Topic 9: Behavioral Exposure & Case Formulation and Treatment Plan {by 3/30}
[Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns. Answer the following: (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event? (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)? {Highly Suggested: Complete an Anxious Patterns Record – this will be required for Exam 2.}
[Case Formulation & Treatment Plan] – For this discussion, share at least two main thoughts: (1) Why is a CBT case formulation important for effective therapy (i.e., how does it help clients get “better”)? (2) Why is it necessary to have specific, concrete, and measurable treatment goals whenever possible?
Your original post should be posted by 3/30. Have your two replies posted no later than 4/1. *Please remember to click the “reply” button when posting a reply. This makes it easier for the reader to follow the blog postings.
Dr. Adam M Volungis 
Mar 24, 2023 @ 11:01:24
After she had gone to the grocery store by herself, she felt as though everyone was looking at her and she could not escape the store. There was a large amount of physiological arousal that made her feel as though she was losing control and may have a heart attack in the store. She was very disappointed in herself, there were feelings of failure and also frustration that grocery shopping is so hard for her. However, she had also understood that she was being over ambitious about going into the grocery store be herself to begin with. One of the safety behaviors used was actually her husband, she always has him there and feels like she needs him to complete tasks. When she left the grocery store and she saw her husband in the car waiting for her, she felt immediate relief and as though her panic attack had almost completely diminished despite her detailed description of all of the symptoms she had.
Case formulation is extremely important, it is an individualized plan for the client that provides structure for both the therapist and the client. Case formulations are collaborative, the client is always involved and able to provide input which can increase their motivation and hopefulness for change. The clients are able to see and understand what is happening and what will happen as well as see the changes made within the case formulation for their benefit. Having these specific treatment goals allows the client to see what the end goals are and understanding the process. When they are measurable goals, the client is able to see their progress, which can provide them with a sense of achievement or success and allows them to feel like they are truly making progress. This structure will keep them in therapy, keep them motivated, and keep them on the right track.
Mar 25, 2023 @ 16:06:03
Hey Tiana,
I agree that her husband was her safety in this situation and I wonder if she had decided to go into the grocery store with him inside of without him if she could have made it through the whole trip as she talks about the comfort he brings her and how he knows how to handle her distress. I agree that case formulations are collaborative, If they were not I feel like therapy would not go as well. It is important that the client is understanding the techniques used, are comfortable using them and also for the client to have a say in their treatment has they are there own expert and know what works best for them. I agree that allowing the client to see their progress within therapy helps provide a sense of achievement or success, which is so important.
Mar 25, 2023 @ 18:24:11
Hi Tiana! I like your point that case formulations not only help the client understand the process of therapy, but also understand what the end goals of therapy are. I think this is especially important because it emphasizes how CBT is goal-oriented and how termination is important to conceptualize from the beginning of therapy. CBT is not meant to be a scheduled conversation with a friend that lasts years and years, but rather it’s important to use sessions to help prepare a client to walk away from therapy better able to solve future problems on their own.
Mar 24, 2023 @ 19:07:53
During the client’s experience, while she explained that she was trying to tell herself that she was not having a heart attack, her physiological response and emotions seemed to indicate otherwise. This underlying catastrophization of “I am having a heart attack” seemed to exacerbate her experience/physiological arousal. The client’s primary negative automatic thought in response to her panic attack appeared to be along the lines of “I couldn’t go into the store by myself without having a panic attack. I am a failure,” as she processed the experience back at home. As a result of her physiological arousal and automatic thoughts, the client decided she needed to get out of the store. She left her carriage where it was and exited immediately. She felt a sense of relief as soon as she left the store and was reunited with her husband. The symptoms began to decrease as she entered the car, knowing that her husband would react to her experience in a way that settled her. Thus, her husband acted as a safety behavior, in that she felt reliant on him largely for that sense of relief in anxious situations. After the fact, she felt silly and a bit embarrassed with herself, that she was not able to leave the store with her groceries (hence the “I am a failure” negative automatic thought).
A CBT case formulation is important for effective therapy because it conceptualizes the client’s presenting problems, associated symptoms, and contributing factors, such that you can purposefully and efficiently plan effective treatment. The case formulation helps facilitate treatment that considers both your idea of how change can occur for a client, as well as the client’s goals and input. This reinforces the key theme of collaboration that helps keep therapy client-centered and thereby is likely to keep a client more engaged and hopeful in the process. The case formulation is also a structured means of organizing information that is obtained from session to session, such that you can always revise it and rely on it to help ground the purpose of each subsequent session. It is necessary to have specific, concrete, and measurable treatment goals whenever possible because this helps to better indicate what interventions will be most effective in order to meet each goal. Treatment goals are desired client outcomes that should logically connect to a client’s problem list and the case formulation. When these goals, or therapeutic indicators, are objective and measurable, this allows for more accurate tracking of treatment progress for both the therapist, client, and any managed care system the therapist is working with.
Mar 25, 2023 @ 16:06:52
Hey Maggie,
I thought it was really interesting when Lindsey was talking about how she felt like she was having a heart attack yet she was telling herself she knew she wasn’t because of what she had learned within therapy. It goes to show that she is somewhat self aware but still has work to do before she can successfully attack it on her own. I agree that her primary negative automatic thought surrounds the idea of being a failure for not being able to complete her grocery trip as she explains grocery shopping should be an easy task yet she was unable to even get to far before having to leave her cart behind and head back out to her husband in the car. I really like that you talk about the importance of CBT case formulation being to conceptualize the clients presenting problems, associated symptoms, and contributing factors. I also like how you mentioned organizing obtained information within sessions as this allows for the clinician and client to track progress and even make changes if needed.
Mar 27, 2023 @ 15:13:55
Hi Maggie! I really like the way you explained her feelings of having the panic attach feeling like a heart attack as exacerbating her physiological arousal and worsening her overall experience. What happened in the store lead to her negative feelings of being a “failure” because she could not grocery shop. I also agree, her husband did in fact act as her safety behavior because of her feelings of relaxation and relief when she made her way to the car knowing he was in there.
I also like how you mentioned the fact that the case formulation is in fact a collaboration between the client and therapist. Both the client is able to give their input and the therapist when creating a lot of the overall plan and treatment plan. The organization of having case formulation is also very helpful leaving room for change.
