Topic 4: Psychoeducation & Behavioral Activation {by 2/13}

There were three readings due last week (Beck – 1 chapter; Volungis – 2 chapters).  For this discussion, share at least two main thoughts: (1) Why is psychoeducation considered a vital component to effective CBT (please go beyond saying it “educates” clients!)?  (2) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT.  Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress.  Your original post should be posted by the beginning of class 2/13.  Have your two replies posted no later than 2/15.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

37 Comments (+add yours?)

  1. Taylor O'Rourke
    Feb 08, 2020 @ 17:45:09

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

    One of the most important aspects of CBT is that it teaches skills to clients so they can become their own therapists and learn the coping to deal with distress on their own. Psychoeducation not only shows the client that their therapist is an expert and is trustworthy to work with, but it also allows therapists to teach their clients new skills so they are able to participate as much as they should in therapy to get the most effective results both outside and inside of sessions. It can initially be off putting for beginning therapists to use psychoeducation because as mentioned previously, the client then assumes they are the expert. This places a lot of weight on the therapist’s shoulders to make sure they are teaching the right things to clients. Once the client does feel that expertness from their therapist, it helps develop a strong therapeutic relationship which as we know, leads to more positive therapeutic outcomes. Like building a therapeutic relationship, psychoeducation is not something that is used just at the beginning of treatment; it is used throughout. In the beginning of therapy, the therapist uses this technique to teach the client about how therapy will work and what expectations they should have for treatment. The therapist should also take this time to educate their client on their diagnosis and any symptoms they may be experiencing. However, while therapist is progressing, therapists should continue using psychoeducation to teach clients new skills that will eventually help them in the real world with things such as social skills. Not only is all of this information used for educating skills, but also helps enhance the client’s motivation and optimism about therapy. Clients will learn that there are others who have these same symptoms and experiences when learning about their disorder from their therapist, which provides universality. Using psychoeducation also provides the sessions with more structure so clients know what to expect and may have any worries or anxieties reduced about what CBT treatment entails. When clients are well aware of what their treatment will consist of, they are more likely to be compliant and be open to collaboration.

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

    There are many reasons why behavioral activation is effective at reducing client distress. In general, the goal of this technique is to minimize behaviors that provide negative reinforcement for a client. They also seek to maximize behaviors that are considered positive reinforcement. Typically, clients who are very distressed have minimal energy and lots of negative automatic thoughts. By attempting to eliminate those characteristics and actions, the client will no longer feel “stuck” and will begin to break their negative behaviors (and later thoughts) and replace them with ones that do not lead to distress. Behavioral activation is made up of activity monitoring and scheduling and graded task assignments. By using activity monitoring and scheduling, a client’s motivation to change can increase dramatically. When clients monitor their activities, they can be reminded of how much or how little they are doing in a week between sessions, so this can increase their motivation to do more next week. They can also gain a sense of accomplishment when noticing what they are doing over a week’s time. This can also provide short-term relief. When clients are working towards scheduling their own activities for the coming week, therapists should use the purposeful passive approach to let them know they should give whatever it is they want a shot. This will encourage clients that may be skeptical about the process. The therapist’s feedback is probably the most important aspect of these techniques. When clients are gaining positive feedback from their trusted therapist, they will feel a sense of success and overall achievement towards meeting their goals. Therapists should always give the client credit when it’s due because this will diminish their distress and increase autonomy, self-efficacy, and hope in the process of getting better. Graded task assignments are also helpful in reducing client distress because they break down bigger, overwhelming tasks so clients can take one step at a time in accomplishing the larger goal. This also seems to be less of a commitment than a schedule for clients. Even when clients do not complete every single task towards their big goal, therapists are still able to reinforce all of the steps they have taken thus far and reflect with the client on their thoughts and feelings. Praising any efforts the client has made is important is minimizing their distress and instilling hope for the future and actually achieving the goal.

    Reply

    • Robert Salvucci
      Feb 12, 2020 @ 13:29:18

      Hey Taylor!

      You did a great job of outlining how psychoeducation moves clients towards becoming autonomous and being their own therapist. It was also insightful to note that we may have hesitation to be perceived as experts, as this places a lot of responsibility on our shoulders. Ultimately, communicating the nature of certain diagnoses and the CBT model can really help clients conceptualize their problems and feel comforted knowing that others have similar obstacles and have made progress.

      Highlighting the sense of clients getting “unstuck” is particularly important, especially with depression. Behavior activation in this sense can provide a sense of direction with support from a therapist. Your summary of the importance of praising all progress and instilling hope was helpful.

      Reply

    • Jenna Nikolopoulos
      Feb 13, 2020 @ 14:29:41

      Hi Taylor! I like how you mention how building the therapeutic relationship and psychoeducation are two things that shouldn’t just be done at the beginning of treatment, but should be done throughout treatment. I also like how you differentiate the kind of psychoeducation that should be done at the start of therapy and how it should change while therapy is progressing. It’s so important that the client understands the basis of therapy and his/her diagnosis and what to expect from it in the beginning as it helps build trust and makes the client feel more comfortable with the clinician. Additionally, like you said, psychoeducation is a great way too boost a clients’ motivation and optimism as learning new skills to change provides them with hope that they will be able to improve and gives them confidence in their abilities to implement these new skills out in the world.

