Topic 4: Psychoeducation & Behavioral Activation {by 10/6}

[Psychoeducation] – Watch PDA-4: Psychoeducation – Diagnosis.  Answer the following: (1) For psychoeducation of specific disorders, what are some ways you can “normalize” each clients’ experience without alienating them or coming off as lacking empathy?

 

[Behavioral Activation] – (1) 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] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML).  Answer the following: (1) Based upon what you know about this client so far (e.g., information from his assessment and this video vignette), what patterns of behavior do you think warrant follow-up in the next session while reviewing his WAML?  (2) How would monitoring this client’s accomplishment and pleasure be helpful for his treatment?

 

Your original post should be posted by the beginning of class 10/6.  Have your two replies posted no later than 10/8.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

 

*Videos can be found at R&L website or here: https://dradamvolungis.com/classes/psy-708/cbt-theory-into-practice-psy-708/videos-psy-708/

47 Comments (+add yours?)

  1. Tom Mandozzi
    Oct 02, 2022 @ 17:26:37

    I thought it was empowering for the client when the therapist said, “anxiety is not that bad” and used a sense of humor combined with clear and comprehensive psychoeducation to simplify the nature of anxiety symptoms and panic disorder. Explaining how anxiety can be important and even helpful in some situations helps to normalize the source of anxiety without minimizing how it feels when anxiety feels overwhelming or excessive. I think this normalized the client’s emotional experience while also expressing that the therapist understands the level of discomfort is significant and real. I feel like education is such a powerful tool to gain some level of control and understanding over symptoms of mental disorders and the way in which they play out and present. By equipping the client with this knowledge, they can feel more capable of taking control over their lives and engaging in skills and strategies to keep symptoms managed. By assuring the client “anxiety will not kill you” can be helpful to normalize that even though panic attacks and anxiety can feel like they can cause physical symptoms or be of physical danger to one’s life, that anxiety will subside and can be managed. Validating the client is important with this too. In the video, Dr. V. validated that the experience feels life-threatening and that it is completely understandable and normal to feel that way, but that steps can be taken to approach the anxiety in a more realistic way. I could tell the client felt more comfortable and assured that they could take some control over their experience and get through their panic attacks. Overall, I think psychoeducation allows the client to feel like they can make some sense over an issue or situation that, in the moment, feels like they could not make sense of before. Dr. V and the client both used body language to express that they understood one another (such as head nodding). Using visual aids, like in the video, to explain the interaction and interrelated relationship between thoughts, behaviors and physical symptoms can help the client to have a visual understanding of the CBT model and then learn practical and helpful interventions to accompany this understanding. When the therapist said: “these thoughts, although feel very real in the moment, there is not much evidence for them…”, the client receives validation while also being challenged with specific evidence. Emphasizing the goal of “breaking the cycle” was a good way of coming up with a tangible solution for the client to overcome the issues in a gradual way and with the assistance of the clinician. The client can feel as though they are not left to manage this issue alone but can also take information with them to manage some aspects of symptoms independently. Allowing the client to be able to explain their symptoms and experiences, instead of making assumptions or describing things in a way that don’t align with what the client is experiencing, may help normalize the diagnosis without speaking for the client or coming off as lacking empathy. Tailoring the approach, including humor, communication style and amount of psychoeducation to the specific client can also help to ensure they are absorbing the psychoeducation and gaining knowledge while their behaviors and experiences are still being normalized.

    I think the nature of CBT interventions in targeting our thoughts, behaviors, and emotions makes behavioral activation an important factor when providing treatment to clients. Because we know that our thoughts and feelings effect our behavior, it is also important to remember that our behavior also effects our thoughts and feelings in a cyclical fashion. By implementing behavioral activation interventions, the therapeutic process can support targeting the client’s behaviors to improve cognitive process and experienced emotions. These improved thoughts and feelings thus continue to improve behavior and can help the client improve their wellbeing as a result. Scheduling activities can help clients more intentionally engage in pleasant events. Behavioral activation supports reduction in negative reinforcing behavior patterns and an increase in productive behaviors. Behavioral activation can help to improve low energy levels and negative automatic thoughts and emotions in clients with significant distress. Because behavioral activation can increase self-efficacy and empower clients to engage in more adaptive cognitive-emotional-behavioral patterns, they are able to ultimately reduce levels of distress and manage symptoms of depression and other disorders. Monitoring behaviors can help the client to make appropriate behavioral changes to improve wellbeing across cognitive, emotional and behavioral processes.

    I think while reviewing the client’s WAML, the withdrawal behaviors are a central focus from this video and would be very important to follow up on in the next session. I think it would also be important to check in again about behaviors that he enjoys, like spending time with his girlfriend and being more active in activities with her (going out to dinner, walking dog, etc.). Negative automatic thoughts that inform withdrawal might also be important to check in about to establish some understanding of these thoughts as they relate to his behavior. Aspects of the client’s routine would be important to check in on (doing dishes, walking dog, morning routine, etc.) during the next session to see what areas need support and a evaluating a sense of how the client’s daily behavior and schedule tasks are structured. As mentioned in the video, even the “small daily activities” are important to monitor and follow up about. How much pleasure that is associated with each task will support identifying ways in which behavior activation can improve wellbeing.

    Monitoring the client’s accomplishments and pleasure would be helpful for treatment because it may inform which behaviors to prioritize when engaging in behavioral activation interventions. For example, if a client rates a specific behavior as highly enjoyable, then treatment processes could support implementing this activity more frequently in the client’s schedule to improve wellbeing and increase the frequency of experiencing the associated pleasure. On the other hand, if a certain behavior is rated very low in terms of pleasure, then interventions can support replacing such behaviors, where appropriate, with ones that are more enjoyable for the client. This may also work to evaluate what behaviors are necessary to implement in the client’s routine (chores such as doing the dishes, walking the dog, etc.) and other tasks that must be completed and which activities are optional and more based on choice and interest. Increasing the frequency of tasks and behaviors that are associated with a sense of high accomplishment or pleasure may improve the client’s emotional and behavioral wellbeing from the standpoint of supporting the client through clinical treatment interventions.

    Reply

    • Bekah Riley
      Oct 05, 2022 @ 11:28:35

      Hi Tom,
      I really enjoyed reading your post this week. I like how you began by highlighting the fact that normalizing different disorders through psychoeducation by emphasizing that the specific disorder is not as bad as it seems and there may even be positives to different disorders can be very beneficial to how the client perceives their disorder. Specifically, having anxiety about a new job may prompt an individual to arrive early or work harder than they would if they had no anxiety or did not really care. In addition, I liked how you had a strong focus on the idea that although different physiological symptoms from a disorder may seem very dangerous, specifically with anxiety and panic disorder, the client is not actually in any physical danger. I think that explaining this can be very reassuring to clients. I also really enjoyed how you highlighted that behavioral activation can both increase self-efficacy as well as empower the client to participate in more adaptive behaviors. Behavioral activation in itself can be very encouraging and empowering for many clients!

      Reply

    • Ashley Torres
      Oct 05, 2022 @ 20:49:46

      Hi Tom, I enjoyed how you explained psychoeducation in your response and gave examples from the video. I also liked how Dr. V used a visual aid to educate the client on CBT. He explained the model as a “negative cycle” and incorporated the client into the mini lesson. The client was able to tell Dr. V her thoughts, physical symptoms, and behaviors she experiences during the class and he showed her how those all influence each other with the visual aid. Not only does the visual aid help picture how CBT works but it helps the client gain self-awareness. This can help them change those automatic thoughts or behaviors in order to decrease distress because they are aware of what causes them.

      Reply

    • Kristin Blair
      Oct 07, 2022 @ 17:59:49

      Hi Tom,

      I really liked how you picked up on the nonverbal cues that expressed an understanding in the videos. I noticed the same thing now that I thought about it after reading your post. I think the importance of that type of body language is often overlooked!
      I also enjoyed your description of how to absorb the psychoeducation portion best. I would definitely agree that it is a triad (or more) things that come together to deliver the information in the most successful manner. Different things help different clients; therefore, the therapist needs to be flexible and malleable in their attempts with each client.
      Nice post!

      Reply

  2. Patricia Ortiz
    Oct 02, 2022 @ 20:39:09

    [Psychoeducation] – Watch PDA-4: Psychoeducation – Diagnosis. Answer the following:
    (1) For psychoeducation of specific disorders, what are some ways you can “normalize” each clients’ experience without alienating them or coming off as lacking empathy?

    Psychoeducation consists of the explanation of the problem to the client. In general, it is explained what the disorder consists of and its characteristics so that they understand it and can deal with it in a more adaptive way, also how the condition affects the client’s life, frequent symptoms, what treatments exist, what can be done to improve, etc.
    I think that first, clinicians must create an atmosphere of trust, accepting the similarities and differences of the client, being with a predisposition attitude of wanting to tune in and demonstrate trust. Also, use the same language as the client. That is, adapt to the linguistic level and the terms the other person uses to create better harmony.
    Another important factor that normalizes the client’s experience is to speak carefully but always be honest. Always measure words because they can confuse the client depending on how we say things. It is essential to be clear and express everything tactfully. Also, each person is different. Each person has different ways of understanding and dealing with things. So, clinicians should know how to treat each person according to their circumstances. Clients should feel like whatever they have will get better and that we are there to guide them and help them overcome it.
    When clinicians psychoeducate the client about their disorders, they could have feelings of frustration and confusion, so it is vital that we always ask for feedback and clarifications, ask about what they did not understand, and make them collaborate and participate in every step of the diagnostic. Also, make accompanying body movements such as nodding; this way, the client would feel cared for and listened to. Active listening is critical because we show that we pay attention to what the client says, not only the words but also the underlying feelings and emotions.
    Finally, I believe that it is critical to recapitulate; to recapitulate is to summarize and order what has previously been stated to a greater extent. This way, we can be sure that the client understood everything that was discussed in therapy and that we are on the same page and begin to work on the next steps.