Mar 25, 2023 @ 15:53:11
Lindsey was feeling ambitious and decided to go into the grocery store by herself, normally she would not go at all, her husband typically shops for them to avoid her from having a panic attack. However, she had her husband drive her to the store and upon entering an aisle she began to feel like she was losing control and felt like she was going to have a heart attack even though she knew deep inside that she wasn’t, she could seem to convince herself. She ended up leaving her cart and getting out of the grocery store. In response to going into the grocery store, her primary negative automatic thought once she got out of the grocery store was regarding how she felt like she failed, she mentioned feeling silly because she feels it should be an easy task to accomplish. It seems Lindsey was mostly feeling like a failure, so a good negative automatic thought could be “I am a failure because I am unable to go into the grocery store on my own”. Upon exiting the grocery store she saw her husband and explains that she immediately felt relief. In this situation her husband was her safety behavior because those anxious feelings disappeared upon his appearance as she mentioned he knows how to handle her in her anxious or distressed states. When her clinician mentions that later down the line her husband may have to be removed from the situation, you could tell her was feeling quite doubtful about that going well. Overall, it seems that she was embarrassed and discouraged that she was unable to complete the task of grocery shopping, which inflicted her negative automatic thoughts around being a failure. But she also appreciated the fact that she gave it a shot on her own after not even approaching the grocery store in two months.
A CBT case formulation is important for effective therapy because it provides a structure plan for the clinician and client. It is important that case formulations are collaborative meaning both the clinician and client work on it together to make sure the client understand and is also comfortable with a specific treatment plan. Depending on the clients culture the structure may have to be very different from someone who was born and raised in the US. In the case of the client being from another culture it is important to incorporate techniques they are comfortable with, while also making sure to fully explain what the technique is and its purpose. It is necessary to have specific, concrete, and measurable treatment goals whenever possible because this allows for the clinician and clients to track the therapeutic progress, keep on track with intended goals while also working to increase motivation within the client.. It can be hard for a client to remember where they were at the start of therapy and all the progress they have made due to therapy sometimes making a client feel worse. It is important to have a way to show them their true progress as it can be hard for individuals to really believe they are making progress.
Mar 25, 2023 @ 18:53:31
Hi Melissa! I really like your mention of the relevance of culture when creating a case formulation. It is definitely likely that depending on which culture/s a client is a part of, this may influence how you will formulate the case. When hypothesizing how presenting problems may have arisen, as well as potential maintaining factors and potential obstacles while undergoing treatment, striving toward cultural competence per client will be important. Some clients may require further psychoeducation, as some techniques may be met with increased resistance due to cultural beliefs or norms.
Mar 27, 2023 @ 15:21:21
Hi Melissa! I agree with your conclusion of what Lindsey’s negative automatic thought was, she did in fact feel like a failure and also how she later felt “silly” because she was unable to complete such an easy task, as she explained it. I also like how you mentioned that not only is her husband her safety behavior because her symptoms seem to subside when she sees him, you also mentioned how Lindsey had stated that her husband knows how to handle her anxious and distressed states. It was good that her therapist made a point to say that he appreciated her effort, it is clear that this comment may have made her feel better about it.
I also agree with what you stated about how important it is that case formulations are collaborative. It helps the client feel more involved, less helpless, and as you mentioned, the client is able to get a better understanding of the treatment plan. I really liked how you incorporated culture as well. This is an important feature to take into account and can make some major changes in the case formulation.
Mar 27, 2023 @ 20:57:05
Lindsey made the ambitious jump to attempt to go to the grocery store by herself, however, this did not completely work in her favor. Her main negative automatic thought was the worry that she was going to have a panic attack, specifically over having a heart attack. During this event, Lindsey was feeling her heartbeat increase, tightness in her chest, dizziness, feeling anxious, feeling like no one was going to help her if she had a heart attack, and so forth. Through these thoughts and feelings, Lindsey acted in her flight or fight response and left the grocery store to return to her husband. When Lindsey and Dr. V are assessing this situation, she reports that she felt relieved when she got out of the grocery store and saw her husband. Even Dr. V notices how even with her describing the situation she appears relieved. Lindsey reports that she is appreciative of her husband and that he is always there for her. Which to an extent is helpful, like Dr. V mentioned, but this is a safety behavior. Having Lindsey work on coping skills and then move into further exposure techniques will be more beneficial than her jumping to the main provoking situation.
A CBT case formulation is important for effective therapy as it helps the therapist know what they are focusing on during therapy. As we discussed, it is important to have structure during therapy, so having a case formulation allows the therapist to know what they are working on with their client. Case formulations also allow therapists to analyze what areas need more focus. Case formulations are done through assessments and what the client shares they need help with. With that, it is important to be collaborative during this process, so the client is aware of the steps and focus is on during the treatment process. Having this process be collaborative allows the client to share their feelings and can either agree or disagree with the steps that are going to be taken. We want the client to be involved as this is their own personal case formulation. It is necessary to have specific, concrete, and measurable treatment goals during therapy as this helps the therapist and client accurately track the treatment progress. We want to set in stone the areas that need the most attention and make sure that both the therapist and client know what they are working on together. With that, making sure there is a way of tracking the process is vital, as this lets both the client and therapist know what’s working and what isn’t working.
Mar 28, 2023 @ 16:07:45
Hi Gitte! I totally agree with you that measurable and objective goals should be used to track the client’s progress and indicate what is and is not working. I hadn’t thought about using the goals in that way. I really like your idea that the goals will be used to keep the client and the therapist on the same page because there is bound to be some kind of miscommunication between people but having the same objective achievement in mind will keep them cohesive.
Apr 01, 2023 @ 10:53:57
Hey, Gitte! I like how you emphasized clients should be involved as much as possible during the case formulation process. It is their treatment, and if it is not specifically tailored to their needs or they disagree with the formulation in any way, the overall treatment will be less effective. In addition, creating measurable treatment goals should also involve the client as much as possible, as it is something that they should identify as meaningful and something to work toward. Moreover, having something measurable allows the client to look back and see how far they’ve come in treatment, thus boosting their motivation to keep going.
Mar 27, 2023 @ 22:14:52
Lindsay felt ambitious to try to walk through the grocery store without her husband. When she began to have an unexpected panic attack in the aisle, she felt like a failure because she thought that “This is such an easy task. I should be able to go to the grocery store. I am a failure because I can’t do it”. In the moment Lindsay felt relieved to leave the grocery store, and she noted that her panic attack symptoms subsided when she saw her husband in the parking lot. However, after she had gotten home and reflected on the event, she felt defeated due to the cognitive distortions that she experienced: discounting the positives and using “should” statements. These negative thoughts caused Lindsay to discredit her effort and feel hopeless about her situation. In regards to safety behaviors, Lindsay utilizes her husband for security when out in public as he knows how to respond when she experiences a panic attack. Sometimes, he may even reinforce her panic attacks by bringing her to the hospital. As Dr. V mentioned in the video, it is important to start phasing out the reliance on her husband so that she can begin to go out in public comfortably by herself.
Case formulation is important for effective therapy because it allows the therapist to individualize treatment goals and interventions to the client’s unique history, presenting problems, and maintaining factors. The therapist and client can collaborate on the possible explanation for the development and maintenance of the client’s symptoms. Further, the case formulation may assist the two in determining appropriate strategies for breaking these maintenance cycles.It is important to have clear, precise treatment goals so that the client can easily visualize what they are working toward. A client may feel less motivated to participate in treatment if they do not clearly understand the steps necessary to reach the end goal. In addition, objective treatment goals make it easier for the therapist and client to conceptualize interventions and strategies, as they should naturally be related to the goal.
