TIP #1. Make learning experiential. As Confucius said: "Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand.

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1 42 TIPS AND TOOLS FOR THE DEPRESSION AND ANXIETY TREATMENT TOOLBOX JUDITH A. BELMONT, M.S. Use Psycho-Educational Tools from Second and Third Wave Approaches CBT, DBT, ACT, MBCT & Positive Psychology Mindfulness focus plus CBT TIP #1 Make learning experiential As Confucius said: "Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand." Get clients involved in their help! Use Psycho-Educational Ensure a strong therapeutic and collaborative alliance. Start each session with a mood check Clarify goals and agenda Use experiential activities and visualizations Use Metaphors to unlock insight Use self-help assignments between sessions Get in the habit of asking for feedback Use Role Play - representing people or thoughts Help client create daily rituals

2 The Therapeutic Relationship Transcends any Techniques Carl Rogers - Unconditional positive regard Linehan - Non - judgmental therapist Hayes - Utmost importance of positive regard Even Ellis emphasized the importance of the client feeling liked COMPASSION POSITIVITY TIP #2 HOPE LIKE THEM HELP SOMEONE CRY Help Your Clients Learn To Think Flexibly with Simple Demonstrations Teach flexibility - Don t just talk about it! Exercises TIP #3 Be Small flexible change can be a big deal! Don t miss opportunities with inflexible Would you thinking! rather have a million dollars or a penny which doubles every day for a month? HELP SOMEONE CRY

3 The Therapeutic Relationship Transcends any Techniques Carl Rogers - Unconditional ndi io nal positive ive regard Linehan n - Non- judgmental therapist Hayes - Utmost importance of fposi positive regard Even Ellis emphasized ed the ei importance of the client feeling liked kd COMPASSION SI ON POSITIVITY I TY What s the biggest room in the world? Opportunity is NOWHERE Perception is Everything Activity: We all perceive differently! Examples Learn the lesson of the Cookie Thief! TIP #4

4 Learn the lesson of the Cookie Thief! The Power of Metaphors Toolkits Distress Tolerance Kit (DBT) The Recovery Toolkit The Drug Free Toolkit The Stress Toolkit The Life Skills Toolkit TIP #5 Demonstrations and visualizations TIP #6

5 Importance of Homework and Self-Help Assignments Practice, Practice Practice! CBT Bootcamp Psycho-Education Introducing your client to CBT concepts TIP #7 Analogy: Therapy as a New Language New Terms New Acronyms Learning the Psychological ABCS Examples of new ABCS: ACT, DBT and CBT TIP #8 Teaching your clients the Psychological ABCS A B C D E TIP #9

6 He is so BAD! They have to like me! I can t stand it! Common Mental Mistakes That s TERRIBLE! Life should be fair! Mood logs, Diary cards, Skill building sheets Between session tracking and practice - cornerstone of all types of treatment Includes rating of believability or emotional intensity TIP #10 Rating the Strength of Your Belief Low Belief Strong Belief Identifying Self - Defeating Beliefs Inventory Sheets, Lists, Cognitive Distortions lists, Journal Logs, Handouts and Worksheets TIP #11 TIP #12

7 Example - Triple Column Technique TIC TOCS - David Burns Automatic Thought Cognitive Distortion Rational Response Task Interfering Cognitions Task Oriented cognitions TIP #13 TIP #14 Types of Cognitive Distortions 1. Over-Catastrophizing 2. Fortune Telling 3. Black and White Thinking 4. Personalization 5. Jumping to Conclusions 6. Labeling 7. Magnification 8. Minimization 9. You should on yourself and others 10. Making Comparisons 11. Mental Filter TIP #15 CBT Techniques Digging Deeper to Core Beliefs Vertical Arrow Technique TIP #16

8 CBT Techniques Coping Card Varieties TIP #17 CBT Example Coping Card #1 Automatic thought: If my boyfriend leaves me, I ll never have anyone else. Response: I won t have anyone at first. But there are a lot of things I can do to meet someone new and I m learning a lot of things in therapy to help me have a better relationship next time. Just because I feel like I am unlovable doesn t mean it s true. Used with permission of J. Beck, from Cognitive Therapy for Challenging Problems (2005). CBT Example Cognitive Reframing Turning Anger into Goals Eliminate the ANTS TIP #18

