Introduction to Cognitive-Behavioral Techniques

Introduction to Cognitive-Behavioral Techniques



This video provides a brief, introductory overview to Cognitive-Behavioral Therapy and Techniques. It is intended for non licensed staff who work with people with severe mental illness and/or addictions. It discusses the theory of CBT as well as providing several techniques to improve the viewers' skillsets.

hello my name's ken kinter and i'm an assistant professor at Rutgers University and the purpose of this video is to provide a basic introduction to cognitive behavioral techniques and as usual my contact information is on the first slide so before we get rolling just want to give credit where credit is due the project that I work for for Rutgers University is called the state hospital psychiatric rehabilitation initiative our mission is to improve the quality of care and the working conditions at New Jersey state psychiatric hospitals that mission simply would not be possible without the generous financial and other types of support provided by the New Jersey Department of Health because of them we can make it happen so that's a it's a beautiful thing and that's what helps fund these videos and and the website and all of the other work that we're doing in the hospitals now all right so we've got an ambitious agenda here that we are going to take on we're going to talk about cognitive behavioral therapy and cognitive behavioral strategies and there's an important difference between the two of those we're going to talk about the the foundations of CBT in terms of the interaction between thoughts feelings and behavior we're going to talk about cognitive distortions which is something I'm sure that you may have just heard about and we're gonna go into it a little bigger greater detail we're also going to talk about different types of cognitive behavioral interventions that you can use and also to explain the use of CBT people with severe mental illness or with addictions and/or with addictions this video is intended toward people that necessarily aren't therapists aren't licensed professionals but work in community agencies or in inpatient settings one of the major points of this presentation is that you don't have to be a cognitive behavioral therapist to use these techniques it does help the more education that you get on CBT the more helpful this will be but this is meant to be a first or foundational step and hopefully to give you some tools that you can use in your in your job so CBT as a prince as a modality emphasizes the role of thinking and how we feel in what we do we'll get into the details of that a little bit talks about how now adaptive learning and just functional patterns of thought impact behavior which impacts symptoms so the bad learning has maybe led to maladaptive behavior and then relearning or replacing that maladaptive learning with better learning can improve the behavior reduce symptoms and hopefully reduce the negative outcomes it's credited with Aaron Beck is credited with this so this is not exactly a new thing but I've noticed it's been slow to permeate through the system lots of people say they know CBT and they practice CBT but you don't really see it initially CBT was directed toward people that had more mild mental illnesses however we've been getting a lot more traction with it in working with people with severe illnesses and addictions so CBT again is sort of a general catch-all term for lots of different things Beks cognitive therapy rational emotive behavior therapy or rebt by Albert Ellis please catch some of Albert Ellis's videos if you haven't seen it totally worth it and dialectic behavior therapy by Marsha Linehan which is something else that's becoming very common in in our hospitals so CBT is sort of this catch-all term so it's not a thing that you do it's sort of an umbrella over many different interventions some of which we're going to be talking about in this video but not all of them and we'll talk about places you can go to get more information so in this presentation we're going to be talking more about cognitive behavioral techniques or cognitive behavioral strategies or interventions rather than therapy as a whole if you don't practice therapy you don't really need to go into the therapy part to that degree these are my hope is that these are just tools that you'd be able to use immediately to improve what you do wherever you work so some of the foundational you know the spirit of CBT as it were learning is at the core of much maladaptive behavior our beliefs shape our reactions you know that whole thing about perception is reality our perception makes reality what it is to us and this is how two people can see the exact same thing and come away with completely different ideas about what happened it's what they've already experienced and learned going into it so behavior and behavior change is also partially a function of the environment interaction with the environment so the mantra that I'm going to drill into your head for the for this video is how you think an active in acts affects how you feel and how you feel affects how you act and think so it's this cycle between thoughts up top of the pyramid here feelings the right and behavior and what I do also includes what I say you know verbal behavior these three are constantly interacting with each other in fact we are we're probably not even aware you might hear a song and you might feel a certain way or think about a certain thing and these things are constantly or constantly cycling through these we might not even what know what the connection is between them but there is a connection so for example what we see here is