      Reply

    • Renee Gaumond
      Feb 13, 2020 @ 17:00:17

      Hi Taylor,
      I agree when you said that “One of the most important aspects of CBT is that it teaches skills to clients so they can become their own therapists.” The idea of autonomy is essential to CBT. It allows the client to become their own therapist and not need the help of the clinician. CBT has a session, or time, limit in order to create that autonomy within the client. Structure in session is what allows the client to become autonomous by the repetition. Eventually the client will learn the formula and apply it to their problems outside of therapy. Once the client becomes familiar with the structure they can begin the processes of terminating therapy.

      Reply

    • Shelby Piekarczyk
      Feb 13, 2020 @ 18:47:12

      Hi Taylor,

      I really like how you say that using psychoeducation helps to develop the client as their own therapist. This allows the client to learn these specific skills and use them throughout their life, outside of therapy and once therapy has concluded. This is extremely important especially in CBT because we know it is a time limited therapy. By helping the clients develop skillsets independently we can help them to live a positive, adaptive lifestyle. I also like how you say that teaching psychoeducation is used throughout therapy and not just at the beginning. As we have learned in class, therapy is constantly changing and different goals are being addressed. Psychoeducation is a key component in helping your client through these changes throughout therapy. Great job!

      Reply

  2. Monica Teeven
    Feb 09, 2020 @ 16:13:20

    1.CBT considers psychoeducation a vital component for the advancement of therapy. This is because in CBT it is imperative that clients learn new skills while they are participating with the clinician in therapy as a team. In addition, in CBT, it is necessary for the client to be given information related to their diagnosis and they must learn to independently employ the cognitive-behavioral skills which they have been taught successfully. In the beginning of therapy, the psychoeducational process is more systematic because at this time the overall expectations for therapy and knowledge about the clients’ diagnosis and issues are the topics of discussion for the first few sessions. Overtime, as therapy moves forward, many psychoeducational opportunities will present themselves such as teaching a new skill to a client and practicing this new skill with the client. While teaching psychoeducation to the client, the clinician should be actively involved in this process. The clinician should ask questions and obtain feedback from the client about the information that it being presented to them. This enables the clinician to see if their client is comprehending the new material being discussed and gives the clinician an opportunity to learn more things about the client’s current issues. Psychoeducation can also demonstrate to the client that CBT is a collaborative form of therapy between a client and a clinician. This, in turn, can assist in promoting the client to continue to think about change and treatment goals in therapy. If a clinician does not provide an adequate amount of psychoeducation in therapy, it may weaken the clinician’s perceived level of expertness by the client and it can decrease the overall effectiveness and and delay reaching the client’s goals in therapy.

    2.Behavior activation can assist in reducing a client’s level of distress for many reasons. The main reason behavior activation can be helpful is that it can show a client an immediate change will result from their actions. It can also help the client lower their level of distress because this CBT technique focuses on the behavior of the individual and not their thoughts. Many clients entering therapy have distressing negative automatic thoughts which hinders their ability to be motivated or confident changing for the better. Sometimes, by showing clients they are able to improve, even to a small degree rather quickly, will improve their motivation and optimism levels regarding their ability to change. It can also decrease their level of distress, uplift their mood and enable them to see the big picture of the goals they want to reach.
    The two most common behavior activation tasks are: activity monitoring and scheduling, and graded task assignments. Even though both of these interventions are at first behavioral, these interventions also involve cognitive strategies and altering of thoughts naturally. Activity monitoring logs can be especially beneficial for a client because the clients may visually see a pattern of their behaviors from their activity log that they did not see before. The individual and the clinician may then be able to pinpoint when certain triggers or stressors occur during the day or week or what activities distress them in particular. To have this “aha” moment can be a relief for an individual because they are now able to see something in writing that they can change to make themselves better. Another way that this form of behavior activation can be helpful is if the client does not initially believe therapy can help them, an activity log that shows there is a pattern of when the client is distressed may change their mind and show that therapy may actually help them.

    Reply

    • Robert Salvucci
      Feb 14, 2020 @ 20:56:11

      Hey Monica!

      Mentioning the many opportunities for psycho education over time was important, as this can assist clients in learning skills themselves and new concepts can be introduced which build on their understanding. This process can assist them in achieving relevant goals, as you mentioned.

      It was also important to touch upon how even small changes in behavior activation can lead to improved optimism and motivation to change. Clients can see patterns that may be causing or maintaining distress when scheduling activities.

      Reply

  3. Mariah Fraser
    Feb 09, 2020 @ 20:22:08

    1. Psychoeducation helps the therapist to model the collaborative component of CBT as a way to show clients that they’re active participation in the process is vital for success. In the early phase of CBT, psychoeducation helps to introduce expectations for therapy as well as to begin to explain the clients’ diagnosis and related problems they may experience. This helps to encourage an optimistic outlook on the therapeutic process as well as hopefully motivate the client to do their part. Further down the road, psychoeducation plays a different role in therapy, which is to integrate new sets of skills for the client to practice and apply in between therapy sessions.

    2. Behavioral activation helps clients to reduce their negative reinforcing behavior patterns and emphasize their positive reinforcing behavior patterns. People who are in significant distress tend to have a more difficult time completing tasks as a result of low energy and negative automatic thoughts. Their difficulties in initiating and completing these tasks instills a sense of low self-efficacy and ultimately reducing their experiences of feeling accomplished. These occurrences further perpetuate the negative automatic thoughts and negative feelings towards oneself thus resulting in feeling stuck because they feel as though nothing can get done. Behavioral activation aims to target the behaviors of the individual at first, as a way to break the vicious cycle of their maladaptive cognitive-emotional-behavioral patterns. Not only does this help the client work towards treatment goals, but behavioral activation can serve as a way to reinforce the concept of CBT being a collaborative process between the therapist and the client when the client does make progress. Behavioral activation can be utilized through activity monitoring and scheduling, where the client can record every activity they engage in and rate their levels of pleasure and accomplishment, as well as any thoughts or emotions they experienced during these activities. Graded task assignments are an alternative method of implementing behavioral activation. This method breaks down the bigger tasks into smaller, more manageable tasks. This may reduce the client’s distress because it provides more opportunities for accomplishment and pleasure, and it may also give indication to what triggers the distress with a smaller task.

