Everything CBT can do to help

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How Can CBT help?

DEPRESSION

What is Depression? 

  • sad mood
  • loss of interest in pleasure
  • hopelessness
  • helplessness
  • lack of self-worth
  • excessive guilt
  • feeling like a burden to others
  • sleeping too much or not enough
  • significant appetite changes
  • reduction in sexual interest
  • low energy and fatigue
  • irritability
  • lasts two weeks or longer
  • most of the day, most days
  • longer periods last years (this could be dysthymia)

Cognitive-Behavioral Treatment for Depression

  • daily routines
  • increased pleasurable activities
  • learning how thinking affects your mood
  • logging your moods, including times of joy
  • changing depressive thinking patterns
  • increasing realistic views of the world
  • building supportive relationships

ANXIETY

What is Anxiety?

  • Fearful ideas of dread
  • Fear of fear
  • Coping through escape or avoidance
  • Inability to handle fear
  • Catastrophic ideas about the future
  • Uncontrollable worrisome ideas
  • A sense of feeling anxiety
  • increases in heart rate and breathing
  • Upset stomach, diarrhea or constipation
  • Flushing in the face
  • Hands and feet feel cold or numb
  • Muscle tension
  • In panic, belief you’re having a heart attack or are going crazy

Kinds of Anxiety

  • Phobias: a fear of a specific thing or situation
  • Social Anxiety: fears that you’ll fail socially and embarrass yourself
  • Panic: Anxiety attacks with racing heart and shortness of breath, lasting about 30-45 minutes
  • Obsessive-compulsiveness: Intrusive thoughts (I’m covered in germs) and rituals to decrease the anxiety from the thoughts
  • Generalized Anxiety: Chronic worrying that’s hard to control that creates stress and physical complaints

Cognitive-behavioral Treatment of Anxiety

  • Exposure to the source of the anxiety
  • Learning new safety beliefs
  • Methods to test anxiety-based thoughts to see if they are realistic
  • Mindfulness and relaxation to handle physical reactions of anxiety
  • Prevention of escape, avoidance, or rituals

Read more about Depression and Anxiety

Post-traumatic Stress Disorder

What is PTSD?

  • Anxiety in response to severe, traumatizing situation
  • Often fears of escaping death or horrific outcomes
  • Avoidance of reminders of the trauma event
  • Thoughts or dreams about the trauma that intrude into your mind
  • Feelings as if it’s happening again
  • Strong emotional and physical reactions when reminded of the trauma
  • Flashbacks that can seem like movies of the trauma
  • Frequently losing track of time during flashbacks
  • Numbed out feelings that can seem like depression
  • Loss of interest in life’s joy
  • A feeling life the future offers nothing, or not being able to think of a future

What are examples of traumatizing situations?

  • Motor vehicle accidents
  • Combat situations while in the military
  • Rape and other assaults
  • Domestic abuse
  • Childhood abuse
  • Victimization by stalking or other terror-inducing situations
  • Witnessing events that are deadly, horrific, or extremely harmful

What is CBT of PTSD?

  • Some form of exposure to the memories or traumatic environments
  • Redesigning the meaning of the trauma event
  • Building safety beliefs to replace danger beliefs
  • Creating a new “story line” about the world and personal competency
  • Names of some treatments include Direct Exposure Therapy, Cognitive Processing Therapy, Narrative Story Telling Therapy.

MARITAL AND RELATIONSHIP PROBLEMS

What do relationship problems look like?

  • Chronic patterns of unresolved arguments
  • Feeling stuck when arguing
  • Defensiveness, criticism, stonewalling or contempt feelings
  • Feeling isolated from the other person
  • A shift to believing the other person has a flawed personality
  • Belief that there is no hope for improvement
  • Emotional and/or sexual affairs

What is CBT of relationship problems?

