Third Wave Behavior Therapies


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Third Wave Behavior Therapies

  1. 1. Some Innovative New Therapies <ul><li>Why look at anymore therapies? Why not stay with what we do? </li></ul><ul><li>more options, more flexibility </li></ul><ul><li>more efficient with some problems </li></ul><ul><li>provide very different approaches </li></ul><ul><li>may be better fit for some clinicians and programs </li></ul><ul><li>challenge bias toward cognitive models </li></ul><ul><li>raise serious questions about how we currently understand human psychology and change </li></ul>
  2. 2. Some Therapeutic Approaches You Should be Familiar With, But Won’t be Discussed Here <ul><li>Stages of Change Interventions </li></ul><ul><li>Motivational Interviewing & Motivational Enhancement </li></ul><ul><li>Solution Focused Therapy (SLT) </li></ul><ul><li>Neurolinguistic Programming (NLP) </li></ul><ul><li>Integrative Behavioral Couples Therapy (IBCT) </li></ul><ul><li>Accelerated Experiential Dynamic Psychotherapy (AEDP) </li></ul>
  3. 3. Note: The Third Wave of Behavior Therapies First Wave - traditional behavior therapy, which works to replace harmful behaviors with constructive ones through a learning principle called conditioning. Second Wave - cognitive therapy seeks to change problem behaviors by changing the thoughts that cause and perpetuate them. Third Wave – movement away from cognitivism, toward new forms of behaviorism, including functional analysis, and traditionally nonclinical treatment techniques like acceptance, mindfulness, cognitive defusion, dialectics, values, spirituality, and relationship development. These therapies reexamine the causes and diagnoses of psychological problems, the treatment goals of psychotherapy, and even the definition of mental illness itself.
  4. 4. Therapies We Will Be Looking At: <ul><li>Third Wave Behavior Therapies: </li></ul><ul><li>Dialectical Behavior Therapy (DBT) </li></ul><ul><li>Behavioral Activation Therapy (BAT) </li></ul><ul><li>Mindfulness-Based Cognitive Therapy (MBCT) </li></ul><ul><li>Acceptance and Commitment Therapy (ACT) </li></ul>
  5. 5. We tend to view natural emotions such as anxiety, anger, fear, and sorrow as damaging and therefore to be gotten rid of in whatever manner possible. Yet a tremendous amount of research, most of it within the past 20 years, shows that attempts at controlling thoughts and feelings typically make matters worse, not better. The anxious person who cannot bear an anxious thought becomes even more anxious; the depressed person who attempts to escape self-critical thoughts only generates more of them.
  6. 6. Behavioral Activation Therapy A treatment for depression and anxiety that holds that context rather than internal factors such as cognitions is a more efficient explanation for depression, and a more efficacious realm in which to intervene. Utilizing behavioral analysis BAT seeks to help people understand environmental sources of their depression, and seeks to target behaviors that might maintain or worsen the depression.
  7. 7. Model proposes that life events, which can include specific trauma or loss, biological predispositions to depression, or the daily hassles of life, lead to individuals experiencing too much environmental punishment and low levels of positive reinforcement in their lives. Many behaviors used to cope with negative feelings that make the individual feel better in the short-run but are detrimental in the long-run increase through a process of negative reinforcement. Avoidance behaviors, such as inactivity and rumination, are the key maintaining factors underlying depression, and treatment aims to combat clients’ use of such maladaptive behaviors.
  8. 8. Targets motivational inertia by working from the &quot;outside-in&quot;, scheduling activities and using graded task assignments to allow the client to slowly begin to increase their chance of having activity positively reinforced. The function, not content, of thought is examined. Developing a nonjudgemental, detached stance toward negative thoughts, avoiding rumination, and focusing on activity. Simple, straightforward and apparently effective with depression.