    [Behavioral Activation] –
    (1) 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 therapy focuses on activating the person to return to activities or contact with their previous life. Some people usually lock themselves up, avoid social contact, and even interrupt personal hygiene, among other things. It is coping-oriented, so it motivates the person to act, even if they don’t want to. Accomplishing a small milestone, like going for a 10-minute walk, can improve their mood. Behavioral activation (BA) focuses on two keys: context and function. That is, the question a therapist asks is what is going on in that person’s environment and what he is doing about it. This therapy leaves the state of mind and the emphasis on the cognitive to focus mainly on behavior. In this interaction, the client learns to observe their behavior and to think of strategies to stop specific actions or to continue with others. Thus, they become the true protagonist of their life.

    I believe that behavioral activation effectively reduces the client’s distress because it helps them get motivated by using reinforcers, making it easier for the person to connect with those activities that generate enjoyment. Work is done on those mechanisms that sustain maladaptive behavior, such as flight and avoidance.

    First, to change how people feel, clinicians have to help them change what they do. Many clients wait to regain the motivation to do things, which is precisely what keeps them locked up. They need to learn to find motivation within themselves. Behavioral activation is a behavioral approach from the outside; that is, a person does not have to wait until they feel like doing something but do something which will make the person feel better later.
    Secondly, behavioral activation helps people replace unhelpful behaviors. For example, suppose a person notices that they abuse alcohol when stressed, which makes them feel worse later. In that case, they could engage in healthier behavior and stress-relieving habit as gardening or another hobby.
    Finally, behavioral activation also helps people engage in social activities and spend quality time with people they care about, for instance, a phone call to a family member or a friend, a movie night with family, etc. Behavioral activation helps the clients regain control of their lives; that way, they can re-engage in activities that make them happy and find the motivation to keep doing them.

    [Behavioral Activation] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML). Answer the following:
    (1) Based upon what you know about this client so far (e.g., information from his assessment and this video vignette), what patterns of behavior do you think warrant follow-up in the next session while reviewing his WAML? (2) How would monitoring this client’s accomplishments and pleasure be helpful for his treatment?

    The objective of Behavioral Activation is to neutralize escape or avoidance behaviors. To do this, it works from the “outside-in” through the programming of activities and the assignment of gradual tasks, which allow the client to begin slowly to increase their chances of having a positively reinforced activity. With this client, the focus is on changing behavioral patterns that make him feel “stuck.” For instance, some of them that I think need to be followed up on are checking how he is doing with getting up early and not being in a rush every morning. Check on his sleeping habits and patterns to see if there is something to change for him to be more active in the mornings. He says mornings are more challenging for him because he is always in a rush, which leads him to not eat a proper breakfast, and he would like to be able to cook a good breakfast to start his day.

    Also, it would be necessary to check how he is doing with having more quality time with his girlfriend. He wants to go to the park and go hiking with her because he says those things are significant to him, and he likes them.
    It is natural for a person who feels sad and has stopped finding pleasure in the activities they used to enjoy to try to cope with the situation through social withdrawal, stopping participating in pleasant activities, and “disconnecting” from their reality. That’s why it is essential to check with him if he could engage in some social activities too.

    Since he says he does not have much time for himself, I would follow up on that and try to make him find other relaxing activities that make him feel better about himself to make him gain a sense of self-efficacy and control. Also, check on how he is doing with football, spending time with his dog, and playing video games.

    Monitoring this client’s accomplishments and pleasure is helpful for this treatment because he will feel like he is moving towards getting things done, which will make him feel less stuck and gradually get a feeling of fulfillment that will make his depression less noticeable each time. It is critical first to address the withdrawal and disengagement that occur with depression, helping the individual begin to take steps to re-engage and become the protagonist of their own life, despite feelings and negative thoughts or the usual lack of motivation.

    Reply

    • Ashley Torres
      Oct 05, 2022 @ 20:40:35

      Hi Patricia, I really liked how you organized your response. The environment a therapist presents is very important and I liked how you included that they must be in an atmosphere they feel safe and trust. A therapist interacts without a variety of populations and I liked how you drew attention to accepting our clients’ differences. We do not necessarily have to agree with them but we need to respect their beliefs and not let our opinions project into the session. Asking for feedback is another important idea you included because if the client is not enjoying the session or feeling productive, they may not come back or you could be wasting their time by not adapting to their style.

      Reply

  3. NikkiAnn Ryan
    Oct 03, 2022 @ 22:14:42

    When it comes to normalizing a client’s experiences, it is important to balance letting them know that they are not alone in what they are experiencing without giving them the impression that their situation is “just like everyone else.” While providing psychoeducation, the counselor can review common symptoms and etiological factors associated with the specific disorder to promote understanding of the characteristics of the disorder and how it may impact them. Tt is important to remember that every client with a specific disorder will not have the same experiences so the counselor should try inquiring more about how each client is affected and remind the client that while these may be common factors, their experiences may differ and that is okay. Counselors should not make assumptions about how the client is affected by their disorder or by how they are feeling regarding the psychoeducation, but counselors should try to gain a better understanding of how their clients are feeling so that they can appropriately empathize with them. Counselors can also connect the specific disorder to the CBT model regarding how the aspects of their disorder relate to their thoughts, feelings, and behaviors. By using the client’s experiences to provide psychoeducation in the context of the CBT model, it can connect the information to the client in a way that is unique to them rather than a generic example for all depressed individuals for instance. When providing psychoeducation on specific disorders, it can also be a good time to generate hope for their treatment.

    Behavioral activation is an effective tool for reducing client distress. It makes sense that behavioral activation effectively reduces distress because it breaks a cycle of negative reinforcing behaviors that perpetuate distress. By not engaging in activities, individuals may experience more negative thoughts and feelings, such as loneliness, laziness, and failure. However, doing something, even something that would be considered relatively small to others like basic activities of daily living, can foster a sense of accomplishment and possibly encourage more activity. It is particularly important to start behavioral activation early in the therapeutic process, especially with depressed clients. Ultimately, behavioral activation can give clients a sense of agency, that they are in control of at least some of their behaviors and that participating in treatment can improve their well-being.

    Two major behavioral themes appeared to come up for the client during this session: his withdrawal and his difficulties with work. It would therefore be helpful for the counselor to pay attention to these two patterns of behavior when reviewing his weekly activity monitoring log. Regarding withdrawal behavior, it will be important to follow up on how much time the client is spending with his girlfriend, going out to eat or walking the dog, or potentially calling or spending time with friends versus how much time he spends at home. The client identified that decreasing his withdrawal behavior is important to him so it would be beneficial to review it during the next session. It would likely make the client feel that his contributions to the therapeutic relationship do not matter as much if his withdrawal patterns are not reviewed after he articulated that it is important to him to change this behavior. As for work, the counselor should follow up on the pleasure and accomplishment ratings for the different activities he does at work to get a better idea of what particular work activities are contributing to his distress. By narrowing down the specific work components that contribute most to his distress, the counselor can help with specific interventions or behavioral experiments to target those areas. It is possible that there is an underlying negative core belief that contributes to his distress related to work and it may be easier to detect it if the counselor can talk about the specific work patterns.

    Monitoring this client’s pleasure and accomplishment during different activities can be helpful for both the counselor and the client to better understand how he perceives each activity. This will help him identify what activities are already pleasurable and potentially increase those activities as well as which activities are not pleasurable that the client may want to be more pleasurable. This provides an area of exploration for the client and counselor regarding what activities are important to maintain or incorporate into his schedule more. Rating his pleasure may also help the client realize that not every activity will be pleasurable and that it is okay. Moreover, taking the time to acknowledge when he feels accomplished can potentially improve the client’s views about his activities and his overall well-being.

    Reply

    • Bekah Riley
      Oct 05, 2022 @ 11:35:20

      Hi NikkiAnn,
      I thought you had a great response this week! I liked how you emphasized that while it is important to normalize the client’s experience, it is also important to avoid saying that their experience is just like everyone else’s. Although different symptoms are commonly prevalent in a specific disorder, how each individual experiences and handles these symptoms may be very individualized to that person. In addition, I enjoyed reading your description of behavioral activation and how it can work to break a negative cycle of unwanted behaviors. Often times when the client shifts an unwanted behavior to something more desired, it quickly begins to reduce their distress!
      Overall, great post!