Mar 28, 2023 @ 19:30:59
Hi Abby, I like that you brought up Lindsey’s cognitive distortions and using “should” statements. We know that jumping to the main anxiety-provoking trigger quickly can discourage individuals and to the main anxiety-provoking trigger too quickly can make individuals feel discouraged and can sometimes do more harm than good. Similarly, this can be said about her husband as well as he is used as a safety behavior. As you mentioned there are times when he reinforces her panic attacks and brings her to the hospital. We want to focus on Lindsey completing the behavior exposure techniques in a therapeutic manner and slowly phase out her husband as safety behavior. Great post!
Mar 28, 2023 @ 21:47:39
Hi Abby!
I like how you first framed Lindsay’s trip to the grocery store as ambitious to not continue to catastrophize the situation with her. Her negative automatic thoughts absolutely discredit the progress she has already made as she was able to put some things in her cart this time, when in the past she hasn’t even been able to step foot in the store alone.
I agree that case formulations are a great way to collaborate on not just the goals of the client, but also to describe the symptoms they are having and to find new way to manage these symptoms with the help of the therapist. Easy visualization of these goals is a great aid in formulating goals and something I definitely overlooked!
Mar 29, 2023 @ 15:57:53
Hi Abby! I love how you mention that case formulation is important for identifying maintaining factors. I didn’t think about maintaining factors, but they are incredibly important for enacting change, because if the maintaining factors are not removed, a behavior cannot change. I also agree that it is important to have clear goals because the client should be able to visualize what they are working towards in order to maintain motivation to change. Great post!
Mar 31, 2023 @ 20:56:12
Hello Abby,
I appreciate that you mentioned how Dr. V explained to Lindsey the importance of starting to develop new coping skills using various therapeutic techniques, instead of always depending on her husband as her safety place and reliance. It is important that the clinician identifies these factors to avoid reinforcement of new maladaptive behaviors that delay her treatment progress.
Mar 28, 2023 @ 07:27:48
Lindsey’s primary negative thought in response to having a panic attack in a busy grocery store was, “I’m losing control.” In the past, Lindsey believed that her panic attacks were heart attacks, yet she tried shifting her automatic thoughts independently to remind herself that she did not have a heart attack. However, despite trying to regulate her emotions by remembering what Dr. V had explained in previous sessions, she felt her symptoms worsening quickly, creating a sense of losing control. Additionally, Lindsey began experiencing other automatic thoughts like “I need to get out,” which likely exacerbated her physiological arousal. Lindsey could not self-regulate her emotions until she left the grocery store and saw her husband waiting for her in the car. In this situation, Lindsey’s safety behavior is seeing her husband. If he were in the grocery store with her, she might not have experienced symptoms related to a panic attack.
A CBT case formulation is essential for effective therapy. The nature of CBT is centered around structured treatment that still contains an aspect of malleability to help the client improve yet to adapt to inevitable bumps in the road. With a completed case formulation, the client and therapist are aware of presenting concerns, related symptoms, and stimuli triggering said symptoms. The client should play a significant role in the conceptualization of the case formulation for the therapy to be effective and for the client to get “better,” as it shows they are motivated for change to occur. Moreover, it is necessary to have specific, concrete, and measurable treatment goals whenever possible to track the client’s overall progress inside and outside sessions. When clients see that they are meeting their goals, they can become more hopeful about the treatment process and may be excited to identify new goals to work toward. On the other hand, if the client is not meeting their goals, it is easier to identify areas where they may be struggling the most and reassess how to address those issues.
Mar 28, 2023 @ 15:54:50
Hi Megan,
I really like what you said about tracking and measuring the client’s progress. Knowing what is working, what isn’t working, and how the client feels about the progress they have made can also be used to inform the therapist about their work. We also know that using evidence-based treatments is the best way to help people. Part of keeping with that is tracking how the client is progressing and making the necessary changes.
Mar 28, 2023 @ 19:34:21
Hi Megan, I agree with your statement on how the nature of CBT is based on structured treatment that can still be malleable. As we discussed in previous classes, having structure is an important part of therapy and is something that helps both the therapist and the client focus on what needs to be done. With that, it is still important to change things around when needed. Furthermore, having the client participate as much as possible in their case formulation will help the client know what areas they will be working on and how during therapy. Nice job!
Mar 31, 2023 @ 09:56:56
Hi Megan,
I like what you have said about Lindsey’s automatic thoughts. Like in your post, it has shift throughout her time of being at the store. She first went in thinking she got this. However, then in the store, her thoughts turned into more having a “heart attack” and the sense of losing control. When it got too much, she then thought that she needed to get out of there. When she saw her husband, she felt relieved. I think this is important to show that because it can tell when the anxiety and panic set in during a situation. I agree with your statement on how the client should play a significant role in the conceptualization of case formulation. Clients should be able to play a significant role because it leads to their care in treatment. If a case formulation does not match up to the client, then it can lead to bad quality of treatment.
Mar 28, 2023 @ 21:34:34
The client’s primary negative automatic came from her loss control and that she felt she was having a heart attack, thinking that she had completely failed. Though she was able to remind herself that these symptoms were actually a panic attack, she was still not able to calm herself down and had to leave the grocery store and eventually head home. Typically she does not enter the grocery store without her husband, so this was an intense step in the exposure therapy early on with her safety behavior (her husband) there to lessen the blow of the exposure. The client’s response to her panic attack was to immediately leave the store and her cart behind to find her husband waiting for her in the parking lot. We can identify her husband’s presence as a safety behavior because he instantly brings her relief in her recollection of the event, but it also shown implicitly through her body posture during the retelling of her panic attack. The client seemed a bit embarrassed with herself when reflecting on her experience at the store and disappointed that she could not align her body with her mind in reminding herself that she is not having a heart attack.
A case formulation is important to lay out a plan for the client to utilize and the clinician to refer back to. This formulation is specific to the individual, creating a collaborative opportunity to incorporate the client’s culture, goals, and even comfort level for different exercises at that point in time. The goals within a treatment plan should be specific to the client of course, but also achievable and measurable to chart a client’s progress for both the client and clinician to see the growth. Treatment plans and case formulations are malleable, as the individual changes and makes progress over time the plan will change to reflect new and improved goals for the client.
Mar 29, 2023 @ 13:39:41
Hi Whitney, I enjoyed reading your post! I liked the point that you made that Lindsay knew that she was having a panic attack but was not able to overcome her symptoms. I think that this is a good example of when a client has the intellectual knowledge of their symptoms but they are unable to regulate their emotional responses because they have not yet developed emotional intelligence. This may be an indication of maladaptive core beliefs or negative automatic thoughts that hinder Lindsay’s ability to control her arousal. It is important that Lindsay ease her way up to grocery shopping alone through small, easily achievable in-vivo and imaginal exposures that will increase her confidence.
