Topic 4: Psychoeducation & Behavioral Activation {by 10/3}

There were three readings due last week (Beck – 1 chapter; Volungis – 2 chapters).  For this discussion, share at least two main thoughts: (1) Why is psychoeducation considered a vital component to effective CBT (please go beyond saying it “educates” clients!)?  (2) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT.  Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress.  Your original post should be posted by the beginning of class 10/3.  Have your two replies posted no later than 10/5.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

30 Comments (+add yours?)

  1. Adam Rene
    Oct 01, 2019 @ 14:23:19

    1. As I compiled my thoughts on this question I thought to myself – “How is psychoeducation not an integral part of any kind of therapy?” Psychoeducation, to me, really is vital in that it directly connects to what I believe should be the goal of any therapist in practice – symptom remission, better results, and your client Does. Not. Need. You. Any. More. As we discussed before, our interactions with our clients take up a very small percentage of their week so it truly is up to them to start practicing what is being taught. Psychoeducation provides clients with an understanding of how these concepts work and play out with relevance to what the client is experiencing as distress. Early phase psychoeducation prepares the client for what they can expect from therapy, what will be worked on, etc. This piece I find to be especially important for the therapist, as you’re both laying the groundwork needed for the client but also setting the standard and expectation for therapy. As the client progresses the psychoeducation takes more a skill-based role where there will be more specific teachings and practices. In my role currently as a Therapeutic Mentor, I usually come in as the ‘skill-based’ personnel and do that active teaching and skill practice work for my clients. I am very excited to participate in the “whole picture” of early phase as well as later phase psychoeducation and the therapy process.

    2. I feel that behavioral activation is so effective to reduce distress because it stands right up against what, to me, is a common form of distress – feeling out of control. As described, clients can be in this vicious cycle of negative automatic thoughts and low energy levels. Behavioral activation techniques like activity monitoring or graded task assignments seek to break down the walls of situations or tasks being overwhelming or out of the reach of control. Activity monitoring is a straightforward way of categorizing your time in a way that one typically does not do, especially as adults. From my own experience, our natural tendency to autopilot can be so strong that we get to a point of never questioning how that routine or thought process started – but if it’s a part of our routine then it’s here to stay unless we do something about it. The added element of pleasure and accomplishment ratings take this a step further through identifying if the behavior I’m engaged in is even “worth it.” To me that would result in a big cartoon lightbulb above my head turning on. This simple activity puts the beginnings of control into a client’s hands just through passive observing and reflecting. Graded task assignments are particularly helpful if there’s a task that is just so big and not knowing where to start. It’s a comprehensive look at the ‘why’ behind the distress, identifying thoughts and emotions, and then ultimately breaking that task down into easily attainable pieces to reduce that distress. Both of these skills in particular are not specific for one situation, they are incredibly generalizable to all kinds of behaviors, situations, habits, etc.

    Reply

    • Zacharie Duvarney
      Oct 01, 2019 @ 15:02:14

      Adam,

      Always providing those insightful work anecdotes. Well done.

      Regarding your thoughts on behavioral activation, I like how you mentioned clients often feel they have no control over their lives. This seems so obvious and yet I hadn’t considered how behavioral activation helps clients regain a sense of agency over their lives. So many of us have fallen victim to the monotony of life, yet we rarely realize it. The effects of living on “autopilot” can be so drastic and yet so hard to recognize. I am glad you mentioned this in your response, as it has given me a more practical and applicable way to understand and explain why behavioral activation is so important.

      Reply

    • Tricia Flores
      Oct 01, 2019 @ 22:08:28

      Adam- I appreciated the idea of being on autopilot and its impact on pleasure. This brings the topic into broader perspective for me. Initially I was thinking about behavior activation as beneficial to clients with depression especially, but the idea of many people being on autopilot and getting into a rut brings the benefit of behavior activation to a broader audience. I noticed this myself in doing the part of the homework assignment of doing the activity log myself. While I am not experiencing distress, noting the points in my week that are on autopilot and void of what I find most enjoyable gives me places that I can tweak my schedule to increase my overall life satisfaction. I can see utilizing this knowledge to help clients as a first-hand experience.

      Reply

    • Katrina Piangerelli
      Oct 02, 2019 @ 20:24:21

      Adam, I agree with your idea that psychoeducation is a vital and necessary part of therapy. I think that this is sometimes overlooked or thought of as just another component of therapy rather than giving it the recognition as an integral part of therapy. I also like the way that you described the client as no longer needing the therapist. This is something that has been stressed in our graduate classes, but I have not heard or learned about outside of this program. This is kind of disheartening because therapists seem to often hold on to clients for years without giving them the skills to properly cope on their own.
      I also agree that behavioral activation is an effective way to reduce distress, and may break the cycle of negative thoughts. I think that you raise a really good point that we have a natural tendency to be on autopilot rather than questioning our routines or thought processes. This is not something I thought about while writing my response, but is definitely an important factor to address. Overall, your insight and description of behavioral activism was very well done and helped me further understand behavioral activation in the CBT model.