  • Rebuilding trust and love
    • Creating ways to learn that your partner “has your back”
    • Accepting or tolerating your partner’s flaws and painful feelings
    • Talking to your partner about your fears and feelings
    • Creating a safe place to be vulnerable with each other
  • Working to know the “real” person who is your partner
  • Softening your approach to raising problems
  • Discovering the hidden meaning your partner holds about seemingly little things
  • Finding the dreams you and your partner have when a conflict happens
  • Learning to have regular times to share with each other about the relationship
  • Taking responsibility when you own part of the problem
  • Saying what you want, not what you don’t want

Read more about relationship issues. 

OPPOSITIONAL AND DISRUPTIVE BEHAVIORS IN CHILDREN

What are disruptive behaviors in childhood?

  • Usually first recognized in pre-school or elementary school
  • If not treated, can become far more obvious in the teenage years
  • Defiance of adults
  • Willful disregard of rules
  • Loud interruptions
  • Verbal or physical aggression
  • Co-existing learning problems and/or attention deficit hyperactivity disorder

What is CBT for disruptive behaviors?

  • Targets both parenting child behaviors
  • Incorporates behavior analysis
  • Parents learn how to
    • Reward with attention
    • Reward with a points system
    • Replace unwanted behaviors with their positive opposite
    • Attend to children when they mind the parents
    • Model positive new behaviors
    • Use practice strategies with children
    • Use time-out from reinforcement
    • Use point systems
  • CCBT uses the Kazdin Parent Management Training model

Read more about Positive Behavioral Parenting

ANGER MANAGEMENT

What is unhealthy anger?

  • There is normal and unhealthy anger
  • Unhealthy anger includes
    • Hurting others with words or physical actions
    • Out of control rages
    • Excessive over-reactions
    • Inability to walk away
    • Blaming others
    • Difficulty in remembering the anger outburst

CBT for anger

  • Identification of underlying depression or anxiety
  • Calming the physical side of anger
    • Relaxation Therapy
    • Mindfulness strategies
  • Changing ideas that contribute to the anger
  • Modifying beliefs that support being angry

AUTISM AND APPLIED BEHAVIOR ANALYSIS

What is autism?

  • Typically seen by ages 24 to 36 months
  • Usually delayed development of speech
  • Disinterest in others or affection
  • Pre-occupation with certain objects
  • Excessive difficulty changing from one activity to another
  • Repetitive behaviors (e.g., flapping hands, rocking back and forth)
  • Echoing what others say
  • Elevated scores on the M-CHAT (https://www.m-chat.org/mchat.php)

How is Autism identified?

  • Direct observations
  • Structured interview, including a history, such as the ADI-R ADI-R
  • Sometimes with formalize play ADOS
  • Coordinated assessments with the primary care physician, psychologist, and other health providers

Competently delivered of applied behavior analysis

  • ABPP Board Certified in Cognitive and Behavioral Psychology with education and training in ABA
  • BCBA-D board certified psychologist
  • BCBA board certified behavior analysts
  • Masters trained ABA providers under the supervision of a competent health services provider such as a psychologist
  • Health Service Providers (psychologists, pediatricians, etc.) who can demonstrate knowledge, skills and attitudes in ABA

ABA has been shown to

  • Build language skills
  • Improve social skills
  • Decrease self-stimulatory behaviors
  • Reduce or eliminate self-injurious behaviors
  • Reduce or eliminate aggressive behaviors
  • Improve behaviors in the community (stores, restaurants, etc.)

ABA includes

  • Providing consultations to the family and other service providers AAP resources on Autism
  • Coordinating with the child’s treatment team/educational team
  • Coordinating with the medical home’s primary care physician
  • Analyzing the function of behaviors Dr. Arnold’s Slides on Functional Analysis
  • Relying on behavioral functions to design the learning of healthier behaviors

Read more about applied behavior analysis services for autism and PDD NOS 

DEVELOPMENTAL AND INTELLECTUAL DISABILITIES

What are developmental or intellectual disabilities?