Mar 29, 2023 @ 14:39:25
Hey Whitney, your discussion about the client was very insightful, you did a really good job mentioning that reading her body language when discussing her experience with the panic attack. When helping a client work through things like this, especially when they are retelling their experiences, it is imperative that you pay attention to their body language. Also, your discussion about case formulation mentioned that it gives you something to refer back to. I think that’s really important to keep in mind, specifically that it is a tool for both the client and the therapist to use to be as effective in therapy as possible. Great job!
Apr 02, 2023 @ 12:36:26
Hi Whitney,
I agree with everything you have to say! I think a case formulation is so important especially in terms of tracking a clients progress. It Is also important to create a plan that works best for each individual as everyones treatment is different from one another. What works for one may not work for someone else so it is important to alter the treatment plan to the specifics client and implement what works best for them and what doesn’t. I think this also goes Hand in hand with collaborative work which is also important in this process so the client is able to express their needs, wants, and most importantly what they have tried that hasn’t worked for them just so they can try something new that may work better.
Mar 28, 2023 @ 21:39:53
Hi Mikayla!
I definitely agree that it would be helpful for her to phase out her need for her husband, as the safety behavior is not always helpful for the client in completely overcoming their goal. I do think that in this instance it was very helpful for Lindsey to have her husband as she rushed into this high level of exposure, but it makes me wonder how soon is too soon for her to start phasing out her husband.
I really like the mind set of the case formulation being a start to the right path for therapy to the individual client. The SMART goals are super effective in short-term therapy and are great to keep in mind when forming a treatment plan! A goal cannot be a good one if the client has no chance in achieving it at all.
Mar 29, 2023 @ 09:35:22
Before entering the grocery store, the client felt ambitious to take it head on. She wanted to see if she could go into a grocery store by herself, without the help of her husband. However, when she entered, some of her physiological symptoms started to appear. In the video, she was talking about how she was walking down an aisle and her body started to feel warm. Someone came into her aisle and then a few more started to appear. Then more of her physiological symptoms appear. Some can include palms being sweaty, chest getting tight, heart racing and feeling like she was going to lose control. The client’s primary negative automatic thoughts soon became “I am going to have a heart attack”, “People are seeing me struggle right now, I need to get out of here,” and “I can not escape right now.” When she exited the grocery store and saw her husband, she soon became relieved. Once home, she then started to think that she failed and it was silly that she failed. She said in the video that “it should be easy to walk into a grocery store.” The safety behavior of the client is her husband. When she was in the store by herself, her physiological symptoms became overactive. However, when she saw her husband in the parking lot, they soon decreased.
Having a CBT case formulation is extremely important for effective therapy. With a case formulation, it can help lay out for both the client and therapist on what to do. It is almost like an agenda or a “to-do” list. It can list out what is needed or expected for the client. Case formulation also helps with structure during sessions. Without some sort of structure in sessions, it can become chaotic for both the client and the therapist. A case formulation can help the therapist determine what needs to be done on certain days. This is also for the client meaning that it is designed for the client. Each case formulation is different for a client. It can be more personable rather than a specific layout used for everyone. It is important to have specific, concrete, and measurable treatment goals because it helps target the client’s presenting problems. As stated before, it can also make it more personable for the client. If a therapist gives off the “same goals” for everyone, many clients may be turned off treatment altogether. Someone who is going in for depression, can not have goals that are related to anxiety. It is important to have goals that are relevant to the client’s presenting problems while also making them personal for them.
Mar 29, 2023 @ 14:33:28
Hey Ashley, I think you brought some really good insight into your discussion about the client. You mentioned that she mentioned her symptoms had gotten worse when people had approached, which I think is something that is a very important thing to note because with anxiety like the client’s I think that it is highly socially influenced. Also, when discussing case formulation you mentioned that it essentially acts like a to-do list, which I think is a really great way to conceptualize it, and I’m definitely going to steal that because it feels a lot more manageable and I also think it’s very accurate.
Apr 02, 2023 @ 21:44:34
Hi Ashley, I like that you thought of one of Lindsey’s automatic thoughts being “People are seeing me struggle right now, I need to get out of here.” With anxiety, clients may be more concerned about how others are perceiving them. The presence of more people in the aisle can result in more judgment from others. Looking at case formulation, the client and therapist are able to pivot when the client is not progressing. Case formulation allows the therapist to see what interventions may work better for the client and use the client’s strengths to their advantage.
Mar 29, 2023 @ 10:14:45
The automatic thoughts we see associated with Lindsey’s panic attack in the moment are “I am having a panic attack” and “I am losing control.” These thoughts can be indicative of the catastrophizing cognitive distortion where she assumes the worst of a possible situation. When in the store she describes feeling fine and then having the feeling of getting warmer. That physiological symptom seemed to trigger a worry in her mind that she was going to have a panic attack, and from that initial symptom it seemed like the others came quickly in succession to it. Her behavioral response to these thoughts and symptoms was to return to the parking lot where her husband was waiting. As soon as she saw him outside waiting for her her physiological symptoms began to diminish a noticeable amount. In this moment he acted as a safety net for her to fall back on when she was feeling distressed. She also attempted to intellectualize her panic attack, telling herself “you aren’t actually having a heart attack” but that did not work to alleviate her symptoms as her feelings were too strong.
A CBT case formulation is important for effective treatment because it takes a cross analysis of the client’s presenting issues from different perspectives (social, behavioral, cognitive, emotional), examines how these issues are affecting each other, and seeks to build up on the client’s strengths to help foster more adaptive skills in dealing with the issues. Instead of limiting ourselves to just a client’s cognitions or behaviors, we look at them from a more multidimensional perspective to understand their problems to best come up with a treatment plan that fits their particular circumstances. It is better to have specific and measurable goals because we want to be able to track a client’s progress demonstrably. A vague goal like “I want to be less sad” makes it hard for us to keep measure objectively, but a goal like “I want to spend more time with friends” is more beneficial because we can measure that at the beginning of treatment no time was being spent with friends, whereas toward the end our client is engaging in social activities several times a week. Additionally, measurable goals give something the client can look forward to and feel the positive reinforcement of achieving them, thus leading to more instillation of hope and more willingness to attempt new goals.
Mar 29, 2023 @ 16:03:21
Hi Lucy, I like that you identified the automatic thought “I am losing control” and connected this to catastrophizing cognitive distortions. A very frequent thought for individuals having panic attacks is that they are losing control or that they are dying. These thoughts are definitely “worst-case scenario” thoughts and can perpetuate the fear and panic they are feeling. Someone with more adaptive thinking would recognize their physical symptoms as anxiety or mild to moderate distress, but the catastrophizing cognitive distortion launches those physiological panic symptoms into a panic attack. I also like that you mention that you can see a cross-sectional view of client’s problems with a case formulation. I hadn’t thought about that, but you can see social, behavioral, cognitive, and emotional aspects of the client’s life that can be contributing to and maintaining the client’s issues. This is important for complete and accurate care and treatment.