a common example of one trip around this around this sort of loop around this triangle here so if someone has thoughts about no one likes me I'm a bad person people want to hurt me if those are the thoughts that a person is walking around with all the time we're almost like a tape we have in our head it's natural that those thoughts would lead to feelings of depression feelings of anxiety feelings of fear so we had now we have those thoughts now we have these feelings so how do we act how do you act when you are depressed or anxious or fearful you might isolate you may avoid people you may procrastinate doing things so and then we go right around the sloop again and then how we act goes out into the environment into the world and then people respond to us a certain way and then that can actually reinforce this so even if it's incorrect the environment can reinforce these inaccurate thoughts and beliefs my own personal observation is that we all have two of these little triangles going on when when we're doing one when we're doing okay and one when we're not so I would almost ask you to think about this if you wanted a homework assignment out of this write down some of your thoughts what does that tape in your head say does it say I'm basically a good person or the world is basically evil and then what feelings come from that then what behavior comes from that I'll give you an example for myself I am NOT a good technical person I'm afraid of techie stuff so one of my automatic thoughts is you just heard it I'm not good at techie stuff I'm afraid of new things and technology so when I'm confronted by having to learn a new thing my reaction might be one of fear one of avoidance one of maybe even shame and then how do I act I avoid it I get frustrated i procrastinate I try to Palm it off on someone else I actually try to trade work so someone else will do my tech work for me and I'll do something else that I'm good at but the problem becomes I automatically tell myself I'm not gonna figure out a new tech thing which actually diminishes my will and my ability to be able to learn that thing so that thought has now shaped my behavior you probably have your own versions that I welcome you to explore those both the good version the positive version and the negative one like my my tech no fear in fact that's also something I encourage you to do with your clients is have them do that triangle as well what does their tape say to them all the time how does it make them feel and what are the behaviors they indulge in I think that's a pretty helpful exercise for all of us so now we move on to cognitive distortions and cognitive distortions are rather consistent things that we do in processing the world around us that impact how we respond to it so you may you may hear some examples of the example I just gave about myself here all-or-nothing thinking I am NOT good technologically well I've just generalized that to mean all technical things and that isn't true mental filter dwelling on a single negative detail instead of focusing on the whole and focusing on something that confirms what I already think magnification or minimization where I exaggerate the importance of this thing disqualifying the positive say I take on some techie thing and I get it right the first time I still come away from that thinking I'm not good at techy things I'll just say I will I got luckier that wasn't that hard so I've dismissed the positive and protected the belief against fact so the next category we have here is jumping to conclusions labeling I'm a loser or I'm no good I'm not tech savvy classic label right there mind reading someone is reacting negative without any evidence to support that fortune-telling where I can just predict what's going to happen without really knowing and then here's where we get back into Albert Ellis again if you want to follow up with that and that was the idea of shooting yourself and shooting yourself if it sounds like it that's probably what it is and that's just beating yourself over things that you should have done or should not have done so again this is this kind of a form of self-abuse here because you didn't do what you didn't do for a reason and this sort of discounts the reason maybe there was a good reason why you didn't do it but now you're kind of shaming yourself over having what you've done or or didn't do part of being very judgmental this is very tough so you should yourself and you should others you know people aren't acting right and then you become angry at them personalisation blame when something bad happens to somebody automatically take that that blame so if you were going to be doing more strict CBT there would be some parameters around it number of sessions the importance of the therapeutic relationship there's a whole attitude and a mentality if you're going to do this more formally and I'll recommend a book at the end if you want to go further into this and learn about how this is done more formally most in this video is more about the informal use of CBT techniques rather than doing the whole thing itself so again it's meant to be collaborative strengths-based and it's based on those foundational on empathy so again you can see why this is being used in settings with people that have a more severe illness because it's much more collaborative it's very consistent with the recovery model approach so other characteristics and I want to point out the difference between these two things the inductive method and the Socratic method so the inductive method think about a detective in fact inductive sounds almost a little like detective you might have an idea of what's going on so now you talk to that person