Topic 8: Core Beliefs & Behavioral Exposure {by 3/24}

[Core Beliefs] – Watch MDD-16: Core Beliefs – Identifying 2 – Core Belief Flowchart-Part A.  Answer the following: (1) In what way was the CBF-A effective in understanding how the clients’ core belief developed? (2) What additional historical information could have been obtained to understand the development of the client’s core belief?

 

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  (Judy Beck neglects behavioral exposure in her book [2nd ed.].)  For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress?  (2) What are some cautions to consider when implementing behavioral exposure interventions?

 

Your original post should be posted by the beginning of class 3/24.  Have your two replies posted no later than 3/26.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

39 Comments (+add yours?)

  1. Tressa Novack
    Mar 19, 2022 @ 17:44:47

    The Core Belief Flowchart Part A (CBF-A) was effective in understanding the development of Mark’s core belief because it asks questions that target various areas in Mark’s life such as people, events, coping skills, stressors, relevant activities, and sociocultural factors in Mark’s life that contributed to him feeling unlikeable. An example that we hear Mark talk about is his experience with Dave in high school who seemed like he became too cool for Mark. Mark mentions how being unpopular in high school and seeing Dave hang around with popular people made him feel very unsure of himself, and as if people did not want to hang out with him. Then when he recounts his experience with his college roommate, Brian, we can understand how the experience of his friendship with Brian fizzling out reinforced the feelings that Mark’s experience with Dave initiated. The CBF-A also touches on coping skills, and we can see how Mark’s tendency to withdraw can strengthen his core belief that he is unlikeable. We see how stressors, such as stress at work, affects Mark and how these factors affect Mark’s interactions with Melissa and his colleagues. The CBF-A helps clients and therapists take into account the multitude of factors from every area of a client’s life that can develop and maintain a core belief.

    Other historical information that could have been obtained to aid in the understanding of the development of Mark’s core belief is more information on how the high expectations that Mark’s parents held for him affected him later on in life. Mark mentioned it briefly and how it led to him being very hard on himself. Sometimes there truly isn’t more to a situation than what the client mentions, but asking one or two more questions to ensure that it is not more than what the client says might be helpful. Knowing if there were any other family dynamics beyond parental expectations that may have affected Mark could be helpful too. Lastly, looking into how Mark doesn’t feel very accomplished since college could be helpful as well.

    Behavioral exposure is very effective for some disorders and types of distress, such as panic disorder and anxiety distress because it requires clients to face their fears head on. Through exposure clients learn to have control over their physiological arousal and that their worst fears are unlikely to come to reality. They learn that their avoidance of the feared situation only worsened their distress. Through behavioral exposure clients can gain a sense of power and self-efficacy that they were lacking prior to the treatment. Clients will learn that they no longer need the safety behaviors that they had before, and as we read in the vignette in the chapter, they will feel like they are beginning to take their lives back. However, there is some caution that is needed to be had with behavioral exposure. As therapists, we do not want to become “safety behaviors” for our clients. It is important to be present with our clients when initiating behavioral exposure, but we do need to make it clear that the eventual goal is for clients to accomplish these tasks on their own. Furthermore, it is really important to pick an appropriate starting place for clients. We do not want to pick a situation that is going to be too anxiety provoking for our clients and set them up for failure. This can set clients back in treatment, ruin the therapeutic relationship, or completely turn them off from therapy.

    Reply

    • Victoria Cestodio
      Mar 21, 2022 @ 12:09:56

      Hi Tressa!

      I also agree that other historical info I would want to know about is his parents and the expectations they held him to, etc. I mentioned in my post that I think parents are some of the first people who have an effect on our potential core beliefs, and it would be great knowing more insight on that and even his relationships with his parents. However, I like how you mentioned looking into why he doesn’t feel accomplished since college, I think that would be very good info to know and dig deeper on why he believes that.

      In your part about behavioral exposure, I think it’s great you mentioned that we want to make sure our clients are not fully relying on us at the end of it. We will be there for them in the process, however having them know that eventually the goal is for them to accomplish them on their own is crucial to the process.

      Great post!
      Victoria

      Reply

    • Vanessa Nichols
      Mar 22, 2022 @ 12:49:49

      Hi Tressa,
      Great post this week!
      I think you did a great job explaining the core belief flow chart. I also agree with you about the historic information. I also thought more details about his family situation would be beneficial to understand the development of this core belief. However, I think it would be beneficial to put the pressure aspect of their relationship on the shelve until we get to the worthiness core belief. I thought it would be interesting to know more about his parent’s relationship and his parent’s relationship with other people. I think the way our parents live and behave (whether we like it or not) has a huge influence on the way we live and behave. If they have similar beliefs or thoughts process as Mark, they could have been the first ones to influence Mark that people don’t really like them.
      I also think you did a great job explaining behavioral exposure. I like that you mentioned it is important to be there with the client. That is really important, especially based on the example used in Dr. V’s book. If Dr.V had not been there for support and to talk her through some of her emotions, I don’t think she would have made it through grocery shopping. Without him, that failure could have turned her away from behavioral exposure.