      Reply

    • Patricia Ortiz
      Oct 07, 2022 @ 17:14:27

      Hi NikkiAnn, I agree with you, and I like how you mention that it is important to have a balance in letting the clients know that they are not alone in what they are experiencing without giving them the impression that their situation is “just like everyone else.” This is so true and important to mention because I think there is a fine line between letting the clients know they are going to be ok and “trivializing” their process. Validation by the therapist involves, in a nutshell, communicating to the patient that their emotional responses make sense and are understandable within their history and/or current context. And also, the therapist accepts the patient’s emotions and communicates this acceptance. Accepting them implies identifying those answers, taking them seriously, without neglecting or trivializing them, with a non-judgmental attitude, and describing them in a non-pejorative way.

      Reply

    • Kat Gatto
      Oct 08, 2022 @ 17:36:05

      Hi NikkiAnn,

      I really liked how you worded that behavioral activation reduces stress because it ends the behavioral cycles that perpetuate the problem! Great post! You can see how this fits so well into CBT too. Once the behavior changes, then so can the thoughts that the individual had about themselves. In addition, it can definitely increase self-efficacy and help an individual believe that they are capable of completing actions that they felt they were unable to do previously. It’s such an affective approach!

      Reply

  4. Bekah Riley
    Oct 05, 2022 @ 11:11:35

    When providing a client with psychoeducation for their specific disorder or comorbid disorders, it is important to normalize the client’s experience while also showing the client empathy. Specifically, when normalizing the clients experience, it can reassure them in the sense that the potential physiological symptoms they feel are not dangerous or deadly. However, in doing so, it is also important to validate that the symptoms the client is experiencing are very real and may feel very dangerous. This may allow the client to recognize that although their symptoms, both psychological and physiological, are threatening, they will not endure any physical harm. For example, in the session between Dr. V and his client Lindsay, her physiological symptoms of the panic attacks she experiences from her arachnophobia can seem so dangerous to the point where she feels like she is having a heart attack. Through psychoeducation, Dr. V explains that although these symptoms are real and feel harmful, they will not cause physical harm. Providing psychoeducation can also allow the client to understand why some of their symptoms occur and why these symptoms cause different avoidant behaviors. When a client both understands their disorder while also feeling that their experience is validated, it can further help them work towards correcting some of their maladaptive thoughts, emotions, and behaviors.

    Behavioral activation has been shown to be an effective technique used in CBT for a number of different reasons. Specifically, behavioral activation targets unwanted behaviors with the goal of shifting these behaviors to something more adaptive for that specific client. Changing unwanted behaviors ultimately helps the client to have less negative automatic and maladaptive thoughts, then also shifting negative emotions to more positive emotions. In order to effectively provide behavioral activation with a client, it is first important to provide psychoeducation on how behavioral activation works in the context of the client’s disorder. It is then important to assign homework in the form of an activity log to allow the client to monitor and track their unwanted behaviors. After the client and therapist identify the client’s unwanted behaviors and why they occur, it is important to work towards shifting some of these unwanted behaviors to more desired behaviors. Behavioral activation can be very effective in reducing a client’s distress because often times different unwanted behaviors are what is causing the client so much distress such as negative thoughts and emotions. Once a client is able to identify these behaviors and shift them to something more adaptive, they will often begin to feel better very quickly. Specifically, when a client has major depression and they are sleeping all day, getting up even an hour earlier to do something productive, even if it is small, can already shift the client’s mood to something more desired.

    Based upon my knowledge of the client with the diagnosis of MDD through watching their sessions so far, there are different behaviors that warrant follow-up in the next session while reviewing his WAML. Specifically with this client, it would be important to follow up on his self-efficacy in his job and other important tasks as well as his tendency to withdrawal from desired tasks. He stated that one of his goals was to be able to be present with his girlfriend through participating in different activities with her such as walking the dog, so it may be important to have a stronger focus on his withdrawal from this task or ability to complete it. In addition, focusing first on what the client was able to successfully accomplish may provide them with a sense of reassurance that they are capable of completing desired tasks. Monitoring the client’s accomplishments will also help to promote motivation to work towards additional goals.

    Reply

    • Tom Mandozzi
      Oct 05, 2022 @ 12:21:31

      Hi Bekah,

      I really liked the point you emphasized about using psychoeducation to accomplish multiple different functions, including both normalizing and validating the nature of the symptomatic experience while also ensuring the client is educated on the fact that anxiety can be helpful and will not cause overwhelming physical harm. By doing both of these things, the client can feel empowered to take more control over their lives and implement strategies for managing diagnoses. It is so important for the client to feel as though the therapist understands the level of dysfunction and that it is real and valid. Great post!

      Reply

    • Teresia
      Oct 08, 2022 @ 19:58:01

      Hi Bekah,

      Great post! I liked how you mentioned the importance of validating the client’s feelings about their symptoms. Letting the client know that their symptoms are real and can be distressing at the moment, but they will not cause physical harm can help them not feel overwhelmed about their diagnosis. When providing psychoeducation about a specific disorder, it’s important to balance honesty and empathy. I also agree that it’s important to follow up on Mark’s withdrawal in a future session in order to increase his social interactions.
      I enjoyed reading your post!

      Reply

    • Tayler Shea
      Oct 08, 2022 @ 21:06:01

      Hi Bekah!

      I really enjoyed reading your response this week! I like how you pointed out that psychoeducation can help clients realize that their symptoms are not deadly. I also like how you pointed out that psychoeducation serves more than one function: validation and normalization. Many times, physiological symptoms can feel very scary! I agree with you about how important behavioral activation can be. It’s so interesting how even a small shift in a client’s behaviors can make such a huge impact on their thoughts and feelings.

      Reply

  5. Amanda Bara
    Oct 05, 2022 @ 11:15:54

    1. When educating clients about specific disorders it is important to normalize the client’s experience in order for them to not feel alienated or that they are the only people in the world feeling this way. Some ways to “normalize” an experience is by using disclosure as a therapist and telling the client that you have felt the same way some times in your life. Also, by educating them on the reality of their experience in regards to the physiological responses they are having which are real. By showing the client that you know what they are feeling and addressing it to physical symptoms they can grasp that there is normalcy to their symptoms. When looking at the video, the therapist did a great job at explaining how the reactions of anxiety can be helpful in some situations and that it is a response that everyone has but that some have it heightened. The therapist also did a great job at bringing reality into the situation while also using humor. He does this by saying, “anxiety is not that bad” and “you are not going to die”. This technique allows that client to see that there is more to them than their anxiety and that he knows what the client is thinking when they are experiencing this type of distress. While doing so the therapist validates the feelings of the client and helps her to realize that they are not alone. This helps to bring in empathy where the therapist knows it can be difficult to experience these thoughts and emotions but there is a light at the end of the tunnel. The visual aid was a useful technique as it further explained why the client was feeling the way she was and to give her hope that there can be change where they will eventually manage their distressing symptoms with the right techniques.
    2. When looking at behavioral activation and its effectiveness as a factor of CBT it makes a lot of logical sense. In order for someone to make changes in their life they must focus on the aspects that are weighing them down. Behavioral activation is a major component to bringing about change and is one of the first approaches in therapy because it brings motivation to clients. Activating behavior will subsequently produce thoughts and emotions to evolve as well. Some individuals may not have the motivation to start exercising but once they do it they may gain the motivation. Specifically, this is seen with patients who are depressed. This in turn will help to change their thought patterns and emotions to be more positive. Once the body starts to change its patterns so will the brain in relation to cognition and emotions. This leads into a cycle of positive change that helps individuals to obtain better coping strategies and adaptive approaches to daily stressors.
    3. For follow up next week it is important to look at what is going on at work and the client’s activity during this time. Since that is a target area and the client is specifically focusing on writing down the activities he gets done at work it is important to cover in the following session. It will also help to target the withdrawal thoughts that the client emphasized during session as he specifically wanted to focus on when that appears during the day and why. If he writes it down in his monitoring log then it will give the therapist an idea of the pattern of these thoughts. Because the negative thoughts and withdrawal can be leading to inactivity it is crucial to pinpoint where they arise and the behaviors that may follow. Knowing the client’s routine and pinpointing areas that they are struggling with and are causing distress or impairment will help to get a bigger picture of the client in regards to their behaviors and thoughts.
    It is also important to focus on the activities that the client enjoys and seeks pleasure in during the day. This can give the therapist areas of reinforcement to use for getting non-preferred activities done. Monitoring the client’s accomplishment and pleasure is helpful for treatment as it identifies areas of motivation. Knowing what motivates a client to feel better and engage in activity is crucial to activating behavior change. From what we know about behavior change and its sequence of changing thoughts and emotions this is an important aspect. If there are no areas of pleasure of accomplishment for a client they will be less willing to work towards specific goals or find hope for feeling better.

    Reply

    • Tom Mandozzi
      Oct 05, 2022 @ 12:27:43

      Hi Amanda,

      I really liked how you mentioned the importance of motivation when it comes to behavior patterns and implementation of behavior activation strategies. I agree that monitoring a client’s accomplishments and the pleasure they experience is so important when it comes to engaging the client in more desirable behaviors. If a client does not enjoy a particular behavior, then they would not likely be motivated to increase engagement in behaviors. If a client reports a high level of pleasure with an activity, then they would have a much higher motivation to complete it and increase the frequency into their routine. Thank you for highlighting this point!

