Cognitive Behavioral (CBT)

My Therapy Technique  Use Experiential Moment Exercise for all Modalities:  Use “Positive Traits” handout in “Positive Psychology” (Betterhelp) category for all works. Especially trying to get the “emotional” part worked on in the CBT model.  Use the “Emotions – Beliefs” list when applying CBT and REBT.  Use the “Negative and Positive Emotions/Self-Talk” list in all situations when assessing client’s self-talk (same as the “Emotions – Beliefs” handout.  Apply Christian Conte and Brene Brown to most work as their videos on anger, anxiety, shame, and vulnerability are key in every approach.  Play video on: “Overcoming Bad Inner Voices” for all clients. General Approach: • Start with rapport. • “What is Tharapy?”. • Plans for Therapy. • Gain biopsyche content along the way. • Examine family dynamics. • Check love language by using the online quiz. • Then look at the past, upbringing, and defense mechanisms. • Then the psychological complexes that defenses turn to. • Then, CBT worksheet and functional analysis to attend to starving the defense mechanism due to negative thought patterns that fuel it. • Then life hobbies that reach out to the new identity. CBT (use emotions list at first to pinpoint style of though/core beliefs/emotions): • Start with rapport. • “What is Tharapy?”. • Plans for Therapy. • Gain biospyche content along the way. • Examine family dynamics. • Narrative handout. • CBT first 3 assignments. • CBT further assignments (see handout list order). • Emphasis on the “Beliefs” portion of CBT. • “Core Beliefs” handout from “self-Esteem” • Use beliefs to examine the past. • Pinpoint creation of core self-concepts in which created these beliefs. • Address and restructure the self-concepts onto more positive traits in order to completely revise thoughts, emotions, and consequences from CBT model – life itself. Relationships (use content from attachment injury section): o Build rapport o “What is Therapy”? o Plans for Therapy. o Attachment language/style quiz and relevant online sources. o Look for both languages: Behavioral language and verbal language (check for contradictions). o Attachment style quiz. o Talk about the results. Experiential Moment Exercise: Let's look at times of greatest emotions - I call this experiential moment. Where all your senses were heightened. I have this opening for my group therapies. It's actually very hard. Let's try it.... Think back on a moment (short time frame). See if you can describe the scenario (in the shortest possible time interval), what was going on around you, and the powerful concluding emotion that followed it. I'll give you an example: o I was sitting in my office during my previous job, the one that I had the most experience in my therapy journey along with the biggest learning experiences, best team I ever had, and the place I was promoted to director. The sun was shining through the window behind me, the air was fresh and smelled a bit like new paint, the sound machine was humming due to blocking noise from a session in the next room, and I was focused on doing documentation. At the end of the conversation, she told me, "Please take care of her, we love her dearly and in high hopes of her recovery". At that exact same time, I looked out the door (it's a glass door) and saw that very client running around piggy backed on another client just having plain old childhood-like fun. In that very moment, I felt very important, determined, and refreshed. o Sometimes, our own narratives are what distresses us, this is why it is absolutely imperative to be able to use the same system, but in a positive light. Also, if you noticed, we sometimes lose our experience within the moment, and see our story in a broad, general sense. Activating our noticement on particular moments of true, positive emotional experience has actually been drained from the human tendency to block, defend, replace, distract, etc. In your wonderful share, what was the very moment that produced ____ emotion? o Let's try one more. Let's use one from your past. Any within your lifetime: Quick scenario (less story content but more of your in the moment action - day, time, posture, activity at the time), sensory surroundings, description that lead to the moment, then all that occurred to set you up for _____ single powerful feeling! Imagery Diagnostic Technique: o Can you please try this exercise? It is actually not a practice of meditation. I developed this as a diagnostic tool in order to understand a person's internal content and imbalance (have a notepad and pen next to you):  Imagine your favorites place in the world. The place you can be alone and just stay there in peace. Make so it is in real time. So an example of mine is: I am sitting under a cherry blossom and overlooking the city with fog surrounding the air (but still transparent). The real time in my imagination is the cherry blossoms continuing to fall down from the tree into my field of sight.  Once you do so, every single time something distracts you from getting out of that place - write it down. It could be anything. Usually it starts with external noise from your environment. Keep writing, then go back into that place. When you leave it for any reason (thought), write it down and go back in. I want you to write truthfully and as real as the thoughts come. Give me 10 things. Substance Abuse: o Focus on attachment model, then self-love and self-parenting. o Use Christian Conte’s “The Box” youtube vid to explain our limited perspectives. Then, tie this to a deeper level and show how addiction convinces us about seeing one side of the box, leading to relapse and return to the drug. o Use Video for application of change:  How to motivate yourself to change your behavior | Tali Sharot | TEDxCambridge o Stages of Therapeutic Implementation:  1) Identification (I clenched my fist again and noticed it earlier when I was angry).  