    Reply

    • Renee Gaumond
      Feb 13, 2020 @ 18:31:36

      Hi Mariah,
      I agree with you when you said that people who have significant distress have difficulty completing tasks due to low energy and negative automatic thoughts which then leads to low self-efficacy. The feeling of getting stuck because nothing is getting done is a good thought too. It really shows how automatic thoughts can effect self-efficacy. When clients repeatedly think to themselves that they can’t do something than self-efficacy becomes effected by those thoughts. The clients become accustomed to those automatic thoughts and their understanding of what they can do becomes manipulated.

      Reply

    • Taylor O'Rourke
      Feb 15, 2020 @ 19:33:26

      Hi Mariah,

      I completely agree with how you said that the purpose of psychoeducation takes a certain shift over time. In the beginning of treatment, it is more so used to set up expectations and educate clients on what they should expect from their potential diagnosis and symptoms. However, as therapy progresses, psychoeducation is used to teach the client skills to be able to be more successful on their own. Every therapist’s goal should be to have their client become their own therapist and be able to function adaptively without relying on the therapist. I believe psychoeducation, and how it changes over time, it a large part of this.

      Reply

  4. Renee Gaumond
    Feb 10, 2020 @ 12:47:02

    (1) Why is psychoeducation considered a vital component to effective CBT (please go beyond saying it “educates” clients!)?
    Psychoeducation is an important component to the effectiveness of CBT. There’s two parts of psychoeducation. The first part is the early phase CBT psychoeducation where the therapist explains the general expectations for therapy and information regarding the specifics of the client’s diagnosis. This phase is mostly focused on facts and concepts that are important for the therapeutic process. The second part of psychoeducation is CBT skill psychoeducation. This phase involves teaching clients new skills that will help them become more autonomous. It allows the client to learn skills in order to act as their own therapist. It’s important for clients to establish autonomy where they can act as their own therapist because of the time sensitive nature of CBT. Clients shouldn’t be expected to be in therapy forever, so becoming autonomous as a client is an ultimate goal. It allows the client to be able to solve their own problems without the clinician.

    (2) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT. Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress.
    Behavioral activation is a process in CBT that focuses on decreasing negative reinforcing behaviors such as social isolation and increasing positive reinforcing behaviors such as spending time doing enjoyable activities. I think this is effective at reducing client distress because of the simultaneous decrease in maladaptive behavior and an increase in enjoyable/adaptive behaviors. Often clients will have negative reinforcing behaviors where they attempt to remove the anxiety or stress of a situation by removing themselves from those things that cause it. An example would be, if a client has a panic disorder with agoraphobia, they will engage in social isolation to escape the distress of social situations. This behavior gets reinforced because it removes the distress from the social interaction by escaping the situation. Attempting to decrease those negative reinforcers for the maladaptive behavior patterns will help those patterns become less prevalent through the process of extinction. Also focusing on increasing positive reinforcing behavior patterns is important because these patterns of behavior can be used to replace the negative reinforcing behavior patterns. Through replacing maladaptive behavior patterns that have been negatively reinforced with adaptive behavior patterns will help the client understand that they don’t need to engage in behaviors such as social isolation to remove anxiety or distress.

    Reply

    • Jessica Costello
      Feb 11, 2020 @ 07:22:50

      Hey Renee! I like your explanation of psychoeducation and how you connected it to the broader goal of CBT which is the client being able to solve their own problems without the help of the therapist. I also liked what you said about behavioral activation and the way it can be used to reinforce positive behaviors and break the client’s associations with negative ones. I think the client understanding behavioral activation can go a long way as a method of psychoeducation as he/she progresses through treatment. Great job!

      Reply

  5. Jessica Costello
    Feb 10, 2020 @ 15:53:39

    1. Psychoeducation is a vital component of CBT because it helps clients understand the nature of the problems. Understanding the cognitive model and relationships between thoughts, emotions, and behaviors can reduce clients’ distress by helping them feel less “crazy”, at least by knowing that other people can experience the same kinds of distortions and have gone through something similar. Explaining the factors behind the client’s problems can also help the clinician appear more of an expert, as the client is receiving some kind of an answer.

    Besides helping the client know what is wrong, another important effect of psychoeducation is it provides clients with a framework to resolve the problems. For example, a depressed client who struggles to make plans with friends can learn the behavioral activation process and its consequences and predict that they will probably begin to feel better if they make the effort to make a plan. Psychoeducation helps clients generalize the skills they are building to other situations in the world outside of therapy.

    2. Behavioral activation gives the client a concrete step to take to analyze and monitor the distress they are feeling around a particular situation. It involves setting up an experiment after which they can monitor any changes (hopefully improvements) in their moods and thoughts through a thought record or activity log. Behavioral activation also motives clients to complete a task they have been struggling with, and keeps them accountable because they will have to discuss with the therapist how the activity went. They can target negative automatic thoughts to challenge later on and reduce the distress they are feeling in the moment with relaxation techniques.