Mar 29, 2023 @ 12:45:25
Lindsey’s primary negative thoughts were that she was having a heart attack, she was not able to get out of the situation, people were noticing her having the panic attack, and afterward that she had failed her ambitious goal. This was a mix of mind-reading and catastrophizing because she assumed that the people also in the aisle could see that she was starting to feel her symptoms. In response to her panic attack, Lindsey left the grocery store and went out to her husband in the car. This acted as her safety behavior because seeing him brought her relief. As Dr. V mentioned later in the session, it would be helpful for her to phase out her need for her husband so that she can be more independent with her actions.
An accurate case formulation will set the right path for therapy and make sure that the client is receiving the treatment they need from the start. Making sure to address the most pressing problems and truly understanding where the distress is coming from will make the job of the therapist easier and more effective. Having SMART goals will also help with the short-term plan for therapy. These types of goals are more likely to be met successfully because they are clearly defined, set a clear path to follow, and have a distinct indication of being finished. Accomplishing anything that the client or the therapist sets will help build the client’s self-efficacy and their willingness to try other things that the therapist asks them to do. Having indefinite or overarching goals are good things to strive for but are not realistic in the day-to-day lives of the clients to be achieving.
Mar 30, 2023 @ 09:52:22
Hi Mikayla! I like that you mentioned that Lindsey engaged in the distortion of mind reading while at the grocery store. This is not something I initially thought of, but it is something that is very important to highlight. It would be helpful for the clinician to point this out in future sessions to show Lindsey that these people likely were not thinking what she thought they were thinking about. I also think it would be helpful to explain the spotlight effect to Lindsey, to show her people are not noticing her as much as she feels they are. I think teaching her about this effect also could validate her because many other people feel this way also. Great response!
Mar 29, 2023 @ 14:29:21
The client’s primary negative thought in response to the event, in short, was that she was having a heart attack. This was prompted by her attempt to go into the grocery store by herself, but doing so caused her to have an unforeseen panic attack, which then led her to feeling like a failure. Despite her awareness that she was having a panic attack and not a heart attack, she was unable to convince herself that this was the case. She went to the grocery store without her husband, and going with her husband is a safety behavior, which led to an increase in her physiological arousal. Her response to this was to immediately leave the store and sought out her husband in the parking lot. Her feeling of relief upon seeing her husband identifies being with him as a safety behavior. The physiological arousal that she was experience while in the store started to diminish upon being with her husband as well.
When practicing CBT a case formulation is an essential aspect to effective therapy. Case formulation helps to provide structure for both the therapist and the client. For me personally, I can foresee myself getting sidetracked with clients often, which isn’t necessarily a bad thing, but a case formulation and treatment plan helps to get back on track. Also, it helps for effective treatment planning. Having a clear conceptualization of the client’s symptoms, precipitating and associated factors, and other information is very helpful when creating treatment goals and strategies. It also gives a jumping off point, since CBT is highly collaborative in nature sharing this with your client can help foster the collaborative empiricism that rests at the foundation of CBT. Having specific, concrete, and measurable treatment goals when possible, helps to track the treatment process. It can inform the therapist of what is working, and you should keep doing; but also, what isn’t working and what should be modified. Also, these characteristics make the goals easier to digest for the client. For the client, knowing that they are achieving their treatment goals helps to show them that therapy is working, which is always good, especially if things may seem like they’re getting worse. They also help further foster the collaborative empiricism by way of making sure the client is involved in their treatment when drafting treatment goals.
Mar 31, 2023 @ 10:04:31
Hi Jack,
I like that you said a case formulation and a treatment plan can help you get back on track in sessions. Though getting sidetracked is not a bad thing in sessions, a case formulation can help the therapist and client get back on track. I also agree with what you said about a case formulation that can help create effective treatment planning. If the case formulation does not give specific details on the client and problems, then it can lead to an improper treatment plan. It is important to highlight every detail on the client in the case formulation that can later help the client. Overall, it should be a collaborative process with the client. At the end of the day, it is the client’s life. If sessions do not revolve around the client’s life and problems, then it can provide more hardship to the client.
Mar 29, 2023 @ 15:54:34
Lindsay’s primary negative automatic thought was that she was a failure. Lindsay, in response to going to the grocery store on her own, began to have a panic attack and exhibited minimizing thinking because she minimized her successes of being brave enough to go to the store and try in the first place and maximized her inability to get through the store without having a panic attack. In response to her negative automatic thoughts and physiological arousal that pertains to her panic attacks, Lindsay left the grocery store and went out to her husband, who was waiting for her in the parking lot. This is a safety behavior for Lindsay, as she uses her husband as a crutch and as a safety “touchstone” when she is experiencing distress.
Case formulation is important for effective therapy because every client has so many aspects to them and they all effect the client in some way. Having a broad view of the client and their background is important for developing a comprehensive, effective treatment plan. Additionally, it helps the therapist to truly individualize the care to each client and take into consideration all of the clients’ needs, symptoms, and abilities. It is also important to have specific, concrete, and measurable treatment goals when possible for documentation reasons, as well as to effectively show the client how they are changing and improving over therapy. Research has shown that when making changes having achievable, concrete, measurable goals makes change easier to accomplish. This is the same in therapy. When a client has a specific and concrete goal to reach, they are more able to structure their behaviors to move towards that goal and are able to easily track their progress towards that goal. It can also be incredibly helpful to show the client the progress they have made towards goals, and if progress is not being made, that is clear as well and changes can be made to the treatment plan to help change begin or move more quickly. It is also helpful when documenting for insurance, to show how your client is progressing.
Mar 30, 2023 @ 09:48:29
Hi Becca! I really like that you pointed out that Lindsey experienced minimized thinking. In the moment, I think it is incredibly easy to think like this. However, she really did make progress, despite her thinking. Because of this, I think it was helpful for Dr.V to point out that she was minimizing and discuss the great progress she actually made. I also like how you described the way Lindsey uses her husband as a touchstone. I really like that phrase and feel it accurately describes her experience with him and being instantly comforted once she is with him. Great response!
Mar 30, 2023 @ 09:45:32
Lindsey took a big step going into the grocery store on her own. In the moment, Lindsey felt some early body sensations of a panic attack. Because of this, her primary negative automatic thought in the store was that she felt like she was having a heart attack and could not escape the store. Following this experience, her automatic thought shifted to “I am a failure” because she could not complete the task. Lindsey responded to her automatic thoughts and arousal by escaping the store and going back into the car with her husband. For Lindsey, her husband is a safety behavior as he makes her feel calm and grounded. In these scenarios, he knows how to help her, which is comforting. However, continuing to use her husband as a safety behavior will prevent Lindsey from reaching true and effective exposure.