      Reply

  6. Ashley Torres
    Oct 05, 2022 @ 20:30:03

    Normalizing people’s experiences with specific disorders can be helpful as long as the clients’ experiences are not pushed aside. Psychoeducation helps clients understand their disorder and reassures them they are not alone because there is science that can be connected to the disorder. For example, anxiety can be a biological and physiological response to threat. When providing psychoeducation, the counselor can use their symptoms to explain why they react or behave the way they do. Instead of just telling the client everyone experiences anxiety, it is important to educate them on what anxiety is and why they experience it more than others. Self-disclosures may also help normalize a clients experience without alienating them because it shows that professionals can also experience these symptoms and they will not cause serious effects if they are under control. If the therapist has built a strong rapport with the client, they can use humor in their psychoeducation session. For example, I liked when the therapist informed the client that their anxiety is not going to kill them. It reassures the client that what they are experiencing is not as bad as what they believe it is. A strategy used in the video was the “negative cycle,” and I believe this is very useful because it teaches clients how their thoughts, behaviors, and physical symptoms interact with each other. Using a client’s experience by having them plug it into the cycle really encourages collaboration and lets the client express themselves without the therapist making assumptions about their experiences. Learning about the cycle motivates the client to make changes because they know what is causing negative experiences.

    Behavioral activation is effective at reducing client’s distress because it pushes them to engage in behaviors that can lead to better feelings or thoughts. They may not feel better as soon as they start the behavioral activation but the more exposure they get, they will gain positive feelings or emotions towards the situation. It works by breaking a cycle that reinforces bad behavior and thoughts. If clients engage in behavior activation, then they may no longer engage in the same behavior which can reduce distress. This can also apply to thoughts and emotions because if a client is changing their behavior, then they are engaging in a different experience that can lead to positive feelings. These clients need motivation to make changes and then they will be reinforced by positive effects and continue the adaptive functions.

    I think there should be follow up on his self-efficacy at work and withdrawal. He really emphasized that he would feel a lot better if the withdrawal would just go away. The client came up with this answer on his own and if the therapist revisits this topic, it shows he is listening and cares for his client. The client mentioned he would like to be more present in his relationship and active with his dog. Therefore, it would be important to revisit these behaviors next session and ask how he felt when either completing or withdrawing from it. If he completed it, he may have had positive emotions that will motivate him to do it again in the future. If he did not complete a desirable task, then the therapist and client can explore how that felt and what can change to improve the experience. It would also be helpful to examine his behaviors at his job because we will get an insight to his automatic negative thoughts. The pair can also acknowledge any positive experience and accomplishments he has at work because it will motivate him to make progress in his field.

    Monitoring the client’s accomplishments and pleasure can be helpful for his treatment because it helps the client gain self-awareness and informs the therapist what is going on outside of session. These WAML are monitoring accomplishments and pleasure therefore they can explore how much pleasure he is receiving and base the session off that information. For example, the next activity will be planning out the day and trying to incorporate activities he enjoyed and learning to re-engage in past activities he found pleasurable. The pair can also work together to come up with strategies to accomplish goals at work and what to do if he becomes discouraged.

    Reply

    • Tuyen Phung
      Oct 06, 2022 @ 22:23:57

      Hi Ashley,
      Your ways of normalizing the experiences of clients without bringing them a sense of being judged or showing a lack of empathy in therapists. It is interesting that you mentioned self-disclosure in the context. With self-disclosure from therapists, clients have a sense that the therapists put their feet in the clients’ shoes. This is a very effective way to build the therapeutic relationship first before they can explain more about the symptoms to the clients. This way also helps the clients understand that they are not alone. I think once self-disclosure is not deep enough to interfere with personal information, it can bring the clients closer to the therapists. I like the way you explained the use of the CBT model to help clients understand their symptoms without feeling their symptoms as unique or incurable. When the cycle of negative thoughts and behaviors is broken, positive behaviors can follow. This brings more hope for them in their treatments.

      Reply

  7. Vanessa U.
    Oct 05, 2022 @ 21:07:04

    [Psychoeducation] – Watch PDA-4: Psychoeducation – Diagnosis. Answer the following: (1) For psychoeducation of specific disorders, what are some ways you can “normalize” each client’s experience without alienating them or coming off as lacking empathy?

    One particular example of psychoeducation that has always resonated with me as both thoughtful and genuine was one I overheard unintentionally a long time ago. It was a discussion in which a child expressed inadequacy and discomfort over taking medication for a mental health diagnosis. The child had appropriately picked up on a seemingly more stigmatized overview of mental health. The adult responded with something to the effect of:
    There is no more shame in treating a mental health condition than for a person who has diabetes and needs insulin to help the body function.
    It struck me as a clever and unique perspective that is hard to argue. It allows the view of the situation to shift from using the medication as a tool instead of weakness.

    Reply

    • Vanessa U.
      Oct 05, 2022 @ 21:42:36

      [Behavioral Activation] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML). Answer the following: (1) Based upon what you know about this client so far (e.g., information from his assessment and this video vignette), what patterns of behavior do you think warrant follow-up in the next session while reviewing his WAML? (2) How would monitoring this client’s accomplishment and pleasure be helpful for his treatment?

      The patterns of behavior that warrant follow-up while reviewing WAML with this client are not unlike those of most others. This client expressed a slightly apprehensive attitude and pointed to a few areas of the assignment that could be burdensome. As a result, maintaining the flow of follow-up & follow-through on the assignment is crucial in setting the tone and expectations early on. At other times, a notable shift in the client’s tone would occur, and he showed increased engagement and interest in the future benefits. For that reason, a review of the assignment allows the client the opportunity to see tangible results of accomplishment.

      Reply

    • Teresia Maina
      Oct 08, 2022 @ 19:57:25

      Hi Vanessa,

      I enjoyed reading your post! You bring up a great point that receiving a mental health diagnosis and seeking treatment is no different from receiving treatment for other health problems like diabetes or cancer. There is a huge stigma surrounding mental health, and some clients may be scared of seeking treatment and feel hopeless due to their diagnosis. Using this strategy can be helpful in normalizing mental health diagnosis/treatment. Great post!

      Reply

  8. Sarah Kendrick
    Oct 05, 2022 @ 22:49:31

    For psychoeducation of specific disorders, “normalizing” each individuals’ experience without alienating them or coming off as lacking empathy occurs in a few ways. By providing information about a specific diagnosis, this can sometimes be just enough for individuals to justify continuing therapy as this provides a label and ensures that treatment can be facilitated (similar to medical problems, individuals may have more hope when there is a specific treatment for a diagnosis rather than when there is no discernable diagnosis or plan for treatment). While there can be no promises made towards fully “curing” an individual, informing individuals of previous clients with a similar diagnosis and related problems have been treated and that they experienced positive outcomes. Experiences can specifically be normalized through discussion of common symptoms (the general and most common symptoms experienced by individuals with similar diagnosis), incidence/prevalence rates (how common the diagnosis is), and possible etiological factors (possible causes of their symptoms). Together, this information reassures individuals that they are not alone and that their symptoms or diagnosis is not something inherently wrong with them and only them. It is still important not to minimize their unique experiences as while most people can empathize feeling anxious, not everyone can empathize experiencing a full panic attack; not everything about their situation is predictable and they may respond or react differently than other individuals to treatment. One thing that was especially evident in the video was the validation of the individual’s experience. This seemed to provide relief and assurance that they weren’t “crazy,” as well as again, hopefully validated that they aren’t alone as they identified experiencing common symptoms of fairly common diagnoses.

    Behavioral activation is effective at reducing client distress as it generally strives to push individuals to do the opposite of their maladaptive patterns. Individuals in distress will often engage in negative reinforcing behavior patterns such as isolating socially, decreasing in their daily living skills (perhaps eating less or eating more “junk,” neglecting to shower or brush teeth or hair, not doing laundry, etc.), and generally not following through with certain tasks as they identify not feeling like they have the energy to do so. Behavioral activation works to increase the positive reinforcing behavior patterns, such as increasing social interactions (spending time with friends and family), daily living skills (maybe pushes individuals to shower at least three times a week, to eat one healthy meal a week, etc. to help reestablish the routine), and to follow through more with tasks (exercising, going to the store, finishing a project, etc.). Individuals this distressed may feel “stuck” as it is difficult for them to start or finish even “simple” daily tasks (such as brushing one’s teeth), which leads to a pattern of feeling unaccomplished, lacking pleasure, and developing low self-efficacy, cycling back to not being able to start or finish tasks as they don’t feel that they are capable of doing so, nor that it matters if it is completed or not. Essentially, behavioral activation works towards getting people to do the things they thought they couldn’t do or lost interest in doing. I think that by holding people accountable in the therapeutic setting, this gives individuals the push they need to get back into learning to be human again. Once individuals start engaging in life again, it makes it harder for them to say they aren’t capable or don’t have the energy to do something when they have proven to themselves that they can in fact do so. Though it is not immediate and takes multiple steps, individuals can work towards becoming more themselves in a manageable and collaborative way.

