{"id":43998,"date":"2021-07-27T06:32:00","date_gmt":"2021-07-27T10:32:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=43998"},"modified":"2021-08-02T16:21:46","modified_gmt":"2021-08-02T20:21:46","slug":"cognitive-conceptualization","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/cognitive-conceptualization\/","title":{"rendered":"Cognitive Conceptualization: Understand Your Patient"},"content":{"rendered":"\n<p>What is cognitive conceptualization? How can you construct a cognitive conceptualization of a patient?<\/p>\n\n\n\n<p>Cognitive conceptualization provides the framework for better understanding your patient. You&#8217;ll ask certain questions to get a feel for what problems the patient might be struggling with. Understanding what cognitive conceptualization is and how it works will help your patient to progress with therapy.&nbsp;<\/p>\n\n\n\n<p>Keep reading for more about cognitive conceptualization.<\/p>\n\n\n\n<!--more-->\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Understanding Cognitive Conceptualization<\/strong><\/h2>\n\n\n\n<p>In order to fully understand cognitive conceptualization, it\u2019s important to know about the cognitive model.&nbsp;<\/p>\n\n\n\n<p>The <strong>cognitive model<\/strong> proposes that <strong><a href=\"https:\/\/www.shortform.com\/blog\/dysfunctional-thoughts\/\">dysfunctional thinking<\/a> is common to all psychological disturbances<\/strong>. In this way, mental illnesses such as <a href=\"https:\/\/www.shortform.com\/blog\/low-mood-and-anxiety\/\">depression and anxiety<\/a> may be considered <strong>thinking disorders<\/strong>. The patient has automatic dysfunctional self-talk that influences behavior negatively; the behavior is then interpreted in a negatively biased way, leading to worse thinking. This reinforces itself into a vicious cycle.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Example: A patient wants to try something new. She thinks, \u201cyou\u2019re definitely going to fail, you\u2019re not good at anything.\u201d \u2192 Anxious about failing, the patient declines to try the new activity. \u2192 She then thinks, \u201cI told you, you can\u2019t get anything right\u2014you\u2019re worthless.\u201d<\/li><\/ul>\n\n\n\n<p>The negative thinking extends to the <strong><em>core <\/em><\/strong><strong>of a patient\u2019s beliefs<\/strong> about herself, the world, and other people, as well as <strong>intermediate levels of <\/strong><strong><em>attitudes, rules, and assumptions<\/em><\/strong> the patient holds.<\/p>\n\n\n\n<p>It\u2019s not just the situation itself that makes a person feel a certain way, but also how they construe it, what lens they use to view it.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Cyclical downfalls can be triggered by <strong>precipitating factors<\/strong>, such as a sudden provocation in stress.<\/li><li>The patient may have had key <strong>developmental events<\/strong> earlier in life that predispose her to the condition.<\/li><li>The patient may have developed <strong>coping mechanisms <\/strong>(adaptive and maladaptive) for the dysfunctional beliefs.&nbsp;<\/li><\/ul>\n\n\n\n<p>The <a href=\"https:\/\/www.shortform.com\/blog\/core-message\/\">key point<\/a> of cognitive behavior therapy is that <strong>these dysfunctional beliefs can be unlearned<\/strong>.&nbsp;<\/p>\n\n\n\n<p>The patient\u2019s cognitive conceptualization exists on 3 levels: 1) core beliefs, 2) intermediate attitudes, rules and assumptions, and 3) <a href=\"https:\/\/www.shortform.com\/blog\/negative-automatic-thoughts\/\">automatic thoughts<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Core Beliefs<\/strong><\/h3>\n\n\n\n<p>These are fundamental understandings regarded as absolute truths\u2014just the way things are. Example: \u201cI\u2019m incompetent.\u201d<\/p>\n\n\n\n<p>They are often not explicitly articulated by the patient consciously.<\/p>\n\n\n\n<p>Early experiences may have developed these\u2014by parents, early authority figures; by a traumatic event; by apparent negative treatment by others (accurate or not).<\/p>\n\n\n\n<p>These generally fall into three categories: \u201cI\u2019m helpless.\u201d \u201cI\u2019m unlovable.\u201d \u201cI\u2019m worthless\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Intermediate Attitudes, Rules, and Assumptions<\/strong><\/h3>\n\n\n\n<p>Attitudes are judgments about a particular outcome or situation. Example: \u201cIt\u2019s terrible to fail.\u201d<\/p>\n\n\n\n<p>Rules are prescriptions for behavior for the patient to follow in certain situations. Example: \u201cIf a challenge seems too great, don\u2019t even try it.\u201d<\/p>\n\n\n\n<p>Assumptions are predictions about how things will go based on the patient\u2019s behavior. Example: \u201cIf I try to do something difficult, I\u2019ll fail. If I avoid doing it, I\u2019ll be OK.\u201d<\/p>\n\n\n\n<p>Generally, the patient\u2019s logic works like this: \u201cIf I engage in my [<a href=\"https:\/\/www.shortform.com\/blog\/maladaptive-coping-mechanisms\/\">maladaptive coping<\/a> strategy], then [my core belief] won\u2019t come true and I\u2019ll be OK.\u201d And the inverse of this: \u201cIf I don\u2019t engage in my [maladaptive coping strategy], then [my core belief] will come true and I\u2019ll be hurt.\u201d<\/p>\n\n\n\n<p>(Note the patient may also have positive inversions, which arise when the patient\u2019s mood is better. For example, a positive assumption may arise: \u201cIf I work hard, I can overcome my shortcomings.\u201d)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Automatic Thoughts<\/strong><\/h3>\n\n\n\n<p>Automatic thoughts arise unconsciously, often in response to a situation and sometimes unprompted. For example, someone who has a core belief that she\u2019s incompetent may be told that her manager wants to meet with her. Her automatic thought may be, \u201cMy boss probably thinks I\u2019m doing a terrible job. I\u2019m finally going to be found out and fired.