Art therapy cbt presentation revised

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Art therapy cbt presentation revised

  1. 1. Expressive Arts & Cognitive Behavioral Therapy (CBT) Treating Adolescent Anxiety Didactics & Case Studies Roger Luscombe, MS, DKATI, RCC. 1
  2. 2. Resources     Approaches to Art Therapy, Theory & Technique 2nd ed. Judith Aron Rubin, ed. Play Therapy, Theory & Practice, A Comparative Presentation, O’Connor & Braaverman, ed’s. CBT Connections, Anxiety Disorders in Children & Adolescents: University of British Columbia Anxiety Disorder Association of British Columbia (Anxiety B.C.) 2
  3. 3. Anxiety B.C. five important elements      Anxiety is normal, everyone experiences it at times Anxiety is not dangerous, although anxiety feels uncomfortable, it is temporary, and will eventually decrease Most people cannot tell when you are anxious Anxiety is adaptive and helps us prepare for real danger or for performing at our best, it triggers our “fight-flight-freeze” response preparing our body to react Anxiety becomes a problem when our body reacts in absence of real danger 3
  4. 4. Key Issues in Anxiety  Anxiety is about fear  Clinical Anxiety is Irrational  Clinical Anxiety is Learned 4
  5. 5. Anxiety Disorders: Overview       Most common mental health problem 12 – 20% of children affected Over 65,000 kids in B.C. with disorder Impact and morbidity not widely recognized Girls often have more fears than boys Number and types of fears across cultures are fairly consistent 5
  6. 6. Anxiety: Overview Continued     Presence of one anxiety disorder increases risk of developing additional anxiety disorder Mom’s with any mental illness are 7 times more likely to have a child with an anxiety disorder Children and youth with anxiety disorders rarely receive appropriate or effective interventions If left untreated there is a significant increase in risk of depression & substance abuse 6
  7. 7. The Experience of Anxiety  Body Fear  Mental Fear  Behavioral Indicators of Fear 7
  8. 8. Components of the Anxiety Response  Behavioral Avoidance  Distorted Beliefs  Over Predictions of Fear  Attentional Bias  Physiological Responding 8
  9. 9. Causes and Maintenance of Anxiety Disorders  Genetics  Temperament  Parenting  Cognitive Factors  Avoidance Behaviors 9
  10. 10. Types of Anxiety Disorders       Social anxiety disorder (separation anxiety disorder) Obsessive compulsive disorder Specific phobias Generalized anxiety disorder Panic disorder w/o Agoraphobia Post traumatic Stress disorder 10
  11. 11. anxiety Regina Lafay 11
  12. 12. Anxiety, Regina Lafay www.survivorart.com  "One of the first pieces I did to express an emotion I had not yet had diagnosed – a feeling that I had known since I was a teen, yet nobody was available to explain it to me or help me through it. I have only recently been diagnosed with Generalized Anxiety Disorder, among others. Words fail me, as they often do, so I choose art to tell my stories. This image helped a group of troubled teenage girls recognize that they are not alone. I continue to be moved by their counselor’s letters, as she and I still keep in touch." 12
  13. 13. Cognitive Behavioral Therapy       Psycho education Managing body symptoms Healthy thinking Building tolerance Relapse prevention Evidence based 13
  14. 14. Evolution of CBT  Behavioral Therapy  Social Learning Theory  Cognitive Therapy  Cognitive Behavioral Therapy  Dialectical Behavioral Therapy  Family Cognitive Behavioral Therapy  Cognitive-Behavioral Art Therapy 14
  15. 15. CBT & Art Therapy      CBT not widely been accepted in the art therapy field There has been the misconception that CBT focuses only on the thinking process In reality imagery, visual thinking and creativity are aspects of cognition Personal constructs are non verbal as well as verbal and creating art can enrich personal constructs' Emotional components, as illuminated in art therapy, are an integral part of understanding a person’s cognitive process  Approaches to Art Therapy, Rubin 15
  16. 16. Core CBT Components  Cognitive restructuring  Physical relaxation  Exposure, coping skills  Social skills training 16
  17. 17. Principals of CBT THOUGHTS BEHAVIOURS EMOTIONS 17
  18. 18. Myers – Briggs Type Indicator     Carl Jung’s Psychological Types Eg. ESTJ - Extraversion, Sensing, Thinking, Judging INFP - Introversion, Intuition, Feeling, Perceiving Dichotomies Extraversion Introversion Sensing iNtuition Thinking Feeling Judging Perceiving 18
  19. 19. Distorted Thinking           All or nothing thinking Over generalizing Mental filtering Disqualification of the positive Jumping to conclusions Magnification (catastrophizing or minimizing) Emotional reasoning “Should” statements Labeling Personalization 19
  20. 20. Cognitive Approaches       Identification of inner, private thoughts Use of positive self-talk Techniques for challenging negative selftalk Self-reward Expectations of good things to happen Evaluation of own performance – partial successes 20
  21. 21. Physiological Approaches  Awareness of body clues  Deep breathing exercises  Relaxation activities 21
  22. 22. Behavioral Approaches  Problem solving skills  Coping skills  Peer support  Identification of pleasant events  Exposure 22
  23. 23. Exposure  Interoceptive Exposure   In vivo Exposure   Deliberately bring on bodily symptoms of anxiety, e.g. spinning, breathing Deliberately entering feared situations e.g. movies, malls Naturalistic Exposure  Deliberately engage in activities e.g. exercise 23
  24. 24. Role of Family & Teachers      Psycho education about anxiety and treatments that work Emphasize that well-intended intuitive responses may actually enable anxiety problems Consistency and firmness in follow through on plans If family concurrent difficulties with anxiety all members receive treatment Assist with homework 24
