Topic 4: The Practice of CBT – Psychoeducation & Behavioral Activation {by 2/15}

There are three readings due this week (Beck – 1 chapter; Wright et al. – 2 chapters).  For this discussion, share at least two main thoughts: (1) Admittedly, not much is covered in our readings for psychoeducation (much more will be said in class). 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 2/15. Have your two replies posted no later than 2/17.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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28 Comments (+add yours?)

  1. Sarah Mombourquette
    Feb 12, 2018 @ 11:57:41

    1) Psychoeducation is a vital component of effective CBT because it helps the clients to understand and learn CBT concepts. If a client does not understand the purpose of the concepts, he or she will have a difficult time implementing them. Examples of psychoeducation include mini-lessons and exercise templates. Mini-lessons are short explanations of CBT theories. By breaking up the theories into smaller units, a client will be able to master an understanding of parts of the theories before tackling the entire process. Exercise templates are also helpful in learning because seeing a method in writing can help a client to retain the concepts. Other examples of psychoeducation such as readings and internet searches can also help clients to get involved in the therapeutic process outside of sessions. Ultimately, each of these examples of psychoeducation are essential in CBT because they allow the client to gain a certain level of control over the therapeutic process. By understanding the theories, the client will be able to take more responsibility for the process. Because the client is the expert on himself or herself, the client will then be able to apply the theories to himself or herself specifically. Another benefit of psychoeducation is that it can contribute to the structure of therapy. The positive combination of psychoeducation and structure will help the client know what to expect from sessions and how to move forward in structuring future sessions.

    2) The main goal of behavioral activation is to engage a client in the process of change. This, in turn, is expected to activate a positive movement for the client while also creating a new sense of hope. The first reasons that behavioral activation is effective at reducing distress is that it can start the process of breaking out of patterns of withdrawal or inactivity. By introducing small actions, the client will learn that he or she can break the pattern of inactivity, even if only in small increments at first. Behavioral activation also shows the client that progress can be made. Because many clients experience learned helplessness, the impact of behavioral activation shows them that it is possible to achieve set goals. Lastly, client distress can be reduced simply from the presence of hope for recovery. If a client has not had success in the past, the small successes that come from behavioral activation are enough to show the client that the process can work. By having hope, the client will then be more likely to actively participate in the CBT process. Behavioral activation often involves the therapist helping the patient to choose a few actions that will change how the client feels. The therapist will ensure that the tasks chosen have a high success rate. Because the client is likely to be successful, he or she will experience in improvement in self-esteem and self-efficacy. Increased self-esteem will reduce the client’s distress because it will enhance the client’s mood and attitude towards himself or herself. Increased self-efficacy will improve the therapeutic process as a whole. The client will believe in his or her ability to succeed in the tasks and will therefore increase the likelihood that he or she will succeed in the tasks.

    Reply

    • Stephanie Mourad
      Feb 12, 2018 @ 20:23:06

      Sarah,
      I agree with you that when a client is able to understand the therapeutic process they are able to gain a certain level of control over it. When a client is an expert on himself or herself, they can apply the techniques and skills of psychotherapy outside of their sessions. Clients should be able to understand these methods and I agree that it is important so that clients know what to expect from future sessions, i.e. homework.
      I also like how you said that if a client has not had success in the past, the small success that comes from behavioral activation is enough to show the client that the process can work. There’s a sense of pride and hope when a planned activity or goal is successful. The client will most likely become more motivated to want to set up more goals and further be active in the therapeutic process.

      Reply

    • Lexie Ford-Clottey
      Feb 13, 2018 @ 13:45:59

      Hi Sarah,
      In your discussion on why psychoeducation is important to the effectiveness of CBT, I think it was important to mention the significance of session structure and how this element is relevant to the therapeutic process. In many ways than one, session structure educates clients on the organization of therapy, what is to be expected from them, and how to make the process collaborative as possible. When clients are informed or knowledgeable to such concepts it becomes easier for them to establish goals, agenda set, and implement treatment strategies. In my opinion, session structure is a form of psychoeducation where clients have to be aware of how therapy works in order to actively participate in the change process. I also like how you highlight the importance of small successes in relation to behavioral activation, indicating that any kind of success or gain is a step in the right direction. Often time’s clients overlook the little improvements that are being made and often get discouraged when the overall goal has not been achieved. Little successes are important because it shows progress is being made and that in order to achieve the end goal clients have to first master certain steps before.

      Reply

    • Louis D’Angelo
      Feb 16, 2018 @ 16:41:35

      Hi Sarah,

      One great point you made in terms of psychoeducation is that by learning and having a firm grasp of CBT skills and models, the client can assert more control and autonomy in their therapy. This achieves a better collaborative empirical relationship and better improvements in therapy. For example, if a client has a firm understanding of the cognitive model they may realize, in practice, that negative emotions have a greater impact on her thoughts than external events. The cleint can then discuss this with her theraptist and form better treatment plans such as regulating chronic emotional disruptions through CBT skills and possibility providing information leading to a emotional disorder.