2) Tracking (I noticed before I clenched my fist I saw something on T.V that reminded me of my ex, then I went through the emotion and broke out of it by drinking tea).  3) Exploration (I found that when I get made and clench my fist, it was modeling from my father growing up). Grief: o Start with share on experiential selfishness (see quote in folder). Then move over to how it affects how we grieve because we are doing it for us, not the love one. Then examine the difference between what we are doing for ourselves to heal versus if we are doing it for the person who past. The goal is to do things in their name, what they would do if alive and what they would want to be carried out.  This takes into question being sober for someone who overdosed. Doesn't this mean we don't need to quit in their name since they probably wouldn't if they were us (evident from their own past experiences with losing love ones through overdose). Or is this the single key for us to carry on their name as even though they wouldn't, they would truly want to? Attachment Injury: o Attachment style quiz and review. o Examine client’s attachment style and explain through the use of the diagrams and article on “Learning to See Differently: Why the Adult Attachment Model Succeeds When Others Fail (Adult Attachment Disorder)”. o Then begin to examine Gottman and educate on the four horsemen. o Articles:  The Two Words Which Make or Break A Relationship  Healing from Attachment Issues  The Difference Between Needing, Wanting And Loving Somebody  Learning to See Differently: Why the Adult Attachment Model Succeeds When Others Fail  Understanding and Treatment Attachment Problems.  Breakup: • Break-Ups Don’t Have to Leave You Broken | Gary Lewandowski | TEDxNavesink o Videos:  Nu Mindframe (see Video order in BetterHelp folder).  Attachment Videos on “Favorites” list. o Investigate the narrative within client’s minds when it comes to their needs, reactivity, and destructive coping (look at the 7 Steps to Improve Emotional Regulation and steps in “Healing from Attachment Issues articles). Trauma: o CPT Website (Look into Individual Therapy Folder) o Have clients download the app (CPT). o Use Symptom Assessment to gage client’s level of severity. Rational Emotive Therapy: Rational Emotive Behavioral Therapy: o The complete curriculum for this group session will be ran by Vince Dugan (Certified Substance Abuse Counselor – CCAPP) and Hai Nguyen (LMFT). This curriculum has been used for many years in public, private, and University practices. The curriculum funs in parallel with the studies, research, and findings from the following: https://www.verywellmind.com/rational-emotive-behavior-therapy-2796000  Session I & II: First, start with educating clients on what REBT is: Use the MS word note and the power point on this.  Session III & IV: Log down “Irrational Beliefs” – keep a journal (ABC). • A – Activating Event: Something happens in the environment around you. • B – Beliefs: You hold a belief about the event or situation. • C – Consequence: You have an emotional response to your belief. o Emotions/Thought handout is also given during this time:  Session V & VI: Use the “Techniques for Disputing Irrational Beliefs” Document.  Session VII +: One of the main effective components of CBT lies behind its nature on a mental “Exercise” methodology. With this, clients whom remain in treatment long term and continued to practice all steps starting session III to session VI. A final handout is given and practiced continuously throughout and brought to session to discuss: Disputing Irrational Beliefs Beliefs and Thoughts have an impact on how you feel and how you feel influences what you choose to do. If the thoughts are irrational, they can trigger, amplify and maintain uncomfortable emotions. Beliefs  Thoughts  Feelings  Experiences Rational beliefs distinguish between “wants” and “needs”. They are based on facts, help protect us from probably harm, help us achieve short term and long term goals, help us avoid significant conflict with other people and help us feel the emotions we want to feel. It is not the event, but rather it is our interpretation of the event that causes our emotional reaction. The process of Disputing Irrational Beliefs (DIBs) consists of challenging a belief by asking the following questions: 1. Can I rationally support this belief? Are these ideas logically connected? Who supports this idea and what is their authority? 2. What evidence exists of the falseness of this belief? Are there exceptions? 3. What are the worst things that could actually happen if I don’t get what I think I want? 4. What good things could I make happen if I don’t get what I think I want? In other words: Question your view of reality. Question your perspective. Is it working for you or is it working against you? “Men are disturbed not by things, but by the views which they take of them.” - Epictetus, 1st century A.D. Challenging Questions Worksheet The following are a list irrational beliefs and challenging questions. These beliefs will lead to thoughts that support feeling mad, sad, angry, hopeless, etc. The challenging questions will help in stopping these irrational beliefs in their tracks. The next page contains a worksheet you can use to put the challenging questions into practice. Common irrational beliefs: 1. I am only as good as what I achieve. 