9 CBT Group Activity Irrational & Rational Songs Other Role Play Variations Feared Fantasy (CBT) Externalization of Voices (CBT) Take turns playing the roles of client s negative thoughts and the role of your positive thoughts. (Empty chair technique) TIP #19 TIP #20 CBT Techniques to Treat Anxiety Cost/Benefit Analysis Depression Screening Inventories/Mood Logs Burns Depression Checklist Beck Depression Inventory TIP #21 TIP #22

10 Biblio-Therapy and Depression ACT - Third Wave Treatment Introducing ACT Acceptance Commitment Therapy Founder: Stephen Hayes TIP #23 ACT - Third Wave Treatment ACT - Third Wave Treatment ACT Techniques Cognitive Defusion TIP #24 ACT Techniques Use of Metaphors White room Conveyor Belt Monsters on the Bus Beach Ball TIP #25

11 More Role Play Variations Passengers on the Bus (ACT) Acceptance Paradox (CBT) Mind Monsters - which one you feed Take turns playing the roles of client s negative thoughts and the role of your positive thoughts. More Metaphors TIP #26 TIP #27 ACT and MBCT Mindfulness and Metaphors TIP #28 Have client make up their own What are common ones? DBT Dialectical Thinking TIP #29 Opposing Needs, Wants, Expectations We are always making compromises (even if you re not aware of them).

12 Oxymorons Jumbo Shrimp Awfully good Pretty Ugly Bittersweet Can you and your clients think of more? TIP #30 Understanding DBT The Four Modules Acceptance Based Techniques Core Mindfulness Distress Tolerance Change Based Strategies Interpersonal Effectiveness Emotional Regulation TIP #31 DBT Techniques to Treat Depression Acronyms Galore TIP #32 MEDDS Mastery - Exercise - Diet - Drugs (prescription) - Sleep - Spirituality Example of DBT Acronyms When you practice ONE MIND, you are focusing on: O: One thing at a time N: Being in the here and Now E: Attend to the Environment M: Be attentive to the Moment I: Increase your five senses N: Take a Non-judgmental stance D: Describe what you experience without interpretation MEDDS Mastery - Exercise - Diet - Drugs (prescription) - Sleep - Spirituality

13 DBT is full of acronyms One Mind One thing in the moment Now Environment Moment Increase Non judgmental Describe Describe Express Dear Man Assert Reinforce Mindful Appear confident Negotiate Common Acronyms ATM: Automated Teller Machine ADD: Attention Deficit Disorder AIDS: Acquired Immune Deficiency Syndrome EPCOT: Experimental Prototype Community of Tomorrow FEMA: Federal Emergency Management Agency 24/7: All the time, 24 hours a day, 7 days a week AA: Alcoholics Anonymous ASAP: As Soon as Possible FYI: For Your Information B.C.: Before Christ A.D.: Anno Domini, year of the Lord Diary and Tracking Logs using Acronyms Know the DBT Modules Radical Acceptance and Mindfulness Emotional Regulation Strategies Distress Tolerance Interpersonal Effectiveness TIP #33

14 Teach Assertive Skills TIP #34 Psycho-Education for Stress: Important to include: Communication Basics Assertive Non-Assertive Aggressive It s not just what you say! So much of communication is non-verbal I never said he stole the money! Role Play Behavioral rehearsal Use role play to teach effective interpersonal communication TIP #35 21

15 Conflict Resolution Exercise: Strive to have no winners and losers - strive for relationships that are WIN- WIN TIP #36 Use Communication Skills Handouts and Worksheets for skill building to practice, practice, practice! I message into You messages worksheets Rhetorical Questions worksheet TIP #37 Communication Log TIP #38 Communication Skills Listening vs Hearing What is the difference? Group Activities: Relationship Building Egg Gem inside of me TIP #39

16 Psychosocial Education: Myth Busting Activity: STRESS IS. Or Who stresses you out activity? TIP #40 Great Group Activities Manage your stress - don t carry it! 16% 4% 31% 12% 6% 7% 6% 18% How I slice my life Clarifying Values Work/Career Health Family Recreation Spiritual Friends Personal/Educational Social TIP #41 TIP #42 12% 4% 16% 6% 6% 18% 31% 7% Work/Career Health Family Recreation Spiritual Friends Personal/Educational Social How I would like to slice my life

17 Clarifying Values Can you think of TIP #43 from your own therapeutic toolbox? Contact Information: Judith Belmont, MS Tips and Tools for the Therapeutic Toolbox series and The Therapist s Ultimate Solution Book

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