    Reply

    • Monica Teeven
      Feb 10, 2020 @ 18:07:01

      Hi Jess! I wanted to add something to your response to question 1. Not only does psychoeducation make the clinician look more like an expert, it can also allow the clinician to ask questions or receive feedback about the new information they are getting. In addition, if a clinician does not provide much psychoeducation, it can also weaken their level of perceived expertness to the client. In your response to question 2, I just wanted to mention how an activity and monitoring log is a behavior activation task that can offer a client to have that “aha” moment. For example, if a client writes down all of their activities throughout the day for 2 weeks, then at the end of the two weeks sees a pattern of when they were distressed, it can provide them with some relief. This is because they visually can see theres an association between the activity or the time of day when the distressing feelings occur. This can be very beneficial to a client who has a hard time believing positive change can occur for them. Great job on your blog post this week Jess!

      Reply

    • Erin Wilbur
      Feb 14, 2020 @ 20:24:40

      Hi Jess,
      I really like your point that psychoeducation makes the client feel less “crazy” because it helps them understand their symptoms. I know at work that when a client is distressed and I’m able to name their symptom and give them some information about it, they’re usually relieved because they have a better grasp on what’s happening when they experience that thought or behavior. I also liked your answer in question 2 that said activity logs keep the client accountable because they’ll have to go over it with their clinician. This really emphasizes the importance of session structure and why we need to make time to go over homework every session! If we don’t, it doesn’t hold the client accountable for completing the homework and then behavioral activation isn’t effective.

      Reply

    • Madison Armstrong
      Feb 15, 2020 @ 18:05:48

      Hi Jess,
      You did a really good job explaining important aspects of psychoeducation. I liked that you emphasized how psychoeducation provides the client with a framework to resolve their problems. With your example you mention how the client may begin to realize they will feel better once they make a plan and I agree that this process will help the client learn to generalize these skills and hopefully enable them to apply this to other relationships in their life.

      Reply

    • Taylor O'Rourke
      Feb 15, 2020 @ 19:37:44

      Hi Jess,

      I like how you mentioned that psychoeducation can eliminate some of those feelings a client may have at first of feeling or being “crazy” due to the symptoms they may be experiencing. I think universality, and having the client they are not alone in how they feel is one of the most important parts of psychoeducation. Clients come into therapy at many different education levels and from many different walks of life, so being able to explain to them that other people feel the same exact way as them provides so much relief to people who thought they were the only ones to ever feel this way. I also agree with how you mentioned it allows the therapist to come off as the expert in the field, so clients should also feel at ease for this reason. They are in the best hands to have the chance to get better.

      Reply

  6. Melanie Sergel
    Feb 10, 2020 @ 16:06:24

    1. Psychoeducation is considered a vital component to effective CBT. Psychoeducation is used throughout all stages of therapy. Psychoeducation is important in CBT because first, the client needs to be educated about the therapy process and what is to be expected of the client and the therapist. Psychoeducation is also used to explain to the client how the client’s environment influences their thoughts, behaviors, and emotions. In CBT, it is very important to teach clients new skills that they can use outside of therapy and we use psychoeducation to give our clients the knowledge and ability to use these skills on their own. Psychoeducation also helps build a therapeutic rapport because it can help portray the therapist as confident, an expert, and attractive. It is also very important to use psychoeducation in CBT to educate the client on their diagnosis and their treatment plan. Therapy would not be as useful if the client did not the correct information of their diagnosis and what their treatment goals were.

    2. Behavioral activation is very effective in CBT for reducing client distress. It is used to reduce negative reinforcing behavior patterns while increasing positive reinforcing behavior patterns. Individuals who are distressed tend to have lower energy levels and negative automatic thoughts that result in negative emotions. We want to shift the client from thinking and behaving this way to a more positive behavior pattern and thinking. This interaction results in making it difficult to initiate and complete what used to be basic daily tasks and activities. The clients’ ability to experience a sense of accomplishment and pleasure is also greatly reduced, resulting in low self-efficacy. The client also feels little to no motivation to change. Negative emotions and automatic thoughts will then continue because they are not getting things done, not meeting basic needs, and not socially engaged. The clients’ maladaptive cognitive-emotional patterns are solidified and perpetuated as their new baseline leading the client to feel “stuck”.

    Behavior activation needs to be initiated after there is some working rapport. Therapeutic successes shared among therapist and client contributes to reducing distress, improved mood, and increasing levels of motivation and hope for change. If behavior activation is successfully implemented, maladaptive behavior patterns are slowly transformed into a lifestyle where accomplishment and pleasure are experienced. Self-efficacy will also be developed. Behavioral activation focuses only on the behavior patterns that the individual is experiencing and doing. Behavior activation helps clients become more active, increasing their sources of reward by engaging in previously avoided daily tasks and pleasurable activities. It can help clients who have difficulty accomplishing tasks by having the client problem solve to break down large tasks into smaller ones. The therapist can help teach the client to set tasks that are achievable while also setting therapeutic goals. The therapist works toward breaking the vicious cycle that the client of maladaptive cognitive, behavior, and emotional patterns that they are experiencing.

    Activity monitoring and graded task assignments are two of the most effective forms of behavioral activation. Activity monitoring is when clients records their activities that they engage in and rate their levels of pleasure and accomplishment. They also record any thoughts or emotions that were experienced when doing the activities. Graded task assignments are used to break down overwhelming tasks into more manageable smaller tasks. It can provide more opportunities for accomplishments and pleasure. It can be used for clients who are not ready or motivated. This can reduce clients’ distress by providing more opportunities for accomplishment pleasure, it may also give indication to what triggers the distress with a smaller task.