\u201d&nbsp;<\/p>\n\n\n\n<p>Patients are often more aware of the <strong>emotion they feel than the thought itself<\/strong>. Automatic thoughts may come in the form of verbal thoughts or images.<\/p>\n\n\n\n<p>A wide variety of situations can evoke automatic thoughts:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>External events<ul><li>\u201cA friend didn\u2019t pick up my call.\u201d<\/li><\/ul><\/li><li>Stream of thoughts<ul><li>A patient thinks about an exam and how much is being tested, then continues thinking about how important her grades are and a cavalcade of other thoughts.<\/li><\/ul><\/li><li>Cognition: a thought, image, memory, or daydream<ul><li>A patient thinks of a violent image.<\/li><li>A patient has a flashback of a traumatic event.<\/li><\/ul><\/li><li>Emotion<ul><li>A patient feels anger, then reflects on that anger. \u201cI shouldn\u2019t be angry at him. I\u2019m such a bad person.\u201d<\/li><\/ul><\/li><li>Behavior<ul><li>A patient binge eats despite promising herself she wouldn\u2019t. \u201cI\u2019m so weak. I can\u2019t even get my eating under control.\u201d<\/li><\/ul><\/li><li>Physiological<ul><li>A patient feels her rapid heartbeat. \u201cWhy is my heart racing so fast? There\u2019s something seriously wrong with me.\u201d<\/li><\/ul><\/li><li>Mental experience<ul><li>A patient feels a sense of unreality. \u201cI\u2019m going crazy.\u201d<\/li><\/ul><\/li><\/ul>\n\n\n\n<p>These automatic thoughts then lead to <strong>emotions<\/strong>. The two are distinct.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Emotions are one word: sad, anxious, angry, jealous, ashamed, hurt, suspicious, disappointed.<\/li><li>Automatic thoughts are expressed as more than one word.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Constructing a Cognitive Conceptualization<\/strong><\/h3>\n\n\n\n<p>As a clinician, your understanding of the patient\u2019s cognitive conceptualization begins with first contact, and is refined over more sessions and gathering more data with the patient.<\/p>\n\n\n\n<p>Example patient:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Sally was criticized as a child by her mother. She was often compared unfavorably to her more successful brother. This led to core beliefs about her inadequacy.<\/li><li>She developed attitudes and rules about always doing the best, being great at everything she tried. In depressed states, she focused on her deficiencies and became afraid of never amounting to anything.<\/li><li>Her coping strategies include having high standards, overpreparing for tests, looking for weaknesses and addressing them, and not asking for help.<\/li><li>Sally received new experiences leading to negative thoughts: her classmates had far more AP credits than she did; she didn\u2019t make the school athletic team.<\/li><li>Sally developed automatic thoughts: \u201cI\u2019m no good. I won\u2019t be able to do this. I\u2019ll probably fail and drop out of college.\u201d She did not question her automatic thoughts.&nbsp;<\/li><li>These automatic thoughts aggravated into meta-thoughts about her emotions and <a href=\"https:\/\/www.shortform.com\/blog\/how-to-break-negative-thought-patterns\/\">thought patterns<\/a>: \u201cWhat\u2019s wrong with me? Why am I so down? I\u2019m just hopeless.\u201d<\/li><li>These thoughts led to self-defeating behaviors, like withdrawing from her friends, discontinuing activities that used to give her positive accomplishment, and not concentrating during studying.<\/li><\/ul>\n\n\n\n<p>Here\u2019s an example of a cognitive model sequence, where a situation prompts automatic thoughts:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Situation: Sally feels exhausted (physiological trigger) when she wakes.<ul><li>Automatic thought: I\u2019m too tired to get up. There\u2019s no use getting out of bed.<\/li><li>Reaction: Emotionally, she feels sad. Physiologically, she feels heavy. Behaviorally she stays in bed.<\/li><\/ul><\/li><li>Automatic thoughts: \u201cWhat if my professor gives a pop quiz? What if this counts against my grade? What if I fail the class?\u201d<ul><li>Reaction: Emotionally, she feels anxious. Physiologically, she feels her heart rate rise.<\/li><\/ul><\/li><li>Situation: Sally notices her rapid heartbeat.<ul><li>Automatic thought: \u201cWhat\u2019s wrong with me? Why am I getting worked up over nothing?<\/li><li>Reaction: Emotionally, she feels more anxious.<\/li><\/ul><\/li><li>Automatic thought: \u201cI\u2019d better just stay in bed, I can\u2019t do anything right now.\u201d<ul><li>Reaction: Emotionally, she feels relief. Physiologically, she feels her heart rate slow. Behaviorally, she stays in bed longer.<\/li><\/ul><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>What is cognitive conceptualization? How can you construct a cognitive conceptualization of a patient? Cognitive conceptualization provides the framework for better understanding your patient. You&#8217;ll ask certain questions to get a feel for what problems the patient might be struggling with. Understanding what cognitive conceptualization is and how it works will help your patient to progress with therapy.&nbsp; Keep reading for more about cognitive conceptualization.<\/p>\n","protected":false},"author":12,"featured_media":13071,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[34,9],"tags":[443],"class_list":["post-43998","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-communication","category-psychology","tag-cognitive-behavior-therapy-basics-and-beyond","","tg-column-two"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.3 (Yoast SEO v24.3) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cognitive Conceptualization: Understand Your Patient - Shortform Books<\/title>\n<meta name=\"description\" content=\"Constructing a cognitive conceptualization of a patient can help you better understand what they need from therapy. 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