COGNITIVE BEHAVIORAL THERAPY & THE SLP

Transcription

1 COGNITIVE BEHAVIORAL THERAPY & THE SLP Lynne E. Hewitt, Ph.D., CCC-SLP Bowling Green State University, Bowling Green, OH

2 DISCLOSURE v The presenter received a complimentary registration to the ASHA convention for giving this presentation. v The presenter has no other financial or non-financial relationships relevant to the content of the presentation to disclose. 2

3 WHAT IS COGNITIVE BEHAVIORAL THERAPY? v Evidence-based treatment for wide array of psychological problems Evidence base described as enormous Hofmann, Asnaani, Vonk, Sawyer, & Fang (2012) p. 436 v Originally conceived by Ellis (1962) Focus on short term treatment De-emphasizing root causes, past history Providing specific strategies Focused on changing behaviors by changing thoughts Altering dysfunctional thought patterns thought experiments homework assignments 3

4 WHAT IS CBT USED FOR? v Mood disorders v Anxiety disorders v Personality disorders v Eating disorders v Substance abuse disorders v Psychotic disorders v Sleep disorders About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm 4

5 PHOBIA EXAMPLE 5

6 HELP FOR SPIDER PHOBIA v S v 6

7 KEY ELEMENTS v Inducing different thought patterns about spiders impacted the emotions experienced v Repeated exposure also a factor in reducing phobic response 7

8 MY INTEREST IN CBT v Individuals with ASD exhibit many co-morbid psychiatric disorders (Leyfer et al., 2006) Anxiety Social phobia Depression OCD v Anxiety and social phobia overlap with pragmatic communication impairment 8

9 CBT & ASD v Evidence that CBT assists with anxiety, including social anxiety Sung et al. (2011); White et al. (2010); White et al. (2013); Wood et al. (2009). v Overlap between intervention to enhance ability to function in complex social environments and therapy to reduce social anxiety Role for psychologist? Role for SLP? 9

10 CAN SLP S ETHICALLY EMPLOY CBT STRATEGIES? v ASHA Code of Ethics, Principle IIB Individuals shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their level of education, training, and experience. 10

11 KEY ELEMENTS v What are we trained to do? v What are other professions trained to do? v What might be possible if we fostered collaborative approaches? 11

12 SLP & CBT v Stuttering involves social anxiety, counseling, changing attitudes and beliefs Menzies, Onslow, Packman, and O Brian (2009) argue that with appropriate training explicit use of CBT by SLP s appropriate 12

13 DESENSITIZATION 13

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16 CONSIDERATIONS IN CBT v Cognitive prerequisites By definition, metacognitive abilities needed Thinking about thinking To some degree, metalinguistic abilities needed Thinking and talking about the language used to express thoughts Suitable for early elementary chronological age &developmental functioning age and older/higher functioning 16

17 CBT & ASD & THE SLP v Influential practitioner Michelle Garcia Winner promotes use of social thinking Winner (2007) Thinking about you, thinking about me Explicitly cognitive approach Core concept is to teach specific strategies and their rationales Influence thought processes in social environment Understand how others are thinking expected versus unexpected behaviors Enhance social problem solving Eye contact example 17

18 WHO WILL PROVIDE THE SERVICES? v Gaus (2007) Cognitive Behavioral Therapy for Adults with Asperger Syndrome Few trained to assist Wrote book for wide range of professions, including SLP s, to enhance skills among providers to support adults with AS/ASD Clear from her examples that many of the need areas that her clients demonstrate are squarely in SLP scope of practice E.g., list of reasons for seeking therapy of one of her clients difficulties with conversation. what questions he could ask when he meets someone and what he should not ask. knowing what topics would be appropriate, and how that might be different in a group than one-on-one. 18

19 CASE EXAMPLE ADAM v Young adult with ASD Sophomore at a public university Struggling academically Difficulty organizing time Trouble with math Difficulty reading higher order college-level texts Difficulty with writing History of social anxiety Negative experiences in first year dorm Attempts to make friends resulted in rejection and high levels of anxiety Multiple texts to individuals in dorm why don t you like me Experienced panic attack when saw a student on the street who was in his 1st year dorm 19

20 P ROV I D I N G S E RV I C E S T O A DA M v Clear social phobia and anxiety disorder Referral to psychological services first order of business v But also need to address maladaptive interactional patterns Conversational and pragmatic intervention in SLP scope of practice v Ideal world: teaming up 20