  9. 9. Mindfulness-Based Cognitive Therapy (MBCT) <ul><li>Based on the Mindfulness-Based Stress Reduction (MBSR) eight-week program, developed by Jon Kabat-Zinn. </li></ul><ul><li>Mindfulness as a therapeutic tool, is the development of the ability to recognize and disengage from mind states characterized by self-perpetuating patterns of ruminative, negative thought. </li></ul><ul><li>This involves moving from a focus on content to a focus on process, away from cognitive therapy’s emphasis on changing the content of negative thinking, toward attending to the way all experience is processed. </li></ul>Meditative practices are very helpful. Control awareness and you control experience!
  10. 10. <ul><li>Spending less and less time in the “doing” (problem-solving) mode, and more in the “being” (here-and-now, accepting) mode. </li></ul><ul><li>The empirical literature on the effects of mindfulness interventions suggest that this approach may lead to reductions in a variety of problematic conditions, including pain, stress, anxiety, depression, personality disorders, disordered eating, and addictions, and it is growing in popularity in many fields, especially those related to healthcare. </li></ul>
  11. 11. Developed by Steven Hayes and others based on functional contextualism and Relational Frame Theory. Originally this approach was referred to as “comprehensive distancing”. Differs from traditional Cognitive Behavioral Therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT focuses on what they can control more directly. Research evidence of effectiveness for a variety of problems including depressions, anxiety, personality disorders, chronic pain/illness management, trauma, addictions, and stress.
  12. 12. <ul><li>Psychological suffering is usually caused by experiential </li></ul><ul><li>avoidance, cognitive entanglement, and resulting </li></ul><ul><li>psychological rigidity that leads to a failure to take needed </li></ul><ul><li>behavioral steps in accord with core values. </li></ul><ul><li>ACT views the core of many problems as due to “ FEAR ”: </li></ul><ul><li>F usion with your thoughts </li></ul><ul><li>E valuation of experience </li></ul><ul><li>A voidance of your experience </li></ul><ul><li>R eason giving for your behavior </li></ul>Core Conception
  13. 13. <ul><li>For example: “Depression is not just a feeling. Depression is an action.” </li></ul><ul><li>Healthy alternative is to ACT : </li></ul><ul><ul><li>A ccept your reactions and be present </li></ul></ul><ul><ul><li>C hoose a valued direction </li></ul></ul><ul><ul><li>T ake action </li></ul></ul><ul><li>Uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. </li></ul><ul><li>Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, and changing or persisting in behavior in the service of chosen values. </li></ul>
  14. 14. Cognitive Defusion : Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be. Acceptance : Allowing internal events to come and go without struggling with them - &quot;just notice&quot;, accept, and embrace them, especially previously unwanted ones. Contact with the present moment : Awareness to the here and now experience with openness, interest, and receptiveness. The six core principles to develop psychological flexibility
  15. 15. Observing the self : Accessing a transcendent sense of self known as &quot;self-as-context&quot; — the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. Values : Discovering and clarifying what is most important to one's true self. Committed Action : Setting goals according to values, to take action on them, bringing more vitality and meaning to their life in the process. The six core principles to develop psychological flexibility
  16. 16. Dialectical Behavior Therapy (DBT) <ul><li>Based on a bio-social theory of borderline personality disorder by Dr. Marsha Linehan that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the 'Invalidating Environment'. </li></ul><ul><li>An 'emotionally vulnerable' person in this sense is someone whose autonomic nervous system reacts excessively to relatively low levels of stress and takes longer than normal to return to baseline once the stress is removed “emotional dysregulation.” It is proposed that this is the consequence of a biological diathesis. </li></ul>
  17. 17. <ul><li>The model is based on a hierarchical structure of treatment goals : </li></ul><ul><li>In the PRE-TREATMENT stage, focus is on assessment, commitment and orientation into the process of therapy. </li></ul><ul><li>STAGE 1 focuses on suicidal behaviors and behaviors that interfere with therapy and the quality of life. </li></ul><ul><li>STAGE 2 focuses on post-traumatic stress issues and related problems. </li></ul><ul><li>STAGE 3 focuses on issues of self0esteem and individual treatment goals. </li></ul>
