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Art therapy cbt presentation revised
- 1. Expressive Arts &Cognitive Behavioral Therapy (CBT) Treating Adolescent Anxiety Didactics & Case Studies Roger Luscombe, MS, DKATI, RCC. 1
- 2. Resources Approaches to ArtTherapy, 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. Anxiety B.C. five importantelements 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. Key Issues inAnxiety Anxiety is about fear Clinical Anxiety is Irrational Clinical Anxiety is Learned 4
- 5. Anxiety Disorders: Overview Mostcommon 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. Anxiety: Overview Continued Presenceof 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. The Experience ofAnxiety Body Fear Mental Fear Behavioral Indicators of Fear 7
- 8. Components of theAnxiety Response Behavioral Avoidance Distorted Beliefs Over Predictions of Fear Attentional Bias Physiological Responding 8
- 9. Causes and Maintenanceof Anxiety Disorders Genetics Temperament Parenting Cognitive Factors Avoidance Behaviors 9
- 10. Types of AnxietyDisorders Social anxiety disorder (separation anxiety disorder) Obsessive compulsive disorder Specific phobias Generalized anxiety disorder Panic disorder w/o Agoraphobia Post traumatic Stress disorder 10
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- 12. Anxiety, Regina Lafay www.survivorart.com "Oneof 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. Cognitive Behavioral Therapy Psychoeducation Managing body symptoms Healthy thinking Building tolerance Relapse prevention Evidence based 13
- 14. Evolution of CBT BehavioralTherapy Social Learning Theory Cognitive Therapy Cognitive Behavioral Therapy Dialectical Behavioral Therapy Family Cognitive Behavioral Therapy Cognitive-Behavioral Art Therapy 14
- 15. CBT & ArtTherapy 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. Core CBT Components Cognitiverestructuring Physical relaxation Exposure, coping skills Social skills training 16
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- 18. Myers – BriggsType 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. Distorted Thinking All ornothing thinking Over generalizing Mental filtering Disqualification of the positive Jumping to conclusions Magnification (catastrophizing or minimizing) Emotional reasoning “Should” statements Labeling Personalization 19
- 20. Cognitive Approaches Identification ofinner, 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. Physiological Approaches Awareness ofbody clues Deep breathing exercises Relaxation activities 21
- 22. Behavioral Approaches Problem solvingskills Coping skills Peer support Identification of pleasant events Exposure 22
- 23. Exposure Interoceptive Exposure In vivoExposure 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. 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. CBT Tools Thought andMood 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. Children’s CBT Resources Tamingthe Worry Dragons, Garland & Clark, B.C. Children's Hospital 26
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- 29. CBT Case Formulation Briefdemographic Problem identification Problem history Family and social adjustment Main cognitive, physiological and behavioral components of major problems Client’s perspective Case formulation 29
- 30. CBT Treatment Plan Prioritizationof treatment targets Tracking of clients progress Methods of treatment Graduation from treatment 30
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- 32. Case Formulation forDavid 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. 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. 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. 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. 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. Stages of Change JamesProchaska & Carlo Diclemente Precontemplation Stage Contemplation Stage Determination Stage Action Stage Maintenance Stage Relapse 37
- 38. CBT Treatment Planfor 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. 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. CBT Tools Used ABCtriangle presented Distorted thinking examined Reading homework on depression & CBT Thought records, challenging depressive thoughts 40
- 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. David’s Art Making& Gaming Clay pieces Biofeedback Game Sandtray World Roofing Paper Medicine Wheel 42
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- 48. Roofing Paper -David 48
- 49. Summary: David CaseStudy 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. TF-CBT for AboriginalChild Trauma Victim Honoring Children – Mending the Circle Spiritual Mental Physical Emotional Relational University of Oklahoma Health Mending the Circle Sciences Center 50
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- 52. Case Study Sara PresentingProblem – General Anxiety & Specific Phobia Treatment Components Play Therapy Genogram Fears Assessment Tool SUD’s Hierarchy Chart Fish Hook Diagram for anxiety attack 52
- 53. Sara cont. Play therapyfamily genogram 53
- 54. Fears Assessment Tool SelfRating Questionnaire, 8 biggest fears Flying Punishment by mother Criticized by parents Giving a recital Snakes Mean dogs Dead people Spiders 54
- 55. SUD’s Chart forFlying 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. Panic Attack FishHook Model 56
- 57. Summary of CognitiveBehavioral 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. In Memory Of DrPeter Donald McLean, CBT Connections Passed away Nov 04, 2008 58