      Reply

    • Will Roche
      Mar 24, 2022 @ 14:47:03

      Tressa,

      I think you made some great points about the significance on the historical information regarding the expectations from Mark’s parents. Especially how you highlighted the point in the video where Mark claims he is very hard on himself. I think this can be translated into the idea that if Mark is not “on top of his game” from a social standpoint, that he if failing at being social and friendly, which might lead him to think he’s unlikable. Mark’s need to be liked might be a partial result of his previous high expectations that were set of him. There is a lot of pressure when you have high expectations, therefore it might exacerbate his feelings of self and create more negative core beliefs. Great work!

      Reply

    • Moises J Chauca
      Mar 25, 2022 @ 13:09:40

      Hello Tressa,
      Great post! I agree with you that asking more questions about Mark’s historical information like his parent’s expectations and dynamics is critical to understanding his core beliefs. Mark’s college experience and thoughts about it can influence his core beliefs as they are connected to his parent’s expectations and dynamics as well. Lastly, great job explaining behavioral exposure. You pointed out the strengths and the cautions of having a client participate in behavioral exposure. It is really important to use a gradual model so the client feels ready for the next step.

      Reply

  2. Victoria Cestodio
    Mar 21, 2022 @ 12:04:03

    The CBF-A was effective in manys in understanding Mark’s development of his core beliefs. The questions Dr. V asked within the CBF-A really aimed to gather info about different relationships Mark has had throughout his life, big events, potential traumas, etc. We got to understand how Mark would deal with some of these tough situations, which he still carries through to today, like shutting down and withdrawing. Mark did this a lot within high school and college within different friendships and we see him do this with co-workers, friends, and even Melissa now. I think touching on his experience growing up and his parents was important to touch on. It seems like Mark focuses a lot on non familial relationships when he recounted for a lot of the reasons he may have these core beliefs, however I think parental influence growing up can really shape the way we think and act. Therefore we got to know that the reason he may feel much more pressured at work and even really stressed (even feeling like he is getting looked at under a microscope) could be because of what his parents expected of him when he was younger.

    The additional historical information I think would have been beneficial to obtain would be any past romantic relationships, and more info about his environment with his parents growing up. I think it would be beneficial to know about his past romantic relationships if we could learn more if these relationships also strengthened his core beliefs of no one liking him, or people leaving him in his life (like his friends he mentioned). In regards to his parents or family in general I would definitely like to know more about his life growing up, and other pressures or stress his parents put him through, did he feel wanted and loved growing up?, etc. Like I said previously, I think parents and family are some of the first influences on core beliefs we have in our life.

    Behavioral exposure is a very effective technique because it has our clients face the fear at hand. For example if someone has a phobia of spiders, we will eventually introduce that stimuli to them and have them use coping skills and strategies to learn how to eventually overcome it in a healthy way. Most people who are in exposure therapy, their coping skill is avoidance, whether that be PTSD, phobias, OCD, panic disorder, etc. As we know avoidance can actually be more harmful to the client, therefore having them learn and be faced with these fears slowly adapts them to not avoid and learn how to live when being exposed to the stimuli. They start to learn that the thought of the fear may be more distressing than the actual thing. Such as being afraid of elevators. Our brains make it much worse in our heads than it actually is/will be. The risks of implementing behavioral exposure could be a variety of things. One being for example someone with PTSD, they may get worse before they get better, they have more flashbacks, more anxious moods, more depressed, etc. before the treatment feels as though it is working and benefiting them. We want to be aware of where to start with our clients, such as the elevator example. We are not going to start our first session in an elevator, we may start going near the elevator, having the therapist ride the elevator without the client, etc. We do not want to overwhelm the client and we do not want the client to do anything they are not comfortable with yet, because that can be extremely damaging to progress.