A CBT case formulation is important for effect therapy because it allows for the therapist to try to piece together the puzzle, which allows them to identify which pieces are missing. In other words, a case formulation allows for the clinician to explain to gain a better understanding of grey areas, so they know what to ask their client. In addition, a case formulation is helpful in forming an awareness of the client’s triggers, which can show where to begin treatment. It is necessary to have specific, concrete, and measurable goals to track the client’s progress. When clients are meeting these goals and checking them off the list, both the client and the therapist can feel hopeful that the therapy is effective. On the other hand, if the goals are not being met, this will show the therapist that these goals may need to be adjusted or made more realistic.
Apr 01, 2023 @ 10:10:33
Hey Emily, you made a good note to point out both the automatic thoughts Lindsey was having during her panic attack at the store and after when she was reflecting on it. Knowing what a person is thinking in the moment is important to know for showing disagreeing evidence to their negative automatic thoughts (“you thought you were having a heart attack, but did you? have you ever?”) but especially knowing what they are thinking after the event has passed is important when it comes to how and why they maintain their negative coping strategies. Analyzing herself as a failure in the situation can make her feel less inclined to attempt exposure again in the future, however, if we reframe it like how Prof. V did, that she took a really big step and she did something that was not possible for her a few months prior can help instill hope and begin at working toward cognitive restructuring and reframing.
Mar 30, 2023 @ 14:30:16
The client’s primary negative automatic thought was “I failed/ did terrible going into the grocery store by myself.” Lindsey started the task by herself, thinking it would be easy to go into the store alone. But once she was in the store, she experienced a panic attack and the associated thoughts. Her response to her automatic thoughts and physiological arousal was to leave the grocery store. She also tried to reassure herself that she was not having a panic attack or heart attack. Seeing her husband in the parking lot was a part of the safety behavior. Lindsey mentioned that her husband immediately tried to lessen her symptoms by offering to drive to the hospital, and they end up going home for the day.
A CBT case formulation provides a therapist with the information necessary to create a personalized treatment plan. Knowing what the client’s history is, and what brought them into therapy in the first place, can give the therapist an idea (or several) of where they would like to go with treatment. Once they have this formulation, sharing this with the client is key to keeping them engaged and reminding them that they have a say in their treatment. Having measurable treatment goals is helpful for treatment notes, but also for the therapist and the client to see how effective treatment is. If the treatment goal needs adjusting, having it be something concrete makes it easier to identify with the client and change to fit the new goal. Also, specific goals are helpful because they can serve as checkpoints for treatment length. If the client is doing extremely well for that particular goal, then it would be the therapist’s job to introduce the next step in the treatment process.
Apr 01, 2023 @ 11:15:17
Hey, Esther! I like how you pointed out that Lindsey could have returned to the hospital after a panic attack but went home instead. I think the hospital could be another of Lindsey’s safety behaviors as she believes she is having a heart attack until a medical professional tells her she isn’t. Although the grocery trip didn’t go the way she wanted, she still took a significant step towards overcoming her agoraphobia as she could remind herself in the moment that she was having a panic attack, not a heart attack.
Mar 30, 2023 @ 15:25:41
Lindsey’s primary negative automatic thought after visiting the grocery store alone was “I am a failure.” This automatic thought displayed polarized thinking as she succeeded in physically going to the store but started feeling the somatic symptoms of a panic attack. Her developing a panic attack and needing to flee the store made her feel that she was a failure because she couldn’t stay in the store for a longer period of time. After her thoughts and physiological arousal, she escaped the store by returning to the car. Lindsey having her husband with her in these settings is a safety behavior because his presence helps her relax. Though, his actions and him being present reinforce the idea that she is safe only when she is with him interfering with exposure.
A CBT case formulation provides an overview of the client’s problems and the context of how the problems have developed and been maintained. It helps the clinician gather information and fill out any missing information. Case formulation also provides a starting point in therapy. Moreover, they can provide the client with a treatment plan that provides structure to subsequent therapy sessions following intake. With this structure, the therapist and client are able to work towards meeting concrete and measurable treatment goals. If certain interventions are not helping the client progress, alternative interventions can be implemented to better reach clients’ treatment goals. With case formulation, clinicians are able to not only see clients’ issues but any strengths that clients have and utilize these strengths towards meeting treatment goals.
Mar 30, 2023 @ 15:46:56
Hi Grace, I enjoyed reading your post! I think it’s important that you touched upon how case formulations can be adjusted throughout the therapeutic process in the case that previous interventions have not been producing much progress. Like you mentioned, the initial case formulation is a good starting point to inform therapeutic strategies and even help prioritize the client’s presenting problems. However, the therapist should often revisit the formulation to ensure it’s validity.
Mar 30, 2023 @ 15:38:44
Based on the video I would assume that the client’s primary negative automatic thought has to do with her fear of having a heart attack in a public place. I might phrase it “I might have a heart attack here, and if I do, no one will help me.” She seems to be afraid of both the physiological symptoms themselves, and of the possibility of being isolated when she needs help. There are really two levels of catastrophization here. On the first level we have the heart attack fears, which are in reality greatly exaggerated. On the second level we have her fear of being left to die because strangers won’t come to her aid. I realize that strangers can’t always be relied on, but I find it hard to believe that absolutely no one would notice if someone keeled over in the grocery store.
The client generally avoids the situations that trigger her negative automatic thoughts. In this case she leaves the grocery store and finds her husband. She seems to both be avoiding the sense of exposure and vulnerability she feels in the grocery store, and to be seeking comfort from her husband. It’s as if she’s thinking, “if anything happens, my husband will take care of me.”
A good case formulation orients clients and therapists and gives them a framework for the conceptualization of goals. All the information received during intake and early sessions will give therapy direction based on how the information is synthesized. With this information, clients and therapists will know what to work on and prioritize, and will also allow them to foresee possible stumbling blocks.
Once a good case formulation is established, we can work on establishing treatment goals. Making goals specific and measurable makes it more likely that we will set achievable goals, while also allowing us to better understand the outcome. Being specific and measurable makes it much easier to assess whether a goal is realistic or not, and once it has been attempted, we can better understand what went well and what went badly. To borrow a theme from the video for this week, I think that specific goals reveal the middle ground between complete success and complete failure. Especially for clients with all or nothing thinking, being able to quantify what being fifty percent successful looks like can mitigate an overwhelming sense of failure.
Apr 02, 2023 @ 21:51:26
Hi Jonah, I like how you have broken down Lindsey’s catastrophizing into first feeling like she was going to die and second going to die alone. When discussing with the client, pointing out both levels can bring up evidence against some of her cognitive distortions. I also like the comment you made at the end of your post regarding all-or-nothing thinking. Showing clients that they will not be able to conquer their fears or anxiety in one go and that progress is made in small parts can be therapeutic and encouraging. It can help clients to review at the work that they have already done and be proud of the progress that they have made.