      Reply

    • Kelsey Finnegan
      Oct 04, 2019 @ 18:11:50

      Adam, I agree that psychoeducation should really be an integral part of any kind of therapy. I do think it is an important component of other therapies as well. I’m certain this is not unique to CBT. However, I appreciate the emphasis CBT places on psychoeducation, and the structured delivery of it makes it more effective.

      Your thoughts on behavioral activation were insightful. One of your thoughts that stuck out to me in particular was “if it’s a part of our routine then it’s here to stay unless we do something about it.” Great point! Bad habits don’t just magically disappear when we don’t want them anymore. Although, that would be nice.

      Reply

  2. Zacharie Duvarney
    Oct 01, 2019 @ 14:53:57

    1.
    Psychoeducation is an integral component of CBT that serves multiple purposes. Chiefly, psychoeducation is a process where the therapist teaches clients about the cognitive model, the CBT process, the client’s diagnosis, automatic thoughts, core beliefs, and skills necessary to improve their presenting problems. Furthermore, psychoeducation is essential in teaching clients how to solve problems outside of therapy. Overall, educating clients on these topics helps them stay motivated throughout the course of therapy, increases their chance for success, and reduces their chance for relapse.

    Aside from educating clients about the aforementioned topics, psychoeducation serves other purposes. When therapists endeavor to provide psychoeducation, they are demonstrating competency and professionalism to the client. Research supports the idea that clients want their therapists to demonstrate these qualities. Not only does this reinforce the client’s confidence in the effectiveness of therapy, but this also builds rapport between the client and clinician.

    Collaboration between therapist and client is necessary for effective CBT. Psychoeducation should be a collaborative process. By having the client participate in psychoeducation, you ensure they understand key concepts before moving forward with therapy. Furthermore, you normalize the collaborative process of CBT for the client. In fact, psychoeducation helps the client acclimate to all aspects of the CBT process (not just collaborative empiricism).

    While psychoeducation is certainly useful for bolstering and ensuring client knowledge, it can be used to ensure the therapist’s competency as well. As aforementioned, demonstrating professionalism and competency improves the effectiveness of therapy. Therefore, good therapists will prepare prior to a session to ensure the information they are presenting is accurate. This is especially useful when a client is presenting with a complex diagnosis or multiple diagnoses. Attempting to provide psychoeducation with inaccurate information can harm the client. Consequently, clinicians should participate in psychoeducation not only to ensure the competency of the client, but to verify their own knowledge as well.

    2.
    Behavioral activation in CBT involves the client monitoring their behavior, scheduling pleasurable and productive activities, and describing how rewarding or pleasurable completed activities are. The rationale for behavioral activation is that many clients who experience distress also experience diminished levels of energy. These clients also typically fall victim to numerous negative automatic thoughts. For example, major depressive disorder (MDD) is characterized by anhedonia and social isolation. Often, these factors perpetuate the depression. Therefore, behavioral activation directly combats these features of depression. By having clients engage in fulfilling and pleasurable activities, we are acclimating them to a non-depressive lifestyle.

    Aside from directly combating key features of depression, behavioral activation helps the clinician tailor treatment plans to their clients. By having clients rate their activities based on pleasure and fulfillment, we can identify behaviors best suited for activation. Furthermore, identifying which behaviors clients struggle with (e.g. hygiene, adult daily living activities, social engagement, etc.) provides valuable information for case conceptualization. Essentially, we can identify a client’s strengths and weaknesses, which allows us to tailor treatment and provide best practice. This information can also be useful in working with clients on a cognitive level. By identifying specific areas for improvement, we can then work to identify what negative automatic thoughts are core beliefs are preventing the client from completing or participating in certain tasks. All in all, behavioral activation not only modifies maladaptive behavior patterns, but also assists therapists in constructing accurate client conceptualizations, which leads to better treatment strategies.

    Reply

    • Katrina Piangerelli
      Oct 02, 2019 @ 20:23:56

      Zach, we share similar views on the beneficial aspects of psychoeducation. Psychoeducation can show that a therapist is competent and professional, as well as provide clients with information to better themselves throughout their lives. I agree that psychoeducation is important in building rapport between the client and the therapist. I think that building rapport is a key component of therapy, without which the client may be uninvolved, uninterested, and unlikely to benefit from therapy. Behavioral activation is also important in CBT and involves the client monitoring his or her behavior and activities, as you outlined in your response. I liked the way that you used the example of a client with major depressive disorder. I think that this is a good framework to utilize while describing behavioral activation and helped me to understand behavioral activation. We shared some similar thoughts on the other ways that behavioral activation is beneficial. Some of the key points that I included in my response were also the benefit of highlighting the areas that the client shows strength and where the client has some weaknesses.

      Reply

    • Adam Rene
      Oct 03, 2019 @ 11:04:42

      Zacharie –

      Thank you for your post. We shared similar insights with regard to both of these topics, but I wanted to give you some praise particularly with how you interpreted the behavioral activation techniques with regard to case conceptualization. When I was writing my post I hadn’t thought past the activity itself and the impact on the therapeutic treatment itself. I appreciated your statements here on how this ‘data’ can be quite useful when conceptualizing the client’s case. An aspect of CBT I have come to appreciate is the prevalence of concrete data and evidence as a means of assisting a client view their thought patterns and behaviors in a new way.