    Based upon the video, the patterns of behavior that may warrant follow-up in the next session regard the withdrawal behaviors as well as the more general daily tasks. The individual identified wanting to be more present with his girlfriend, such as going out on more dates, walking the dog together, and generally being more active both in his life and the shared experiences with his girlfriend. He did agree with having low energy levels and this may further be something to follow up on. Monitoring the individual’s accomplishment and pleasure may be helpful for his treatment as this may show what activities he enjoys and wishes to do more of (provides a goal) as well as may show that even when he perhaps feels as though he is not accomplishing anything and can’t be productive, this may test his reality and provide evidence that he does indeed accomplish some things, though maybe not all the things he hoped to accomplish. By completing more tasks that he values and enjoys, this will hopefully increase his motivations towards developing more of a routine and finding more enjoyment and pleasure from his day to day life and from things he has missed out on (feeling less stuck and more energized).

    Reply

    • NikkiAnn Ryan
      Oct 07, 2022 @ 08:31:18

      Hi Sarah,

      I liked your description of behavioral activation. I think you made an interesting point that behavioral activation sometimes involves having the client do the opposite of their current maladaptive patterns. Also, I think it is particularly important that you highlighted that individuals may feel as if they “can’t” do certain things but that behavioral activation can help demonstrate that they can in fact do something, such as spending more time out of the house. Through this process, individuals may start to feel like they are more in control of their actions and may feel more autonomous which is an important part of the therapeutic process.

      Reply

    • Patricia Ortiz
      Oct 07, 2022 @ 17:27:17

      Hi Sarah, you are right! I agree that not everything about some clients’ situations is predictable and they may respond or react differently than other individuals to treatment. There are people who are more sensitive than others for instance and, therefore, events that happen to them affect them in a special way, no matter how insignificant they may seem. These people are predisposed to have a more intense response than others to the same adverse event. A lot of things come into play when it comes to how people deal with different situations. So, that is why it is important to validate our client’s emotions and feelings and detect specific needs and adopt different solutions for different cases.

      Reply

    • Kat Gatto
      Oct 08, 2022 @ 17:48:14

      Hi Sarah! Awesome post! I like how you said that normalizing an individual’s struggles, by telling them that people with similar setbacks have felt relief from the approaches provided in cognitive behavioral therapy, can help give them hope. I think examples of success stories can be extremely uplifting too. Self-disclosure is another way a clinician can normalize a client’s experiences as long as it is limited and in the best interest of the client. Psychoeducating a client on the biological fear response involved somewhat when individuals have anxiety is another way that client’s can understand thier illness and why it affects them and so many others the way that it does! Somatic symptoms in anxiety can definitely feel ostracizing, so great point!

      Reply

  9. Tuyen Phung
    Oct 05, 2022 @ 22:51:51

    After watching the video and finishing the reading, I see that there are several ways that therapists can use to normalize each client’s experience without alienating them or showing a lack of empathy. First of all, it is important to avoid denying their symptoms. The clients may feel that the therapists do not know anything about their distress or suffering. In contrast, it is necessary to help them understand their distress. In the video, Dr. V helped the client understand her symptoms of panic attacks without judging them as seriously as the client thought. By showing her various theories that explain the reasons for a panic attack, he helped her understand her symptoms logically without letting exaggerated thoughts dominate her. Therefore, applying different approaches to explain distress for clients can be a useful way. In addition, using the prevalence rate of people who get the same symptoms can lessen anxiety and worries in clients. By talking about the rate, therapists help clients see that their symptoms are not seriously uncommon as they thought. Also, some positive factors can get from the symptoms for some people. In the video, Dr. V provided the fact about a number of people who have anxiety like her. Anxiety can be good for some cases as it stimulates actions in people. However, it can be problematic when it is too frequent. By showing knowledge about the symptoms with explanations in terms of physical and psychological arousal, therapists show their expertise in the symptoms. As a result, clients can have a sense that the therapists understand their symptoms more than they do. They can put trust and follow guidance from the therapist. Finally, psychoeducation about CBT in which clients understand how their thoughts, emotions, and behaviors are interrelated can help clients understand more about their symptoms and where they come from. Dr. V was successful in explaining how the cycle of the client’s patterns of thoughts, emotions, and behaviors are related to her panic attack and anxiety. The client showed her understanding by saying that she has never heard about it.

    Behavioral activation is one of the typical uses in treatment with CBT. It is normally used in the initial phase of therapy. As behavioral activation aims at reducing negative reinforcing behavior patterns while increasing positive reinforcing behavior patterns. In other words, by monitoring the daily activities of clients, therapists help them to understand what activities are the main attributions of their distress, what cause barriers for them to enjoy their lives, and what can become manners to improve their conditions. At times, clients with pathology, especially distress and depression focus more on their negative patterns rather than their positive patterns. Therefore, behavioral activation can help them have a better view of the positive patterns in their daily lives. Moreover, behavioral activation helps clients reduce their avoidance of looking causes of their symptoms and their underestimation of their positive events or activities. Furthermore, behavioral activation helps clients recognize their maladaptive cognitive behavioral patterns which one can influence another. As a result, the clients are motivated to change one pattern, leading to the change of the others. People with distress tend to focus more on their negative activities in their daily lives. With typical types of behavioral activation that are the monitoring of activities and accomplishment and pleasure, therapists help clients evaluate the degree of activities that cause their distress and contribute to their pleasure. As a result, they can manage to change in a positive manner.

    In video MDD-5, it sounds obvious that the client will follow up in the next session is his withdrawal. He may notice more about his sleep routine while mentioning his tight time between waking up and going to work. In the conversation, he was partly aware of his withdrawal as the symptom in which the more he stayed in bed, the less he wanted to wake up. This withdrawal may be one of the reasons for his distress. He may have not recognized his routine before he mentioned his daily schedule. Therefore, the tendency to withdraw can be a focus of the next session. Also, it should be mentioned about positive activities that he wanted to do in order to avoid withdrawal. He may have more time with his girlfriend and for dog waking. When he mentioned this positive activity, he seemed to find it helpful in the past. Therefore, the client may evaluate the level of accomplishment and pleasure in his effort to reduce his withdrawal. This accomplishment and pleasure will be certainly discussed in the next session. Monitoring his accomplishment and pleasure can be helpful for his treatment because he may focus more on pleasure while reducing the negative patterns that contribute to his distress. As a result, he can manage his distress by being motivated to engage in more positive activities such as interacting with his girlfriend and other people rather than his withdrawal.

    Reply

    • Yoana Catano
      Oct 08, 2022 @ 22:10:38

      Hi Tuyen, I agree in the way you explain how the expertise that the therapist shows during the psychoeducation phase helps the client to build the trust, as you said, maybe therapists understand their symptoms more than they do, and this is hard to achieve if empathy is not part of the process. Validating their feelings is key in this process without validating negative thoughts. This client seems to be smart and able to understand the process, but she is also suffering from the symptoms and in need to be validated, her situation is causing psychological distress and normalizing with the help of theory has set the initial step in reducing anxiety and giving hope.
      In the second video, you mentioned how the client had the withdrawal as the reason for his distress, and how the daily schedule helped him to realize what was happening in his routine. The behavioral log seems to be a really good tool to bring self-awareness of what is maintaining the negative cycle but also how positive activities (behaviors) is opposite and more rewarding.

      Reply

  10. Yoana Catano
    Oct 06, 2022 @ 11:27:52

    Clients come to our practice in need of help with some psychological distress, even when our role is to work collaboratively with them; in some degree, they expect to hear from the professional the explanation about what is happening. The principle of instauration of hope, fits with psychoeducation, because it gives the client the possibility to understand that their problem has been studied before and has a solution. In the video, this was stated verbally by the client, who expressed relief after understanding that it could be fixable, but also with the possibility to understand that her feelings were normal according to her anxiety. Validating her emotions and not the thoughts was the key in the psychoeducation to demonstrate empathy. It is not easy to hear that “your thoughts are not real”, especially when they feel very real in the moment, but she was always validated in her emotions when the sensation was compared to a heart attack, and the need to visit the ER, situation that anyone could ended up doing in her situation. Normalize through psychoeducation implies giving her the explanation of what anxiety is, and how this represents an evolutional protective role, but also clarifying that there are individual elements in the way is processed that maintain and worsen the condition, that could be modified.
    The effectiveness of behavioral activation is based in the cognitive triad, starting with thoughts, emotions, or behavior, will start the change in the pattern that maintains the psychological distress in the individual. Most of the individuals that come to therapy have low energy, usually it is related to their frustration in trying to fix the problem without getting any results, in this case, it is hard for them to initiate or activate themselves in daily activities. With behavioral activation, they can start thinking and feeling differently, and they will engage in collaborative work. The reinforcement that comes with accomplishment will direct the clients in the right direction towards the change in basic needs, self-efficacy and social engagement. Behavioral activation provides a sense of short-term relief and it’s less invasive, considering this a good initial step to break the vicious cycle.
    During the video, it was discussed how hard the mornings were for the client, it is important to follow up what reinforces this pattern with the activity monitoring, what things he gets done during that period and what could potentially be replaced with more functional activities. Also, it is important to review if basic needs are being met, to design a specific treatment plan that targets those areas first. On daily basis, it is necessary to know what activities are pleasurable for the client, that he could use as reinforcement for the less pleasurable but necessary behaviors.
    On the other hand, work is a target for his depression, a low self-efficacy is related to the lack of achievements at work, with the behavioral log, the client could be ignoring behaviors that contradicts those thoughts, then it would be a good way to start challenging those thoughts that diminish his self-efficacy. It means, some of those achievements can be highlighted, so the self-efficacy perception can also increase.