  25. 25. CBT Tools         Thought and Mood Charts SUD’s Chart (subjective units of discomfort) Fear Hierarchy Chart Fear Monitoring Form Grounding Tips PTSD Impacts of Events Scale Brief Screening Instrument for Panic Attacks Relaxation Scripts  Breathing, progressive muscle relaxation 25
  26. 26. Children’s CBT Resources Taming the Worry Dragons, Garland & Clark, B.C. Children's Hospital 26
  27. 27. CBT Resources cont. 27
  28. 28. CBT Resources cont 28
  29. 29. CBT Case Formulation        Brief demographic Problem identification Problem history Family and social adjustment Main cognitive, physiological and behavioral components of major problems Client’s perspective Case formulation 29
  30. 30. CBT Treatment Plan     Prioritization of treatment targets Tracking of clients progress Methods of treatment Graduation from treatment 30
  31. 31. Case Study David 31
  32. 32. Case Formulation for David   Demographics:  Adolescent, rural isolation, single parented, marijuana friendly community Problem Identification:  Psychiatric Dx: Disthymic disorder with more severe depression (double depression)  Academic, social and family stressors  Substance misuse  General anxiety and social phobia 32
  33. 33. Case Formulation cont.- 1  Problem History, Family & Social Adjustment:      Unhappy as a baby Ongoing depression last couple years History of family depression w/ hospitalization Poor relationship with bio dad Daily use of marijuana for 5 years 33
  34. 34. Case Formulation cont.- 2   Problem Identification Cognitive   Physiological   Negative self image, self punishing, fears of future failure, downward spiraling thinking Poor diet, lack of regular meals, lack of exercise, over sleeping, Behavioral  School avoidance, social withdrawal, no employment, heavy marijuana use (self identified) 34
  35. 35. Case Formulation cont.- 3  Client’s perspective    Depression, low self esteem, addiction acknowledged Sense that his personal history affects his current state Goals include reducing fears, increase self esteem, improve friendships, school graduation, and be drug free 35
  36. 36. Case Formulation cont.- 4  Case Formulation     Psychiatrist had diagnosed depression and recommended CBT treatment CBT idea had hooked David, though reluctant some readiness present (Prochaska stages) Positive male therapist transference Anxiety seen as possible core disturbance 36
  37. 37. Stages of Change  James Prochaska & Carlo Diclemente       Precontemplation Stage Contemplation Stage Determination Stage Action Stage Maintenance Stage Relapse 37
  38. 38. CBT Treatment Plan for David          Psycho education Exploration of ABC triangle Reframing Social exposure Expressive arts exploration Stress reduction Involve family in treatment Relapse prevention Ten to Twelve independent sessions 38
  39. 39. Treatment Plan cont. - 1  Tracking of client’s progress         Home work check-ins, reading assignments Thought & mood records Sleeping pattern changes Socialization changes School attendance record Drug and alcohol consumption Changes in family time Diet & exercise changes 39
  40. 40. CBT Tools Used     ABC triangle presented Distorted thinking examined Reading homework on depression & CBT Thought records, challenging depressive thoughts 40
  41. 41. Expressive Arts Exploration        Icebreaking, rapport making Invites cognitive conversation Provide creative outlet Self esteem through art making / product Insight acquisition Co-art making positive transference Provides visible record of change 41
  42. 42. David’s Art Making & Gaming     Clay pieces Biofeedback Game Sandtray World Roofing Paper Medicine Wheel 42
  43. 43. Clay - David 43
  44. 44. Sandtray - David 44
  45. 45. Biofeedback Stress Management 45
  46. 46. Clay - David 46
  47. 47. Clay - David 47
  48. 48. Roofing Paper - David 48
  49. 49. Summary: David Case Study     CBT model intrigued youth Psycho education around thoughts, emotions, behaviors very beneficial Art therapy engaged and gave youth insight & increased self esteem Positive transference enabled personal transformation process 49
  50. 50. TF-CBT for Aboriginal Child Trauma Victim        Honoring Children – Mending the Circle Spiritual Mental Physical Emotional Relational University of Oklahoma Health Mending the Circle Sciences Center 50
  51. 51. 51
  52. 52. Case Study Sara   Presenting Problem – General Anxiety & Specific Phobia Treatment Components     Play Therapy Genogram Fears Assessment Tool SUD’s Hierarchy Chart Fish Hook Diagram for anxiety attack 52
  53. 53. Sara cont.  Play therapy family genogram 53
  54. 54. Fears Assessment Tool  Self Rating Questionnaire, 8 biggest fears Flying  Punishment by mother  Criticized by parents  Giving a recital  Snakes  Mean dogs  Dead people  Spiders  54
  55. 55. SUD’s Chart for Flying Phobia          1 2 3 4 5 6 7 8 9 Looking at airplanes Airplane play, sandtray, puzzles Make airplane, clay, paper mache Going to local airport Going to Castelgar airport Getting near a plane Sitting in a plane Short flight on plane Long flight to Hawaii 55
  56. 56. Panic Attack Fish Hook Model 56
  57. 57. Summary of Cognitive Behavioral Art Therapy    CBT illustrates how thoughts & emotions & behaviors co -influence each other CBT has particular treatment strategies to create healthy thinking, emotional awareness and positive actions Art Therapy accomplishes these same goals and fits well with CBT treatment strategies 57
  58. 58. In Memory Of  Dr Peter Donald McLean,  CBT Connections  Passed away  Nov 04, 2008 58

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