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Presented by:
Alissa Gleacher, PhD
The Center for Mental Health Implementation and Dissemination Science for Children, Adolescents and Families
at New York University Child Study Center
Empirically Supported Treatment (EST) ◦ CBT has been studied through research
◦ CBT has been compared to other therapies
◦ CBT has been found to be more beneficial than other treatments for specific disorders
Cognitive Behavioral Treatment
•Thoughts
•Thinking Patterns •Responses
•Behavioral Patterns
•Intervention
•Active
Type of therapeutic intervention
Model of how to view children’s problems
Provides a structure for sessions
Specific therapeutic techniques ◦ Set of techniques that when applied together in a
specific order and structure have been effective in treating many different disorders
Cognition Emotion Behavior
The CBT Model:
•“I am stupid”
•“I never do anything good”
•“No matter how hard I try,
it’s no use”
•Sad
•Disappointed
•Withdraw
•Get upset
•Throw Something
•Get Aggressive •Frustrated
•Angry
What factors are maintaining the child’s behavior?
What are the child’s strengths/weaknesses in coping?
What other factors influence the problem? Peers Parents School
Label problematic thoughts
Use emotion as a guide for thoughts
Identification of problem behaviors
Classes of problems:
Internalizing Anxiety
Depression
Shyness
Externalizing Impulsive
Aggressive
Oppositional
Internalizing Externalizing
Over-Controlled Under-Controlled
Think
Emotion
Do
Physical
Reaction
-“I can never do anything right” -“I am a failure” -“I am dumb” -“I hate school, I don’t want to do this”
-Yells
-Acts aggressive
-Defies authority
-Muscle tension
-Physiological arousal
-Frustrated
-Hopeless
-Angry
-“I don’t want to have a panic attack”
-“If I have a panic attack at school, no one will help me” -“Other kids will laugh at me” -“I am going to die” -“No one can make me go to school” -“No one understands”
Think
Emotion
Do
Physical
Reaction
-Avoid school and other locations
-Physiological arousal: shaking,
sweating, increased heart rate,
butterflies
-Anxious
-Panicked
-Worried
Let’s review another case:
◦ Please use the chat box to submit one of
your own case examples.
Agenda setting
Active approach
Homework
Socratic
Measurement
Present-focused
Components have no fixed length
All sessions start with agenda and HW review
Can thread multiple components together
Make sure you are using the evidence-base to make decisions about treatment
Who has time to learn all these different manuals?
Lots of manuals use the same technique, but present it slightly differently
Case in point: Problem Solving
Identify potential parent role in cycle of interactions
Examine maintaining variables
Contingency management training
Engage the parent in treatment process
Often a main catalyst for change
Integral to treatment process
Expert on their child
CONSULTANT -provide information CHEERLEADER
-provide encouragement COACH
-supervise/administer treatment components CLIENT
-target of specific aspects of intervention
Psychoeducation
Somatic Management
Cognitive Restructuring
Time out procedures
Contingency Contracts
Homework
Problem Solving
Didactic Instruction
Behavioral Shaping
Modeling & Guided Participation
Role Plays
Skill Training & Rehearsal
Problem Behaviors Goals Interventions
CBT Program Components Some for children, some for parents
Who has ever done problem solving with a client?
How do you do it?
What are the procedures?
Problem solving as part of protocols that you have learned before?
Please use the chat box to tell us which procedure you use for problem solving.
The STEPS to Problem Solving…
S- State the problem T- Think of solutions
E- Evaluate the solutions P- Pick the best one S- See how it works
Let’s use the STEPS to solve a problem…
Does anyone have a problem faced by one of their clients?
Please use the chat box to submit a problem.
Definition
Purpose
Actions
Written agreement for preventing and solving
problems
Collaborative – mutual rather than one-sided
Especially good for adolescents
Used for performance deficit versus skill deficit.
Behavioral contracts clearly delineate
expectations in order to avoid confusion.
I agree to: ◦ Be in my seat by 8:30am. ◦ Raise my hand before I speak. ◦ Complete morning assignments before lunch recess.
◦ Complete afternoon work before final recess.
I agree that if I do the above, I will earn: ◦ …extra time in the Art Room (10 mins.)
◦ …extra time at the computer station (10 mins. ) ◦ …points that I can trade for Pokemon cards
I agree that if I do not do the above each day, I will:
◦ …not be able to participate in recess activities
Attention Strategies: ◦ Attends
◦ Praise
◦ Active/Selective Ignoring
A technique of verbally describing positive behavior
Consistent external monitoring leads to increased
internal monitoring of behavior; Provides the child
with information about appropriate behavior
Consistent description of appropriate behavior that is
observed:
“Jason, you’re sitting at your desk quietly.”
Definition
Purpose
Actions
Positive reinforcement of a particular behavior
indicating approval or satisfaction
External reinforcement can lead to increased
intrinsic motivation to perform specific behaviors;
Provides information on appropriate behaviors
Verbal or non-verbal positive reinforcement:
“Jason, you’re doing a great job.”
Definition
Purpose
Actions
Briefly removing all attention from a particular
negative behavior (attention seeking behaviors) and
attention is given to appropriate behaviors
Behaviors will diminish if they are not rewarded;
Based on the principles of reinforcement
No eye contact or verbal response
Definition
Purpose
Actions
Active Ignoring Works Well For:
•Whining and Fussing
•Pouting and Sulking
•Loud crying/tantrums intended to punish others
•Loud complaining
•Continuous demands
Guidelines for Active Ignoring:
1. Briefly remove all attention from the child
2. Refuse to argue, scold, or talk
3. Turn head to avoid eye contact
4. Don’t show anger, or amusement in your manner or gestures
5. Pretend to be absorbed in another activity
6. Be sure that behavior does not result in a reward
7. Give the child lots of attention when the target behavior stops
Contact:
Alissa A. Gleacher, Ph.D. Assistant Professor
NYU Child Study Center | Department of Child and Adolescent Psychiatry
One Park Avenue, 7th Floor, New York, NY 10016
Tel: 646.754.5089 | Email: [email protected]
Use chat box to submit questions to panelists.
January 16th, 2013, 12PM What's your Compassion Index? Understanding
our Tolerance to Secondary Traumatic Stress and Compassion Fatigue
Presented by: Cheryl Sharp, ALF, MSW
***
February 13th, 2013, 12PM Engaging Children and Caregivers into Services
Presented by: Mary McKay, PhD
Questions or Comments:
Additional information and resources
available at
www.ctacny.com