    Reply

    • Tayler Shea
      Oct 08, 2022 @ 21:12:07

      Hi Yoana,

      I really like how you noted that when clients come to see us, they are looking to hear our professional opinions on their conditions. I also like how you explained the connection between psychoeducation and hope. I feel like I didn’t think of it that way, but it is so true! I agree it can be hard to not offend our clients when telling them how their thinking patterns are maladaptive or untrue. I like your thought about behavioral activation being the fist step of symptomatic relief for clients. Great post!

      Reply

  11. Sam Keller
    Oct 06, 2022 @ 13:01:17

    [Psychoeducation] – PDA-4: One way you can normalize some disorders is by showing how aspects of their disorder are tied to adaptive functioning. Anxiety is a good example because panic and avoidance are protective measures and can be part of adaptive functioning. Being able to explain the biology of what is happening with different processes can also be helpful because it allows clients to understand what is going on in their body that might be involved in their disorders. In other cases you can relate their other symptoms to other people you may have treated in the past with a similar disorder. Emphasizing that they are not alone in their experience while also respecting some of the unique factors of their symptoms can strike a good balance between normalizing and avoiding alienation. Explain symptoms in a matter of fact way without judgment, which can increase their comfort level when discussing other symptoms in the future. Pyschoeducate using specific aspects of their experience when you can in order to personalize the information more to them. Ask clients what specific examples they can think of after explaining symptomatology in more general terms in order to get more information from the client about their experience.

    [Behavioral Activation] – Behavioral activation can give the clients a sense of increased control over their lives. Oftentimes with mental illness their symptoms can take over large portions of their lives. They will often not feel in control. Giving an increased sense of control can increase their sense of confidence which they can build on moving forward. In the case of depression and anxiety often their response to distress can be to do nothing, either in the form of giving up or avoidance. Even if they go do an activity and they don’t feel better right away, getting up and trying something is still a huge step and is better than nothing. Behavioral activation can help a person identify pleasurable activities and increase them moving forward in order to boost mood. It can also help the therapist and the client identify activities that are difficult for the client. They can then work to troubleshoot and problem solve to make those activities easier. It can help avoid rumination because when you are doing activities it is more difficult to obsessively think. It can help a person maintain basic things like hygiene and keeping a clean environment which can improve mood. If the activity is some kind of physical exercise it can help by improving mood, giving a sense of accomplishment, and increasing physical health. It can also improve their social connectivity if they are doing activities with others.

    [Behavioral Activation] – MDD-5: (1) I would check in on self-efficacy connected activities such as work and other projects. I would also be looking at his social activities and social connectedness. It seems like those are two of the biggest areas of distress for him. Because work is a big area for him I would be looking for patterns within that area in order to troubleshoot more in detail. I would look at what during his work day is causing him distress. He didn’t sound super certain about eating every day so I would at least briefly check on that. I would also look for patterns of activities that cause some anxiety and avoidance.
    (2) I would be looking for increasing accomplishment with this client in order to build his confidence. He seems like he has anxiety around things going wrong or predicting that things will go poorly based on previous videos. I would want to tell him all of the times that things had gone right and use that as a basis to boost his expectations in a positive direction. When he was having periods of depression and self-doubt about his ability to accomplish things I would want to be able to highlight his past accomplishments in order to do some reality testing.

    Reply

    • Tuyen Phung
      Oct 06, 2022 @ 22:41:39

      Hi Sam,
      Your post is very informative and clear. It is interesting that you mentioned a sense of self-control when clients do behavioral activation. I also think that when clients do not pay attention to their daily routine, they tend to think that their symptoms come as a destiny for them and find it hard to get rid of them. Once they have a clearer view of their daily activities with the suggestions from their therapists, they can evaluate which one is negative and contributes to their symptoms and which one can help them improve their symptoms. Regarding the intention to do the behavioral activation, some clients may see them as bored. I think motivational interviews should be used. Your observation about the case of video MDD is great when you focus on broad issues such as social connectedness and self-efficacy. I also think that he needs to have a more stable routine for sleeping, eating, and going out first before targeting bigger goals.

      Reply

  12. Rylee L Ferguson
    Oct 06, 2022 @ 13:18:52

    One way to relay information regarding specific disorders with empathy to a client is to not talk about symptoms or diagnosis in the abstract but to relate it specifically to them and their experience. Rather than listing criteria or using jargon you could explain the qualifying symptoms using examples from their life that apply and relate. Making the conversation very personal and using language the client can understand can help them connect to the information during the education process. It can also be helpful to clearly illustrate that while certain experiences might be normal to some extent, they can be problematic if they happen too much or too intensely. This can show the client they are not alone in their experience but also that it is not trivial. Asking the client if they have any questions after the explanation can also show them how much you care that they truly understand and that this is beneficial to them rather than it being a lengthy lecture to show of your own knowledge.
    I think oftentimes people get stuck in routines or habits without even realizing it. They feel distress about their life but do not know where to start or even necessarily what exactly needs to change. The behavioral activation, starting with the monitoring, helps people get a good perspective on how they spend their time. This helps them be able to identify problem areas and get ideas for ways to approach improving their habits. Setting goals and then being able to track progress then helps the client be able to physically see the changes as well as feel better overall. Cutting down on bad habits and replacing them with ones that promote better well-being creates good behaviors that then can influence better thoughts and emotions. The client may have a renewed sense of their capabilities and think they have accomplished what they set out to do. They also may feel more fulfilled and empowered as they have regained a sense of control over their life.
    I think looking specifically at the times he spent withdrawing or avoiding social interaction warrant further follow up and exploration in later sessions. For instance it might be helpful to look at what events preceded his withdrawal as they may have contributed to his feelings of wanting to isolate. Looking at his ratings of pleasures and feelings of accomplishment during these periods would also shed some light on how enjoyable and effective this tactic actually is in minimizing his stress. If they prove to be minimally pleasurable and give him little sense of accomplishment that can be all the more motivating for him to work to avoid this type of behavior in the future. How often these periods crop up can also put the problem into perspective as how debilitating and prevalent it is in his life. In contrast it would also be useful to look at any social interactions that he does list in his log. Seeing if they were pleasurable and felt like an accomplishment could also work to motivate him to branch out and engage in more of these types of activities.
    Other than by providing motivation, monitoring accomplishment and pleasure is also helpful in seeing the utility in certain behaviors. Just because something is boring or taxing does not mean the activity is not worth doing. For example, with this client, doing some of his household chores seems to be exceptionally difficult due to his depressive symptoms. However, while he might not find the chores fun at the moment, he may notice that he feels better after getting them done. These feelings of being productive and achieving a goal can come to outweigh the immediate negative feelings first associated with the task. Noticing these situations in the activity log can help illustrate to the client the give and take of some behaviors.

    Reply

    • Rachel Marsh
      Oct 08, 2022 @ 21:48:07

      Hey Rylee,

      I enjoyed reading your post! I especially like some of the points you brought up regarding behavioral activation. Firstly, you make a great point when you talk about how most times we develop unhealthy habits/routines unintentionally and initiating change in these habits to healthier ones can feel overwhelming at times. By having a comprehensive assessment of time spent doing certain activities as well as satisfaction and pleasure derived from those activities can help clients visualize the activities they enjoy and gain satisfaction from. Thus, they are more likely to engage in those activities to continue experiencing those emotions.
      Moreover, I like how you discussed the benefit of demonstrating the functions of certain behaviors to clients. You make a great example by highlighting an individual living with depression who has difficulty engaging in household chores. Though most people wouldn’t perceive these activities as enjoyable, the satisfaction gained from these activities can still provide a sense of achievement.
      Overall, great post!

      Reply

  13. Rachel Marsh
    Oct 06, 2022 @ 13:24:13

    Psychoeducation-PDA-4

    For psychoeducation, some ways a counselor might normalize a client’s experience while remaining empathic and maintaining therapeutic alliance include validation, reassurance, and making the client feel less alone. Firstly, making the client feel less alone can help them normalize their experience. This can be done by providing the client with a sense of universality by letting the client know that others experience the same thing they do. For example, at the beginning of the video with Lindsey, Dr. V educates her on some of the functions of anxiety to show how it is a shared emotion among all people and that it is a typical human experience. Moreover, he discusses how some individuals experience disproportionate levels of anxiety, such as in Lindsey’s case. Another way a counselor might achieve this is by highlighting the experience of similar clients. For example, Lindsey exhibits some hesitancy and anxiety regarding the methods that Dr. V highlights to help her, such as going to the grocery store or restaurants. Dr. V responds to her anxiety by indicating that most clients have this reaction but that he will be there to support her through each task.
    Additionally, validating the client’s experience by using statements such as “it makes sense you would think/feel that way” can help the client feel as though others can see where they are coming from in their thoughts and emotions. This way, the individual will feel supported. For example, in the video, Lindsey describes her thoughts and emotions associated with her panic disorder and agoraphobia symptoms. Dr. V validates her by letting her know that her experiences are understandable. If a counselor were to tell a client that everyone experiences anxiety, but fails to validate the client, the client might feel as though their experience is invalid or not acceptable.
    Finally, reassuring the client that you will work through their situation together can help demonstrate empathy. For example, through the video we see how Dr. V works through the cognitive model with Lindsey using examples of her own thinking patterns. He then emphasizes the importance of collaboration in the process of helping Lindsey change her maladaptive thinking and behavior patterns.