      Reply

  2. Stephanie Mourad
    Feb 12, 2018 @ 16:07:36

    (1) Cognitive behavioral therapy is based on the idea that patients learn skills for modifying cognitions, controlling moods, and making productive changes in their behavior. Therapist success results in the ability to teach these skills to their client. Psychoeducation is also important in terms of patient relapse. Therapists should arm clients with knowledge that reduces risk of relapse. CBT is geared toward helping patients become their own therapist. Eventually clients will have to leave therapy and use the skills and techniques learned in session on their own. Therapists should educate patients on how to continue to use cognitive and behavioral self-help methods after the conclusion of therapy.
    There are many different types of psychoeducational methods that may be beneficial to use. The first is mini-lessons, which can be short explanations or illustrations of CBT theories or interventions. These help the patients understand concepts and it is important to avoid lecturing style. Exercise templates are also very useful and a good way to educate and explain how the procedure works. Therapy notebook is another method and written exercise, homework assignments, handouts, rating scales, notes on key insights, and other written or printed materials can be organized in a therapy notebook. Self-help books, handouts, or other materials are available in print or on the Internet are often used in CBT to educate patients and to get them involved in learning exercise outside treatment sessions. The final methods is computer-assisted CBT which is fairly new but can help with treatment of phobias.

    (2) Behavioral activation is used to describe a simple procedure that engages the patient in a process of change and stimulates a sense of positive movement and hope. The therapist helps the patient to choose one or two actions that could make a difference in how he feels and then assist with working out a brief plan to carry out the activity. Patients typically come to therapy in order to move in a positive direction and are looking for guidance to help carry out those steps. It helps patients break out of patterns of withdrawal or inactivity, show them that progress can be made, and stimulate hope for recovery. I think that this is effective because it is the patient deciding the action that is helpful in moving forward. The patient is the one motivated to change and come up with goals and so when those goals are met, the patient feels a sense of pride and hope.
    For example, in one of my therapy sessions I have voiced my need to want to overcome some of my social anxiety and my therapist had me come up with different activities that I could perform. My goal was to invite a group of friends out to a social gathering. In the end, the goal I created for myself tested me to overcome some of my social anxiety and once I was able to carry out this task, I felt a sense of happiness and hope. It made me feel as though that I could overcome obstacles by setting goals for myself and it made me want to set more goals in the future.

    Reply

    • Sarah Mombourquette
      Feb 14, 2018 @ 16:50:38

      Hi Stephanie, I thought that your point about the significance of psychoeducation in relation to relapse was very important. If a client is, as you said, armed with the knowledge of how to adaptively manage various situations, he or she will be less likely to relapse. Similarly, if the client does relapse, the hope is that he or she will be able to make use of the concepts of CBT to overcome that obstacle. Because CBT is not intended to be long-term, psychoeducation is an important part of teaching the client to use the CBT skills without the direct presence or guidance of the clinician. The various methods of psychoeducation that you described (mini-lessons, exercise templates, therapy notebooks, and internet use) all lead the client in a more self-reliant direction as opposed to being completely reliant on the clinician for guidance. Similarly, the client is responsible for making use of these techniques, enabling him or her to gain more independence in the therapeutic process. In your discussion about behavioral activation, I liked that you pointed out how beneficial it is for the client to be helping determine what the actions will be. This allows for the client to feel that he or she is making progress by coming up with his or her own goals.

      Reply

    • Louis D’Angelo
      Feb 16, 2018 @ 16:22:16

      Hi Stephanie,

      I loved how you included the aspect of hope in the early intervention strategy of behavioral activation. Simple homework assignments build to get the cleintbul and moving has a significant impact in improving their mood and self efficacy. The simple means to a big impact gives the client great hope in therapy and the notion that improvements can be made. Building hope is particularly important with this treatment as it is geared towards individuals with major depressive disorders and my be experiencing feelings of learned helplessness or hopelessness.

      Reply

    • Abbey Lake
      Feb 17, 2018 @ 15:41:32

      Hi Stephanie,

      One great point that you made regarding cognitive behavioral therapy and psychoeducation is that teaching clients through psychoeducation helps to prevent patient relapse. One of the distinguishing characteristics of cognitive behavioral therapy is that it prepares clients to become their own therapist once therapy concludes. I found your post to be very informative because you discussed multiple methods of psychoeducation that were mentioned in the reading. I also enjoyed reading your example of your own experience in therapy and how behavioral activation was beneficial for you as a client. I agree that behavioral activation is an excellent way to help motivate clients.