Mar 30, 2023 @ 16:29:05
After taking a step into the grocery store and briefly being in there Lindsey began to feel as if she was having a panic attack which was her negative automatic thought. She also felt trapped and like she can’t leave the store which caused her to panic a little more and feel an increase in physiological arousal.. Her negative automatic thought turned into her thinking that she is a failure because she felt she had failed herself and the task. In response to her feeling like a failure and feeling like people were looking at her experiencing panic attack symptoms she left the grocery store and went to her safe space which is her husband who was waiting for her in the car. Being around him makes her feel safe as she knows that he knows how to handle her panic attacks and feelings around this specifically and overall just feels like nothing can happen to her when he is around.
A case formulation is important for effective therapy because it gives the therapist the opportunity to create a treatment plan specific for each client and alter it as they go to make it work better for the client. It allows both the client and therapist to work collaboratively to figure out what works for the client and implement it into their treatment. It is also very important to have specific, concrete and measurable treatment goals because both the therapist and client want to see progress and also work towards something that they are struggling with. As therapists we also want to give the client the ability to “get better” with realistic goals that we know they can do and participate in. Working collaboratively also gives the client motivation and a say which will make them want to participate more.
Mar 31, 2023 @ 18:01:10
Hi Rena,
I liked the phrasing that you used in response to the client’s treatment goals. Being a flexible therapist is important too. If a therapist is convinced their treatment plan will work, but the client and their progress say otherwise, it shows that the therapist is causing harm. Listening and working with clients to get them to their goals is a valuable skill. Providing clients with achievable goals gives them the chance to grow in the way that they choose.
Apr 02, 2023 @ 01:12:28
Hey Rena, I agree with Esther as well. I like how you mention the importance of being flexible as a therapist. Being flexible is one of the most important traits that makes someone a good therapist. Additionally, I agree with you about using collaboration to spark motivation and interest in treatment modalities/homework given to them. Collaborative empiricism is the driving force of CBT and demonstrates that client progress is much better when the therapist and client work together towards the same goals.
Apr 02, 2023 @ 15:04:41
Hey Reba, I agree with you that collaboration is an important aspect of effective CBT and treatment plans. If a clinician dictates the treatment plan without allowing client input, then the client may not be working towards an ideal goal for themselves or not feel comfortable in the process. The client’s voice should be heard and taken into consideration when making a treatment plan. After all, they are the one’s completing these steps.
Mar 30, 2023 @ 18:01:53
Lindsay was feeling ambitious and wanted to take on going into the grocery store by herself. After entering the store she began to experience physiological sensations of a panic attack. Her primary negative automatic thought was that she was going to have a heart attack and that others were observing her “abnormal behavior.” After exiting the grocery store her physiological symptoms calmed. When reflecting, her negative automatic thought shifted to, “I am a failure.” Lindsey’s safety behavior was seeing her husband. Once she entered the car she knew her husband would be able to relieve any other anxious thoughts. After the fact she admitted that she felt embarrassed that she could not complete the grocery shopping alone.
A CBT case formulation is significant for effective therapy because it conceptualizes the presenting problems, associated symptoms, and contributing factors. It is important to be collaborative with the client as this can increase motivation and hope for change. It allows both the client and therapist to keep track of progress. Specific, concrete, and measurable treatment goals will keep the therapy at least semi-structured and for both parties to have a solid understanding of what is being worked on. Measurable treatment goals are essential to be able to track and reflect on what is working and what is not. Clients may become discouraged without the ability to see how far they have come since the beginning of therapy.
Mar 31, 2023 @ 16:25:38
Hi Maria,
You make a great point about case formulation and the importance of involving both the clinician as well as the client. It is important to involve the client in the case formulation because it gives them a way to view and track their own progress. It is very important for the client to know how far they have come and how much they have improved since they began therapy. Case formulations also need to have quite a lot of structure and measurability. The reason for this is that this allows the progress made by the client to be easily detectable and also allows space for reflection. These are important as they will only encourage the client to continue their progress.
Apr 02, 2023 @ 14:47:31
Hi Maria,
I agree that having a case formulation is important as it conceptualizes the presenting problems. I think collaborative work is also so important as it helps the client advocate what has helped them and what hasn’t. this can also help sessions be focused on certain things where there is structure and plan around what needs to be worked on. A treatment plan allows the individual and therapist to track and progress and overall just rule out what isn’t working.
Mar 30, 2023 @ 19:27:13
Lindsey’s primary negative automatic thought was that she was having a heart attack due to going into the grocery store by herself. Despite knowing she was having a panic attack, she was unable to fully believe it due to thinking it could be a heart attack. Her physiological symptoms include sweaty palms, tightness in her chest, and a racing heart. Those symptoms coincide with heart attack symptoms and can be scary which may cloud the person’s judgment. Lindsey typically goes to the grocery store with her husband, which is her safety behavior, as it provides her with comfort during distress. Lindsey left the grocery store to see her husband in the parking lot in the hopes to decrease her symptoms. Her symptoms improved significantly after leaving the store and seeing her husband. As Lindsey progresses, she could slowly taper off her safety behavior to build her confidence in going places alone.
CBT case formulation is essential for effective therapy because it provides structure and strives to make treatment planning purposeful, efficient, and effective. Structure is needed during individual sessions and the overall treatment plan to keep on task to achieve goals. However, case formulations should be modified throughout the treatment as the client progresses. If a client does not do well with behavioral exposure, the client and clinician should address what happened to better understand what the next step can be. Case formulations give clinicians the ability to see what areas need to be addressed and their priority. The process should be collaborative as the client plays an important role in the decision process. The client has a say in their goals and can agree or disagree with the case formulation. If the client is not comfortable with a certain area or thinks that the treatment is moving too quickly, the clinician needs to respect the client and make changes to the treatment plan. It is necessary to have specific, concrete, and measurable treatment goals during therapy because it helps track the treatment progress. Like I said before, if the client is not meeting their goals, the client and clinician need to adjust the goals.
In addition, concrete and specific goals make the client’s treatment personalized to their presenting problems.
Apr 02, 2023 @ 01:02:54
Hey Taylor, I appreciate that you mention how distressing a panic attack actually is. As you say, a panic attack can feel physiologically similar to a heart attack and clouds a person’s judgment during those moments. This is important when counselors consider where their client regards treatment/exposure readiness. I think therapists should try their very best to accurately gauge their client’s readiness so they don’t try something that would hinder progress. Even more so because of the physiological (and psychological) distress a panic attack places on an individual.
Mar 30, 2023 @ 22:55:23
Lindsey’s primary negative automatic thoughts and cognitive distortions involved anticipating a panic attack she would have while at the grocery store. Lindsey worries she will not only have a panic attack while at the store but also worries about the possibility of a heart attack. Lindsey’s cognitions are distorted in this context for a few reasons. First, Lindsey is having negative automatic thoughts about her safety and her inability to control if she has a panic attack while in public. Lindsey responded to her distress expectedly. In order to remediate her physiological arousal and worries about having a panic attack in the store, she left. As a means of relieving herself from this distress, she found comfort in her husband and leaving the store all together. This was a clear safety behavior because she avoided her fear and found solace, even if it was temporary. However, Lindsey’s negative automatic thoughts became prominent when she began to think that she was a failure because she couldn’t complete a “simple” task.