    Reply

    • Vanessa Nichols
      Mar 22, 2022 @ 12:39:09

      Hi Victoria,
      Great post this week!
      I really liked your post this week and felt like you did a great job explaining the effectiveness of the CBF-A. I also thought it was beneficial to get a look into Mark’s past friendships and high school. It was interesting to see that his withdrawal and avoidance behavior occurred even back then. I think it was important to know that this is how Mark has been coping with this core belief for a while.
      I also thought it could be beneficial to get more information about past romantic relationships or rejection and more information about his family. However, I thought with the family it should be focused more on his parents’ relationship and his parents’ relationship with other people. I agree with you that parental influence can really affect the way we think and behave. So I wondered if Mark’s parents think similarly to him and maybe instilled some of these beliefs in him by saying them about themselves.
      I also think you did a great job explaining behavioral exposure. I think what you said about how it can worsen before it gets better is super important. Behavioral exposure is not easy, and the client has to put themselves in a really uncomfortable position and almost react to the anxiety. At first, this can be really rough, and if you don’t prepare a client for that, it could be too much and cause them to discontinue therapy. So I totally agree with you that taking it slow and letting the client be prepared for what will happen is beneficial to successful behavioral exposure.

      Reply

    • Tressa Novack
      Mar 22, 2022 @ 21:23:51

      Hi Victoria,
      Great response! I agree that touching on Mark’s parents is important and we heard a little about them, but not too much to be able to draw a conclusion on how deeply they may have impacted him. He talked a lot about friends rather than family, so it might be good to hear more about that to have a better understanding of how it affected him. However, sometimes we do need to take our clients word for what it is, and there may not be more to something than what they say. There’s definitely a balance we need to learn to strike as therapists. I like that you added in past romantic relationships as historical information that would have been helpful to us. I didn’t even think about that, but it is definitely important. I also like what you have to say about behavioral exposure. I agree that where we begin with our clients is extremely important, because overwhelming them can be extremely detrimental to their progress. Your points area also true that our brains often make our fears seem worse than they actually turn out to be. It’s important that we explain these thought processes to clients when we begin behavioral exposure with them.
      Tressa

      Reply

    • Moises Chauca
      Mar 25, 2022 @ 13:31:08

      Hello Victoria,
      I enjoyed reading your post! You made great points about additional historical information about Mark and explained Behavioral exposure really well using great examples. I agree with your point about gathering information on Mark’s romantic relationship and the environment of his parents as we see that Mark believes that he is not lovable or worthy of it. Lastly, I enjoyed reading your example of behavioral exposure and the integration of the gradual model in your post.

      Reply

  3. Vanessa Nichols
    Mar 22, 2022 @ 12:26:07

    I thought the CBF-A effectively understood how the client’s core belief developed because it systematically broke experiences. The best part of this flowchart is that it helps break down the past without going off-topic or going down a rabbit hole. The flow chart did a good job asking about a recent experience and helping Mark push past those and focus on where/when he remembers feeling similar in the past. I think the information about Dave and Brian was highly significant. I think Dave was the first real loss of a friendship that Mark can remember, and the fact that he remembers not getting information about one of his hockey games and it still was making him emotional today shows how significant that loss was to him. I think because of the Dave experience, the Brian experience was more powerful than it necessarily needed to be. Due to Mark being vulnerable to those feelings of rejection, Brian’s loss of friendship made him again feel like he is an unlikeable person reinforcing the core belief.
    Additional Historical information that could have helped understand Mark’s development of the core belief could be Mark’s past relationships with women or dating experience. This could have been beneficial just to provide more insight into what kind of rejection he has faced. However, I think Mark’s unlikeability stems more from friendship and other men. We do not hear too many problems with him thinking Melissa is losing interest, cheating, or breaking up with him. I also wondered about his parent’s and home life. I know Mark did talk about the pressure they put on him; however, I mean more in regards to his parent’s relationship, friendship, outlook. Sometimes growing up around people who always think people don’t like them or if his parents don’t have many friends, those negative emotions or outlooks can be pushed onto their kids, causing Mark to have this anxiety (at a young age) that people do not like him.
    Behavioral exposure is significant to help alleviate fear and anxiety and decrease avoidant behaviors. Exposure to the feared objects, activities, or situations in a safe environment helps reduce fear and decrease avoidance because you are slowly gaining evidence that the fear and avoidance are unnecessary. Behavioral exposure is essentially a way for clients to face their fears with support and assistance if things go bad. From the book, we learned that Exposure therapy had been demonstrated to be a helpful treatment for Phobias, GAD, Panic disorder, etc.
    It is imperative to take behavioral exposure slow but not too slow. The client must experience a decent range of anxiety while performing the task. This is important, so they feel progress is being made. However, too much anxiety to the point where they cannot complete the task or have a full-blown panic attack would negatively affect treatment. The client could feel this is too much, too scary, or that they are a failure and unable to defeat this anxiety. Doing too much is significantly worse than doing too little because it can turn the client completely off from therapy. It is essential to break down the activities into detailed steps that match where your client is at.