  • Usually start early in life or at birth
  • Sometimes associated with syndromes like Adrenoleukodystrophy
  • Typical symptoms may include
    • Speech development delays
    • Delays in motor development like walking or crawling
    • Lower than average mental abilities
    • Difficulties in learning social behaviors and social rules
    • Difficulties learning pre-kindergarten or academics skills

How may developmental or intellectual disabilities identified?

  • Mental abilities testing
  • Academic achievement testing
  • Assessment of adaptive behaviors
  • Interviews with parents, teachers, and others who know the individual well
  • Rating forms

What are interventions for developmental or intellectual disabilities?

  • Application of behavioral strategies to instruction/teaching like Direct Instruction
  • Use of behavior modification and ABA
    • Use rewards systems
    • Implement attention as a reward
    • Improve social skills
    • Develop or improve toileting skills
    • Teach every day skills like tying shoes or job performance skills
    • Replace problem behaviors with skills that are appropriate
    • Behaviorally based academic interventions
    • Direct Instruction (Nat. Institute for Direct Instruction)
    • Instructional reliance on rewards and modeling
    • Hierarchical instructional design
    • Repeated reading to increase fluency and comprehension (Research on Repeated Reading)
    • Study skills like the SQ3R (Univ. of Vermont on SQ3R)

Read more about Learning, Educational, and Disability Issues

ADDICTION AND SUBSTANCE ABUSE

What is addiction and substance abuse

  • Excessive use of substances like illegal drugs or alcohol
  • Inability to stop using
  • Disruptive impact of drugs or alcohol on everyday life and relationships
  • Drug or alcohol based damage no health

What is a behaviorally based treatment for addictions and abuse?

  • Strategies for thinking about changing and deciding to change
  • Controlling patient’s exposure to triggers of substance use
  • Coordination with primary care physician
  • Defining abuse as a problem to manage
  • Development of skills to live life without substance use
  • Identifying and managing the urges to use substances
  • Building new habits that are stronger than the substance use habits
  • Creating social skills to build healthy, non-using social supports
  • Support for involvement with other programs like 12 Steps
  • Treatment of co-existing mental health problems

Read more about addictions, alcohol and substance abuse. 

Attention Deficit/Hyperactivity Disorder (ADHD)

What is ADHD?

Three forms

  1. Mostly impulsive/overactive type
    •   Poor control of impulses, especially regarding things they like
    •  Failing to wait for things to be explained
    •  Talking a lot
    •  Trouble stopping things they like to do
    •  Hard time waiting or being patient
    •  Poor planning and high-risk actions
  2. Mostly inattentive type
    • Hard time directing attention to less interesting tasks
    • Described often as daydreaming or not listening
    • Trouble staying with a task they don’t find interesting
    • Easily distracted when things they find interesting happen
    • Often forgetful
    • Poor strategies to organize tasks if not interested in them
  3. Combined impulsive and inattentive type

How is ADHD diagnosed at CCBT?

  • Primarily use Barkley’s model, (http://www.russellbarkley.org)
  • Barkley’s behavioral rating scales
  • Structured interviews to assess behaviors, attention, and co-existing disorders
  • Rating forms to assess executive functions and daily life functioning
  • Achenbach rating forms (http://www.aseba.org)
  • Pediatricians and Family Physicians often use a screener
  • Vanderbilt rating form
  • Similar approach to diagnosis in adulthood

What is CBT of ADHD?

  • Training in organizational skills
  • Self-monitoring of and skills to manage attention
  • Self-control of impulsivity/ Stop-Think-Do (Sample Treatment)
  • Parent management training
  • Usually in conjunction with medical management if moderate or severe ADHD
  • In adults, addition treatment of procrastination

SCHOOL-BASED CONSULTATIONS

What is CCBT’s approach to school consultations?

  • Functional Behavior Assessments (FBAs)
  • Creation of behavioral plans to increase positive behaviors
  • Use of planned ignoring
  • Designing of effective prompting
  • Development of attention and point-based reward systems
  • Effective redirection
  • Systemic rule-governed behavior plans

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