and ask questions to get facts to see if that is borne out or not the Socratic question the Socratic method is more about asking questions you know so the client asked questions view you ask questions of them and then you determine whether the hypothesis is accurate and again this is about a teaching process if the if one of the fundamental cornerstones of CBT is that things are learned and our behavior is the product of our learning then we have to use changing that learning to change that behavior and as we'll talk about homework and practice assignments is a pretty critical now one of the reasons that CBT has become more involved with people with severe mental illness is also that it's an alternative or a supplement to medications sometimes medications don't fix everything medications don't necessarily fix the social isolation that comes with mental illness or the social skills deficits that come along with it medications can possibly be dangerous to someone and you can't medicate some things away and there's a maximum of medication that people can take a person may also be in favor of a non medication related solution in fact my experience is it very many people with mental illness do want solutions that our medication involved because the medication comes with side effects and other sorts of hassle and the research does back up that CBT is helpful both in combination with medications and and even on occasions in lieu of it so some of the things that we're trying to target through CBT are these symptoms medication resistance symptoms that we were just talking about down this left corner and then other aspects that maybe aren't so symptom related but our real-world related such as motivation some of these things we mentioned here are actually we would describe as negative symptoms of schizophrenia but then also collateral damage that's done as a side effect of having a severe and persistent mental illness so CBT hits these things either where medication fails to go or can't go it wasn't designed to go so we're gonna be talking about eight specific CBT techniques for the remaining time in this video and they're listed right here we're going to go through them one at a time so Socratic questioning boy Columbo is a really dated reference that's another one if you want to catch that or look that up the pretty helpful Columbo was actually a very it was meant as being a detective show but it's very helpful for therapists because it displays this great technique for getting it information and at the end of every show we'll say something oh yeah there's just one thing I don't understand and then that's when the problem is solved so basically what Socratic questioning is it's helping the client to learn about and draw conclusions maybe new conclusions or additional conclusions to what's happened to them what's a different way of looking at what happened and the way you've been looking at it and it's about finding meaning so if you're walking down the hall and someone you know is coming the other way down the hall you say hi to them and they don't say hi to you you might become enraged and say I can't believe that person just ignored me why would they do that and then that's gonna change the way you act going forward toward that person other people but then what happens later on if you find out that that person just got chewed out by their boss and they had just walked out of really getting crushed or if you found out they just lost their job or if they just found out that someone close to them and died now doesn't that change the whole equation so even if you don't know that those other things happen Socratic questioning is about what is it possible that one of these things happened it was some other reason than they were ignoring you and that sort of takes the emotional air out of the balloon by changing the thought we've changed the feeling we change the behavior so again you're at seduced Socratic questioning you're just asking informational questions and carefully attending to the answers and a lot of these questions are bad how do you feel about this it's really about the person's perception and how they interpret it and their openness to interpret this differently if it comes down and avoid closed-ended questions so you don't want a lot of yes/no answers going back and forth you can watch our videos on motivational interviewing specifically or if you want to get more detail about open and closed ended questions so here's some examples of Socratic questioning so tell me what are the disadvantages are of public speaking because it might be different for each person what happens if you continue continue to yell at your voices in public so here you're exploring what happens if we keep going this way and then it's also a major effort for us to understand the meaning that a person ascribes to a particular event because again what we think it is doesn't matter it's what they think it is and and how deeply have they thought into the why of that anyway they may not have even questioned it as we'll talk about a little bit automatic thoughts we don't question positive reinforcement anything this can be praise this can be something more tangible it's anything positive that follows a behavior that in Risa's the possibility that happening again if someone who's normally late to group they show up on time you say you did a great job I really appreciate you showing up on time to group today if you notice someone's grooming is better oh you look really nice today so you you can do that with praise or there can be more tangible things in the hospitals we use food as a reinforcer all the time you may have different different things but it needs