    Reply

    • Jeremy
      Mar 27, 2022 @ 19:05:41

      Hey Vanessa,

      I really lIked your discussion post!. I thought you pointed out the strengths of this tool, that it allows the group to stay on track and not follow to many rabbit holes. Definitely, this is one of the skills that needs bo fostered when working with clients and may be difficult to see how far to exproese certain aspects of their clients live.
      I also appreciate y discussion of behavioral exposure, I think stressing the imratcanto fa not going too slow is often overlooked, The end of the day it really should be well articulated between the client and therapist.

      Reply

  4. Moises Chauca
    Mar 22, 2022 @ 18:59:29

    One was that CBF-A was effective in understanding the development of these core beliefs by identifying the historical events and influential factors like significant individuals and stressors through domain questions that reflect on these factors. In the video, we see how Dr. V questioned Mark about these factors that lead to him describing his experiences with friendships and rejection. Mark shares that he experienced rejection from an experience in high school with his friend Dave, where he felt that he was not good enough to hang out with Dave because he was too cool for him. Then we see how this experience influenced his other experiences later in his life. In college, Mark shared that he felt the same feelings with his friend Brian. In addition, we see that Brian coping skills were withdrawing from other events, so he does not feel like this. We see how these events has reinforced Mark beliefs of worthlessness and not being able to be loved.

    Additional historical information that could be obtained is his romantic and academic experience. This information can aid us to understand any emotional and cognitive experiences that reinforced the unlovable belief. Mark academic experience can tell us if Mark has a negative experience with a teacher or peer about his grades or intelligence ability that could have influenced the core belief. Lastly, it is important to track down Mark parents and friends influence on his beliefs. He mentioned being pressured by his parents, but it would be helpful to see Mark relationship to their parents, is it positive or negative. A negative relationship with significant others can influence these beliefs.

    Behavioral exposure is very effective in some mental disorders because it targets one of the main factors of these disorders that is avoidance and withdrawal. For example, clients with anxiety disorders tend to fear the future outcomes that lead them to avoid going outside. Behavioral exposure is helpful to ease this fear by exposing the client to different situations that cause them fear and teach them coping skills to be able to endure their fear in safe spaces. However, There are some challenges that a therapist might experience from behavioral exposure are the client not being ready to engage or are not able to assess the change in anxiety and fear provoking behaviors. Lastly, some clients might not be ready to engage on specific techniques like in vivo exposure or diaphragm breathing. In this situation, it is recommended to review the purpose of the technique with the client and start with baby steps.

    Reply

    • Tressa Novack
      Mar 22, 2022 @ 21:30:06

      Hi Moises,
      Great post. I like how you pointed out that Mark had the same feelings and experience with his friend Brian as he did with his friend Dave in high school. I noticed this as well. I also like how you pointed out that other important historical information would be romantic relationships and academic history. These are both great points. I talked about how Mark’s relationship with his family would be good to explore, but completely forgot about romantic relationships. I also like how you stated that behavioral exposure targets avoidance and withdrawal. Avoidance behavior can often make our fears and anxieties worse, which is why it is so important to target it! Also, you make a really great point about starting with baby steps. It is crucial to make sure that we do not overwhelm our clients when we use behavioral exposure.
      Tressa

      Reply

    • Victoria Cestodio
      Mar 23, 2022 @ 20:28:01

      Hi Moises,

      I agreed with you on learning more about Mark’s past romantic relationships. However, I think learning about his academic performance would also be good information to know. Definitely seeing if he’s ever been ‘rejected’ by teachers or other types of authority figures could tell us a lot.

      Like you said in your last paragraph, some clients may not be ready to engage in exposure, which is totally ok. However, as therapists we need to know when something may be too much and make sure we are not pushing our clients to do anything they don’t want to do or are not ready for.

      Great post.
      Victoria

      Reply

    • Lauren Pereira
      Mar 23, 2022 @ 21:13:20

      Moises,
      CBF-A is very effective in identifying events and factors to then be able to consider a persons core beliefs. I like how you include an example from Dr. V’s video in order to backup your thoughts. Marks past experiences has really been effecting him and continues to effect the way he thinks about himself. Using the CBF-A gives us a better idea of where he stands with his core beliefs and it identifies more stressors through questioning and more context.
      I think it is a good idea to consider Mark’s previous romantic relationships because this could be part of the reason for why he thinks of himself in a more negative aspect. Being able to identify what his previous relationships were like, it can give us more answers. I also considered the thought of identifying his academic experiences and getting to know what he was like in a school setting because these years as a child are significant and can have big impacts.
      I enjoyed reading the thoughts you had on behavioral exposure because it can be very effective in certain mental disorders. It does target avoidance and withdrawal which can be identified within anxiety. It is important to consider the cautions so that you can do whats best for your client in that situation.
      Great post!