    Reply

    • Jessica Costello
      Feb 10, 2020 @ 16:10:24

      Hi Mel! I like the point you made about psychoeducation building the therapeutic relationship as well as how behavioral activation can influence self-efficacy. It is very important to break up overwhelming tasks into more manageable tasks. I think that completing one smaller activity can positively influence the client to complete more complex activities that they once found overwhelming.

      Reply

    • Monica Teeven
      Feb 10, 2020 @ 18:21:26

      Hi Mel! I wanted to mention a couple of things about your response to question 1. You are right that psychoeducation can increase the level of perceived expertness of the clinician. However, it also is important to realize that if a clinician who does not provide much psychoeducation to the client will not only decrease their level of perceived expertness, it can also delay reaching the client’s goal in therapy. In addition, while a clinician is providing psychoeducation to the client, it is important to make sure the client is understanding the new material that is being provided to them. It is also an opportunity to learn more about the client’s current issues. Good job this week on your blog post!

      Reply

    • Mariah Fraser
      Feb 14, 2020 @ 14:35:16

      Hi Melanie!

      I thought it was important to note the relationship between the use of behavioral activation and increasing self-efficacy. The more the client is able to accomplish by breaking down the task into smaller, more manageable tasks, the more they will feel confident that they can get things done! Hopefully as the client begins to practice this technique, it will also increase motivation and energy as the client is mastering these tasks.

      Reply

    • Erin Wilbur
      Feb 14, 2020 @ 20:49:47

      Hi Mel,
      I really liked your emphasis on the psychoeducation of therapy structure and explaining the environmental factors of the thoughts and behaviors that our clients experience. I think it’s easy to forget about these parts and to think that psychoeducation is just explaining the diagnosis and symptoms, when it’s much more than that and is such an important part of CBT. I also think it’s critical to remember the importance of rapport when implementing behavioral activation. If I were told to spend a lot of time and effort on something like an activity log by someone I didn’t know and didn’t feel comfortable with when I already have decreased motivation, odds are I would say no and be annoyed that they were asking so much of me. Good job!

      Reply

  7. Shelby Piekarczyk
    Feb 10, 2020 @ 16:22:09

    1. Psychoeducation is a crucial part of CBT because unlike other therapies, CBT is a collaboration between the client and the therapist. Within CBT, the therapist helps teach skills to their clients that they can use in real life settings, ultimately becoming their own advocate/ therapist. Using psychoeducation, the therapist not only educates their client on disorders but gives them tools to effectively cope on their own. Another important aspect of psychoeducation is informing the client that they are not the only individuals who feel this way, and that their thoughts/behaviors are common for the diagnosis they are portraying. This can help your client to feel more in control and start to have more positive thoughts about therapy and the therapy process in general. Another important factor of psychoeducation is the more the therapist looks ‘attractive’ and like an expert the more the client will believe in them and the process of therapy. Like we have learned/discussed in class, being ‘attractive’ to the client and being knowledgeable, builds a stronger therapeutic relationship, strengthening therapy. Therefore, psychoeducation not only educates the client but it develops a stronger therapeutic relationship, guides the client in the direction of being their own advocate, and help the dynamic of therapy be more of a collaboration instead of the therapist running the sessions.

    2. In CBT the primary goal of behavior activation is to reduce negative reinforcing behavior patterns while increasing positive reinforcing behavior patterns. When an individual is extremely distressed, they normally have low energy levels, leading to tasks and activities not getting accomplished. Within behavior activation, the behaviors of the individual are targeted before thoughts. The two forms of behavior activation are activity monitoring and scheduling and graded task assignments. When using a weekly activities log, the client is keeping track of their weekly activities where they can ultimately see what they did or did not do, with hopes of leading to an increase of motivation to change. Going over each weekly activity log in therapy will give the therapist and client a chance to discuss what happened during the week and develop an action plan moving forward. Additionally, daily activity schedules can be implemented in therapy helping the client to see their behaviors/activities daily. Next, a graded task assignment can help break down large tasks that at first seem too big to accomplish. By doing this you can give your client a sense of accomplishment by completing a task that was given to them. A graded task assignment will also help to increase motivation when the client sees that they have completed a task. Behavior activation is a very important part of CBT because it targets maladaptive behaviors within your client while also giving insight to some maladaptive thoughts and automatic thoughts to later discuss in therapy.

    Reply

    • Ashley Foster
      Feb 13, 2020 @ 15:11:21

      Hey Shelby. Reading your post, you did a great job breaking down all the details of psychoeducation and behavioral activation. I agree with how being able to give psychoeducation to our clients, it makes us as therapist look more attractive and be able to connect with our clients. Hopefully bringing them back for more. Psychoeducation is such a big piece in rapport building and does a lot for the client in just getting the knowledge they need to know to be more successful in treatment. Great job with the post!

      Reply

    • Mariah Fraser
      Feb 14, 2020 @ 14:35:39

      Hi, Shelby!

      I think you gave a lot of details and provided a good description of psychoeducation and behavioral activation. I like how you linked behavioral activation to potential insight that may happen within the session regarding the client’s maladaptive thoughts. I also liked that you said not only are we teaching the client to be their own therapist but also their own advocate! I hadn’t thought of it in that way but it makes a lot of sense!

      Reply

  8. Robert Salvucci
    Feb 10, 2020 @ 16:34:07

    1.
    Psychoeducation serves to build therapeutic rapport, set the stage for therapy expectations, provide a framework to work from in and out of session, and help clients develop a sense of autonomy and mastery.

    Therapeutic rapport is built by communicating your expertise and conceptualization of therapy to clients. This instills a sense of hope in mitigating distress and provides insight into the nature of distress. It also can provide clients with a sense of empowerment when they understand the role they can paly in improving their quality of life.