    Behavioral Activation

    In the readings, one reason that stood out to me that behavioral activation is effective is because of the emphasis on providing opportunities for positive reinforcement and minimizing negatively reinforcing behaviors (I.e., avoidance, withdrawal. For example, research highlights a lack of positively reinforcing environment as a possible etiology for depression (Volungis, 2019). Individuals with depression typically experience anhedonia, or loss of pleasure in previously enjoyed activities.
    In terms of positive reinforcement, this may stem from behaviors that were previously associated with positive reinforcement but have lost this association. Thus, the client becomes less inclined to acquire positive reinforcement through their environment, resulting in loss of motivation and low energy levels. This inhibits the individual’s ability to engage in daily activities and gain a sense of satisfaction from completing such activities. Overall, behavioral activation aims to increase opportunities for positive reinforcement by cultivating a sense of pleasure and accomplishment from the client’s daily activities.

    Behavioral Activation-MDD-5

    Question 1

    After watching the session with Mark, some behavioral patterns that I would want to follow-up on in a subsequent session are his withdrawal, sleeping patterns, and cognitive/emotional patterns when completing activities. In the session, Mark mentions several times that he has withdrawn from previous activities, especially ones that are social. If this were to continue, this would likely impact his social network and level of social support.
    Mark also mentions that he experiences difficulty trying to get up in the morning. He discusses how he enjoys taking time to engage in self-care in the morning, but at the same time lacks the motivation to get up. Mark also has a 9-5 job and has progressively been waking up later to the point where he feels rushed. If this continues, he is likely to be late for work which may impact his employment status.
    Finally, I would want to follow-up on Mark’s cognitive and emotional patterns that he has when going about his daily activities. For example, I might go more in depth about some of the automatic thoughts he has when completing his activities that may be impacting his motivation and sense of satisfaction from those activities.

    Question 2

    Monitoring Mark’s sense of accomplishment and pleasure would benefit him in several ways. Firstly, this might provide insight into which activities specifically increase Mark’s positive emotions and energy levels.
    Additionally, this could help determine Mark’s level of self-efficacy and identify activities to increase his sense of purpose and self-efficacy. Mark seems to struggle with anhedonia and has decreased his participation in his previously enjoyed activities. In line with behavioral activation theory, activities that the client can gain a sense of pleasure from provide positive reinforcement, thus increasing the frequency of participating in those behaviors.

    References

    Volungis, A. M. (2018). Cognitive-behavioral therapy: Theory into practice. Rowman &
    Littlefield.

    Reply

    • Sarah Kendrick
      Oct 09, 2022 @ 22:03:49

      Hi Rachel! I like that you really identified how normalizing individuals’ experiences includes essentially normalizing the “abnormal”: that while anxiety is a normal human experience, the amount of anxiety some people feel is more intense and “abnormal,” though many people do experience this intensity (normalizing but also validating the individual that they are not alone). I also appreciate how you acknowledged that you would follow up with mark’s sleeping patterns and his feeling rushed due to waking up later and later for work. I did not identify this but this is definitely an important behavior to work on that would hopefully make Mark feel more motivated and stay efficient in how he plans his work days.

      Reply

  14. Tayler Shea
    Oct 06, 2022 @ 14:08:22

    Psychoeducation is the process of educating a client about a topic regarding their presenting concerns. The therapist may begin by defining the symptoms and etiology of a specific disorder. They may explain what CBT is and the interactions between thoughts, feelings, and behaviors. In my opinion, the first step to not offending your client is building a relationship with the client where they feel that they can trust you. You want your client to trust your professional opinion and the information that you are giving them. Additionally, having a foundation built upon trust will help your client feel less judged within the session. It can be easy for a therapist to sound scripted, nervous, or non-engaged during psychoeducation. It’s very important to practice psychoeducation skills, to prevent those feelings.

    It is also important when working with a client that you are not talking to the client as if you are smarter than them. In the video, I liked how Dr. V was explaining panic to his client, but not talking to her like she is a child. You want to keep your terminology and the amount of information that you are using understandable and simple. Beginning the conversation by explaining the relationship between thoughts, behaviors, and emotions helps. Many clients will be visual learners. As Dr. V demonstrated in the video, creating charts or diagrams can help clients understand and more easily digest information. Finally, If your client begins feeling frustrated with your diagnosis or begins to not understand what you are explaining then it is important to destigmatize, empathize, and revert back to building rapport. Reminding the client that a diagnosis does not define them is helpful in a situation like this. Sometimes, taking a break from education can help the client return to a state of mind where they feel comfortable again.

    The goal of behavioral activation is to reduce the number of negative behaviors that the client is engaging in and increase the number of positive experiences within their daily routine. Behavioral activation typically consists of the client taking part in activities that they stopped doing when they became distressed. This intervention may begin with a task as small as getting out of bed and getting dressed for the day. Behavioral activation is often the first intervention used in CBT and is so successful because it makes sense that when clients are engaging in more positive behaviors, they will ultimately feel better and then think better thoughts. Behavioral activation is naturally reinforced by its positive outcomes and can also build the client’s confidence. The client will begin to experience fewer maladaptive thoughts and begin engaging more in the adaptive behaviors that the client and therapist have identified together. It makes sense that when a client engages in positive behaviors, they will feel good which will then cause them to think more positively.

    I think that we should follow up on the client’s negative automatic thoughts. These thoughts continue to the client’s depression, and it is important that we follow up to determine if those thoughts are getting better or not. I think that it is also important to follow up on his behaviors. We should ensure that he is getting his chores done, going to work, and spending time with his girlfriend. These are behaviors that can improve his thought patterns if he is regularly engaged. The client seems to be lacking self-efficacy at work, it would be important to follow up with the client regarding that thought pattern.

    I think that monitoring our client’s success would increase the client’s self-efficacy as they begin to witness themselves making progress. Monitoring will also help the therapist assess the effectiveness of the treatment and if they need to change their intervention. As the client and therapist begin noting what makes the client feel good and what they do not enjoy, they will know what they should work on maintaining. If they discover certain activities help the client feel better, they will know that they need to maintain that activity and behavior. Finally, monitoring progress will empower the client to continue their positive behaviors, making them more likely to continue.

    Reply

    • NikkiAnn Ryan
      Oct 07, 2022 @ 08:43:03

      Hi Tayler,

      I think you did a great job discussing the importance of monitoring the client’s accomplishments and how it can be beneficial to his therapeutic progress. I thought you made a great connection to self-efficacy and how the client’s self-efficacy may increase as they acknowledge their progress. I also like that you discussed how monitoring the client’s pleasure and accomplishment can assist with improving treatment interventions. By doing the weekly activity monitoring log and recording their level of pleasure and accomplishment, clients may realize things that they thought were important that are not actually that important to them or they may realize that something that is important to them but that is not producing as much pleasure or accomplishment as they would like should become a key area to work on.

      Reply

    • Amanda L Bara
      Oct 07, 2022 @ 13:07:30

      Hi Tayler! I like how you highlighted the point of building rapport with the client. It really is so important to establish and maintain that trust with someone in order to give good psycho-education. Without building that relationship as a foundation, the education could be questioned and may not produce the desired effect on a client. I agree that it is important to follow up on the client’s negative automatic thoughts. Focusing on these thoughts will help to understand and work on behavioral activation. Great post!

      Reply

    • Yoana Catano
      Oct 08, 2022 @ 22:28:10

      Hi Tyler,
      You brought an important point discussing what happens when a client think we are smarter and tense the relationship. I agree that building rapport is not something that only happens at the beginning, it is part of the whole process and it means that we need to go back and forth to make sure the client understands that this is a collaborative process and we are there to help. Better outcomes are related to a good therapeutic relationship. Psychoeducation gives us that role of having the knowledge on something, but being aware that we want to stablish and maintain a collaborative relationship, would be the best way to keep empathy during the process.
      In the second video, I agree with you in the need to work on the client’s self-efficacy at work. I think he could be doing more than what he sees, and this is part of the cognitive distortion. Those negative thoughts might be lacking of evidence if he does not perceive or acknowledge his accomplishments.

      Reply

  15. Kat Gatto
    Oct 06, 2022 @ 14:52:46

    [Behavioral Activation] – (1) 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.

    For a lot of clients, avoidant tendencies (i.e., emotion-focused coping mechanisms) perpetuate their level of anxiety or depression. Someone who is depressed might believe that they are terrible at maintaining their household chores; thus, their lack of self-efficacy leads to them ignoring the prospect altogether. Once the client begins to behaviorally activate, and do the things they were avoiding, their self-efficacy can increase. The concrete proof that is provided from competently completing a behavior, that they previously thought they were unable to achieve, is priceless.

    [Behavioral Activation] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML). Answer the following: (1) Based upon what you know about this client so far?

