l Cognitive Restructuring or -...
Transcript of l Cognitive Restructuring or -...
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Cognitive
Restructuring
or
Cognitive ReplacementAdapted by G. Lee Griffith, Ph. D. primarily from Cormier, S., &
Cormier, B. (1998). Interviewing strategies for helpers:
Fundamental skills, and cognitive behavioral interventions (4th
ed.). New York: Brooks/Cole.
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Four Stages in Helping
2
RelationshipAssess &
GoalStrategy and Implement
Evaluate & Terminate
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Select
Meta-model
Problem Solving Self-management
Self-monitor
Increase or
decrease?
Increase what?
Cognitive
Cognitive
Modeling
Affective
Emotive
Imagery
Behavioral
Symbolic, self,
participant,
covert
modeling &
Decrease what?
Cognitive
Cognitive
Restructuring
& reframing
Affective
Stress Inc.
Musc. relax
sys dens.
Behavioral
Antecedent
control3
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CR Used for
• Anger
• Anxiety
• Arthritis
• Athletic competition
• Bulimia
• Cancer
• Crime victims
• Children of Alcoholics
• Cultural differences
• Depression
• Epilepsy
• Gambling
• Headache
• Insomnia
• Lifestyle transitions
• Martial Therapy
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CR Used for
• Memory and belief
• OCD
• Pain
• Panic
• Parent training
• Perfectionist behavior
• Phobia
• Psychosomatic
complaints
• Relapse with
alcoholics
• Self-esteem
• Smoking
• Stress
• Worry
• Writing 6
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CR Used with Clients:
• African American
• Asian American
• Christian
• w/ Physical challenges
• Elderly
• Gay Men
• Latino
• Lesbian
• Low-income
• Native American
7http://www.iowaworkforce.org/lmi/publications/latino/latino.jpg
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With Diverse Clients
• Watch your language (ex. Not
―generalization‖ rather ―thinking all bad
things means everything will be bad)
• Use an educational not therapeutic rationale
• Adapt to clients language, age, education, and
abilities. (two steps not ten)
• Cooperate with helpers who have more in
common with the client (ex. race language
tradition. )8
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Cognitive Restructuring
Rationale: purpose and overview of the
procedure.
Assessment: Identification of client thoughts
during problem situations.
Intervention
Introduction and practice of coping
thoughts.
Shifting from self-defeating to coping
thoughts.
Introduction and practice of positive or
reinforcing self-statements.
Homework and follow-up.http://www.jewsforjudaism.com/web/images/counseling.jpg
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Rationale
• Describe procedure.
– Counselor explains difference between rational, or self-
enhancing, thoughts (facts) and irrational, or self-
defeating, thoughts (beliefs) and provides examples of
each.
– Counselor explains influence of irrational and self-
defeating thoughts on emotions and performance.
• Apply to problem
• Confirm client’s willingness.http://www.competencesoftware.net/sarbox/soximg/purpose.jpg
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Sel
f-d
efea
ting T
hou
ghts
About
Mee
tin
g• Before
– What if I don’t come across well?
– What if they don’t like me?
– I will blow this chance to have a good relationship.
• During
– I’m not making a good impression
– I am boring them. They wish this was over
– I just want to leave
– They will never want to see me again
• After
– That’s a lost cause
– I always sound stupid with strangers
– I will never bother to do this again
11http://www.napi.hu/newsimages/photos/2007/0329/projekt_meeting_03.JPG
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Sel
f-en
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hou
ghts
abou
t M
eeti
ng
• Before
– I will just get to know them
– I will just be myself
– I will talk about something I enjoy
– We will just see if anything develops
• During
– I know something about this
– I can talk about ________.
– It will take time to get to know them
• After
– It went OK.
– It was easy to talk about interesting things
– I enjoyed meetings someone new
– I was able to be myself12
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Thoughts in
Problem Situations
• Ask client to
– describe problem situations
– identify examples of
• self-enhancing thoughts
• self-defeating thoughts typically experienced in these situations.