    Part of psychoeducation is outlining the therapeutic process. This provides a sense of structure, direction and progress for clients, as we mentioned when discussing session structure. It can also inform clients of common pitfalls and what to expect from therapy, such as potential increased distress when working through common habits or thought patterns. Education around directing towards goals collaboratively and doing homework also exposes clients to the active nature of counseling.

    As part of explaining the process, the CBT model is referenced and explained as the underlining philosophy of therapy. This can help clients make progress outside of session and familiarize themselves with the nature of their core beliefs and automatic thoughts, as well as the relationship between thoughts, emotions, and behaviors. Over time they will be able to more effectively utilize these skills on their own, as well as take a more active role in sessions.

    2.
    The positive outcomes of behavioral activation are no surprise, as behavioral activation involves the scheduling and commitment to behaviors which generate positive emotion, provide mastery experience, and instill a sense of responsibility and autonomy.

    Behavioral activation helps clients find the smallest possible increment of change and consistently commit to making that change, ideally creating many micro-habits that eventually lead to dramatic changes in well-being. This allows clients to see the impact that certain behaviors have on their mood and sense of self-efficacy. It also familiarizes them with important behavior change principles, such as the relationship between motivation, emotion, and behavior, as well as identifying strategies and routines which are most helpful to them. Through committing to these activities, clients can slowly regain a sense of control, purpose, and mastery in their lives, as the cycle of planning, commitment, and positive behavior improves mood and works in concert with cognitive change to create long term changes in their sense of self and self-efficacy. The nature of graded task assignment also provides a framework from which to set reasonable, meaningful, and achievable goals.

    The monitoring of behaviors and commitment to meaningful behaviors also allows clients to see any maladaptive patterns that have contributed to their distress. Clients may see how one activity (sleeping late, excessive TV watching) results in a chain reaction of inactivity, impulsivity, and low energy. These activities focus in on concrete, changeable steps that can be made to improve quality of life. Behaviors that contribute to distress can slowly be modified and substituted for more adaptive behaviors. Over time this will ideally result in a series of habits which require less and less effort to begin.

    Reply

  9. Erin Wilbur
    Feb 10, 2020 @ 20:18:43

    1. Psychoeducation is a vital part of CBT for several reasons. Along with educating the client, it can provide a sense of relief for some. Many clients don’t understand their diagnoses and the symptoms that come with them when they enter therapy. By providing psychoeducation, the therapist may relieve some anxiety that comes with confusion about a diagnosis or certain symptoms. It will lay the groundwork for future sessions, because the client will know what to expect and better understand the therapeutic process. It also shows the client that the therapist is an expert, which strengthens rapport because the client trusts that the therapist knows what they are doing and is able to help. Later on in CBT, psychoeducation also serves as a tool to teach the client skills that will aid them in maintaining what they have been taught after therapy ends. By including the client in psychoeducation, it highlights the collaboration aspect of CBT and teaches the client that they can also be an “expert” in their diagnosis.
    2. Behavioral activation is effective at reducing client distress for many reasons. It increases positive, reinforcing behavior patterns to improve clients’ quality of life. By having clients monitor their daily activities and rate whether they were pleasurable, therapists can encourage and plan more pleasurable activities with their clients, increasing positive behaviors. It can also be very motivating for clients to see that they had “good” days or hours throughout the week, because it can often be hard for a depressed individual to reflect on the positive aspects. By increasing the client’s awareness of and motivation for positive activities, therapists can then work with clients to schedule daily activities that will be beneficial and will reinforce the clients’ motivation for change. Behavioral activation is effective because it gives the client hope and helps them recognize that change is possible.

    Reply

    • Shelby Piekarczyk
      Feb 13, 2020 @ 18:50:30

      Hi Erin,

      I really like how you say that behavioral activation helps to increase positivity in the clients life. By using logs to keep track of their days/weeks they can see positives in their lives that they may not have realized in the moment. I think that this can be a very crucial part of therapy because for the client to see that they have accomplished positive things can lead to positive behavior change moving forward. I also like how you said that using psychoeducation can be a relief for some patients. I also believe that using psychoeducation can help clients realize that their symptoms are not completely abnormal and out of this world. Validating some of their symptoms can help lead to behavior change and positive changes moving forward.

      Reply

    • Madison Armstrong
      Feb 15, 2020 @ 17:59:50

      Hi Erin,
      I think that you did a great job at showing why psychoeducation is important and what makes behavior activation effective at reducing client distress. I agree with the fact that providing a client with psychoeducation about their diagnosis will help relieve some anxiety they may be experiencing. I also think that psychoeducation is important to show the client that the therapist is knowledgeable about the treatment they are providing. I liked that you mention with behavior activation that it can be beneficial for a client experiencing depression to reflect on positive aspects of there days. This can be a powerful way to increase an individual’s motivation.

      Reply

  10. Jenna Nikolopoulos
    Feb 12, 2020 @ 16:01:15

    1. Pyshcoeducation is considered a vital component to effective CBT because not only does it allow clients to understand the terms and techniques used by clinicians, but also it helps teach clients important coping and problem-solving skills that they can use in different areas of their lives when therapy has terminated. Psychoeducation is one of the ways that lets clients become active participants in their sessions, which makes therapy more effective overall for clients. Additionally, psychoeducation allows the therapist to be seen as an expert by the client, which helps build upon the therapeutic relationship because the client will feel more comfortable and trust his/her clinician due to believing that the clinician knows what he/she is doing. A good therapeutic relationship leads to more positive outcomes for clients. Psychoeducation also provides structure for clients as it allows clients to know what to expect of therapy, which reduces their anxiety overall and helps them be more open to being active in sessions and collaborating with his/her clinician.