      Reply

  3. Paola Gutierrez
    Oct 01, 2019 @ 16:24:44

    1. Psychoeducation is a fundamental component of CBT that is integrated into the therapeutic process; psychoeducation does not just happen in the initial stages of therapy, but is incorporated throughout therapy. In psychoeducation, the therapist communicates with clients about the CBT model (such as automatic thoughts), their diagnoses and implications of diagnosis, the clients’ case formulation/conceptualization, the process of therapy, and the skills/strategies that the clients will work on during therapy. I use the word “communicate with” rather than “teach” because although psychoeducation certainly has a teaching component in which the therapist educates the client, psychoeducation is a collaborative process between client and therapist. I picture psychoeducation as a discussion between client and therapist about the therapy components listed above. Secondly, psychoeducation provides an opportunity for the therapist to convey his/her competency to the client. A therapist who has strong psychoeducation skills is likely to increase the client’s confidence in the therapist’s ability to effectively help them, as well as boost the client’s optimism of therapeutic outcomes. Psychoeducation also strengthens the therapist’s knowledge and understanding of the cognitive model and of mental health diagnoses. At best, a therapist who sounds unsure when using psychoeducation will confuse clients and perhaps increase clients’ anxiety about therapy. At worst, the client may not return to therapy. Therefore, therapists need to be confident and accurate in the information that they are presenting to clients.

    I think of psychoeducation as serving to clarify and demystify the therapy process. To me, psychoeducation is the explanation of the purpose of the therapy, what will happen in therapy, and what is expected of both the client and therapist in therapy. Psychoeducation relieves client’s anxiety and stress about therapy by establishing clear expectations and helping clients understand the process. As a result, psychoeducation works to build rapport between client and therapist as he/she learns more about CBT and their presenting problems/diagnosis. Therapists also need to use psychoeducation to teach clients new skills in CBT. Having a clear rationale and purpose for testing a new skills or techniques and being able to communicate them to clients will increase clients’ likelihood of adhering to treatment. For example, a therapist who can explain to clients why certain homework assignments are given increases the client’s motivation to complete the assignment, and thus, sustain and increase engagement in treatment. Lastly, psychoeducation provides clients with the tools and knowledge that they need in order to be their own CBT therapist once treatment ends. In this way, CBT gives clients greater autonomy and self-efficacy to be able to effectively help themselves. For all of the aforementioned reasons, psychoeducation is an integral component of CBT and facilitates the treatment process for therapists and clients.

    2. Behavioral activation is most effective for treating clients with depression, because behavioral activation works to increase the client’s engagement with activities/tasks that provide a sense of accomplishment and/or pleasure for the client. For individuals who are psychologically distressed, behavioral activation “tests” clients’ automatic thoughts about their low levels of energy and the low levels of pleasure they anticipate experiencing from events/activities. Behavioral activation is intended to limit or reverse particular behaviors that clients have adopted that increase dysphoria, such as staying in bed, withdrawing from social activities and other behaviors that promote inactivity. Behavioral activation is one of the first steps in improving clients’ distress, because becoming more active is a relatively straightforward and tangible to begin to lift clients out of their depressed mood.

    Behavioral activation strategies include activity logs and activity plans. Clients and therapists can keep track of and discuss the activities that clients are engaging in most frequently/regularly and which ones the clients are neglecting/avoiding. Clients and therapists work collaboratively in behavioral activation to plan and schedule activities into the client’s daily schedule that are enjoyable or accomplishing for the client in some way. Thus, the client’s sense of satisfaction and mastery increases through behavioral activation. Helping improve clients’ mood more easily either invalidates or reduces the validity of clients’ negative automatic thoughts about some aspects/areas of their lives, which paves the way for more intense work on automatic thoughts and core beliefs. Behavioral activation that relieves clients’ distress in the early stages of therapy can increase their optimism and confidence that therapy will have productive and positive outcomes. In summary, I view behavioral activation as not only a strategy to decrease maladaptive behaviors and increase adaptive ones, but as a way for clients who are depressed or have otherwise withdrawn from pleasurable activities to start to “take back” their lives by making their daily routines and schedules more satisfying again.

    Reply

    • Tricia Flores
      Oct 01, 2019 @ 22:01:36

      Paola- I gained new insight into the way you described psychoeducation as more a communication between the client and the therapist as a collaborative relationship as opposed to a teaching dynamic. I can see this as building greater therapeutic rapport and helping the client feel empowered to act independently and eventually take on the treatment as a protege and the therapist as mentor.
      Your point that psychoeducation clarifies and demystifies the therapy process is also accurate in my opinion. By having a strong knowledge of psychoeducation the therapist shows their expertness to the client and the worthiness of continuing treatment.