2. If he/she doesn’t love me then I’m worthless. 3. Other people should follow the rules I know to be right. 4. It’s not okay to have this feeling. I should just be happy. 5. The problems in this relationship are all my fault/their fault. 6. This situation is hopeless; nothing will ever improve. 7. If this person doesn’t like me then other people must feel the same way. 8. I must be able to do it all; if I can’t then there’s something wrong with me. 9. My life is too hard. Life shouldn’t be this difficult and frustrating. 10. Anger is not safe; I must not let myself get angry about this. Challenging Questions: 1. What is the evidence for or against this idea? 2. Am I confusing habit with a fact? 3. Are my interpretations of the situation too far removed from reality to be accurate? 4. Am I thinking in all or nothing terms? 5. Am I using words or phrases that are extreme or exaggerated like always, forever, never, need, should, must, can’t and every time? 6. Am I taking selected examples out of context? 7. Am I making excuses? I’m not afraid; I just don’t want to go out. The other people expect me to be perfect. I don’t want to make the call because I don’t have time. 8. Is the source of information reliable? 9. Am I thinking in terms of certainties instead of probabilities? 10. Am I confusing a low probability with a high probability? 11. Are my judgments based on feelings rather than facts? 12. Am I focusing on irrelevant factors? Challenging Questions Worksheet Questioning your beliefs and thoughts can be helpful in undoing irrational beliefs. Pick one of the beliefs from the previous page. Write it in the belief line below. Then select four challenging questions and write them below along with your answers using a new perspective. Belief: Challenging questions and answers: Question 1: Answer using new perspective: Question 2: Answer using new perspective: Question 3: Answer using new perspective: Question 4: Answer using new perspective:  End. Cognitive Behavioral Therapy: o The complete curriculum for this group session will be ran by Vince Dugan (Certified Substance Abuse Counselor – CCAPP) and Hai Nguyen (LMFT). This curriculum has been used for many years in public, private, and University practices. The curriculum follows a similar format to the following: https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/  Session I & II: These introductory sessions will be purely based on the explanation of CBT and its effectiveness through research, short term, and application in the substance abuse population. It will then consist of distributing worksheets/summaries of CBT, discussed during group, and returned for the next session. Below are the worksheets: ABC Model The Cognitive Model Explanation Thoughts → Emotions → Behaviors Cognitive behavioral therapy (usually referred to as "CBT") is based upon the idea that how you think determines how you feel and how you behave. The diagram and example below show us this process: Example: Pharrell Situation: A stranger scowls at Pharrell while passing him on the street Pharrell's Thoughts: "I must've done something wrong… I'm so awkward." Pharrell's Emotions: Embarrassed and upset with himself. Pharrell's Behaviors: Pharrell apologizes to the stranger and replays the situation over and over in his head, trying to understand what he did wrong. In this example, you might've noticed that Pharrell's thought wasn't very rational. The stranger could've been scowling for any number of reasons. Maybe the stranger just got dumped, or maybe he scowls at everyone. Who knows? As humans, we all have irrational thoughts like these. Unfortunately, irrational or not, these thoughts still affect how we feel, and how we behave. Consider how Pharrell might've responded to the same situation if he had a different thought: Thought → Emotion → Behavior "What a jerk!" Angry Pharrell shouts: "What's your problem?!" "He must be having a bad day…" Neutral Pharrell walks away and forgets the incident. Using the cognitive model, you will learn to identify your own patterns of thoughts, emotions, and behaviors. You'll come to understand how your thoughts shape how you feel, and how they impact your life in significant ways. Once you become aware of your own irrational thoughts, you will learn to change them. The thoughts that once led to depression, anxiety, and anger will be replaced with new, healthy alternatives. Finally, you will be in control of how you feel. Please write any feedback or questions for your counselor about this exercise. The Cognitive Behavioral Model  Session III & IV: Once this has been learned and grasped, the third and fourth session will take the exercise/action phase. Clients are asked to log down three scenarios during their week to fill in the CBT model itself. It is taught to be short, simple, and ingrain the style of thought behind the model itself. Example below: Situation  Thought (distortion)  Emotion  Behavior Example: T.V Show rejection ---> Labeling (It's probably because I am not good enough) ---> Emotion? ----> Stayed more isolated and fixated on this stressor. • Clients are also given a list of negative thoughts and emotions to help guide them in their self-analysis. Example below:  Session V: Clients are now shown, taught, and take turns during the group to personalize cognitive distortions into their own lives and experiences. They are then asked to combine this to their overall tracking assignment mentioned in session III and IV above on the Cognitive Behavioral Model. They are to once again redo the assignment on 3 examples per week, but now include the cognitive distortions onto their format: Situation -> Thought (include distortion here) -> emotion -> Behavior.  