What are some additional cognitive and behavioral techniques? - Chapter 19

This chapter discusses some additional techniques that could be useful during CBT treatment.

What does problem solving and skills training consist of?

Clients are encouraged to devise solutions to their problems. Some clients are deficient in problem-solving skills and need direct instruction in problem solving. Many clients also have skill deficits and require skill training from their therapist or an outside source. Clients that don’t have these skill deficits will be able to solve their problems after their inhibiting automatic thoughts are discussed and diminished. The therapist should increase clients’ self-efficacy, so that they will have more confidence that if problems arise, they will be able to handle them.

How can therapists help clients make decisions and allow them to refocus?

Many clients have difficulties making decisions. A simple solution is to compare disadvantages and advantages of each option and then decide on which option is best.

Refocusing is useful when concentration is needed for the task at hand, such as completing a work assignment, and when clients are having obsessive thoughts for which rational evaluation is ineffective. The therapist will teach clients to label and accept their experience and then refocus on the attention-seeking task at hand. Some times clients are too distressed by their thought to immediately refocus again, distraction is then a helpful short-term technique. This may only be used as a short-term solution and is harmful if used too much. Then the distracting will turn into avoiding. In this way clients will not learn that feeling upset may be painful, but is not harmful. If clients avoid their feelings, the AWARE-technique could be used.

What are some ways that can help improve a client's mood and behavior?

For some clients, it is helpful to use the activity chart, not to schedule activities, but to monitor their moods while engaged in various activities, to look for patterns of occurrence.

• Relaxation and mindfulness

Many clients benefit from learning relaxation techniques. These techniques should be learned during sessions, because for some clients relaxation exercises will lead to anxious thought that need to be discussed. Mindfulness techniques help clients non judgmentally observe and accept their internal experiences, without evaluating or trying to change them.

• Graded task assignments

This technique approaches the process of reaching a goal in small steps. In this way the client won’t get too overwhelmed.

• Exposure

Many clients engage in avoidance as a coping strategy. Avoidances are called safety behaviors if they associate them with decreasing anxiety. Clients believe that if they engage in safety behaviors the threat will decrease. In exposure-therapy clients are faced with their fears and are not allowed to engage in safety behaviors. Repeating the exposure will eventually lead to diminished anxiety. It is important to provide a rationale for exposure; otherwise clients won’t like to do it.

• Role-playing

Role-playing can be used to uncover automatic thoughts, to develop an adaptive response, to modify intermediate and core beliefs and to practice and learn social skills. Before teaching clients social skills, the level of skill they already possess has to be assessed. Many clients know exactly what to do and say, but have difficulty using this knowledge because of dysfunctional thoughts. In this case role playing to teach social skills is not necessary.

• Using the ‘pie’ technique

It can be helpful for clients to see their thoughts in graphic form. A pie chart can be used for helping clients set goals or determining relative responsibility. In the pie chart they can see that there are alternative explanations for someone else’s behavior.

• Self-comparisons and credit list

Clients have a negative bias in information processing. They compare themselves with the person they would like to be. This will not lead to improvement in their psychiatric disorder. The therapist should help the client change the self-comparison into more functional comparisons. Clients should focus on how far they have progressed since their worst point, rather than on how far they are from their best point. Credit lists are daily lists of positive things the client is doing and deserves credit for. By making these lists the client will focus more on the positive things and feel better about themself.