      Reply

  3. Cassie McGrath
    Feb 12, 2018 @ 19:28:42

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

    Psychoeducation is a very important aspect to any therapy. The basic definition of psychoeducation involves informing the client and teaching the client about the psychological processes as well as the diagnosis. This is an important aspect because it keeps the client informed about what is happening. A client should never be unaware of what is happening in a session and should always feel that they know where their session is headed. Another important aspect of psychoeducation is that if the client is fully aware and educated in what is going on than he or she may be more likely to believe in the process. Having an understanding of the process makes it easier for the client to feel like he or she is going to be successful. In CBT, this is especially important because the client is going to be assigned homework and other tasks. If the client is not aware of the importance of these tasks and homework assignments then why would the client complete them? Understanding why the homework is important and how it will help or be beneficial to the client aids in the client completing it. In addition, in CBT there is an importance to keep a client fully a part of the process. If the client is not fully educated on the process then they are not able to fully be a part of it. Psychoeducation is important in CBT and is not a one stop shop, it is something that should be continuously done through the sessions so the client continues to learn and grow.

    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 is one of the first things that should be addressed in a therapy session. One of the key aspects of behavior activation is to break the negative behavioral loop that is occurring for the client. This loop is continuously fed by lack of motivation and lack of positive outcomes, if there is a negative outcome to a behavior or an outcome that does not elicit an outcome that is completely desirable this continues the loop. A major component of behavior activation is changing the motivation behind the actions to try and promote a more positive outcome. How could this reduce stress for clients? Even if there is a slight alleviation from the negative loop that would allow for some stress relieve for the client. in addition, if the client begins to feel that there is some decrease in stress and begins to break that negative loop then there may be an increase in motivation. This increase in motivation could lead to more positive change (with the help of other resources) which will help to build a positive loop rather than a negative loop of continuity.

    Reply

    • Stephanie Mourad
      Feb 12, 2018 @ 20:32:13

      Cassie,
      I like the point that you made about if a client understand the process of therapy then he or she will more likely believe in the process. I think that a lot of hesitation to go to therapy or continue going to therapy is because people have too many misconceptions about the process. I also agree that homework and assignments that are given should be explained and not forgotten. There are times when I went through the therapeutic process that my therapist would assign me homework and somehow it would never be brought up in the next session. The importance of being active should be explained and clients should understand the importance of why they should be a part of the therapeutic process. It is important to educate and emphasize the point that CBT is collaborative and not one-sided.

      Reply

    • Lexie Ford-Clottey
      Feb 13, 2018 @ 15:11:25

      Hey Cassie,
      I think it was important in your post to focus on client awareness in relation to psychoeducation and the effectiveness of CBT, because such factors and concepts greatly influence therapy outcomes and ones willingness towards change. As you mentioned, when clients are educated and informed throughout the process of therapy they believe more in their abilities, are motivated, and view change as worthwhile. Without a sense of understanding, clients may find it hard to actively participate in therapy, in which setting goals and implementing strategies may fare ineffective. Therefore, maintaining awareness and education throughout the entire process helps both the client and therapist remain on the same page, which contributes to successful therapy outcomes. In regards to behavioral activation, I like how you use the terms “negative behavioral loop” in describing a clients state of well-being. This is important because in order to reduce client distress therapists have to target the root of the problem which often involves a cycle of maladaptive behavior.

      Reply

    • Sarah Mombourquette
      Feb 14, 2018 @ 16:51:09

      Hi Cassie, I like that you emphasized the importance of keeping the client informed about what is happening during sessions as well as where the sessions are headed. Because CBT emphasizes the importance of a collaborative therapeutic relationship, a client should be aware of where the sessions are headed. I also agree with the idea that psychoeducation will promote success and follow-through. As you said, if a client understands why he or she is being asked to do something, he or she will be more likely to actually do it. In your discussion about behavioral activation, I think it was important that you pointed out how easy it is to remain in a cycle of inactivation once you are in that cycle. I agree that even a small dent in this loop has the ability to reduce client stress. Therefore, behavioral activation has the ability to positively impact an individual’s motivation and likelihood of success.

      Reply

    • Tori Bryant
      Feb 16, 2018 @ 22:13:28

      Hi Cassie,
      I liked how you response to question #1 spoke to the fact that psychoeducation incorporates the client in the therapeutic process and how important that is. Clients should not feel like they are being purposefully kept in the dark about why certain tasks or topics are done in session. The therapeutic alliance and use of collaborate empiricism could greatly suffer if a client does not understand or feel included in decision being made in and out of sessions. I also enjoyed that in the first sentence you mentioned that psychoeducation around diagnosis, not just therapy, is crucial. I think it would be easy for a client to respond negatively to receiving a diagnosis and psychoeducation can help them better understand what their diagnosis means and what can be done in the future, especially during therapy, to improve functioning.