Session VI: Clients have now been able to grasp the model, distortions, and overall format of CBT through previous sessions and ready to utilize “Untwisting” techniques. They are now shown techniques to neutralize their negative thoughts. Technique shown below: Ten Ways to Untwist Your Thinking From "The Feeling Good Handbook" by David D. Bums, M.D. © 1989 l . Identify The Distortion: Write down your negative thoughts so you can see which of the ten cognitive distortions you' re involved in. This will make it easier to think about the problem in a more positive and realistic way. 2. Examine The Evidence: Instead of assuming that your negative thought is true, examine the actual evidence for it. For example, if you feel that you never do anything right, you could list several things you have done successfully. 3. The Double-Standard Method: Instead of putting yourself down in a harsh, condemning way, talk to yourself in the same compassionate way you would talk to a friend with a similar problem. 4. The Experimental Technique: Do an experiment to test the validity of your negative thought. For example, if during an episode of panic, you become terrified that you' re about to die of a heart attack, you could jog or run up and down several flights of stairs. This will prove that your heart is healthy and strong. 5. Thinking in Shades of Grey: Although this method may sound drab, the effects can be illuminating. Instead of thinking about your problems in all-or-nothing extremes, evaluate things on a scale of0 to 100. When things don't work out as well as you hoped, think about the experiences as a partial success rather than a complete failure. See what you can learn from the situation. 6. The Survey Method: Ask people questions to find out if your thoughts and attitudes are realistic. For example, if you feel that public speaking anxiety is abnormal and shameful, ask several friends if they ever felt nervous before they gave a talk. 7. Definite Terms: When you label yourself 'inferior' or ' imperfect' or 'a fool' or 'a loser,' ask, "What is the definition of 'a fool'?" You will feel better when you realize that there is no such thing as 'a fool or 'a loser.' 8. The Semantic Method: Simply substitute language that is less colorful and emotionally loaded. This method is helpful for 'shou ld statements.' Instead of telling yourself "I shouldn't have made that mistake," you can say, "It would be better if l hadn't made that mistake." 9. Re-attribution: Instead of automatically assuming that you are "bad" and blaming yourself entirely for a problem, think about the many factors that may have contributed to it. Focus on solving the problem instead of using up all your energy blaming yourself and feeling guilty. 10. Cost-Benefit Analysis: List the advantages and disadvantages of a feeling (like getting angry when your plane is late), a negative thought (like "No matter how hard I try, I always screw up"), or a behavior pattern (like overeating and lying around in bed when you're depressed). You can also use the cost-benefit analysis to modify a self-defeating belief such as, "I must always try to be perfect." o One of the main effective components of CBT lies behind its nature on a mental “Exercise” methodology. With this, clients whom remain in treatment long term and continued to practice all steps starting session III to session VI. A list of further handouts are given:  Cognitive Model Explanation  Cognitive Model Diagram (optional)  The Cognitive Behavioral Model (optional)  Have client’s log their own situation of stress to start applying the below.  Cognitive Distortions  Decatastrophizing  Thought Record  Weekly Schedule for Behavioral Activation or Daily Mood Chart (optional based on their mood stability).  Thought Log  Automatic Thoughts  Countering Negative Thoughts  Countering Anxiety  The Cognitive Model Practice Exercises  Challenging Negative Thoughts  Challenging Anxious Thoughts  Core Beliefs  Socratic Questions  Putting Thoughts On Trial  Exposure Hierarchy o End. Forgiveness and Self-Love: o Work on exploring forgiveness and not move a client to forgive but to understand what to forgive and what it would look like. Then make the choice to forgive.  Use all articles I have. o Move to self-love after this as a very relevant topic to work on after forgiveness.  Use all sources and articles. General and Online Techniques: o Share articles and discuss with clients. o For smart clients, show articles and have them defend it while I role play asking questions.  Example is the article on helping others to reduce one’s anxiety. Mindfulness and Relaxation: o Aquietmind.com o Oak, Headspace, and Simple Habit Meditation App (Oak is the best) Praises/Reinforcement/Motivation: o Use Certificate creator for intervals in therapy (like 1 month for online).