      Reply

  5. Emily Barefield
    Mar 23, 2022 @ 09:26:28

    Using the Core Belief Flowchart was a great way to gain a better understanding of the formation and persistence of Mark’s core beliefs. Parts of this technique reminded me of looking for evidence for and against the core belief. In this case, Mark’s entire life, as opposed to a specific situation of group of situations is examined for evidence for, and to some extent against, the core belief. I appreciated how Dr V. was not super strict with the tool (for example, circling and underlining, or continuing to ask questions when Mark did not answer the question quite right instead of shutting him down), as I think this helped facilitate Mark being able to share insightful information. Asking about situations in the past where Mark has been rejected by others was particularly helpful in explaining his core belief. Friendships in adolescents and even early adulthood can be very impactful in forming how you view yourself, especially in social situations. Mark shares two different stories in which people whom he considered to be close friends truly no longer wanted to spend time with him. This can be really tough, especially for someone who places so much value on relationships with others. I did appreciate that the technique asked Mark what he likes about himself and what he is most proud of. I think the answers to these questions can be useful for Mark to look back on when he struggles with this negative core belief and as he begins to formulate a new core belief. When exploring this core belief, it could be potentially beneficial to look at Mark’s previous romantic history. Perhaps if he experienced a difficult breakup where the core belief that he is unlikeable surfaced, that could be useful to explore. However, it may not be that useful now due to his relationship with Melissa. Digging more into his family history could potentially be useful. The answers to the question “What negative messages did you get about yourself from arguments with your family?” could potentially be providing evidence for Mark’s core belief without him realizing it. I also like the question “Who has influenced the way you think, besides family members?”

    Exposure is effective for certain types of distress because it can provide direct evidence that the individual is able to cope with or can learn to cope with a situation they viewed as overwhelming. Exposure is used to stop the avoidance of the situation which has been continually reinforced when anxiety is reduced by an individual avoiding the situation. Exposure teaches the individual that they can tolerate the distress without harm coming to them. When implementing exposure it is important to consider how fast you as the therapist begin implementing these techniques. It is important that the clients learn that they are able to tolerate these situations. Pushing a client to an exposure activity that they are unprepared for may result in frustration and the reinforcement of the belief that they cannot tolerate the situation. However, it is also important that that the therapist is careful that the client does not become dependent on their presence in order to tolerate a situation. The therapist should provide support at the beginning of the exposure process, and over time the client should learn to carry out the skills on their own.

    Reply

    • Madelyn Haas
      Mar 23, 2022 @ 18:13:11

      Hi Emily,
      Great post this week! I think you did a good job summarizing why CBF-A works well, specifically in relation to Mark. With background knowledge, it makes sense why these current events with Jeff hurt so much. He sees the similarities between Jeff not inviting him out to his high school friend and college roommate drifting away. This information opens up new ways to understand and eventually re-shape his core beliefs.

      I think looking into his past romantic history could potentially be beneficial for his core belief as well. If he has felt rejected in the past by a partner or potential love interest, this feeling could affect how he sees himself. I also think it would be beneficial to look into significant relationships he had with adults in his childhood, like his grandparents or teachers. They could have affected how he views himself significantly.

      You did a nice job in explaining why exposure techniques work. If someone always avoids something, they will never learn that that situation is actually safe/not so bad. Also, it is important to note that the therapist should mention to the client that anxiety will likely be very high in the beginning of exposure. Normalize that but explain to the client that it will pass with time and practice, and that it is ultimately beneficial for them in their day to day lives.
      -Madelyn Haas

      Reply

    • Lexi
      Mar 24, 2022 @ 13:45:49

      Hi Emily

      I appreciated your discussion of hoe Dr, V chose to use the tool and I agree his approach was helpful essentially in keeping Mark feeling motivated and engaged rather than frustrated. As we watch more and more videos with Mark I think it is striking how much more confident and empowered he is becoming as the therapy progresses. You really get a sense that he is establishing a level of confidence and autonomy that is important to foster and encourage. Asking Mark what he likes about himself is I agree, important in helping to sustain the positive view of himself that is forming. Creating more accurate or helpful core beliefs is so important in the case of someone like Mark who is struggling with feelings of being unworthy or unliked.