      Reply

  4. Lexie Ford-Clottey
    Feb 13, 2018 @ 11:47:27

    1. Psychoeducation is a critical feature to effective CBT because it aids in the process of collaboration by providing clients with the knowledge, resources, and tools to understanding and modifying presenting problems/issues. With clients as active participants to their own change, it is important to possess knowledge and information about the process of therapy in order to increase engagement and therapy outcomes. The more informed or knowledgeable a client is dictates how he/she may view the change process, in which educated clients are likely to take more responsibility and ownership within the therapeutic process. When clients understand what is going on and what is expected from them in therapy, they appear more motivated and optimistic towards setting goals and implementing treatment strategies. With this said, the role of a CBT therapist is one of a teacher/coach, where clients learn effective ways to foster education both in and outside of therapy. In order to enhance the educational experience for clients therapists utilize a wide variety of methods/resources which include but are not limited to mini-lessons, exercise templates, therapy notebooks, and recommended readings. Mini-lessons are short explanations or illustrations of CBT theories that help clients better understand concepts. These lessons are not only interactive and engaging, but are useful in helping clients learn how events, thoughts, emotions, and behavior interact and influence one another in a reciprocal manner. Depending on the clients learning style exercise templates can foster education, in which seeing the methods in writing can help individuals learn and retain concepts quickly and efficiently. Therapy notebooks allow clients to keep an organized collection of homework assignments, hand-outs, notes, and written exercises from therapy sessions. Therapy notebooks promote learning because clients can use this as a reference between sessions or once therapy has concluded. Therapy notebooks serve as self-help tools that remind clients of the CBT concepts they have learned. It is also common for therapists to recommend readings to their clients, in which certain self-help books, handouts, or materials found online, can promote learning outside treatment sessions. When assigning readings therapists should choose materials that are appropriate and relevant to the specific client. With this said, psychoeducation is a continuous process that is focused on the present and future, indicating that such skills and knowledge are expected to be utilized even after therapy has ended. With therapy not meant to last forever, psychoeducation allows clients to independently solve problems and to become their own therapists. Therefore, psychoeducation is a vital component to effective CBT because it fosters independence among clients and ultimately leads to successful treatment outcomes and lower rates of relapse.

    2. Behavioral activation is centered on the well-being of clients and is focused on helping individuals take control of their lives, become active, and lead healthier lifestyles. The main goal of behavioral activation is to facilitate the process of change within individuals in order to stimulate hope and establish a sense of positive movement. Behavioral activation is effective at reducing client distress because it allows clients to see the light at the end of the tunnel, indicating that there is room for progress and change. For clients who display low self-esteem, a lack of motivation, and increased helplessness it is important to help them recognize that obstacles can be overcome and that the desired goal is reachable. Often time’s clients are less motivated or willing to engage in tasks/activities that they view as too big. In order to change this perception, behavioral activation helps clients breakdown big tasks and take smaller steps towards change. When clients begin to experience success and are able to view things in a more positive light this rebuilds confidence, self-esteem, and self-efficacy. Boosting client self-efficacy is important because the more individuals believe they can do something the more likely they are to complete it and succeed. Behavioral activation also reduces client distress by helping individuals reverse unpleasant cognitions/behaviors, in which breaking out of patterns of withdrawal or inactivity is the goal. With this said, individuals usually seek therapy because they want change but may not know how to go about it. In these instances, clients are looking for guidance and effective ways to foster change and growth. When therapists help clients choose actions that could make a difference in how they feel this allows for both parties to work together on a brief plan to carry out the activity. When clients realize that focusing on one area at a time results in more positive feelings towards the end goal they are likely to modify their patterns by adopting more adaptive attitudes. Client distress is also reduced when hope for recovery is present and more importantly when the client is active in the therapeutic process. Clients who view small gains as positive signs towards a healthier lifestyle appear more motivated and willing to put in effort. Overall, behavioral activation is effective at reducing client distress because its framework is based on symptom relief and enhancing well-being.

    Reply

    • Abbey Lake
      Feb 17, 2018 @ 15:29:14

      Hi Lexie,

      I agree that psychoeducation is an important feature of CBT because it provides clients with not only knowledge but also resources and tools for understanding and modifying issues. In my blog post I also discussed how clients are encouraged to be active participants in the therapeutic process. You made an important point in noting how this improves therapy outcomes as it helps the client to take some responsibility in the process and motivates them to be more engaged throughout therapy. I think you are right in saying that clients will more effectively retain concepts discussed in therapy through proper psychoeducation and application of concepts. I liked your point about how behavioral activation builds confidence, self-esteem, and self-efficacy. I think that this is especially effective with clients who are depressed because often times depression can cause people to have a sense of hopelessness or a lack of motivation and behavioral activation may be a good method to help individuals to break out of patterns of withdrawal or inactivity and become more hopeful about therapeutic outcomes.