to be immediate and you may need to do it every time at first but then the goal is to step it back so it's every so often think about how important how good of a draw a slot machine is and it certainly doesn't pay out every time there's that powerful draw and when is that reinforcer gonna be there modeling critical this is a critical one very simple but not easy theoretically we're doing it all the time so if we had a camera on us or if we were in a mirror what would we see would we see somebody who comes in sits down throws our stuff on the desk rolls our eyes and go okay what are we gonna do today or do you see somebody that's energetic and enthusiastic and engaged in what they're doing what would you see if you saw yourself on camera if you saw yourself in a mirror and is that what you want to put out we're modeling all the time good and bad we can't control it we can't turn it on and turn it off and people all around us are serving as models all the time and I love Zoolander by the way so that's why that pictures on there alright so shaping is next for people that have severe illness and severe deficits they're not gonna get from where they are to where they could be all in one pop none of us do so it's this matter of breaking a big job into smaller jobs and then providing reinforcement for each success for example we had a gentleman in her hospital very paranoid did not like to sit in groups he would stand in the doorway we can't really do that people have to get in and out the door and we closed the door for groups anyway so now if I say look you either need to sit at the group table or you need to leave I lose the guy so we said look you can you can't stand in the doorway because we're gonna close the door when people need to come and go but you can set up a chair right by the door and sit right and that's fine and that's what he did and he also told us not to call on him or not to talk to him but eventually what happened is instead of having him move closer we worked on me having him share and having him read so little by little and praising him each time for his cooperation or where he sat we got him closer and closer to the table so you divide a big job into like a million little jobs and praise after each one to just gradually nudge that person in the direction I mean look we all crawl before we walked right role playing now this one's pretty critical and a lot of people are really uncomfortable with it role playing is a fantastic technique what is some situation that your clients gonna have to deal with soon a job interview a stressful situation being able to stand up for themselves being able to say no to someone who's offering them drugs so we can do role plays between people in a group setting or just do it at an individual setting you and that person but practice it this way a person gets a little prior experience in it it's not as good as in vivo it's not as good as being in the real world doing it but it's really nice practice and the more you practice something the better you'll get at it and then you can and then you can use it any D&D geeks out there besides me just asking so cognitive or structuring this one is a little more sophisticated but very effective as well and part of this is going back to that triangle we want to teach our clients the role that thoughts and feelings have in behavior behavior doesn't just come out of nowhere so there's a version of this there are a couple different versions of this thing that you can use one version of this is called catch it check it change it and that is if you have a thought process that you normally engage in like things always work out for the worst for me catch yourself doing it check it does it match up with the what's going on in the world and then change it how do we substitute that negative thought for a more positive one so how do we turn things always go bad for me into sometimes things go bad for me but sometimes things go well so they have a five-step method here that they describe describe the situation what's the strongest emotion that you feel what is the strongest belief that's out front again like our little triangle from before challenge the thought is there evidence for it what's the evidence against it it's almost I almost picture a court of law where the prosecution and the defense has to make a case and we're trying to establish reasonable doubt and then finally we get to the action so did it work in this case if that belief or thought didn't work for you let's change it let's make it into something else or let's develop an action plan I love substituting new thoughts or positive thoughts for the for the older thoughts so here we get down into automatic thoughts and we're surrounded by automatic thoughts at 12 o'clock I'm automatically hungry and I go to lunch why am i magically hungry at 12 o'clock every day no it's just when lunch happens so I've just kind of rolled along with it we just automatically take for granted that that's how it is and we don't think about it but there's usually a bias involved there somewhere it's not it's it's autopilot but autopilot ignores the fact that everything is actually a little different each time and it prevents us from being open to new experiences so first we have to assess somebody's automatic thoughts it's hard to you think them so often it's like the water that you swim in so how do you address automatic thoughts so you ask people what is what's on that tape what are some automatic things that you think this means that and there are different techniques that you can use to conjure that so you want to see what the automatic thought is and you want to see what that mood is that corresponds to