Slide_Conceptualizarea in CBT

8/12/2019 Slide_Conceptualizarea in CBT

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CONCEPTUALIZAREACLINIC (CASE

FORMULATION) N CBT


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CE ESTE CONCEPTUALIZAREA CLINIC?

O descriere a tabloului clinic

O explicaie teoreticasupra cauzelor i factorilor demeninere, cu rol informativ pentru intervenie

Elemente cheie:

descrierea simptomelor,

factori predisponzani (receni i distali),

factori de meninere,

factori protectori (puncte tari) i

indicaii specifice pentru intervenie


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TIPURI DE CONCEPTUALIZARE

Conceptualizare general ex. modelul stres-vulnerabilitate

Conceptualizare specificpe categoria de diagnostic

pe situaia/problema specific (ex. modelul ABC)


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MODELUL STRES-VULNERABILITATE


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CONCEPTUALIZARE SPECIFIC FOBIESOCIAL (CLARK & WELLS, 1995)


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CONCEPTUALIZARE SPECIFIC


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CONCEPTUALIZAREA (KUYKEN,PADESKY, & DUDLEY, 2009)


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FUNCIILE CONCEPTUALIZRII

1) Sintetizeazexperiena clientului, teoria CBT i datelede cercetare

2) Normalizeazreaciile clientului fade tabloul clinic

3) Susine angajamentul clientului fade tratament4) Face ca problemele numeroase i complexe sfie mai

uor de gestionat de client i terapeut

5) Ghideazselecia, focalizarea i ordinea strategiilor de

intervenie


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FUNCIILE CONCEPTUALIZRII

6) Identificpunctele tari i ntrete reziliena clientului

7) De cele mai multe ori sugereazutilizarea unorintervenii eficiente

8) Anticipeazproblemele ce pot aprea n terapie9) Ajutla ntelegerea lipsei de rspuns la terapie i

sugereazci alternative

10) Faciliteazprocesul de supervizare (structurarea

discursului)


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PAI N FORMULAREACONCEPTUALIZRII (PERSONS &

TOMPKINS, 2007) Obinei o list de probleme comprehensiv (5-8 probleme) Stabilii un diagnostic DSM (pe cele 5 axe)

Selectai un diagnostic principal (responsabil de cele mai

multe simptome/pe care se focalizeaz scopurile terapiei) Selectai modelul potrivit de conceptualizare pentru categoriageneral de diagnostic

Individualizai acest model astfel nct s fie incluseproblemele din list

Propunei ipoteze despre originea mecanismelor psihologice

Descriei factorii precipitani cureni


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EXEMPLU

Example: Formulation of the Case of John John is a 37-year-old, single, second-generation Japanese American male who lives alone and is selfemployed as a web designer. John, who has hepatitis C, was referred by his nephrologist for treatment of depression and poor medical adherence. His chief complaint to the therapist was: My doctor says Im not getting better and its time for some new ideas. Johns therapist developed the following formulation of his case. The origins, mechanisms, andprecipitants are identified in brackets [e.g., origins], and the problems are italicized. Caused by [origins] a likely biological vulnerability to anxiety (as evidenced by his mothers apparent social anxiety) and by rearing in a household in which (due to his mothers shyness and her difficulty adjusting to the American culture) there were few visitors and thus few models of easy

social interaction, and in which his father was largely absent but when present often brutally critical and attacking, John developed [mechanisms] schemas of others as critical and rejecting, of himself as weak, weird, and helpless, and of the future as hopeless. These schemas, activated by [precipitants] his worsening medical problems and increasing pressure from his physician to comply with treatment recommendations, have exacerbated Johns social anxiety and passive, unassertive, and avoidant behaviors. Johns medical problems also trigger [precipitants] his schemas by causing physical symptoms (sweating, trembling, fatigue, and dizziness) that he fears others will notice and then think him as weird or weak. In addition, Johns social anxiety and unassertiveness worsen his noncompliance, because the symptoms block him from following some of his physicians recommendations (e.g., to attend a self-help group for hepatitis C) and even from participating fully in treatment-planning discussions with his physician. The noncompliance, of course, aggravates his medical condition and the symptoms he worries that others will notice. Johns views of himself as weak and of the future as hopeless, together with all his other problems, cause depression and suicidal thoughts and urges. John copes with distress through avoidance (which leads to social isolation that generates evidence to support his belief that others are rejecting and he is weird), and alcohol abuse (which exacerbates his liver disease, depression, and social isolation).


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CONCEPTUALIZAREA CLINICVALIDATTIINIFIC

Este teoria subiacentvalidattiinific?

Procesul, impactul, utilitatea conceptualizrii (fidelitate i

validitate)


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CONCEPTUALIZAREA CBT VALIDATTIINIFIC

Conceptualizrile CBT oferdescrieri acurate dar nmulte cazuri teoriile explicative sunt insuficient explorate acest lucru se reflectn formularea conceptualizriii n practic

Are conceptualizarea clinicvaliditate ? - oameniiutilizeazn general scurtturi mentale (euristici) inclusiv

n luarea deciziilor n mediul clinic

Reprezentativitatea, disponibilitatea (ex. Informaiirecente), ancorarea (organizarea informaiilor n jurulunei idei iniiale)


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ARE CONCEPTUALIZAREA CBTFIDELITATE?

Practicienii CBT de obicei sunt de acord ntre ei n ceeace privete descrierea simptomelor, dar acordul estemoderat n ceea ce privete mecanismele

etiopatogenetice


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ARE CONCEPTUALIZAREA CBTVALIDITATE?

Date inconsistente legate de corespondena cuexperiena subiectiva pacientului

mbuntete rezultatele terapiei?- Formularea individualizata cazului (fade prezentareageneral, manualizat) nu aduce rezultate mai bune nterapie (ex. Emmelkamp et al., 1994) dar tratamentele

indiviualizate au rezultate mai bune n timp (Jacobson etal., 1998)


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RECOMANDRI PENTRU OCONCEPTUALIZARE EFICIENT

Generarea unor ipoteze provizorii i testarea lor continu

A sta mai aproape de nivelul descriptiv al conceptualizrii;inferenele pot duce la idiosincrazii

Mai multe preri - crete nivelul de acord inter-evaluatori:grupuri de intervizare

Triangularea datelor (obinerea de informaii din mai multe

surse)

Atenie la euristici

Urmrirea protocoalelor de intervenie


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GHID PENTRU FORMULAREA UNORCONCEPTUALIZRI CBT EFICIENTE


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EXEMPLUCONCEPTUALIZAREA NTULBURRILE DE ANXIETATE

Conceptualizare a:

Categoriei

Tulburrii specifice Problemei specifice intr-un caz


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CONCEPTUALIZAREA TULBURRILORDE ANXIETATE (WELLS, 2007)


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MODELUL COGNITIV AL TULBURRII DEPANIC (WELLS, 1997)

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