      Reply

  5. Tori Bryant
    Feb 14, 2018 @ 17:08:04

    1) Psychoeducation is a crucial part of CBT because it assists the clients in understanding why they are doing what they are doing in and outside of therapy sessions. It is more likely that anyone, not just clients, will perform a behavior if they grasp the basic and greater purpose of what they are doing. Once they see the benefit of doing homework or completing a thought record, they will become more invested in the process and care more about the outcome of the exercises.

    I think about clients with social anxiety who would be extremely anxious when they think about completing a homework assignment that involved going out in public in strange clothing. In order for these clients to buy in to why this exercise would be beneficial for them, it would be a great idea for therapists to utilize psychoeducation to explain the positives of completing this exercise. I also think about clients with depression who may lack energy to complete tasks that are asked of them by their therapists. In order to motivate the clients, therapists could use psychoeducation to explain how the techniques being used will improve the clients’ ability to function if completed. Psychoeducation is a motivator because it provides and instills hope for clients if they put the work in.

    2) Behavioral activation is essentially a process of change that is used to bring about hope and optimism in clients. Due to client negative cognitions that have led to negative behaviors, clients can get stuck in a negative, and potentially disengaged, cycle in regard to their lives and what is going on around them. It seems as if they do not register all the potentialities for positive activity anymore and the goal of behavioral activation is to get them reengaged with these hopeful and optimistic habits and activities. Self-efficacy can also be reinforced when behavioral activation is employed if the client and therapist come up with an activity that the client can successfully engage in. Once clients see that they are able to achieve some form of success and their self-efficacy improves even slightly, there is a greater chance that their outlook on circumstances could be less negative and they believe in themselves more. Cognitions may become more positive and the client could be more open-minded to what they can try to make long lasting changes in the future. Behavioral activation is great way to start change and lead to an even greater and long-term change for clients, which will lead to a lessened level of distress.

    Reply

    • Teresa DiTommaso
      Feb 15, 2018 @ 12:44:47

      Hi Tori,

      I really like what you said about behavioral activation and how it relates to self-efficacy and how clients would be more open-minded after successful behavioral activations. I believe that your point about self-efficacy really brings in a lot of different elements that are needed to make that long-term change, as you mentioned. In order to make those long-term changes, the client has to start somewhere. By making that connection between behavioral activation and becoming more open-minded, I really think you emphasized one of the important foundations for facilitating larger changes later on in therapy.

      Reply

    • Cassie McGrath
      Feb 16, 2018 @ 19:14:30

      Hi Tori,

      I like how you brought up the example of working with a client with social anxiety and how certain homework assignments may cause additional distress for the client. You bring up a really good point that clients who are more educated around the process and understand why the homework is important rather than thinking that their therapist is hoping to embarrass them. I do think that there are additional resources that should be utilized in this such as some coping skills to deal with some of the immediate anxiety that the individual feels when doing the homework. I also like your example for the depressed individual. I also think that hearing why something is going to work gives hope to those that may be hopeless. Knowing that there is proven effectiveness of an activity can help to motivate a client to be more willing to participate if they are motivated for change.

      Reply

  6. Louis D'Angelo
    Feb 14, 2018 @ 18:24:47

    1. Psychoeducation is a necessary part of cognitive behavioral therapy as it serves many crucial aspects in facilitating and maintaining change. Educating a client on theory, models, and skills provides both confidence in treatment as well as solid foundations outside treatment. One reason psychoeducation is important is that educating a client on theory and evidence based practice not only shows your expertise and builds a client’s confidence in you as a therapist but give clients confidence in the effectiveness of treatment. What is being taught itself is also important. Teaching a client skills and methods of controlling thoughts and emotions increases positive change in the intersession periods as well as preventing relapse after termination of treatment. Peticularly after termination, teaching a client to become their own therapist establishes self-reliance and gives them the knowledge to work through obstacles in their life themselves using the methods they have previously and successfully used in therapy. Education using resources, diagrams, and a therapy notebook give the client a reference to guide them to self reliance after termination and prevent relapse. Through psychoeducation, cognitive behavioral therapy efficiently treats problem behaviors and cognition by endorsing self reliance and preventing relapses.

    2. Behavioral activation is effective at reducing distress in what it avoids as well as what it provides the client. Creating an activity schedule and endorsing movement and pleasurable activity avoids negative behaviors and cognitions such as rumination, stagnation, and anhedonia. The key example is the client staying in bed all day despite that this does not result in any positive change in mood or physical symptoms of depression but only maintains a low energy level. Behavioral activation is also effective for what it provides the client. An activity schedule provides the client with structure and goal setting. Engagement of pleasurable activities and intrinsically reinforcing behaviors increases energy and mood even if recording mood checks are necessary to see the subjective changes after activity. Behavioral activation also increases behavioral momentum and the likelihood for these behaviors to continue and increase. This increases pleasure and mastery, and intern increases mood and self efficacy by accomplishing tasks and keeping with an activity schedule. As one of the first action plans in early treatment, behavioral activation is effective in reducing maladaptive behaviors such as rumination, stagnation, and anhedonia and increases productivity, behavioral momentum, pleasure and mood, mastery of skills, and self-efficacy. Simply using this technique and getting a depressed client active and engaged, the benefits are substantial in such early treatment.