      Reply

    • Bianca Thomas
      Oct 02, 2019 @ 13:25:21

      Paola, I like how you noted that psychoeducation provides the therapist an opportunity to display their competency as a counselor, and how efficacious it is in building the client’s confidence in the therapist’s skills. I also agree with your point that if the therapist seems unsure when using these skills, the client may become confused and their apprehension might become increased. I also appreciating your point on how this process demystifies the therapeutic process and gives the client a clear picture as to what is going to happen within therapy.

      Reply

    • Zacharie Duvarney
      Oct 03, 2019 @ 10:41:07

      Paola,

      You and I both stressed the importance of demonstrating professional competency through psychoeducation. I am glad you cited this as an essential feature of psychoeducation, as I feel that this is typically overlooked. Many individuals who work in a particular field for a long period of time forget how important it is to stay up to date on relevant practice. Psychoeducation can be engaging for clinicians given it is a good way to stay up to date with relevant literature.

      Overall, well done.

      Reply

  4. Kelsey Finnegan
    Oct 01, 2019 @ 21:39:27

    1. Psychoeducation is an essential component of effective CBT because it allows the client to eventually “be their own therapist.” We do not want our clients to become dependent on us. In order for clients to improve their mood, they need to be able to recognize and change their negative automatic thoughts and core beliefs on their own. Therefore, it is important to educate the client on these concepts along with the skills they can use to make changes to their maladaptive thoughts. When clients are able to implement these changes on their own, this can reduce the risk of future relapse.
    Additionally, psychoeducation allows you to demonstrate your expertness to the client, which can increase the effectiveness of therapy and strengthen the therapeutic alliance. Clients are more apt to trust you, if you appear to know what you are talking about. If you do not appear knowledgeable, clients will not value your opinion. They will likely go and find a different therapist or even decide therapy won’t work for them altogether. Psychoeducation also plays an important role in client motivation because it allows the therapist to model collaboration, which can help improve the client’s level of self-efficacy and enhance their sense of control over the therapeutic process.

    2. Behavioral activation intends to reduce negative reinforcing behavior patterns such as social isolation, avoidance, and lack of participation in activities of daily living (grooming, chores, etc.) Concurrently, it works to increase positive reinforcing behavior patterns like social activities and household chores, which often result in feelings of pleasure and accomplishment. When clients are more active, their sources of reward increase and their feelings of distress due to not completing important tasks decrease. Behavioral activation can also help to improve problem-solving skills by breaking down daunting tasks into smaller, more achievable ones. Once clients begin accomplishing small tasks, their sense of self-efficacy often increases along with their motivation. Also, behavioral activation activity logs can help to identify maladaptive behaviors to work on changing.

    Reply

    • Paola Gutierrez
      Oct 03, 2019 @ 13:26:16

      Kelsey — I appreciated how you talked about behavioral activation as a tool for problem-solving. Helping clients break up large tasks/activities into more doable ones is likely to help clients feel less overwhelmed. As you said, behavioral activation is a powerful tool to help clients boost their self-efficacy. If they can feel more confident about their abilities to complete even mundane tasks like household chores, easing them into the more involved cognitive work of identifying and modifying automatic thoughts and core beliefs will likely be less of a challenging task. You put a lot of thought into your post — well done!

      Reply

    • Anthony Mastrocola
      Oct 04, 2019 @ 10:13:42

      Hi Kelsey,

      I really enjoyed reading the first part of your post. I also believe that it’s important to stress the client’s role in autonomously treating themselves post-therapy. Counselors must promote client independence through skill-building in key areas, such as identification of negative thoughts and emotions. If clients can avoid dependence while in therapy, success is more likely post-therapy.

      Reply

  5. Tricia Flores
    Oct 01, 2019 @ 21:48:01

    1. Why is psychoeducation considered a vital component to effective CBT?

    Psychoeducation is a vital component to effective CBT because it engages clients in treatment, builds therapeutic rapport, and provides skills needed to autonomously apply CBT skills in the future. Psychoeducation engages clients in treatment by educating the client in how their minds work according to a cognitive behavioral framework, which helps clients understand the importance of being an active participant in treatment. The buy-in means that clients are not looking to others including the therapist to solve their problems and also not thinking that emotions, behaviors, and the environment is something that only happens to them, but they are an active participant in shaping their lives.
    Psychoeducation can build rapport. A successful therapist will model the collaborative role in treatment instead of lecturing. Successful psychoeducation will assist the therapist in taking on the expert role, showing their value to the client.
    One goal of CBT is for it to end. By teaching clients the skills through psychoeducation they will be able to autonomously solve their problems in the future. This means that not only the specific areas that were addressed in treatment, but other concerns that arise could be addressed through prior skills development. This does not mean that a client would never return to treatment, a brush up of skills or new skills might be needed. This is especially helpful for clients who may have not had the skills or confidence to deal with problems independently previously.
    Psychoeducation is vital throughout treatment. In early treatment psychoeducation is important to acclimate to treatment, build motivation and optimism, and learn about their condition. Learning about the condition assists in normalizing experiences. Clients can learn about the benefits of CBT so that they can see the benefit of staying in treatment. Later in CBT skill psychoeducation new skills are learned and pscyhoeducation can take the form of utilizing technology and books. Smaller lessons in skills will come together to form larger CBT concepts.