it this one's a classic relaxation exercise is just getting people to do breathing exercises getting people to do imagery because again very often the emotions that people are feeling in response to these automatic thoughts and these cognitive distortions they feel negative feelings they feel fear they feel angry or they feel sad so how can we restore that person to basically this is another way of interrupting that triangle you change their emotional state you change the way they feel you insert a new behavior that's designed to change that feeling and then we'll get to the thoughts from there there's a picture of Bora Bora by the way so you're welcome it's the prettiest slide out of all of them and next practice assignments now we're careful with the word homework I work in an inpatient setting we don't want people to get too comfortable with the idea of hospital as home so even though practice assignments is longer I prefer it to homework if a person lives in their home fire away with homework although sometimes there's a negative stigma if our clients had a really rough time at school or they may say I'm grown I'm an adult I'm not I'm not about homework that I gave that up after school but I think people can relate to practice except for Allen Iverson but we'll keep moving so we assign at the end of session individual or group session critical to review it in the next session did they do it praise all over the place and then how can we go forward from there if it didn't happen let's review it with the person why didn't it happen was the job too big do we need a cue in the environment when to do it so the reason they didn't do it is at least as important so it's critical the practice assignment should have some meaning for them it should be something that they want to do it's going to help them get to where they want to be are there others that we can help with this practice assignment someone else to cue that person when to do it or to give them feedback about it practice it in session first so you do the role play in session and then the homework is to do it out in the world somewhere before next session so it's a great reinforcer these things can be written verbal or behavioral the behavioral ones are particularly effective you actually get to practice doing something in so these CBT methods these are some of the impacts they develop a therapeutic relationship it's you and that person working toward their common goal we all have things that we're working on so it reduces the amount of stigma we're dealing with it's educational and again some of the the primary things that we're trying to get here is to change thoughts change core beliefs usually negative core beliefs and to get them to show new behaviors you know in a a they call it stinkin thinkin and a lot of CBT is geared towards stinkin thinking so not only is it effective for people with mental illness it's also very effective for people with addictions almost every person with an addiction I've ever worked with has some really significant significant negative core beliefs and they generalize those negative core beliefs to the whole world and if you're constantly thinking negative thoughts about yourself there's a trigger to medicate going on all the time and it's hard to treat the addiction without treating those underlying beliefs that fuel that so we're also trying to improve people's treatment adherence and also prevent relapse which we're all very happy about that so just to summarize some of the points that we've covered here cognitive behavioral thinking emphasizes the role of thinking and past learning in emotions and ultimately behavior you don't need to be a CBT therapist to utilize CBT techniques the more you know about CBT the more it helps in the better shape that you are but it's not necessary some of these strategies that we talked about are very simple what you think impacts how you feel and what you do they all impact each other it's a circle that's going on all the time cognitive distortions and automatic thoughts which every one of us has impacts are thinking feelings and behavior we described eight different cognitive behavioral interventions which you can use some of these are very simple as simple as modeling or as complicated as going into that cognitive restructuring piece and CBT is very helpful people with mental illness and addictions and even with even without people with mental illness or addictions just being able to think for yourself about how your thoughts what your thoughts are what feelings they conjure and what behaviors you conjure because I'm sure some of these are adaptive and helpful for you and some of them are not and it's good to know what they are the very virtue that they're automatic means we haven't thought about them enough and what they do so I wanted to point out a couple resources most of this material came from the right book that you see right here it's a great book it also has a DVD that actually shows CBT techniques in practice with people that have psychotic symptoms so if you work with people that are severely mentally ill it's a fantastic resource there are many cognitive behavioral societies in major cities if you look them up you will find them and they have a lot of information for you about cognitive behavioral therapy and then also the website you see at the bottom here is our website we have a lot of additional videos on a number of topics I encourage you to check out our website and see the resources there I hope you enjoyed the video and at some point I hope to catch up with you again soon take care

#Introduction #CognitiveBehavioral #Techniques

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