Psychopathology (Final) CBT for Panic Dx and Personality Dx

Common catastrophic thoughts

Fear of death or disability Fear of losing control/
insanity Fears of humiliation or embarrassment

Cbt techniques for panic dx

Interoceptive exposure cognitive restructuring
exposure interventions situational exposure

Interoceptive (internal) exposure

one CBT treatment for panic disorder Rationale:
provides opportunities to examine negative predictions about
internal sensations and Rationale: provide opportunities to
increase tolerance and acceptance to internal sensations thru
repeated exposure Method: engage in systematic
exercises that induce feared internal sensations (dizziness,
increased heart rate) head rolling
hyperventilation stair running full body
tension chair spinning
interoceptive exposure makes the feared sensations more safe- at
home or in office w therapist

Cognitive restructuring

one cbt tx for panic dx ID nature of thoughts (they
don�t have to be true to affect emotions) Learn about
common biases in thoughts Treat thoughts as �guesses� or
�hypotheses� about the world Specifically:
Increase awareness of thinking patterns Monitor
relationship between thinking and panic episodes
Challenge thinking Establish adaptive thinking
patterns

Exposure Interventions

one cbt tx for panic dx Provide rationale for
confronting feared situations Establish a hierarchy of
feared situations Provide accurate expectations
Repeat exposure until fear diminishes Attend to the
disconfirmation of fears (�What was learned from the
exposure?�)

Situational exposures

another method of tx panic dx Provides a new learning
opportunity to examine negative predictions about feared
outcomes Increases tolerance to internal sensations in feared
situations Fear hierarchy to be completed ID safety
behaviors

Five factor model of personality

Openness (to experience) Conscientiousness
(constraint) Extroversion Agreeableness
Neuroticism (negative affect)

List of personality dx

Antisocial PD Narcissistic PD Borderline
PD Schizotypal PD Dependent PD

Antisocial PD

Psychopathy is a severe variant of this Disregard for
and violation of the rights of others Recklessness,
impulsivity, aggressiveness, irritability, indifference to
mistreatment of others Differential diagnosis
narcissistic personality traits; substance dependence
disorders Low conscientiousness

Narcissistic Personality Dx

Pervasive pattern of grandiosity, need for admiration, or
adulation, and lack of empathy Differential dx
Antisocial personality disorder

Borderline Personality Dx

Pervasive pattern of impulsivity and instability in
interpersonal relationships, affect, and self-image Most
frequently diagnosed and studied personality disorder
Efforts to avoid abandonment; engaged in reckless activity
(impulsive); episode of rage or anger; self-mutilation
Differential diagnosis: Mood disorders
Dissociative fx Eating dx Substance use
dx Anxiety dx

Schizotypal Personality Dx

Pervasive pattern of social and interpersonal deficits marked
by acute discomfort with close relationships, eccentricities of
behavior, and cognitive- perceptual aberrations Odd
beliefs, magical thinking, social withdrawal, unusual perceptual
experiences Differential diagnosis: Schizophrenia
(people with schizotypal might appear to have prodromal symptoms
of schizophrenia)

Dependent Personality Dx

Pervasive and excessive need to be taken care of that leads to
submissiveness, clinging, and fears of separation
Difficulty making decisions without others� input, need for
others to assume responsibility, difficulty disagreeing with others,
lack of self confidence Differential dx
Agoraphobia, schizophrenia, severe injuries, dementia

what are the broad goals of DBT?

Dialectical (two things that can seem like opposites but can
both be true at the same time) People are doing the best
they can but need to try harder Balance acceptance and
change at the same time really helpful for BPD

four components of DBT treatment

Structured individual therapy (focus on dialectics and
behaviors) Skills group (weekly, 2 hours, learn new
behavioral skill to develop interpersonal skills and coping
skills) Skills coaching (call therapist 24/7 to get help;
helps reaction at difficult times) Consultation team (dbt
therapists work on teams)

The 5 Steps of Dialectical Behavior Therapy

Mindfulness (be aware of present, rather than focused on past
or being worried about future) The middle path (how to
compromise with peers and take new POV) Distress tolerance
(ID and developing coping skills for times of crisis w/o turning to
harmful behaviors) Emotion regulation (skills to maintain
stable mood. Connection between physical and emotional health)
Interpersonal effectiveness (develop healthy relationships,
develop boundaries, and assert themselves)