    2. Why is behavioral activation effective at reducing client distress?

    Behavior activation is effective in reducing client distress by reducing negative reinforcing behavior patterns and increasing positive reinforcing behavior patterns. A distressed person often has negative automatic thoughts and low energy. Two forms of behavior activation include activity monitoring and scheduling and graded task assignments. Monitoring activities can engage a client in understanding how she spends her time and specific areas for improvement. It could break a broader feeling of hopelessness and helplessness into specific goals that the client can feel success at changing. It is a simple first step that shows some fast relief, helping clients buy into therapy.
    Along with activity logs, daily activity schedules assist in providing a decrease in distress by increasing pleasure before (anticipation) and during an activity. Tracking during this time can show the client data backing up their decrease in distress. Including small activities and those that are potentially pleasurable will result in a sense of accomplishment and success.
    Behavior activation is a good example of why homework is important in CBT. Without the activity logs and daily activity schedules behavior activation is a broad subject that can be discussed in treatment, but perhaps not acted upon as fully as with planned assignments.
    To give an example of the benefits of behavior activation’s impact, a person whom I saw at a recent gathering was speaking about a new therapist she has and her excitement about treatment. She had only had 2-3 sessions, but was already discussing feeling able to make plans to go back to work. She had been going to a therapist whom she had been doing general talk therapy with for a year, which she stated was nice, but did not result in progress. She stated that she was excited about the skills and techniques she was learning with her new therapist. She described several skills and behavior activation. It became apparent that the therapist she had started with had a CBT focus. After not working for several years and having significant symptoms, she felt enough hope and progress to feel like she could work towards going back to work, something she hadn’t discussed for a long time.

    Reply

    • Bianca Thomas
      Oct 02, 2019 @ 13:31:22

      Tricia, I really appreciated that you demonstrated an example of how behavioral activation impacted someone so strongly within your own life. It is incredible to hear how after only a few sessions the client felt confident in creating plans and even going back to work.

      I also thoroughly enjoyed how you noted that from psychoeducation, the client will learn not to look at anyone, even the therapist, to solve their problems, and how reciprocal determinism plays a major part of the way their life results. It is very true that the therapist is the model by which the client observationally and collaboratively learns to execute these processes.

      Reply

  6. Bianca Thomas
    Oct 02, 2019 @ 13:20:36

    1) Why is psychoeducation considered a vital component for effective CBT
    Simply put, psychoeducation allows the client to learn new skills, in a collaborative fashion, and puts them in charge of their own therapy. Psychoeducation gives the individual insight into their diagnosis, helps them to understand their experience much better, such as understanding the basis of core beliefs and negative automatic thoughts and how those play into their daily lives, gives them tools to make necessary changes to their maladaptive behavior patterns, and provides them the skills necessary to independently take control of their own lives, without relying on the therapist for years on end. Psychoeducation, aside from “educating” provides the client with autonomy, a sense of independence due to their ability to learn and facilitate, and a sense of efficacy and self-esteem due to their collaborative role in making themselves feel better, and eventually doing it without the aid of the therapist. If the client sees that they are making results in a collaborative fashion, because they understand what the therapist is doing, and can eventually do it themselves, it will provide them with the motivation to continue treatment and to continue facilitating the skills demonstrated.

    2)There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT. Share your thoughts on possible reasons why behavioral activation is effective as reducing client distress.
    I believe behavioral activation is effective in reducing client distress because the individual is breaking their pattern of maladaptive coping responses, thoughts and emotions (staying home, in bed, watching Netflix, pondering why they are unable to feel better or initiate contact with others), and creates a new pattern of behavior that allows them to stimulate physiological, emotional and cognitive processes that have been idle. The individual receives positive reinforcement from others and themselves for achieving a goal that they felt they were unable to complete, enhancing their motivation and willingness to complete the activity again, as well as try new activities. Through consistently breaking the maladaptive pattern as well as the negative automatic thoughts, the individual is stimulating reinforcing adaptive thought patterns from positive, affirming action and initiating a new behavior. The individual learns to continue monitoring, scheduling, and initiating action, and gains a sense of self-efficacy over the newly found control over their life, and their pleasure in activities that have been seen as impossible for a long period of time.