    2. The goal of behavioral activation is to reduce one’s negative reinforcing behavior patterns (e.g., isolating oneself in social situations) while increasing positive reinforcing behavior patterns (e.g., spending time with friends). This process wants to help clients be more active as engaging in more activity increases a client’s sources of reward by participating in daily tasks and activities that were previously avoided. Since clients who are significantly distressed usually have lower energy levels and negative automatic thoughts, this creates negative emotions, which then makes it more difficult for clients to initiate and follow through on basic daily tasks and activities that they used to do. As a result of these clients not being able to perform daily tasks and activities and socially isolating themselves, their negative automatic thoughts and emotions begin maintain, which solidifies a cycle of maladaptive cognitive-emotional-behavioral patterns. Since behavioral activation focuses on behaviors in individuals, by getting clients to become more active in their daily lives, it will help break the maladaptive cognitive-emotional-behavioral patterns that they have created.

    Behavioral activation has been shown to be an effective treatment for increasing activity levels and decreasing distress and depression levels in depressed clients. Additionally, this technique has been shown to help clients who have a hard time getting things done by problem solving to break down large tasks into more achievable tasks while setting goals at the same time. Since clients experiencing these distressing emotions and thoughts have no motivation to change, they would prefer to have some improvement sooner rather than later, which is why behavioral activation is beneficial as it provides something that is fairly easy and tangible that can be used early on in therapy. However having some sort of a good therapeutic relationship is needed before being able to use any of these techniques because the therapeutic successes shared amongst the clinician and client help to reduce distress, improve mood, and increase leveling of motivation and hope for change. If implemented correctly, clients will be able to accomplish more and develop self-efficacy.

    Two effective forms of behavioral activation are activity monitoring and graded task assignments. Activity monitoring is when clients record the kinds of activities they participate in, assess their levels of pleasure and accomplishment, and note any thoughts or emotions they experienced during said activities. Graded task assignments break down big tasks into smaller, more achievable tasks. Not only to do these tasks help supply clients with more chances for attaining accomplishments and pleasure, but also can help reduce distress in clients and allow them to make small strides in moving forward, which helps to build self-efficacy.

    Reply

  11. Madison Armstrong
    Feb 12, 2020 @ 21:42:51

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

    Psychoeducation is a vital component to effective CBT because it educates, motivates, strengthens the therapeutic alliance, and provides the client with some relief. Throughout CBT, the therapist provides the client with psychoeducation relative to their symptoms and diagnosis. This provides the client with information about the expectations of therapy, the cognitive model, diagnosis, treatment plan, and case formulation. Educating your clients with this information allows for the therapeutic relationship to be strengthened because it shows your client that you are dedicated to helping them and that you are knowledgeable about what you are able to do to help them. This knowledge gives the client a sense of relief because there is no mystery in what is expected of them because they are being told in the beginning stages. They can also sometimes find relief when their diagnosis is “normalized,” learning about their disorder. For example, someone learning about an anxiety disorder would learn about the fight or flight response and see the biological reason why they react the way they do. Learning that there is a way to change your thoughts, emotions and behaviors can motivate clients to achieve these changes on their own throughout therapy.

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

    Behavior activation in CBT focuses on reducing negative reinforcing behavior patterns and increasing positive reinforcing behavior patterns. Specific ways that this is done is through the use of activity monitoring and graded task assignments. These two methods target the client’s motivation and negative emotions and thoughts. This helps a client monitor and analyze the distress they are feeling by completing tasks that help to change their behavior. This can provide the client with a sense of accomplishment and pleasure from completing tasks, chores or assignments that they expect from themselves. Monitoring this behavior enables the client to bring this behavior to conscious awareness so they are paying attention to it and actively working on making changes. A graded task analysis allows the client to take a big and overwhelming task and break it down into smaller more digestible sections. This allows the client to analyze the big task and see exactly the parts that are causing them distress. Once the client is aware of the distress and what causes it the client can then talk through this with their therapist.

    Reply

    • Melanie Sergel
      Feb 13, 2020 @ 18:38:20

      Hi Madison! You did a great job explaining why psychoeducation is important in CBT. I like that you make the point that it shows the client that you are dedicated to helping them. I agree with you that psychoeducation can show the client this. It is important for the client to feel that you care about the therapy process because if they think that you do not, then they will not care either. I also like that you state that educating the client can give them a sense of relief by “normalizing” their diagnosis. I believe that this is very important to teach clients because they may feel very overwhelmed and that they are alone. Great job on your post!

      Reply

  12. Tim Keir
    Feb 12, 2020 @ 23:29:26

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

    Ultimately, psychoeducation is the end goal of treatment; when the client has been successfully taught enough strategies that their symptoms and general distress has been drastically reduced, then they can be considered successfully treated. Yet psychoeducation has significant roles to play throughout the clinical experience and beyond the acquisition of knowledge.

    The first thing that psychoeducation helps with is rapport. There is no better way to help develop a sense of expertness than being able to explain automatic thoughts and the cognitive triad to a client in an accessible manner. It shows the client that you do in fact know what you’re talking about, and furthermore will be able to properly express these ideas to you as well. It also helps ease the client into the idea of therapy as well, which can be beneficial for clients who may still be on the fence about the experience. Demystifying the experience through teaching brings the client far more comfort in the process. This applies to the formulation of a diagnosis and treatment plan as well; how it is presented and taught to the client can drastically affect their response to it. A clinician who takes the time to explain their reasoning behind their choices and asks for feedback will be far more likely to get the client on board with the plan than one who simply creates a diagnosis and drops it on their client.

