Supercharge your practice with cbt+
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How to use the best therapies for the best effect. Theory and practice from CBT DBT ACT and CFT integrated for you.
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Supercharge your practice with cbt+
- 1. Supercharge Your Practice with CBT+ Integrating CBT and Third Wave Therapies Dr Fiona Kennedy drkennedy@greenwoodmentors.com
- 2. WELCOME !
- 3. Workshop content • Deepen your understanding of how CBT, ACT, DBT and CFT can work together • Use NAVIGATES to guide yourself and your client through therapy • Learn how to clarify values
- 4. Workshop content • Analyse problem behaviour • Understand when to tackle trauma • Use the self-help book Get Your Life Back and downloadable materials from the website to help your clients’ progress
- 6. Core processes of change: Trust Commitment Willingness Persistence Perspective Taking (Mindfulness) Exposure New Skills New Learning Inside and out (relationships)
- 8. Mindfully u Judgements – shoulds, oughts, and global negatives “I’ll never get better” “I’m completely bad” u Reframe mindfully, no judgements
- 16. Key points • Mindfulness and validation • Shame-busting • Target behaviour list • Commitment to change
- 18. BUILD AWARENESS OF THE PROBLEM BEHAVIOURS
- 19. Name and be mindfully Aware of the problem behaviour(s) • Identify each behaviour so that you can “see” it in your own mind • Formulate each behaviour with client
- 20. • Guess the Wheel Of Experience Thoughts Feelings Body Sensations Behaviour
- 21. Awareness • Awareness of thoughts, feelings, etc during the target behaviours • Awareness of TFBBs about the target behaviours • Awareness of how the target behaviours keep life restricted and distressing
- 23. CLARIFY VALUES
- 24. Values • In my relationships I would like to be… • In my health I would like to be… • In my job/spending my day I would like to be… • In my leisure/personal growth I would like to be…
- 26. Take a moment • Choose just one area and write down two or three words which reflect your values • Relationships • Health • Work/how I spend my day • Leisure/personal growth/contribution
- 27. Mandy Values • Be independent (able to earn some money) • Be someone who looks after my health • Show love and care to my cats • Be a loving supporting friend to Gill
- 28. Mandy “Bull’s Eye” my day Relationships Health Leisure/Growth How I occupy my day
- 29. Your Values Bull’s Eye Leisure/Growth How I occupy my day Relationships Health Leisure/Growth How I occupy my day
- 30. IDENTIFY THE FUNCTION OF THE BEHAVIOUR
- 31. Behaviour Analysis • Chain analysis (DBT) • Unpack the CBT Wheel of Experience into a sequence • Look for trigger events • Look for reinforcement (short term gain) • Look for consequences (long term pain)
- 33. Self harm behaviour chain Call from Mum She hates me Heart rate, sweating Rage Decide to cut Go to bedroomGet blade cut arms Relief Calm feeling Urge to cut Hide cuts Shame Short term gain Long term pain Target behaviour
- 34. Vunerability cloud Keeping razor blades in bedroom Believing Mum hates me Staying up late drinking Believing I’m no good
- 35. Call from Mum She hates me Heart rate, sweating Rage Decide to cut Go to bedroom Get blade cut armsRelief Calm feeling Urge to cut Hide cuts Shame Short term gain Long term pain Target behaviour Keeping razor blades in bedroom Believing Mum hates me Staying up late drinking Believing I’m no good
- 36. Breaking The Links • Can work on vulnerability cloud or on behaviour chain • List with client all the things they could do differently next time • Offer coaching if appropriate • Choose three • Make a plan (My Breaking The Links Plan)
- 38. SET SMART GOALS
- 39. Goals -set some small goals to move towards your Values • E.g. Mandy’s Health Value: – “Look after my health” – Goal – Eat more nourishing food
- 40. Mandy’s goal: eat more nourishing food Swap cakes for oatcakes Make soup Eat breakfast
- 42. Accept self and others, validate and be compassionate • Teach client acceptance and self-validation – Model this in the relationship – Teach validating others first
- 43. Acceptance and Self- Validation • Believing I’m no good • My inner critic as The Bully • Perfect Nurturer • Two Chair Work • Mindfulness
- 46. TACKLE TRAUMA
- 48. Childhood Adversity • Abuse and neglect obviously have long lasting consequences • The self-self and self-other relations which the client brings to the therapy reflect this damage • The coping strategies to deal with distress are mostly learned early in life
- 49. Dissociation • 15-30% of PTSD presentations involve dissociative symptoms • Early trauma tends to produce dissociation • Three levels at which dissociation affects us: – Perceptual – Experiential – Personality
- 50. Structuring Trauma Treatment • Stabilise • Approach trauma • Re-stabilise
- 51. Options for treating trauma • Low-intensity (relaxation, self-soothing, adaptive avoidance, self-affirmation, grounding) • Reliving • Rescripting
- 52. USE EXPOSURE TO EMOTIONS
- 53. Emotions and Exposure - learn to identify, experience and regulate emotions • Not all clients can answer “How do you feel?” • How articulate is your client about emotions? – Identifying, labelling, expressing • Education and skills for handling emotions (see skills section) • Horrible feelings (emotions) are what we usually work to avoid
- 54. Exposure and Emotions • Exposure involves willingness to approach what is usually avoided • What are the key avoidance patterns in your client’s behaviour? (see chain analyses) • What emotions are ‘hot’ in your client’s chain analysis?
- 55. Exposure • Cultivating willingness (Mindfulness) • Graded exposure aimed at increased willingness • Behavioural experiments • Inner child work
- 56. Model • Exposure
- 57. TEACH NEW SKILLS
- 58. Skills • What skills are essential for your client to learn? – Handling thoughts, feelings, images, body sensations – Relationship with self and others • What is the plan to teach the skills and ensure skills generalisation?
- 59. Skills training – teaching client to handle thoughts, urges, flashbacks, images, etc • Handling thoughts • Handling feelings • Handling images…flashbacks, anxiety images, hallucinations • Handling dissociation • Handling setbacks and keeping going
- 60. Skills Training • Direct training • Modelling, shaping, reinforcing • Attention to generalisation
- 61. TIPP skills • Change the Temperature of your face • Intense exercise • Paced breathing • Progressive relaxation
- 62. Thought handling • CFT – Compassionate mind training • CBT: – Thought reviewing – Socratic Questioning • Mindfulness – Thought Soldiers • ACT: defusion – Singing in the Shower – Cartoon Voices
- 64. Handling Thoughts Goals and Values
- 65. Handling Emotions – Reducing emotions • Opposite to Emotion Action – Mindfulness to emotions • Physicalising exercise
- 67. Skills: Choice Points Step towards Values and Goals Step away from problem behaviour Keep doing what I’ve always done
- 68. Want more? • www.greenwoodmentors.com/events • Two Day Event Supercharge Your Practice with CBT+ – integrating CBT DBT ACT and CFT – London and Online – 31st October and 1st November 2019 • Two day event on PTSD and Dissociation – London and Online – 19th and 20th September 2019
- 70. Evaluations • Please let us have your evaluations of this workshop now through Oli or online on our GreenWood Mentors Facebook or Linked In pages
- 71. Thank You from all of us