    Reply

    • Teresa DiTommaso
      Feb 15, 2018 @ 12:41:03

      Hi Louis,

      One important part of psychoeducation that you hit on that I did not realize is its importance to establishing yourself as knowledgable about the therapy you are conducting as a therapist. As mentioned in multiple literature that we have read, there are better treatment outcomes if the therapist comes off as confident and knowledgable (among other things). By informing the client, you are showing that you have a solid knowledge in what you are teaching them and that the process has empirical support to back it up. Additionally, I think by showing your expertise, trust can be established. I just wanted to thank you for bringing that up because it is something that I completely missed!

      Reply

  7. Aleksa Golloshi
    Feb 15, 2018 @ 09:54:51

    1. Psychoeducation is part of a three-step system that helps therapists effectively maximize CBT skills. Psychoeducation is a vital component to therapy because it educates clients using a variety of methods. Conducting mini-lessons is one method therapists use when short explanation or illustrations of CBT theories may be useful to the client understanding a certain concept. Circular diagrams can also be used to illustrate the linkage between a client’s events, emotions, thoughts, and behaviors. Creating an exercise template is another aspect to psychoeducation that helps clients further understand CBT methods, which will then help the therapist maximize CBT skills. The therapist can write out an example of an exercise in a session while they explain how the procedure works. The exercise should then be given to the client as a template for future work. Seeing this method in writing can help the client learn the concept quicker, which can help them apply CBT skills more effectively to their maladaptive thinking or behavior. A therapy notebook is another method that is useful to effectively conduct CBT therapy. Writing down exercises from sessions, homework assignments, handouts, rating scales, and notes on key insights promotes learning and helps the client remember and use CBT concepts, even after their therapy has ended. Psychoeducation also involves reading self-help books, handouts, and other materials to get clients involved in learning exercises outside treatment sessions. These readings will discuss aspects such as core beliefs and automatic thoughts, and will include behavioral exercises. Recommending certain books and distinct chapters to clients helps them further understand concepts that the therapist is discussing in sessions. This aids in the client’s understanding of CBT, which contributes to the success of the therapy. The last method that enhances psychoeducation is the application of computer technology. A 2004 study found that a computer-assisted approach was more effective than standard CBT, when helping patients gain knowledge about CBT. (Wright et al., 2006, p. 85) This computer-assisted approach also reduced measures of cognitive distortion. Virtual reality is one of the many extremely useful tools these computers have. Programs have been developed to assist in exposure therapy as well as test height phobia, agoraphobia, and PTSD. Experiencing the feared situation can help the therapist conduct in vivo exposure. Critics have questioned how this computer software affects the therapeutic relationships between the client and therapist but studies show that these programs are successful and accepted by clients.

    2. Behavioral activation is effective at reducing client distress because it stimulates a sense of positive movement and hope in the client. Judy Beck shares that many clients have withdrawn from at least one activity that previously gave them a sense of achievement or an activity that lifted their mood. They instead resort to staying in bed, watching TV, or just sitting around. Behavioral activation helps the client become more active and gives them credit for their efforts. This is an important part of therapy because it reduces the client’s stress but also strengthens their sense of self-efficacy by showing themselves that they can take more control of their mood than they previously believed. The therapist will help the client choose an action that could make a difference in how he/she feels. Then the two will develop a brief plan to physically do the activity. Completing a task, such as inviting a friend to dinner, can be an overwhelming step for someone who has depression. Behavioral activation can help this client illustrate how they are going to invite their friend to dinner, and once they complete this task they will get a sense of well being and most likely approach similar situations with the same positive feelings. Partaking in relatively small activities can encourage the client to be hopeful when they decide to attempt challenging activities.

    Reply

  8. Abbey Lake
    Feb 15, 2018 @ 10:19:15

    1.) Psychoeducation is considered a vital component to effective CBT because it not only educates clients but it helps to generate a sense of hope in clients because it teaches them methods that have been scientifically proven to work in the past. For example, a client with severe depression may come into therapy feeling as though they are helpless, but once they learn that others who have also been severely depressed have experienced CBT and are now feeling much better as a result the client may feel a bit more optimistic about therapy and its effectiveness for his/her particular challenges. Psychoeducation also helps the client to build effective coping strategies. Wright (2006) discusses how CBT is based on this idea of teaching clients skills so that they can modify cognitions, control moods, and change maladaptive behaviors. It is important for a CBT therapist to teach these skills well so that the client fully understands and can utilize these skills on their own. The readings also discuss how having psychoeducation can help prevent relapse in clients and also helps clients to learn how to “become their own therapists”. In other words, it helps clients to learn skills that will help them when they are faced with challenges and are no longer in therapy. Much of the work in CBT is done in between sessions and this is only possible through psychoeducation. Mini-lessons, writing out exercises in session, using a therapy notebook, and recommended readings are some of the activities that Wright (2006) discusses as useful methods of psychoeducation. Learning in therapy sessions prepares clients to apply knowledge and skills outside of sessions. This is an important aspect of CBT because CBT requires that both the client and the therapist are active participants in therapy. In regards to psychoeducation the therapist plays an active role in teaching skills and coping strategies to the client and the client plays an active roll in learning these skills and applying them when possible.