    Lastly, the psychoeducation that occurs is often a great way for clients to build confidence in their own mastery. There is pride to be had in discovering new ways to think of the world and applying them to your own life. The acquisition of such skills allows the client to feel objective improvement from therapy, which helps them engage in treatment even more. If the client feels confident that you are giving them the tools necessary to make big changes, then they will be all the more ready for even more intense homework and participation as therapy goes on. Thus, psychoeducation is valuable not only for its teachings, but also in its ability to establish rapport and build confidence in therapy itself.

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

    Individuals come to therapy when they are no longer adaptively dealing with their lives. More often than not, clients are in a rut of familiar patterns that are not effective in reducing the symptoms the client faces. Of course, the client knows that their behavior needs to change in order to improve – but the idea of changing everything is just so amorphous and overwhelming. Especially in cases of depression, a constant state of fatigue and anhedonia in most activities makes the task of changing one’s lifestyle even more daunting.

    Fortunately, that’s exactly where behavioral activation comes in! The enormous labor of change is specified, labeled, and organized so that instead of an amorphous desire to “improve”, one can objectively begin making small adjustments to their schedules that gradually develop into far more functional and satisfying habits. Daily habits are recorded by clients for homework alongside a personal scale of how satisfying the action was. Over time, the homework changes from monitoring one’s activities to finding which ones provide benefit, and then planning those into the schedule far more often. Larger, more difficult tasks that could overwhelm the client can be broken down further as well, into graded task assignments.

    Such tasks bring a clarity and accountability to how one spends their day. By laying out an account of their time, the client can visually examine their own behavior patterns. Seeing this structure can help one account for their time better and more easily see ways in which it can be altered. It turns a vague sense of where the time is spent into a solid document and demystifies ones’ efforts. Further demystified are the small changes in the schedule that are planned out and made over time; incremental changes that are visually seen can be easier to follow through, especially if they are given specific times to be done. The client’s willingness to implement small changes to that schedule creates a foot-in-the-door effect, where small amounts of participation engender further changes later on.

    Reply

    • Jenna Nikolopoulos
      Feb 13, 2020 @ 13:38:13

      Hi Tim! I liked that you discussed the connection between psychoeducation and confidence. It’s so important for the client’s confidence to be built during therapy as they will be less likely to be an active participant in sessions and less likely to do the homework/practice new skills if they don’t have any confidence in their abilities. I think you make a great point by mentioning how learning new skills will help the client feel like they are improving, and if they feel like they are improving, then the more engaged they will be during treatment. Clients’ confidence in their abilities to master new skills is key to helping them make improvements in their lives and with a good therapeutic relationship, along with an understanding of the psychoeducation, the client will feel more confident in their abilities to make that progress.

      Reply

    • Ashley Foster
      Feb 13, 2020 @ 15:02:58

      Hey Tim. I thought it was interesting how you explained psychoeducation being the end goal of treatment as it is something achieved for the client. When I think of psychoeducation, I think of it being the first step as the client can establish a better understanding of what is going on. Never the less, I think psychoeducation is something we do throughout treatment and both thoughts of the concept are correct. Great job with the post.

      Reply

  13. Ashley Foster
    Feb 13, 2020 @ 11:03:30

    1. Psychoeducation is considered a vital component to effective CBT. Psychoeducation gives a better understanding to the client of what is going on. how they can better understand themselves. Most individuals who are in therapy are experiencing negative automatic thoughts and core beliefs. These lead to maladaptive functioning. With the knowledge of what they are experiencing, we can instill a sense of hope through educating our clients and giving them a sense of what they are up against. Having this knowledge, individuals can better plan and be more aware of how to cope. Additionally, psychoeducation teaches new skills to the client. The goal in CBT is to have the client become autonomous. This done through their ability to problem solve and cope on their own. Psychoeducation plays a big role in that. If a client is experiencing symptoms of low energy and does not know where it is coming from, psychoeducation can open that door to inform that they are experiencing a symptom of depression. Having this knowledge, they can begin to start treating and coping with their depressive symptoms and move towards being autonomous.

    2. There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT. Behavior activation is effective at reducing client distress. Behavior activation is done as one of the first line intervention in therapy to help clients who are experiencing patterns within depression or having a hard time getting things done. For these individuals, they usually get stuck in dysphoria. They need activation and tools to break the stuck cycle. This is done with a few different techniques to aid the client to move forward towards the next step in treatment. One technique used is activity monitoring and scheduling. This helps in decreasing distress in clients as we all need structure in our lives. When clients loose site of that structure/ schedule of things to do, there is the increase possibility to fall back into their depression and get stuck back into the dysphoria. With restructuring patterns of behavior, it helps our clients become more autonomous and successful in treatment.

    Reply

    • Melanie Sergel
      Feb 13, 2020 @ 18:26:55

      Hi Ashley,
      I like that you make the point that psychoeducation can give the client a better understanding of themselves and that it gives the clients a sense of hope. This is really important because clients may feel alone in what they are experiencing. With psychoeducation you can teach your client that they are not the only one experiencing these symptoms and that it is actually normal with those who also suffer from the disorder. This may help the client feel less overwhelmed with what is occurring because you can explain that therapy has helped others experiencing the same thing. You also did a great job explaining behavior activation and how it assists clients by giving them structure.

      Reply

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Adam M. Volungis, PhD, LMHC

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