______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
FIRST, SECOND, THIRD WAVE CBT, A SIMPLIFIED CASE EXAMPLE OF FEAR OF FLYING (AEROPHOBIA) Conceptualization Treatment Goal Treatment Approach First Wave • Early life experience of their
• Decrease intensity of response (anxiety, fear) to stimulus of thought of airplane, sitting in an airplane, flying in an airplane. • Change deeply held beliefs about flying. • Change fear-inducing thought patterns.
• Exposure • Shaping • Systematic desensitization
brother holding his hand over her mouth and her fear of being unable to breathe or move. • Avoids flying, which prevents anxiety, reinforcing perceived dangerousness of flying.
Second Wave
• Irrational belief about the
• Notice and challenge
dangerousness of flying leads to fear, and anxiety that interferes with flying. This may be in contrast to less or no anxiety related to more dangerous modes of travel (e.g., automobile).
irrational thoughts related to flying, safety, and the ability to tolerate anxiety symptoms. • Exposure and systematic
desensitization to unlearn maladaptive responses to flying and learn to cope with distress with less anxiety.
• Challenge irrational thoughts related to the early childhood incident with the brother as unrelated to flying.
• Socratic questioning to evaluate the accuracy of fears. • Rationalizing fear based on flying statistics. • Mindfulness practice to: • Notice and feel fear. • Notice sensations and tolerate the experience of anxiety. • Notice mind “thinking” thoughts that may or may not be accurate. • Utilize values-based contextual assessment to examine quality of life goals and desire, for example, to travel and hike national parks with friends. Table 1
Third Wave
• (General, depends upon theory) • The client struggles to live a value-driven life (hike) due to psychophysiological response to sensations they label as anxiety.
• Instead of “fighting” or trying to eliminate symptoms (anxiety, fear), change the relationship to noticing, experiencing, and tolerating symptoms. • View within holistic, values-based, contextual perspective.
adaptive and maladaptive behavior, including increased hand- washing, hoarding toilet paper, wearing or refusing to wear masks, isolation, and watching news 24/7, among many others. Digital CBT-I Case Example: Quarantine, Isolation, Suffering from Circumstances Imposed by COVID-19 Pandemic Lola, a 36-year-old married mother of three (ages 8, 6, and 2), presents for psychotherapy via video telehealth two months into the COVID-19 pandemic. She presents feeling over- whelmed and anxious, trying to juggle working from home and parenting her three children, two of whom are attending
school virtually. Lola complains of inability to maintain sleep, compulsions to check social media and watch news 24/7, anxiety, increased appetite, and irritability, with no reported history of suicidality or mental health treatment. When asked what may be causing and maintaining her current level of stress, she voiced a litany of thoughts, all of which she described as unchangeable “circumstances,” including: • “I can’t do this.” • “The numbers who are sick are skyrocketing. People are dying.”
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