    2.) There are many reasons why behavioral activation is effective at reducing client distress. I think one of the main reasons that behavioral activation is so successful at doing this is because it instills hope in clients. It shows the client that positive change is possible. In behavioral activation the client picks one or two particular actions that he/she believes has potential to make a difference in how he/she feels and then the therapist helps the client to make a simple plan to carry out the activity. This helps to instill hope in clients because it shows them that the therapist is going to work together with them to solve problems and that it is possible to make progress and overcome their struggles. Behavioral activation also helps to get the client involved and active in therapy. This alone can help to reduce client distress because it causes the client to focus their energy on positive change in a way that is not overwhelming because its not an attempt to fix overarching major challenges that the client may be facing but rather it is a way to start small and focus on just one or two particular actions to make a positive change. Behavioral activation is a helpful way to get clients to change behavioral and cognitive patterns that are having a negative impact on clients. Beck (2011) makes an important point regarding behavioral activation and depressed clients in explaining that most depressed clients have withdrawn from daily activities that previously lifted their mood and helping these clients to become more active while at the same time giving themselves credit for making these efforts to be more active can help improve their mood and strengthen their sense of self-efficacy. Behavioral activation encourages clients to show themselves that they can take more control of their mood. This realization can significantly help reduce client distress.

    Reply

    • Cassie McGrath
      Feb 16, 2018 @ 19:19:46

      Hi Abbey,

      I really like your description of behavioral activation. You bring up some important considerations with individuals who are depressed and how they lose interest in their everyday activities. I also think that your focus on hope is important. Hope can be a big motivator for a client. If the client has hope that there is a possibility for change and behavioral activation can give them a glimpse of that, I would imagine that their motivation to continue to change would increase. I also think there would be a positive change in self-efficacy if the individual begins to see changes and feel that they are able to make change and feel better.

      Reply

    • Tori Bryant
      Feb 16, 2018 @ 22:22:52

      Hi Abbey,

      I really like that you mentioned not overwhelming the client in your response to question #2 about behavioral activation. Clients who have been inactive, disengaged, or feel helpless may find tasks that are reasonable to someone functioning adaptively impossible. It’s important for the client and therapist to work together to come up with tasks that challenge the client but are achievable and will instill hope, optimism, and increase in self-efficacy. If the client is overwhelmed it is far more likely that they will lose hope in their ability to complete tasks and they may even doubt the effectiveness of therapy.

      Reply

  9. Teresa DiTommaso
    Feb 15, 2018 @ 12:35:20

    1. Psychoeducation is directly tied to the ultimate goal of CBT, in that the goal is for the client to become his or her own therapist by the end of treatment. At the beginning, it is the therapist’s job to take more of a lead, but throughout treatment, and especially through psychoeducation, the client should be able to problem solve on his or her own. That is one of the main reasons psychoeducation is so important. Psychoeducation informs the client why and how these treatments within CBT are so effective. By explaining the mechanisms of the treatments, such as behavioral activation, the client can get a better understanding of how to implement the tools on their own. Not only can clients learn the skills needed to adjust maladaptive behavior and thoughts from psychoeducation, but they can also gain insight that what they are feeling and doing is “normal” for their specific type of suffering. Wright and J. Beck talk specifically about those clients who are suffering from depression, and case examples within both of the texts showed that when the clients understand what depression does to them, they are less hard on themselves. This allows for the client to hope. Hope is extremely important in all types of therapy, but through psychoeducation during CBT, the client can realize and understand that their current problems manifest the way they do for particular reasons and there are empirically supported steps that can help alleviate those problems. Personally, I think educating the client helps with the power balance within the therapeutic relationship as well. Because it is a collaborative process, the client needs to be educated properly if he or she is going to participate in therapy in a positive way. Psychoeducation can also add a sense of structure to the
    2. Behavioral activation, as described by Wright et al. (2006) is all about a simple task that engages the client by stimulating activity and motivating the process of change. A therapist and client can talk about wanting to change or potential ways to change all session, but without appropriate action, no real progress can be made. That is where behavioral activation comes into play. Behavioral activation provides an opportunity for the client to succeed and change, even if it is a simple task. For the distressed client, perhaps getting dressed every day is not an easy task. Therefore, the client and the therapist are able to work together to develop a plan of action for the client to reach said goal. If behavioral activation is done properly, it seems as though it almost always succeeds. If the client is successful in their action, then they are able to gain self-confidence, increase in hope, and a true belief that they can make the necessary changes to be a happy and healthy individual once again. Without this rehearsal outside of session, not much progress can be made. Therefore, without behavioral activation and all the steps that come along with it, therapy would not be very effective in reducing client distress. Behavioral activation also plays a large part in evaluating automatic thoughts of the client. If the client succeeds in their task, then the negative automatic thoughts, such as, “I can’t do this” are challenged and even refuted. Through the combination of behavioral activation and the challenging of automatic thoughts, potential to decrease the distress of the client skyrockets.

