Join Alliance Family & Community Care (AFCC) in Making a Difference

Alliance Family & Community Care (AFCC) work one to one counseling and therapy at home. Personal care assistant meaning our Clinician will coming to your house for service. Could be telehealth, or video. Have you ever noticed that certain things that you do influence your mood or anxiety? For example: When you listen to sad music do you ever notice feeling sad for longer periods of time? Do you ever feel less motivated to apply for a job or school when you are actively worrying? 

Behavioral activation is one of the most important CBT skills used in treating depression. It has to do with the way that behaviors and feelings influence each other.  In this chapter we’ll learn how your behavior can directly affect your mood, for better or worse, and how to use skills to put ourselves in situations that will make it most likely to improve our mood. 

Behavioral Activation (BA) is a specific Cognitive Behavior Therapy (CBT) skill. It can be a treatment all by itself or can be used alongside other Cognitive Behavior Therapy skills such as cognitive restructuring. Behavioral activation helps everyone to understand how behaviors influence emotions, just like cognitive work helps us understand the connection between thoughts and emotions. 

 - Behavioral activation is helpful for many people. If you answer “yes” to any of the following questions, BA could be a good fit for you.  

•Do I have a sense of what is triggering my mood or anxiety?  

•Do I generally find myself doing very little, with little pleasure or meaning in my life? •Are there     times that I feel better or worse and I’m not sure why? 

•Do I have a difficult time working with my negative thoughts, but seem to feel better when I can get myself moving and doing something?  

•Do I have a hard time even knowing what I enjoy or find meaning in? 

Behavioral Activation is based on the well-researched understanding that depression often keeps us from doing the things that bring enjoyment and meaning to our lives. This “downward spiral” (explained in the first chapter of this manual) causes us to feel even worse. In Behavioral Activation we work to reverse this cycle using our actions and choices.  

Depression is set in motion by difficult events that happen to us. If you are dealing with a big loss, stressful situation, or change in your life, feelings of depression could be a result. While it is important to address these external events and sometimes to talk about the past, it is also important to find ways to address our current situation, find ways to fulfill on our future life aims, and find time for enjoyment. Behavioral Activation can help with this part of treatment.

 We often wait to feel better or more motivated before doing something. 

Remember that anxiety and depression come from parts of our brain that are really trying to protect us by getting us to avoid or isolate. This means that as long as we are following the lead of the anxiety and depression, we will continue to feel less motivated and want to avoid and isolate.

Objectives  

- To understand CBT and the process of Brief CBT.  

- To identify key treatment considerations and problems most suitable for Brief CBT. - To learn how to assess the patient’s suitability for Brief CBT.

What is Brief CBT, and why does it require specific treatment considerations?

CBT combines cognitive and behavioral therapies and has strong empirical support for treating mood and anxiety disorders. The basic premise of Cognitive Behavior Therapy is that emotions are difficult to change directly, so CBT targets emotions by changing thoughts and behaviors that are contributing to the distressing emotions.

- Brief CBT is the compression of CBT material and the reduction of the average 12-20 sessions into four to eight sessions. In Brief CBT the concentration is on specific treatments for a limited number of the patient’s problems. Specificity of the treatment is required because of the limited number of sessions and because the patient is required to be diligent in using extra reading materials and homework to assist in his or her therapeutic growth.

- Brief CBT can range in duration from patient to patient and provider to provider. Although variability exists, the following table shows an example session-by-session outline. You are encouraged to think flexibly in determining length of treatment. Time-limited therapy may  offer additional incentive for patients and therapists to work efficiently and effectively.  However, the exact length of treatment will likely be determined by a host of factors involving the therapist, patient, and treatment setting. As indicated in the following table, you are not expected to rigidly adhere to a "set schedule" of progress or topics but rather should be flexible and adaptive in approaching all brief CBT applications. For example, it is often helpful to work within a "session-limited framework" where the patient receives four to six sessions of "active" treatment, followed by one or more follow-up sessions that occur at increasing intervals after the active-treatment phase.

 CBT is structured and goal directed. The context is supportive, and the techniques are paired with a collaborative therapeutic stance. Nonspecific factors refer to the relationship components of therapy (e.g., rapport, installation of hope, trust, collaboration) and can be compared with specific factors that refer to the technical aspects of psychotherapy Nonspecific factors are common within all psychotherapies and serve as the foundation for patient improvement. Specific factors refer to intervention techniques unique to the type of therapy being provided (e.g., CBT, psychodynamic, interpersonal). Studies show that nonspecific factors are responsible for a large percentage of the change associated with psychotherapy treatments. 

The cognitive model challenges this subjective experience and suggests, instead, that it is the thoughts we have about situations that give rise to emotions. Individuals who are depressed or anxious tend to display patterns of dysfunctional or “inaccurate” thinking. In the cognitive elements of CBT, the therapist trains the patient in specific skills that help the patient learn to improve his/her mood and change behavior by modifying the way hr or she thinks about situations. A key tool in identifying and examining the associations between thoughts, feelings, and situations is the thought record.