• Model examples of thoughts or ―links‖ between event and client’s emotional response. (If needed)
• Instruct client to record content of thoughts before, during,
and after upsetting situations before next session.
• Use client’s record to identify client’s self-defeating
thoughts.
http://www.sonoma.edu/users/k/koshar/n340/images/worry.jpg
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Identify Problem Thoughts
• What are the situations that upset you?
• What do you think before you go there?
• During?
• After?
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3 Kinds of Defeating Thoughts
• Worry thoughts
– I am afraid
• Self conscious thoughts
– I won’t do well
• Catastophizing &
Exaggerating
– I never do well
– I always blow it15
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Data Gathering Homework
16
Date: _________________ Week: _____________
Situation Emotions Self-defeating statements
1.
2.
3.
1.
2.
3.
1.
2.
3.
Have client observe 3 each day for a week.
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Practicing Coping Thoughts
• Explains purpose and use of ―coping
thoughts‖
• Give examples of coping thoughts for:
– Before the situation preparing for it
– During the situation
http://www.wideopenwest.com/~bmg/stress_files/coping_200x240_10tips.jpg
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Examples of Coping Thoughts
Before
• I’ve done this before, it is
never as bad as I think
• Stay calm
• Focus on doing my best not
others reaction
• This can be a good
challenge
• It won’t be bad only a few
people will be there.
During
• Focus on the task
• What do I want to say?
• What do I want to
accomplish now?
• Relax and focus.
• Step back a minute, take a
deep breath.
• Take one step at a time.
• Slow down, take my time
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Types of Coping Statements
• Situational
– Only a few will be watching
• Steps
– The first step is
• Feelings
– Keep cool, stay calm
• Encouragement
– I did it
• Coping vs. Mastery—no
perfectionism19
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Client should:
• Think of additional coping statements
• Practice verbalizing coping statements individually
• Practices sequence of statements
• Internalizes meaning of statements
– (convince an audience)
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Shifting from Self-Defeating to
Coping Thoughts• Model shift
• Client practices shift– Client imagines or role plays a situation .
– Recognizes a self-defeating thought (signaled by a finger).
– Stops the self-defeating thought (supplemented with a clap).
– Replaces the thought with coping thought (supplemented with deep breathing).
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Practice of Positive Self-Statements
• Explain purpose and use of positive self-statements
• Gives some examples
• Client thinks of additional examples
• Counselor models
• Client practices– Before
– During
– After
http://www.everyarabchristian.com/images/encourage.jpg
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Examples of Positive Self-
statements
• I did it!
• I handled that well.
• I did not let my emotions get
the best of me.
• I made some progress and
that feels good
• See, that went pretty well
after all.23
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Homework and Follow-Up
• Use cognitive
restructuring outside the
interview.
• Record on log sheet
number of times
cognitive restructuring
used outside of
interview.
• Arrange for follow-up.
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Homework Log Sheet
Date/Time Situation Auto
Thought
Emotion(s) Adaptive
Response
Outcome?
Thoughts
that lead to
bad feelings
Physical
sensations
Thoughts
How
strongly
believed
What
feelings?
How
intense? 1-7
Alternative
thought
What did
you do?
What did
you feel?
25
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Self-defeating or self-enhancing statement?
• ―I’ll never be able to pass this test.‖
• ―How can I ever give a good speech when I don’t know
what I want to say?‖
• ―What I can do is to take one thing at a time.‖
• ―I know I’m going to blow it with all those people
looking at me.‖
• ―What I need to think about is what I want to say,
not what I think I should say.‖
• ―What if I’m imposing? Maybe I’m just wasting their time.‖
• ―Why bother? She probably wouldn’t want to go
out with me anyway.‖
• ―I may not win, but I’ll do my best.‖
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Self-defeating or self-enhancing statement?
