Cognitive Skills for Challenging Behaviors

Transcription

1 Welcome October 22, 2009 MARRCH Fall Conference EDENS GROUP is dedicated to assisting professionals with the creation and implementation of innovative and accountable approaches to their work. EDENS GROUP is committed to providing continuing education experiences that will assist professionals in enhancing their clinical skills and increase the level of quality client care. Edens Group Training Center 1019 Jessamine Ave East Suite 200 St Paul, Minnesota (651) phone (651) fax Meet Your Trainer: KAREN EDENS, Founder and President, EDENS GROUP, has almost four decades of professional experience in the design and delivery of continuing education. Karen delivers a variety of professional development seminars; consults with treatment providers and various community groups and provides employer services related to creating and maintaining healthy workplaces. After today s session, you will be able to: Describe the impact of cognitive skills methods on client behaviors. The Basics of Cognitive Behavioral Therapy Apply select cognitive skills methods to challenging client behaviors.

2 A CBT Primer CBT as a multifaceted set of tools (not one therapy). CBT as a distinct approach from other therapists. CBT two primary approaches. 1. Cognitive Restructuring 2. Exposure Therapy General Definition of CBT The use of experimentally established principles of learning for the purpose of changing maladaptive behavior - J. Wolpe Branded Cognitive and Behavioral Therapies Skinnerian Therapy Exposure with Ritual Prevention (ERP) Cognitive Behavioral Therapy (CBT) Dialectical Behavior Therapy (DBT) Generic Cognitive and Behavioral Therapies Operant Therapy Behavioral Skills Training Exposure Cognitive Restructuring Therapy When I get too technical, the audience starts to look like this. Other Approaches Carl Rogers ( Rogerian Humanistic ) Sigmund Freud ( Freudian or psychoanalysis 1800 s to 1960 s) Biological (Wash U 1970 s to Present)

3 Cognitive Approach The ABC s of Affect/Behavior Therapeutic techniques designed to identify, reality (A) Noise test, and correct distorted conceptualizations and the dysfunctional beliefs (schemas) underlying these cognitions (B1) Burglar (B2) Cat (B3) Spouse Arriving Safe - A. Beck (C1) Panic Call 911 (C2) Irritated (C3) Relief/Happy Anxiety Disorders Mood Disorders Insomnia Dementia Specific Applications CBT With Adolescents Depression PTSD ADHD Drug Abuse Anxiety Oppositional Defiance Disorder Conduct Disorder Prevalence of Co-Morbidity Ages at the 50th Percentile of the Age-at-Onset Distribution for Major Disorders (Kessler et al., 2005) Clinical Populations and Common Co-Existing Disorders Conduct/Oppositional Disorders ~40-50% ADHD ~30-60% Depression ~25-60% Anxiety Bipolar PTSD, Trauma Learning Disorder Eating Disorder 50% tile age of onset Projected Lifetime Risk at Age % 16.3% 25.4% 31.5% Disorders

4 Maturation Occurs from Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 20) We thought brain development was complete by adolescence We now know maturation is not complete until about age 25!!! Earlier: Motor Coordination Emotion Motivation Later: Judgment Blue represents maturing of brain areas Source: PHAS USA 2004 May 25; 101(21): Epub 2004 May 17. Seven Implications of Arrested Development for Adolescent Behavior Preference for physical activity high excitement and low effort activities activities with peers that trigger high intensity/arousal novelty Less than optimal balance of emotion and logic when making decisions consideration of negative consequences Greater tendency to take risks and show impulsiveness Opportunities for Treatment! Two treatment approaches that seem to be brain friendly:! Cognitive behavioral therapy! Motivational interviewing! Characteristics of CBT! Focus on immediate, relevant and specific problems! Change based on self-! responsibility! Self-efficacy can occur!

5 Characteristics of Motivational Interviewing! De-emphasize labels! Emphasis on personal choice and responsibility! Therapist focuses on eliciting the client's own concerns! Resistance is met with reflection and nonargumentation! Treatment goals are negotiated; clientʼs involvement is seen as vital! Characteristics of CBT-friendly Goals Immediate problems Problems that are highly relevant Specific problems Problems that can be CBT Goals for a Client With Motivational Interviewing Drug abuse Depression ADHD Conduct Disorder Confrontational vs. Motivational Exercise: Confrontational Interviewing Exercise: Motivational Interviewing How many years have you been abusing alcohol? Abusing marijuana? The screening test indicates that you are probably chemically dependent. The test says that you use on a weekly basis, yet you are denying that you are chemically dependent. The screening test indicated that your use has increased recently. What specific changes have you noted? What are some of the benefits that you get from using? What are some of the negative things about using? What concerns do you have about your current pattern of use?

6 When might a confrontational style be indicated? Five principles of motivational interviewing Express Empathy Attitude of Acceptance Understanding the Client s Perspective Reflective Listening Avoid Argumentation Arguments are counter-productive Try Care-Fronting Roll with Resistance In the face of arguing, reframe. Offer different perspective. Invite new view, but do not impose. Support Self-Efficacy Client is Responsible for Change. Empower the Client. Change is more self-rewarding when its source is internalized.

7 Develop Discrepancy Amplify discrepancy between the present and future. Explore important goals. Emphasize how continued behaviors of concern will interfere. Functional Analysis Serves two purposes 1. Determine the immediate and observable triggers or determinants of the presenting problem 3. Clarifies the positive and negative consequences of the behavioral problem Decisional Balance Exercise Cognitive Restructuring Pros and Cons Probing Leads to Goal Setting Identify negative and maladaptive thoughts Teach adaptive, positive self-statements Dealing With Resistance What three interviewing techniques are particularly useful when faced with resistance? Role reversal or role playing If persistent and severe, seek another day