forgot to set an alarm Overslept and ended up late for work | |
| Thought Record - Emotion | Angry, Anxious, Emotional Intensity: 90% | |
| Thought Record - Automatic Thought | I’ll be fired. I’m always messed up. I’m an idiot. Belief Strength: 90% | |
| Thought Record - Thought/Distortion | Fortune-telling; magnifying | |
| Thought Record - Alternative Thought/View | Late once before, & I wasn’t fired. I can offer to stay late and make up time. I need to be sure of my alarm. | |
| Thought Record - Outcome | Emotional Intensity: 40% Belief Strength: 20% | |
| ● Examples of Thought Distortions: ○ All or nothing thinking: | viewing a situation as absolute black or white | |
| ● Examples of Thought Distortions: ○ .Magnifying or minimizing: | exaggerating things way out of proportion to what is reasonable or assuming things are much less important than they are | |
| ● Examples of Thought Distortions: ○ Catastrophizing or fortune-telling: | arbitrarily predicting the worst case scenario without considering what is most likely to occur | |
| ● Examples of Thought Distortions: ○ Mental filter: | focusing only on the negative and ignoring the positive | |
| ● Examples of Thought Distortions: ○ Emotionalizing or emotional reasoning: | presuming that feelings are facts and ignoring or discounting evidence to the contrary | |
| ● Examples of Thought Distortions: ○ Personalizing: | blaming self for everything even when there is no evidence that you are at fault | |
| C. TIC-TOC TECHNIQUE | ● To discover new options for achieving desired goals. Most effective when both Cx and Therapist reflect collaboratively on the options | |
| TICs | task-interfering cognitions | |
| TOCs | task-oriented cognitions | |
| TicToc Activity | Task-Interfering Cognitions (TICs): I have nothing to do all weekend. I just lie around all day doing nothing. I’m worthless. It doesn’t do any good to do anything. | Thought Distortions: All-or-nothing thinking Task-Oriented Cognitions (TOCs): I don’t feel like doing anything, but it won’t hurt me to try to do some things I used to like to do. I might even feel better |
| Self-talk: | Describe the process in which human beings continually talk to themselves out loud or as part of an inner dialogue stream that is experienced both on the conscious and unconscious levels. | |
| Affirmations: | Written or oral statements that confirm or reinforce something as true; counteract negative self-scripts or beliefs | |
| ELLIS'S RATIONAL EMOTIVE BEHAVIOR THERAPY ● Core tenet: | Irrational beliefs about how things "must" and "should" be for persons to be happy lead them to make themselves miserable | |
| ELLIS'S RATIONAL EMOTIVE BEHAVIOR THERAPY ● Provides cognitive restricting to identify: | (A) Activating events, (B) Irrational beliefs, and (C) Emotional and Behavioral Consequences related to specific situations, beliefs, or emotions that are interfering with a person’s well-being. |
Created by:
avemaria