  18. 18. <ul><li>Before moving on to the next phase, the targeted behaviors of each stage are brought under control. </li></ul><ul><li>Post-traumatic stress related problems such as those related to childhood sexual abuse are only dealt with directly after Stage 1 has been successfully completed. Doing this would create a potential risk of an increase in serious self-injury. </li></ul><ul><li>Any problems of this type such as flashbacks that emerge while the patient is still in stages 1 or 2 are dealt with using techniques known as “distress tolerance.” </li></ul>
  19. 19. <ul><li>In Stage 2, the treatment of PTSD involves exposure to memories of the past trauma. </li></ul><ul><li>At each stage of therapy, focus is placed on the specific targets for stages that are arranged in a definite hierarchy based on relative importance. These targets vary between the different modes of therapy but it is essential for therapists working in each mode to have a clear understanding what those targets are. In every mode, the overall goal is to increase dialectical thinking. </li></ul><ul><li>The patient is required to record instances of targeted behaviors on the weekly diary cards. Failure to do so is regarded as therapy interfering behavior. </li></ul>
  20. 20. <ul><li>The success of treatment is dependant on the quality of the relationship between the patient and therapist. The emphasis is on this being a real human relationship in which both members matter and in which the needs of both have to be considered. There is a skilled balance between flexibility and firmness. </li></ul><ul><li>Dialectical strategies underlie all aspects of treatment to counter the extreme and rigid thinking encountered in these patients, the key dialectic being 'acceptance' on the one hand and 'change' on the other. </li></ul><ul><li>The DBT approach includes specific techniques of acceptance and validation designed to counter the self-invalidation of the patient. These are balanced by techniques of problem solving to help in learning more adaptive ways of dealing with difficulties and acquire the skills to do so. </li></ul>
  21. 21. <ul><li>There are four primary modes of treatment in DBT : Individual therapy; Group skills training; Telephone contact; Therapist consultation. </li></ul><ul><li>Skills Training groups focus on skills considered relevant to the particular problems experienced by people with borderline personality disorder. </li></ul><ul><ul><ul><li>Core mindfulness skills </li></ul></ul></ul><ul><ul><ul><li>Interpersonal effectiveness skills </li></ul></ul></ul><ul><ul><ul><li>Emotion modulation skills </li></ul></ul></ul><ul><ul><ul><li>Distress tolerance skills </li></ul></ul></ul><ul><li>Has been increasingly used in treating other disorders including suicidal and para-suicidal behavior, substance use disorders, anxiety disorders, eating disorders, and depression. </li></ul>
  22. 22. Mindfulness Skills <ul><li>Increases your powers of observation </li></ul><ul><li>Helps you to focus and concentrate your attention </li></ul><ul><li>Helps to shift attention from internal to external, and from external to internal </li></ul><ul><li>Reduces tendency to use emotional avoidance and escape </li></ul><ul><li>Increases ability to use Wisdom </li></ul>
  23. 23. Wisdom Attends To All Forms of Knowing Available To Us Rational Knowing Emotional Knowing Intuitive Knowing Wisdom Intuitive “ Guessing” “ Gut Feelings”
  24. 24. Emotion Regulation Skills <ul><li>Break down experiences into their smaller components </li></ul><ul><ul><li>Bodily </li></ul></ul><ul><ul><li>Thoughts </li></ul></ul><ul><ul><li>Behavior </li></ul></ul><ul><ul><li>Environment </li></ul></ul><ul><li>Mindful of experience (pleasant and unpleasant) </li></ul><ul><li>Tease apart primary from secondary emotional reactions </li></ul><ul><li>Increase positive experiences </li></ul><ul><li>Take opposite action (terminate cyclical patterns of painful emotions) </li></ul>
  25. 25. Distress Tolerance Skills <ul><li>Decrease emotional pain by being Mindful to it </li></ul><ul><li>Learn to self-soothe </li></ul><ul><li>Distract from pain when you can’t change the situation prompting the pain </li></ul><ul><li>Improve the moment </li></ul><ul><li>Critical thinking skills (acceptance) that can increase your pain tolerance </li></ul>