    I would definitely start to work more on the client’s low self-efficacy at work, if possible. Specifically, he mentions feeling rushed in the morning because he is finding it difficult to get out of bed. I might want to work on his ability to prepare a quick breakfast in advanced the night beforehand. This way, in the morning, he is not just “trying to bring something,” he has something ready and available. If it is something he particularly enjoys, then it might add additional incentive to get out of bed. The dishes are piling up, so he may also want to look into making a dishwashing plan so that he can feel the relief of having clean dishes more often. This way, it is not an additional weight on his shoulders and it will also be easier to meal prep. Whatever homework the client feels is doable and not overwhelming. Perhaps instead of getting out of bed at 8:00 am, he can try 7:30 am at first. It is not where he was at 6:30 am, but it is a start toward getting there. Chances are that his flustered feelings contribute at least partly to his belief that he cannot adequately do his job.

    (2) How would monitoring this client’s accomplishment and pleasure be helpful for his treatment?

    Monitoring the level of pleasure and accomplishment would be extremely helpful for this client. If he is more aware of what activities he finds pleasurable, or obligations he finds not pleasurable, then he can better structure his day in a way that may lift his mood. For example, if he finds work and washing the dishes to be a 4 for pleasure; then, perhaps after work he should try to add an extra activity that he finds more enjoyable before tackling the more daunting task. This way, he may not feel so drained. In addition, given that anhedonia is somewhat present, it would be beneficial for his depressive symptoms if he adds activities, where he feels more elevated, to his schedule.

    Reply

    • Amanda L Bara
      Oct 07, 2022 @ 13:04:05

      Hi Kat! I really enjoyed your discussion post. I like how you focused on self-efficacy and how you highlighted the avoidant tendencies in regards to anxiety/depression. It really is important to increase one’s self-efficacy as it helps to motivate them into accomplishing their goals. I like your idea of the meal prepping as that is something I would not have considered when thinking about this situation. Nice job!

      Reply

  16. Kat Gatto
    Oct 06, 2022 @ 14:59:45

    Watch PDA-4: Psychoeducation – Diagnosis. Answer the following: (1) For psychoeducation of specific disorders, what are some ways you can “normalize” each clients’ experience without alienating them or coming off as lacking empathy?

    There are many ways that a clinician can start normalizing the clients’ experiences in an empathetic fashion. When it comes to psychoeducation, it is crucial not to be too technical in ways that a client will find off-putting. If the client is to feel understood, then the clinician must word things in a way that they can understand. In addition, using examples or self-disclosure can be helpful. Self-disclosure should be used in moderation and only when it benefits the client. Obviously, if it is relevant and brief. Another way to normalize in a non-alienating and empathetic fashion is by validating the client’s emotions. As a clinician, it means a lot when a client hears that their emotions to certain experiences are not so uncommon (i.e., they are not alone).

    Reply

  17. Kristin Blair
    Oct 07, 2022 @ 17:47:34

    A great way to normalize a client’s experience when diagnosing specific disorders is to connect with “normal” human behavior and how it can overlap and/or mimic other feelings that perhaps many other people experience. For example, I liked how in PDA 4, Dr. V starts by saying, “Anxiety…it’s not that bad. Believe it or not, anxiety is a normal experience that all of us have.” This can be a useful tool to make an individual feel seen and validated. It’s also beneficial to use visual aids like Dr. V’s use in the video. This can allow the client to understand the topics and ideas in a more straightforward way. I believe that the more the client understands their diagnosis, the more eager they will be for treatment. But, overall, the more you can relate their diagnosis to the “normal human experience,” the less alienated the client would feel.

    Behavioral activation is centered on an individual’s values, thoughts, and beliefs, and I think that alone makes it appealing to most. It looks pretty personalized to each person who utilizes the tool. That being said, when a person begins to track their behaviors and visually see how they are impacting their emotions, it makes it MUCH clearer than if you were trying to identify these shifts as they are happening. It also makes it much easier to spot problematic patterns in certain behaviors that always elicit the same negative thoughts or emotions. This gives the individual more control over what specific things they should minimize or replace altogether. A big reason people can get so frustrated and overwhelmed with how they feel is the lack of control. So engaging in a tool that can foster more control and awareness of one’s own life and actions should more often than not be helpful!

    3. With this client, I think that following up with some of his withdrawal tendencies would be a great place to start. As well as checking in with some activities that he vocalized that he would like to be better at, like being more present with his girlfriend, etc. It would also be beneficial to follow up on his self-efficacy with his job. He seems to be good at his job, but he voiced that he had not been feeling as confident due to how he has been feeling.

    Monitoring the client’s accomplishments and pleasure would be helpful in his treatment because it will be helpful in terms of identifying which behaviors to prioritize and/or minimize. If things are rated as more highly enjoyable than others, we could help the client by making those more enjoyable and accomplished feeling tasks more supported to facilitate a better mood. It will also be helpful to evaluate necessary tasks like dishes, cleaning, and walking the dog and devise interventions to succeed with these tasks, even though they aren’t the most pleasurable activities.

    Reply

    • Sarah Kendrick
      Oct 09, 2022 @ 21:54:46

      Hi Kristin! I like how you identified that behavioral activation can visually aid individuals towards seeing how their behaviors impact their emotions. We can think about how things affect us and often miss a lot of things, so having that on paper may definitely bring to light certain things! I also liked your acknowledgement of control and how it is fostered through behavioral activation, it’s definitely easier to become more engaged when you feel that you are in more control than your environment or thoughts/emotions.

      Reply

  18. Kristin Blair
    Oct 07, 2022 @ 18:08:07

    Hi Tuyen,

    Yes! I love that you mentioned how important it is not to be dismissive or deny a client’s feelings. I think that is so important in any interactions we have throughout life, but more so in a professional therapeutic relationship.
    I also liked how you discussed the importance of showing expertise by verbalizing knowledge and then explaining and delivering that knowledge to the client and checking for their understanding. Showing this level of expertise can also help strengthen rapport!
    Great post!

    Reply

  19. Teresia Maina
    Oct 07, 2022 @ 22:35:59

    [Psychoeducation] – Watch PDA-4: Psychoeducation – Diagnosis. Answer the following: (1) For psychoeducation of specific disorders, what are some ways you can “normalize” each clients’ experience without alienating them or coming off as lacking empathy?

    To “normalize” the client’s experience when providing psychoeducation about a specific disorder, it’s important to balance honesty and empathy. In the video, Dr. V made it a point to inform the client that anxiety is not a bad thing normalizing the disorder but also went on to list the benefits of anxiety-like protecting us from danger. Another strategy clinicians could use is disclosure letting the client know that other people experience the same thing as them, letting them know that they are not alone. Clinicians can also use the client’s symptoms to personalize their experience when educating them about their disorder.

    [Behavioral Activation] – (1) 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.

    In CBT, we use behavior activation to reduce negative behavior patterns and increase positive behavior patterns. It helps clients break negative cycles, which can lead to more positive emotions and thoughts and act as a motivator. Behavior activation pushes clients to partake in activities they have lost interest in. Using activity monitoring or scheduling tools can help the client and therapist see what areas they need support. The visualization of the activity sheet can also help the client see where they need to make changes, even if it’s something they already know. For example, when we did the activity sheet, I realized I needed to sleep more, even though this was something I already knew. Seeing it on paper made me realize there were things in my schedule I could change in order to get more sleep.

    [Behavioral Activation] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML). Answer the following: (1) Based upon what you know about this client so far (e.g., information from his assessment and this video vignette), what patterns of behavior do you think warrant follow-up in the next session while reviewing his WAML? (2) How would monitoring this client’s accomplishments and pleasure be helpful for his treatment?

    After reviewing Mark’s WAML, a behavior pattern that warrants follow-up is his withdrawal. Focusing on why Mark tends to withdraw from situations could help lessen his distress while also motivating him to participate in more social interactions with his girlfriend and friends. His morning routine is something else that would warrant a follow-up.
    Monitoring the client’s accomplishments and pleasure can be helpful in treatment because you could create goals based on what the client puts down but also could as act as positive reinforcement. For example, if the client does a task and while they do not receive any pleasure from it, in the end, they feel as if they accomplished something. This could be used as a motivator to show the client that even tasks that are not pleasurable can have a positive outcome.

    Reply

    • Rachel Marsh
      Oct 08, 2022 @ 21:38:50

      Hey Teresia,

      I loved reading your post! Firstly, I appreciated some of the points you highlighted regarding the ways in which a counselor might be able to normalize a client’s experience while remaining empathic. It is essential to help clients feel validated in their experiences but also give them a sense that they are not alone in the things they experience. Using examples of the client’s own experiences and educating them on some of the functions of their symptoms, such as anxiety with Lindsey in the video, can be beneficial for the client in this way.
      Additionally, I like the points you made about behavioral activation. Specifically, I like how you discussed the importance of visualization and shared an example from your own experience with your sleep schedule. You make a great point when you say that we might know we need to make a change in a certain area, but representing this visually can help give a clearer idea of
      the areas of your life you can grow in.
      When filling out the activity sheet, I also had a similar experience. I have an extremely busy schedule between working over 40 hours a week most weeks and doing school without much time for friends, family, or even my self sometimes. I knew I was busy and should take more time to rest before this activity. But seeing it on paper gave me some ideas of how I might be able to optimize my schedule to achieve this without sacrificing my work or school time.
      Overall, I enjoyed reading your post! You made some insightful points!

      Reply

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Adam M. Volungis, PhD, LMHC

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