      Reply

  6. Will Roche
    Mar 23, 2022 @ 13:25:19

    The CBF-A is an integral part of understanding the underlying reasons beneath Mark’s core beliefs because it helps look into specific events in which the origins of these core beliefs began to grow. The CBF-A looks deeper into the past in terms of trying to recollect memories that spurred such ideas in Mark’s head. The event in which Mark’s friend Dave in high school began to slowly distance himself from Mark after time when Mark wanted to be closer with Dave really affected how Mark began to think about himself. Similarly, in college when Mark experienced a similar situation, this further exacerbated this core belief that started to solidify itself into Mark’s belief system. This reinforcement of the belief in college after it already happened to Mark in high school just deepened the wound of the idea of unlikability and had further impacts on Mark down the road. Now that Mark is working, he finds similar doubts within himself and his ability to remain connected with his colleagues. Whenever there is a doubt in this belief that he shares a connection with someone, his unlikability core belief appears and has negative impacts on Mark’s mental health. The fact that the CBF-A is capable of uncovering these aspects of a personal shows how important it can be when discovering the origins of a person’s core belief.

    I think it would be important to get a stronger understanding of Mark’s historical experiences with women/past relationships. In the memories he recounts of his unlikability, he expresses these issues with friends who are typically men, yet he has what seems to be a stable relationship. I’d be curious as to if these feelings about friends could also translate to prior histories with other women and if he has experienced similar disconnects with women over time and if it’s had any impact on this core belief idea of unlikability. Furthermore, if any events did happen in past relationships, were they hurtful enough to worsen this core belief? Overall, I think his past romantic relationships should also be closely considered as they are with his platonic relationships.

    Behavioral exposure is an interesting area of therapy because it appears to teeter on a line for those with severe anxiety about certain scenarios. Systematic desensitization is an effective measure of behavioral exposure because it can slowly help people cope with their stresses of reliving or facing the stimuli that causes their phobia/panic/distress etc. For many cases, behavioral exposure is important because it might be unhealthy to live a life of complete avoidance of that situation. Someone who was in a traumatic car accident would eventually need to be reintegrated into a lifestyle of comfortability of being in a car so they can maintain a healthy and normal lifestyle. While this is no easy task, it is evident that certain situations may require that to happen. Therapists must use caution when implementing behavioral exposure techniques because it can backfire and make the situation for their client worse. Overall, behavioral exposure can be vital for some patients so that they can be systematically desensitized enough so that they can return to living a normal and healthy lifestyle.

    Reply

    • Madelyn Haas
      Mar 23, 2022 @ 18:03:39

      Hi Will,
      I enjoyed reading your response this week. I think your point about the reinforcement of his core belief in college is great. Maybe if he hadn’t had the experience with his friend in high school, he would not have been so hurt by the situation with the roommate. Two significant friendship losses can hurt a lot more than just one. It is interesting but unfortunate how beliefs often build up over time, even with non-traumatic incidents.

      I think your point about his past experiences with women could be good to look into as well. We have not heard him talk about his experiences, either positive or negative, with women besides Melissa. Social rejection always hurts, but it can be especially painful if it is from a romantic partner or a person someone is romantically interested in. I also think it would be important to look at adult figures from his childhood, like teachers or coaches because they can shape someone’s views about themselves significantly.

      I think you summarized behavioral exposure well. It is important as a therapist to use this technique accurately and effectively. A clinician should consider safety behaviors and the level of difficulty that would benefit their clients. It is also important to warn clients that anxiety will probably increase in the beginning, but that it will subside with practice and experience. Great post!
      -Madelyn Haas

      Reply

    • Lexi
      Mar 24, 2022 @ 14:04:23

      Hi Will,

      I was also thinking about how it is interesting that Mark only shares experiences of being rejected my males in his high school / college/ professional peer groups and not in romantic contexts or by women. I wonder why that is or if it just speaks to his security with his girlfriend Melissa. In any case I agree that any potential romantic rejection would be helpful in building the understanding of how this core belief came to exist and remain a part of his operation. Agree with you too that there is definitely a striking pattern in Mark carrying over the perceived rejection by male peers that he experienced in high school and college and kind of “projecting” that experience onto Jeff at work now as an adult professional. Think its clear that these experiences left a big impression on Mark and that he is kind of “reliving them” by generalizing these feelings and perceptions in newer relationships and situations.