    Reply

  7. Olivia Corfey
    Oct 02, 2019 @ 13:51:41

    1.Psychoeducation is an essential part of CBT. The specific therapeutic style is designed to teach the client to use techniques and increase their knowledge and self awareness of their maladaptive thoughts, feelings, and behaviors. Gaining knowledge and self awareness can help clients to identify and modify the maladaptive elements within their lives. In order to gain understanding of oneself and the maladaptive thoughts, emotions, and behaviors, one must be educated upon their specific diagnosis, symptoms and implications these have onto one’s life. Although the education aspect is important, psychoeducation helps to build rapport through the demonstration of the counselor’s knowledge of the topic and how this therapeutic style will potentially help relieve symptoms. Having an open discussion of symptoms and diagnosis through psychoeducation can also help the counselors formulate an initial presenting case and refresh their knowledge of the disorder and corresponding symptoms. Clients may be relieved to have their experience normalized to a certain extent. They are then aware they are not the only ones that have these experiences. It is essential not to express pity or minimize the client’s experiences while normalizing the client’s symptoms. Therefore, a balance between attempting to normalize and not minimizing the experience is necessary. Specifically to CBT, there are multiple opportunities for psychotherapy throughout the course of the sessions. Psychoeducation in the beginning stages of treatment emphasize the structure of sessions moving forward. The client is educated upon the requirements from the client, such as an active participant in their own therapy as well as the use of homework. In the early stages of psychoeducation, the cognitive model is also taught in order for the client to have a full understanding of the interaction between events, automatic thoughts, emotional and physiological responses and the outcome behaviors. The understanding of reciprocal determinism may help the client to feel more in control of their thoughts, feelings, and emotions. The basis of CBT lies upon the cognitive model, therefore, by teaching the cognitive model, it helps to demystify the therapeutic orientation. By demystifying CBT, the client may be more comfortable in therapy. Psychoeducation is also needed in order to teach the client new skills, as well as how to implement the new skills into one’s life. Teaching skills is a large part within CBT, therefore a client will have to have an understanding of the technique, how it is useful and why. Having knowledge about the skill and techniques may make it easier for clients to use them in their everyday lives, continuing after the termination of therapy.

    2. Behavioral activation in CBT is effective in reducing clients distress due to the primary goal of reducing negative reinforcing behavior patterns and increasing positive reinforcing behavior patterns. Through increasing activity, a client will increase their origin of reward by engaging with pleasurable activities. Helping clients to become more active gives them something to accomplish and therefore something to give themselves credit for the efforts they are putting into improving their mood. This also helps increase their level of self-efficacy moving forward within treatment. Behavioral activation can help clients understand that they have more control over outcomes then they may have previously thought. Behavioral activation provides tangible goals that can be accomplished in a short period of time, providing the client and the counselor with the evidence of improvement to work from. By obtaining small therapeutic successes, a client will be more likely to continue to participate in treatment and take more control in their own treatment outside of the therapeutic sessions.

    Reply

    • Kara Rene
      Oct 03, 2019 @ 13:41:35

      Olivia,

      I enjoyed your point that providing psychoeducation on a client’s diagnosis helps to provide insight into their symptoms, especially as they relate to the facets of CBT. I can imagine how just providing clients with psychoeducation about their symptoms combined with psychoeducation about the cognitive model can help clients start to see their symptoms through a CBT lens.

      You raise a good point that behavioral activation can help to increase a client’s self-efficacy! I hadn’t thought about it in that way, but I can see how obtaining success in one therapeutic intervention not only helps to increase the client’s optimism that CBT will help, but also their sense that they will experience success in further therapeutic interventions- which is important because we want clients to at some point be confident enough in using CBT techniques that they no longer need us!

      Reply

  8. Katrina Piangerelli
    Oct 02, 2019 @ 20:23:12

    (1) Why is psychoeducation considered a vital component to effective CBT (please go beyond saying it “educates” clients!)?

    Psychoeducation is important in helping clients to learn new skills in order to work collaboratively with the therapist, which is an integral component of CBT. Another goal of psychoeducation is to provide clients with this knowledge so they are able to practice and apply cognitive-behavioral skills on their own (becoming their own therapist). This sets clients up for success, as they are then able to help themselves long after they have gone to therapy. Psychoeducation allows the client to work autonomously and can reduce the risk of relapse in a client’s mental health disorder. It also helps the therapist establish therapeutic rapport and facilitate motivation to change, as well as improving treatment retention.
    In the early phase of treatment, psychoeducation allows clients to warm up to the therapeutic experience rather than being asked deeply personal questions. Education about a client’s specific diagnosis is also very important, and allowing them to learn how CBT has the potential to reduce their distress and ultimately improve their quality of life may give the client hope and incentive to stay in therapy. In the early phase it is important to address collaboration, session structure, goal directed, taking notes, homework, challenging ways of thinking and behaving, increased distress before reduced distress, autonomy, the cognitive model, diagnosis, case formulation, and the treatment plan. Each of these parts of psychoeducation is vital to helping the client understand how treatment can help them and what treatment looks like. These components also help clients to understand more about themselves and their mental health, and allows the therapist to build a relationship with the client that shows that they are competent. By providing psychoeducation, the therapist is also introducing the client to key terms and their meanings within the cognitive model. This helps the client in the long run, as they will understand what they are doing later on in therapy.
    Psychoeducation should not be used solely in early phase, but instead in nearly every session moving forward. Psychoeducation within these sessions will set the client up for success in feeling relief from distress, building autonomy, and changing their maladaptive cognitive-emotional-behavioral patterns.

    (2) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT. Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress.