21 CBT SHOWING UP ON PINTEREST 21

22 SOURCE v 22

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24 BEST OF BOTH WORLDS v CBT-trained psychologists interact with SLPs to provide supports in tandem v Such an approach would be example of interprofessional collaborative practice (IPP)... multiple health workers from different professional backgrounds work[ing] together with patients, families, carers, and communities to deliver the highest quality of care (WHO, 2010, p. 13) v Successful IPP founded on interprofessional education...students from two or more professions learn[ing] about, from and with each other to enable effective collaboration and improve health outcomes (World Health Organization, 2010, p. 13). 24

25 I N T E R P RO F E S S I O N A L E D U C AT I O N A N D T H E S L P v Zraick, Harten, & Hagstrom (2014) articleid= &utm_source=asha&utm_medium=enewsletter&utm_cam paign=sig10perspectives Changing healthcare and education landscape Emphasis on patient-centered outcomes Evidence that collaborative practice results in better outcomes Importance of having a clue what others are up to. v Strengths for communication disorders Historically a collaborative, interdisciplinary field sister professions of aud and SLP Training in variety of healthcare and educational settings Use of ideas from psychology well-embedded in our practice 25

26 I N T E R P R O F E S S I O N A L E D U C AT I O N A N D T H E S L P, C O N T. v Weaknesses for SLP Large scope of practice leaves limited time for formal training with other professions May or may not be affiliated with medical schools or other allied health training facilities Behind other professions such as nursing in IPE 26

27 IPE AND THE FUTURE v May be required in future accreditation v Sites may start requiring evidence of IPE before taking students v ASHA is on board: 27

28 BACK TO CBT v IPE/IPP would enhance service provision for individuals with pragmatic language impairments and social anxiety Perfect world: Service provision done collaboratively psychologists offering CBT expertise SLPs offering pragmatic communication expertise 28

29 THOUGHTS? v How is our training pertinent to CBT? v Where are we lacking? v Models of collaboration what are best practices? v How should our profession move forward to enhance practice using IPE/IPP both for CBT and more broadly? 29

30 REFERENCES v Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart. v Gaus, V. L. (2007). Cognitive-behavioral therapy for adult Asperger syndrome (Guides to Individualized Evidence-Based Treatment). Guilford Publications. Kindle Edition. v Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of Cognitive Behavioral Therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), v Keehn, R. H. M., Lincoln, A. J., Brown, M. Z., & Chavira, D. A. (2013). The coping cat program for children v with anxiety and autism spectrum disorder: a pilot randomized controlled trial. Journal of Autism and Developmental Disorders, 43(1), v Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation, 13(1), v Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J.,... Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism & Developmental Disorders, 36(7), v Menzies, R. G., Onslow, M., Packman, A., & O Brian, S. (2009). Cognitive behavior therapy for adults whostutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 34(3),

31 REFERENCES, CONT. v Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53(4), v Sze, K. M., & Wood, J. J. (2007). Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: A case report. Journal of Contemporary Psychotherapy, 37(3), v Sung, M., Ooi, Y. P., Goh, T. J., Pathy, P., Fung, D. S., Ang, R. P.,... Lam, C. M. (2011). Effects of cognitive behavioral therapy on anxiety in children with autism spectrum disorders: a randomized controlled trial. Child Psychiatry & Human Development, 42(6), v White, S., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A.,... Scahill, L. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child & Family Psychology Review, 13(1), v White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A.,... Scahill, L. (2013). Randomized controlled trial: Multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of autism and developmental disorders, 43(2),

32 REFERENCES, CONT. v Winner, M. (2007). Thinking about you, thinking about me: Teaching perspective taking and social thinking to persons with Social Cognitive Learning Challenges (2nd ed.). San Jose, CA: Think Social Publishing. v Winner, M. (2012). Treatment. Retrieved September 23, 2013 from v Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009a). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), v Wood, J. J., Drahota, A., Sze, K., Van Dyke, M., Decker, K., Fujii, C.,... Spiker, M. (2009b). Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with highfunctioning autism. Journal of Autism and Developmental Disorders, 39(11), v Zraick, R. I., Harten, A. C., & Hagstrom, F. (2014). Interprofessional Education and Practice: A Primer for Training Future Clinicians. SIG 10 Perspectives on Issues in Higher Education, 17(2),