      Reply

  7. Lauren Pereira
    Mar 23, 2022 @ 15:51:29

    The CBF-A is effective in understanding how the clients’ core belief developed. This core belief flowchart is meant for focusing on specific events and topics that pertain to clients situations which is how it helped Mark. It was able to focus primarily on the people in Mark’s life, the plans he schedules with them, as well as the important stressors and skills needed to be used throughout his coping process. The CBF-A helps to get a grasp on the best coping skills for Mark’s to use depending on his core beliefs. This structure was able to help us develop better questions to help Mark and it was able to give us more explanations on how he has felt or dealt with certain stressors throughout the processes. Mark spends a lot of time doubting himself and he needs to have reassurance, beginning with the situation he had with Dave in high school and now later in life he has also questioned his colleagues and whether or not he is liked by them. In order to find the best coping skills for Marks core beliefs, it is important to determine the core roots of his feelings in these certain situations to get a better picture of why he may feel or act the way he does.

    Other historical information that could have been obtained to better understand Marks core belief would have been the relationship he established with his parents, and the relationships he had experienced in elementary school with his peers and teachers. First, one of the most important relationships to consider is with the two individuals who raised Mark. These people are most important in determining how he was brought up and the type of environment he was surrounded by throughout his younger years. This can determine how they interact with people and how they cope. It would be interesting to know if Marks parents were more strict or lenient with him and how it could impact him today. I think his elementary school years is also an important time to figure out how he interacted with children at school and if he played with everybody or if he was a child to play more on his own. It would also be interesting to find out how he interacted with teachers and if they gave him the appropriate amount of time and attention in the classroom. It would be nice to see how he developed in his first few years of schooling and how he did with his academics as well.

    Behavioral exposure can be very effective for certain types of disorders and feelings of distress. This type of action gives the client the ability to face their fears, head on. In many cases, if a client is experiencing anxiety, it can be beneficial for them to be exposed by different fearful situations in order for their worries to be more at ease later on. This is also a good coping skill to use since it gives the client more control over their own thoughts and they will be more prepared for what is to come. Clients can then begin to feel more self aware of what is going on around them and they can gain a sense of confidence.
    When implementing behavioral exposure interventions, we do want to keep in mind some cautions that can come along with it. First, we want to start off with a task that we know our client will be comfortable in accomplishing because we do not want to immediately be setting them up for failure. This can negatively impact the therapeutic relationship and they may not want to continue on with that same type of exposure. The other direction this could go would be if you use the exposure too slow rather than too abrupt. You want to make sure the behavioral exposure is still providing the client with some anxiety in order for the exposure to be effective and complete. If the client doesn’t feel any changes or does not feel accomplished in their tasks, it could turn them away from therapy and they may give up quicker. These reasonings are why it is so important to take behavioral exposure seriously and identify what needs to be available to the client in order to help them overcome their fears.

    Reply

    • Monika
      Mar 24, 2022 @ 12:15:27

      Hi Lauren,
      Great response. After learning a little about Mark’s history, we know that he developed an unhealthy way of coping, i.e, withdrawing from situations. And so, I agree with you that CBF-A helps get a grasp on the best coping skills for Mark’s use. It also helped us in learning more about Mark’s thinking patterns(self-blame and self-doubt), which can be modified further down the sessions. In the case of Mark, exposure therapy can help him replace his negative core beliefs with neutral or positive ones and develop good coping skills. I also agree with you in the case of exposure therapy we should start with a level that the client is comfortable with, not doing so can not only traumatize the client further but also impact the therapeutic relationship negatively.
      You made really good points.

      Reply

  8. Madelyn Haas
    Mar 23, 2022 @ 17:54:32

    The CBF-A chart is effective in showing how a client’s core beliefs developed because it goes into detail about current situations, past events, stressors, cultural background, and significant moments/people that shaped these beliefs. In Mark’s case, he can point to specific events that shaped his belief. He points to two serious friendships that he feels like fell apart that could reflect on him as being “unlikeable.” He had a high school friend that drifted away, and he also had a college friend/roommate that drifted away. While others may easily deal with changes in friendships, these two events made him consider that maybe he isn’t worth being friends with. The CBF-A puts these past events in context with current events (e.g., Jeff going out to lunch without inviting Mark). These connections gave context to why Mark feels unlikeable and why the lunch event felt like such a rejection to him.

    Going into more past beliefs, although we have a pretty solid understanding of his core beliefs, could help to understand the situation even further. I think looking into significant adult figures from his childhood would help. Whether they are his parents, his grandparents, teachers, they could really shape how he feels about himself. He did briefly mention that his parents had high expectations for him, but other than that he did not point out anything his parents said or did that hurt him. For that reason, asking about other significant adults could be important. Teachers and coaches have such a big influence on children’s lives, so it is important to discuss them when appropriate. One other important aspect could be his relationship with peers as a child. He mentioned that he felt hurt by both his college roommate and high school friend, so it would be interesting to ask about other peers or friends from elementary into middle school to see if there was anything more to it.