• I will never be able to do this again
• Why bother she will not want to go out with me anyway.
• ―Using a wheelchair is not as hard as it looks.‖
• I had to come to this country without my son,
now he won’t want anything to do with me.
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Role Play
You need to approach your
boss about a raise,
promotion, or change in
duties. You know what to
say, but you are keeping
yourself from doing it
because you aren’t sure it
would have any effect and
you aren’t sure how the
person might respond.http://www.german-business-etiquette.com/img/23-meeting-with-your-boss.jpg
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Coping thoughts: Before
"I've done this before, and
it is never as bad as I
think."
"Stay calm and anticipate
this."
"Do the best I can. I'm not
going to worry how
people will react."
"This is a situation that
can be a challenge."
"It won't be bad--only a
few people will be there."
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Coping thoughts: During
"Focus on the task."
"Just think about what I want to do or
say."
"What is it I want to accomplish
now?"
"Relax so I can focus on the
situation."
"Step back a minute, take a deep
breath."
"Slow down, take my time, don"t
rush."
• "OK, don't get out of control. It's a
signal to copehttp://imgsrv.charliefm.com/image/kych/UserFiles/Image/concentration.jpg
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Anxiety
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Anxiety: Preparing for a Stressor
• What is it you have to do?
• You can develop a plan to deal with it.
• Just think about what you can do about it.
• That's better than getting anxious.
• No negative self-statements; just think rationally.
• Don’t worry; worry won't help anything.
• Maybe what you think is anxiety is
eagerness to confront it
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Anxiety: Confronting and
handling a Stressor • Just "psych" yourself up-you can meet this
challenge.
• One step at a time; you can handle the situation.
• Don't think about fear; just think about what you have to do.
• Stay relevant. This anxiety is what the doctor said you would feel.
• It's a reminder to use your coping exercises.
• This tenseness can be an ally, a cue to cope.
• Relax; you're in control.
• Take a slow deep breath. Ah, good.
http://greg.snoro.com/Greg%20in%20China/images/Breathe.jpg
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Anxiety: Coping with the feeling
of being overwhelmed • When fear comes, just pause.
• Keep the focus on the present; what is it you have to do?
• Label your fear from 0 to 10 and watch it change.
• You should expect your fear to rise.
• Don't try to eliminate fear totally;just keep it manageable.
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Anxiety: Coping with the
feeling of being overwhelmed
• You can convince yourself to do it.
• You can reason your fear away.
• It will be over shortly. It's not the worst thing that can happen.
• Just think about something else.
• Do something that will prevent you from thinking about fear.
• Describe what is around you.
• That way you won't think about worrying.
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ANXIETY: Reinforcing self-statements
• It worked; you did it.
• Wait until you tell your therapist about this.
• It wasn't as bad as you expected.
• You made more out of the fear than it was worth.
• When you control them, you control your fear.
• It's getting better each time you use the
procedures.
• You can be pleased with the progress
you're making.
• You did it!
http://trinitybell.com/images/celebrate2.jpg
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Anger
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38
Anger: Preparing
for a provocation • What is it that you have to do?
• You can work out a plan to
handle it.
• You can manage this situation.
• You know how to regulate your anger.
• If you find yourself getting upset, you'll know what to do.
• There won't be any need for an argument.
• Time for a few deep breaths of relaxation.
• Feel comfortable, relaxed and at ease.
• This could be anxiety situation, but you believe in yourself
http://exclaim.ca/images/upside_of_anger.jpg
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39
Anger: Confronting the
provocation • Stay calm.
• Just continue to relax.
• As long as you keep your cool, you're in control here.
• Don't take it personally.
• Don't get all bent out of shape; just think of what to do
here.
• You don't need to prove yourself.
• There is no point in getting mad.
• You're not going to let him get to you.