    The main goal of behavioral activism in CBT is to reduce behavior patterns that are negative reinforcement while also increasing positive reinforcement behavior patterns. A client who is more active may have an increase in reward by engaging in daily tasks that were previously avoided. Behavioral activation can also help clients who struggle to get things done by problem-solving, ultimately breaking down large tasks into smaller ones. “Therapeutic successes” typically contribute to reduced distress, improved mood, and increased levels of motivation as well as hope for change. Behavioral activation can also naturally reinforce the collaborative nature of CBT. If behavioral activation is effectively implemented, then maladaptive behavioral patterns will be transformed into a lifestyle that is focused more on the experience of accomplishment and pleasure and the development of self-efficacy.
    Behavioral activation is effective at reducing client distress because it works to help clients break the cycle and become “unstuck.” It can help to provide some immediate relief and to allow the client to perform some activities and complete daily tasks with a sense of accomplishment and pleasure. I think that a part of behavioral activation involves looking at an individual’s daily activity monitoring log and helping clients to recognize what they have accomplished, even if the completed tasks are small. The therapist should challenge and gently push a client, which will lead that client to experience success and movement. Behavioral activism is also used to help the clinician create a specific treatment plan for a client. Something that becomes useful in behavioral activation is having a client rate their pleasure and sense of accomplishment for specific tasks. This can help a client and therapist discover where the client is struggling and may need more support, while also identifying areas in which the client is strong. Ultimately, this helps with case conceptualization and supporting clients in their strengths and weaknesses.

    Reply

    • Adam Rene
      Oct 03, 2019 @ 11:09:53

      Katrina,

      Thank you for your post. We certainly agreed on almost every aspect of both of these topics. I appreciated your detailed descriptions of how psychoeducation benefits the client, the therapist, and the therapeutic relationship. I also appreciated how you constructed your response to the effectiveness of behavioral activation and included how this connects to case conceptualization.

      Reply

    • Olivia Corfey
      Oct 05, 2019 @ 17:39:25

      Katrina,
      We have very similar understandings of the importance of psychoeducation. Your point that psychoeducation allows the clients to work autonomously in order to help reduce the risk of relapse aided in furthering my understanding. I also appreciated your emphasis on the continuation of psychoeducation throughout the sessions. Thank you for your post!

      Reply

  9. Anthony Mastrocola
    Oct 03, 2019 @ 09:37:41

    (1) Why is psychoeducation considered a vital component to effective CBT (please go beyond saying it “educates” clients!)? 

    Psychoeducation is important for the counselor him or herself. The beginning clinician can benefit from continuous practicing of the concepts, interventions, and theories relevant to CBT. The more practice will result in increased confidence. Confident counselors have a better chance of alleviating client anxiety surrounding therapy than an unconfident counselor. In the most basic sense, therapy involves a counselor providing a service for the client. Psychoeducation is especially crucial throughout the entire early phases of therapy. It is the job of the counselor to provide explanations and rationale for the practices and interventions that will be experienced throughout the period of therapy. Clients may be new to therapy, or have negative experiences heading in. The counselor can assist in forming accurate expectations through clear agendas and proper psychoeducation. If the counselor is unclear or unconfident in providing psychoeducation during the initial sessions, the client may be discouraged from continuing therapy. Psychoeducation is meant to alleviate initial client anxiety by providing hope and positive expectations.

    Cognitive behavioral therapy is grounded in the belief that distressed individuals are able to alleviate troubling symptoms without professional help. Individuals first enter therapy distressed and require help from the professional. Psychoeducation provides the skills that will eventually lead the client into better overall functioning. Once these skills are practiced and mastered, then clients will be more confident in alleviating their own distress post-termination. Psychoeducation provides clients with direction and autonomy. As clients become more educated on their own diagnosis and treatment, then they will be more invested in therapy and participate more. The more clients learn, the more willing they will be to provide effective feedback. As clients increase their awareness and understanding, they can use more autonomy to steer treatment. Educated clients are more confident in making their own choices in treatment. A counselor that understands and can elaborate on a particular diagnosis may also decrease client feelings of hopelessness. Sufficient psychoeducation may provide clients with explanations for their behaviors and emotions.

    (2) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT.  Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress. 

    Behavioral activation can be especially effective in the early phases of therapy. Clients entering therapy are often especially concerned about distressing emotions and behaviors. A lack in daily activity caused by negative emotions results in the client feelings worse than before. Scheduling specific behavioral activities can be an effective way of reducing distress. If clients engage in the planned activities, then there will be early success. This success may be enough to promote hope in clients, encouraging them to continue to plan and execute activities. As individuals become busier, negative behaviors such as withdrawal, isolation, and lethargy decrease. Positive reinforcement resulting from successful behaviors changes negative experiences that are the sources of distress. Generalized negative experiences can slowly be changed from new positive experiences. Clients that experience early behavioral and emotional improvements move to a place where they can transition to identifications of harmful thoughts and beliefs. The strategies of tracking daily activities are successful in comparing thoughts, emotions, and behaviors. As clients track their behaviors, they are able to list their immediate emotions. Follow-up in therapy involves relevant thoughts and patterns of behaviors, emotions, and thoughts. Behavioral activation decreases distress, because it initiates success and promotes psychoeducation. Activity tracking is an effective way or increasing therapeutic gains while the client is out of therapy. Clients are able to constantly think about the lessons of therapy while they track their behaviors. Clients are able to learn gain insight into the activities they perceive as pleasurable, and which activities are distressing. Once emotions and thoughts are considered, then certain activities can be increased or eliminated accordingly.