    Reply

    • Aleksa Golloshi
      Feb 17, 2018 @ 14:59:53

      Hi Teresa!

      I enjoyed reading about your idea on educating a client because it aids with the power balance. If a client is properly educated and is aware of certain theories and techniques than they will most likely be more confident in the therapeutic process, which is something we, as therapists, can’t teach them. I also like how you mentioned that hope is an important aspect of the therapeutic process. Hope is needed for clients to continue therapy so that they alter their maladaptive behaviors and can live a healthy life. I really enjoyed reading your post!

      Reply

  10. Allexys Burbo
    Feb 15, 2018 @ 14:25:51

    (1) Beyond its educational value, psychoeducation is a vital component to CBT for a number of additional reasons. As the goal of CBT is to help clients move towards positive behavior change by way of their own accord – although collaborative in nature – the ultimate objective is that the experience will encourage independence. In providing psychoeducation, the idea is that clients will obtain the knowledge necessary for facilitating and maintaining change outside of the therapeutic setting. Ideally, in this instance, the client has learned skills vital for sustaining positive change, understands their function within the context of their own personal well-being, and is able to generalize and apply this knowledge outside of the collaborative relationship, in turn, building autonomy. Additionally, psychoeducation aids in the rapport building process. In this instance, the client perceives the therapeutic process as one that is collaborative (that is they too play a major role in treatment process) exemplified in the overt attempt on the part of the clinician to include the client in every aspect of treatment by keeping them informed around components of the therapeutic process and CBT itself. Providing this information in the beginning phases of therapy, especially, may help divert attention from the personal experience of the client, creating a nonthreatening environment and consequently putting the client at ease. Beyond this facet, psychoeducation can also build optimism and motivation increasing the likelihood that a client will remain in therapy and generate a successful outcome. For these reasons, psychoeducation is an essential contributing factor to the effectiveness of CBT.

    (2) Behavioral activation, by its definition, helps to engage and motivate the client in the change process by stimulating a sense of hope and positivity toward change. In the initial phases of therapy, especially, clients may feel discouraged and hesitant to change maladaptive cognitive and behavioral patterns. Because CBT relies so heavily on the collaborative experience of both the client and clinician, resistance to change on the behalf of the client could be detrimental to the therapeutic process. For this reason, behavioral activation is especially important in the early phases of treatment as a means of both building rapport and motivating clients to move towards positive change. Behavioral activation procedures help reduce client distress by encouraging clients to become aware of their maladaptive cognitions and behaviors while, in succession, providing them with a means to reduce those factors which produce psychological pain through specific, goal-directed activities. In the short-term, these specific procedures may potentially provide an outlet for immediate relief. If the client recognizes this feature, and experiences less psychological pain through engaging in behavioral activation tasks, they may feel relief at the prospect of movement towards more positive changes. Initially, behavioral activation procedures are focused around behaviors as opposed to thoughts, allowing the client to become acclimated to the process itself. This strategy also proves less invasive which may motivate the client to be more receptive to treatment and the clinician him/herself. Additionally, as the collaborative nature of CBT allows the client to play an active role in the therapeutic process, upon completing tasks derived from therapy (initiated by behavioral activation) he/she may feel a sense of accomplishment or pleasure, effectively relieving distress and bringing the client closer to their goal.

    Reply

    • Aleksa Golloshi
      Feb 17, 2018 @ 14:57:21

      Hey Allexys,

      I really like how you stated that behavioral activation procedures focus on behavior which make it less invasive and a bit less intimidating to clients, as opposed to focusing on their thoughts. I also like how you included this would most likely motivate clients in terms of treatments. We will probably encounter clients that are hesitant to even see a therapist and so these techniques will definitely help them ease into treatment. It’s a lot less intimidating to discuss behaviors because those are actual facts that a person is doing. Clients might be hesitant to discuss thoughts because they might be afraid that the therapist is judging them for what they’re sharing. Therefore, focusing on behavior is a great place to start.

      Reply

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Adam M. Volungis, PhD, LMHC

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