• Don't assume the worst or jump to conclusions.
http://www.selfhelpzone.com/wp-content/uploads/2007/08/anger-management13.jpg
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40
Anger: Confronting the
provocation 2• Look for the positives.
• It's really a shame that this person is acting the way she is.
• For a person to be that irritable, he must be awfully
unhappy.
• If you start to get mad, you'll just be banging your head
against the wall.
• So you might as well just relax.
• There's no need to doubt yourself.
• What he says doesn't matter.
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Anger: Coping with arousal and
agitation
• Your muscles are starting to
feel tight.
• Time to relax and slow things
down.
• Getting upset won't help.
• It's just not worth it to get so
angry.
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Anger: Coping with arousal and
agitation
• You'll let him make a fool of himself.
• It's reasonable to get annoyed, but let's keep the lid
on.
• Time to take a deep breath.
• Your anger is a signal of what you need to do.
• Time to talk to yourself.
• You’re not going to get pushed around, but you're
not going haywire either.
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43
Anger: Coping with arousal and
agitation
• Try a cooperative approach.
• Maybe you are both right.
• He'd probably like you to get really angry.
• Well, you're going to disappoint him.
• You can't expect people to act the way you
want them to.
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Anger: Self-reward
• It worked! That wasn't as hard as you thought.
• You could have gotten more upset than it was worth.
• Your ego can sure get you in trouble, but when you watch that ego stuff you're better off.
• You're doing better at this all the time.
• You actually got through that without getting angry.
• Guess you've been getting upset for too long when it wasn't even necessary.
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Pain
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Pain: Preparing For The Painful Stressor
• What is it you have to do?
• You can develop a plan to deal with it.
• Just think about what you have to do.
• Just think about what you can do
about it.
• Don't worry; worrying won't help
anything.
• You have lots of different strategies
you can call upon
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Confronting and handling the pain
• You can meet the challenge.
• One step at at time; you can handle the situation.
• Just relax, breathe deeply and use one of the strategies.
• Don't think about the pain, just what you have to do.
• This tenseness can be an ally, a cue to cope.
• Relax. You're in control; take a slow deep breath. Ah. Good.
• This anxiety is what the trainer said you might feel.
• That's right; it's the reminder to use your coping skills
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48
Pain: Coping with feelings at
critical moments• When pain comes just pause; keep
focusing on what you have to do.
• What is it you have to do?
• Don't try to eliminate the pain; just
keep it manageable.
• You were supposed to expect the pain
to rise; just keep it under control.
• Just remember, there are different
strategies; they'll help you stay in
control.
• When the pain mounts you can switch
to a different strategy; you're in
control
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Pain: Reinforcing statements
• Good, you did it.
• You handled it pretty well.
• You knew you could do it!
• Wait until you tell the
trainer about which
procedures worked best
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Classic Self-defeating Ideas
50http://zenhabits.net/fotos/20071212thoughts.jpg
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Loved
• It is a dire necessity
for an adult to be
loved or approved by
virtually every
significant person in
his or her community.
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Achieve
• One should be
thoroughly competent,
adequate, and achieving
in all possible respects if
one is to consider
oneself worthwhile.
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53
External
• Human unhappiness
is externally caused
and that people have
little or no ability to
control their
sorrows and
disturbances.
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54
Past
• One’s past history is an
all-important determinant
of one’s present behavior
and that because
something once strongly
affected one’s life, it
should indefinitely have
a similar effect.
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Perfect
• There is invariably a
right, precise, and
perfect solution to
human problems and
that it is catastrophic
if this perfect solution
is not found.
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56
Danger• If something is
or may be
dangerous or
fearsome, one
should be
terribly
concerned
about it and
should keep
dwelling on the
possibility of its
occurring.
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Catastrophic
• It is awful and catastrophic when things are
not the way one would very much like them
to be.
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58
Avoid
• It is easier to avoid than to face certain life
difficulties and self-responsibilities.
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Upset
• One should become quite upset over other
people’s problems and disturbances.