    Reply

    • Paola Gutierrez
      Oct 03, 2019 @ 13:32:08

      Anthony — you talked about how psychoeducation helps clients learn more about themselves in terms of their mental health diagnosis and what they may be going through. In turn, this helps improve clients’ sense of hopelessness (about their state, or about therapy). I think this is particularly powerful, because a therapist who can reassure clients and help them feel more hopeful is so important for motivating and engaging clients in therapy. You did a great job of emphasizing why psychoeducation is crucial for CBT.

      Reply

    • Kara Rene
      Oct 03, 2019 @ 13:34:55

      Anthony,

      I liked how you pointed out that psychoeducation is valuable not only to the client, but also the counselor, especially early in practice! You raise a good point that the repetition of concepts involved in providing psychotherapy is a good opportunity for the counselor to get practice with those concepts at the same time.

      I also enjoyed your point that as clients increase positive activities, there negative activities will decrease, as well as that the short-term relief offered by behavioral activation is a helpful reinforcer to continue doing the selected activities!

      Reply

    • Olivia Corfey
      Oct 05, 2019 @ 17:46:53

      Anthony,
      I really enjoyed your post! Your point about how psychoeducation can benefit the client as well of the counselor is enlightening. I agree a confident counselor has a better chance of reducing the anxiety around beginning therapy sessions. I also liked your comment of about how behavioral activation may bring about hope. The feeling of hope may aid within the client’s self efficacy and therefore, may be more likely to continue and find relief through therapy.

      Reply

  10. Kara Rene
    Oct 03, 2019 @ 13:30:14

    1. I believe that psychoeducation should be a valuable part of any therapeutic modality, but it is especially important in CBT because it is a necessary ingredient for the client to one day become self-reliant, no longer needing the therapist. Psychoeducation helps to demystify both the therapeutic process and the client’s diagnoses. The process of providing early psychoeducation about CBT helps the client feel that they know what to expect from therapy and helps set expectations for how each session will proceed. It also serves to build rapport and communicate therapist expertness. Providing psychoeducation about a client’s diagnosis can help to normalize and demystify the client’s experience with mental health. Additionally, early phase psychoeducation provides a less intimidating start to therapy, particularly for client’s who are wary of “diving in”, and helps clients to feel optimistic about their treatment by explaining the effectiveness of CBT. Most of all, psychoeducation throughout the therapeutic process helps the client learn to be their own therapist by explaining the process and purpose of CBT and how it relates to the client’s life, so that someday the client can leave therapy confident in their own ability to apply what they have learned independently.
    2. In CBT, behavioral activation is meant to reduce client distress by reducing negative behavioral patterns while increasing positive behavioral patterns. Oftentimes clients with significant levels of distress struggle to complete everyday activities and as a result, feel “stuck.” Behavioral activation helps to interrupt this cycle and can also provide some short-term relief. It also has the potential to create a more positive environment for the client through the addition of interactions with social supports, having a more pleasant living environment (by completing daily basic chores), and producing endorphins by getting the body moving. I am currently working with a client who is in a difficult depressive phase and I have been thankful for the timing of our learning about behavioral activation so that I can use it as a skill-building therapeutic intervention. We have been working to identify activities that she still enjoys despite being depressed and assigning homework that involves doing one of those activities an agreed-upon number of times before her next session. This week we decided to do one of those activities as part of our session and it actually made a visible change in her presenting mood. My client was able to identify that she felt much better after engaging in the activity, which was so encouraging! I am hoping that she will remember how her mood changed when she is finding it difficult to engage in activities due to low energy. It can be frustrating to know that a client needs more but that I am not qualified to offer the “more” they need yet, so it has been nice to be able to put behavioral activation into practice with this client.

    Reply

    • Anthony Mastrocola
      Oct 04, 2019 @ 10:34:45

      Hi Kara,

      I also agree that all forms of therapy can benefit from providing psychoeducation. It is an effective way to provide transparency, ultimately alleviating initial client anxiety. As a result, expectations will be clearer, and the therapeutic relationship will continue to improve. I also appreciate the example you provided from your own work experience, and I’m glad that behavioral activation had a positive effect on your client.

      Reply

    • Kelsey Finnegan
      Oct 04, 2019 @ 18:34:52

      Kara,
      I appreciate your point that psychoeducation normalizes and demystifies the therapeutic process and the diagnosis. Not only does this strengthen the therapeutic alliance, but it can help reduce client’s anxiety surrounding their mental state as well. Clients will be more receptive to treatment and motivated to follow through when their experience is normalized and further understood.

      I enjoyed reading about your experience with your own client. I imagine it is helpful and exciting that you are able to put these skills into practice as you’re learning them.

      Reply

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Adam M. Volungis, PhD, LMHC

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