Case formulation and treatment plans are vital to effective CBT. Cognitive behavioral therapy is a therapeutic approach that incorporates evidence-based research and theories. In order to accurately form a treatment plan, a therapist should utilize case formulations, as one without the other is generally futile. Case formulations are key in providing structure to the therapeutic process. It is important to have specific, concrete, and measurable treatment goals whenever possible as a way to determine if therapy is working for the client. It provides an understanding of what is and isn’t working for a particular client. Additionally, it allows therapists to remain flexible and adjust treatment plans to fit a clients specific needs.
Mar 31, 2023 @ 16:15:12
Hi Alysha,
I think you did a great job explaining Lindsey’s negative automatic thoughts. You pointed out how these thoughts are very distorted, which Lindsey was also able to point out. Sadly these negative thought patterns are so automatic and uncontrolled for someone with a mental illness. These thoughts control all areas of an individual’s life and are very distressing for that individual. As you mentioned these negative automatic thoughts cause such an immense amount of stress on Lindsey that it caused a strong physiological arousal in her. This physiological arousal is what makes Lindsey feel as though she is going to have a panic/heart attack. That is why when this physiological arousal occurred Lindsey automatically needed her safety behaviors and barriers to help lower the symptoms of the arousal. Leaving the store and seeing her husband waiting for her provided her comfort and gave her the feeling of safety. This is important for an individual like Lindsey, but if the safety measures are being consistently used in situations they can become very reliant on the safety barrier. That is why it is essential for individuals like Lindsey to work on exposure to different social situations.
Apr 02, 2023 @ 14:54:57
Hi Alysha,
I strongly agree that case formulation and treatment plans are an important part of effective CBT. Structure is very helpful in sessions to ensure the session is productive and accomplishes the intended goal. However, as you said, the clinician should remain flexible and adjust the treatment plan as needed. Not every session will go exactly as you planned due to external factors, so it is important to ‘go with the flow’ as long as it is relevant and productive.
Mar 30, 2023 @ 23:16:39
The client was concerned when entering the grocery store that she was going to have a panic attack/heart attack. While the client knew she wasn’t having a heart attack, she even told herself she wasn’t, yet it still affected her. The reason for this is that even though she knows she is not, her body is having a physiological response and this is causing her to become very distressed. These strong thoughts and emotions caused the client’s symptoms to develop quicker and more intensely. The primary negative automatic thought the client had in response to her panic attack was “I am a failure because I was unable to do a simple task, such as go into the grocery store alone.” This negative automatic thought and the arousal that followed caused the individual to leave the store and her carriage in a panic. The client had an intense sense of relief after she was able to remove herself from the situation and saw her husband waiting for her. The moment she was removed from the situation and with her husband, her symptoms and negative emotions started to decrease quite rapidly. This showed us that the client relied heavily on her husband as a type of safety barrier between her and the social situation. After the entire situation was over the client felt a bit embarrassed considering she left the store so quickly without her groceries. While the negative automatic thought really impacted her, she was able to identify her triggers and attempt to go into the grocery store. This is beneficial and hopefully next time she will be able to stay in the store longer and complete the task without having a panic attack.
Using CBT case formulation is extremely important for an effective therapy session. The reason for this is that it provides a stable and structural plan for both the clinician as well as the client. Case formulations need to be collaborative and decided by both clinician and client. Both the client and the clinician need to work together and develop a plan that they both agree on. It is essential that the clinician runs the case formulation by the client and make sure that they understand all components of the treatment. It is also essential that the client is part of the process as they will be able to tell you whether or not they are comfortable with the case formulation. The client needs to feel comfortable and confident in the treatment plan as this will give them a higher chance of success throughout therapy. With that being said the clinician needs to make sure that all case formulations have specific, concrete, and measurable treatment goals. Without these three things, the treatment goals and therapeutic process, in general, will cause issues to arise when you are trying to show the client’s progression throughout therapy. Keeping track of the client’s process as well as their ups and downs will give the clinician a great view of where to go next in therapy. I also think it is great for clinicians to be able to show their clients how much they have progressed throughout the therapeutic process. It’s important to show that over the course of each session that client has grown and hopefully progressed to a better place than they once were.
Mar 31, 2023 @ 20:44:53
Hello Stephanie,
I agree with your three arguments on the importance of a case formulation in CBT, especially when you mention how important is for the therapist to consistently follow the therapeutic steps based on a coherent and evidence-based approach, measure the client progress, and be able to modify particular goals linked with specific concerns.
Apr 01, 2023 @ 13:32:28
Hi Stephanie,
I appreciate how you pointed out that the client needs to feel confident and comfortable. Therapy can be a bit of an uncomfortable process sometimes, especially when talking about things that might be hard to say aloud. Reminding clients that they have a say in what their therapy looks like can help them understand why the treatment plan is the way it is.
Mar 31, 2023 @ 20:38:55
Watching Lindsey video, it was a great example that demonstrated one of the classical features of social anxiety regarding catastrophized thinking. Her immediate thoughts 9cognitive distortions) after experiencing her panic attack at the grocery store were that she was a failure for not being able to complete such a common task such as going to the grocery store. Even though Lindsey that Lindsey experienced a powerful emotional response to the event she demonstrated positive use of her cognitive abilities and coping skills to direct herself outside the store where her husband was waiting. In addition, she was also able and aware that the action taken might have been a rapid step regarding her situation. Another essential element on the video, is the safety behavior that Lindsey coped, which is her husband presence and support. Explaining important details Dr. V explained to Lindsey that although she felt relived from her negative symptoms in his presence when being anxious, in the future would be important that she gradually focused on independent techniques to help her manage her distressed moments. For instance, learning to use relaxation techniques such as the one she started during the session would help her manage her anxiety and develop new positive coping mechanisms.
A case formulation is a major key of CBT which is an evidence-based approach based on empirical interventions. Therefore, the therapist and the client identify and set realistic and assessable goals that support the treatment plan’s development and outcome. This factor helps the therapist and the client explore these goals to take the right actions to modify and improve the treatment plan. Also, the client will constantly be involved and informed about his/her own important part of contributing to the treatment plan and measure his progress based on these measurable interventions.
Apr 01, 2023 @ 10:21:38
Olgena, You made a really observation picking up on not Lindsey’s negative automatic thoughts in the moments of her panic attack, but also identifying the cognitive distortions that were taking place in that instance (her catastrophized thinking). Despite telling herself that she was not having a heart attack, this cognitive distortion would not let her believe that. Her coping skills (intellectualizing) were not working because her distorted thinking was getting in the way of her rational thinking. Perhaps more cognitive work needs to be done before she faces something so high on her fear hierarchy again so that she can be better equipped to handle her negative automatic thoughts.