    Behavioral exposure is a useful therapeutic technique, especially for those who anxiously avoid certain situations/fears. Behavioral exposure is effective because it teaches people that their fears/anxieties are not always valid or as scary as they once thought. When someone anxiously avoids something for so long, they build up negative expectancies about that situation. By exposing the client to their fear (with prepared coping skills and plans), it allows them to test the situation. Once they get through the situation, they slowly unlearn the maladaptive avoidance behavior. As mentioned earlier, it works especially well for those with anxiety disorders and related disorders (e.g., phobias, OCD, etc.). It is effective because it works to slowly diminish a client’s anxiety surrounding a specific situation by testing whether that anxiety was warranted or not. Although behavioral exposure is a great technique, therapists should make sure to warn their clients about a few things before trying it. First, therapists should specify that the client’s anxiety will probably increase initially before it decreases. This can be incredibly distressing for clients, so it is important to note that it is normal and will diminish with exposure and persistence. Second, one consideration is a client’s “safety” behaviors. Although these behaviors can relieve anxiety temporarily, they are usually maladaptive and will work against the exposure technique in the long run. It is important as a clinician to figure out these safety behaviors and to work with the client to phase them out in the long run. Third, one final thing to be cautious about is not making the behavioral exposure experiments too small, as the client will likely not get any sense of accomplishment, or too big, as the client will feel very anxious, probably will not follow through, and/or will feel like a failure.

    Reply

    • Lauren Pereira
      Mar 23, 2022 @ 20:57:00

      Madelyn,

      I do agree that the CBF-A effect put Mark’s past events in context with current events. It considers the effects of how his core beliefs have been developed as well. I like that you included to mention the two main scenarios that he had shared about both his high school and college friend. This helps to indicate how losing these friendships has made Mark feel about himself over the years.
      I also think it would be beneficial to look into the adult figures Mark has been surrounded by throughout his childhood. These types of individuals would make a big impact on a child and how he looks at himself.
      Behavioral exposure is a great technique and I agree that it can be effective, especially in individuals who struggle with anxiety. They tend to try and avoid certain situations and this exposure can help them get over their fears.I also considered the cautions of these experiments being too small. It can definitely be too big as well so it is important for the therapist to find the right amount of balance so that they do not effect the therapeutic relationship. This exposure can be very risky for clients if not used correctly.
      Great post!

      Reply

    • Monika
      Mar 24, 2022 @ 12:03:32

      Hi Madelyn,
      I really enjoyed reading your post this week, you have done a great job and covered all the relevant points. I especially liked the point you mentioned that looking into significant adult figures from Mark’s childhood could also help in further exploring his core belief. We don’t have much idea about Mark’s parents, grandparents, and their relationship with Mark. I think people start internalizing things if they are experiencing the same sort of thoughts and feelings with more than a person or setting. So, learning more about his family can be beneficial in getting to the root cause of his core belief. Also, I agree with you on warning clients about behavioral interventions before beginning so the clients are mentally prepared, this is crucial to avoid further trauma.
      Great Post!

      Reply

    • Will Roche
      Mar 24, 2022 @ 15:00:31

      Madelyn,

      I like how you had a unique take on what historical information should be looked further into. Without being to psychodynamic/Freudian, I agree it’s certainly necessary to see what adult figures had an impact on Mark’s developmental growth throughout his childhood, teenage years and early adulthood. Perhaps there were significant things he learned from his parents, family members, family friends, teachers, coaches, etc. There are definitely many things that can be considered when looking into historical information and what could have led to these core beliefs. Similarly, his friendships or acquaintances with peers in school/sports could also impact his feelings of unlikability and his other core beliefs. If he had multiple scenarios similar to the situation he had with Dave, it’s definitely something worth looking into and determining if there are other factors that contribute to Mark’s core beliefs. Great post.

      Reply

  9. Monika
    Mar 24, 2022 @ 11:54:52

    CBF-A helped in exploring the history of Mark’s core belief. We can see how his past experience with his friend Dave, especially in adolescence, kind of started to shape his core belief of I am ‘unlikable’. The flowchart also helps us understand how Mark’s relationship with Dave made him feel and the kind of negative thoughts he started getting about himself. Also, Mark developed unhealthy coping mechanisms like withdrawal which could have made things even more difficult for him to handle. He tries to distance himself from whatever is stressing him out, I think he just avoids stressful situations without confronting them or dealing with his emotions. But doing this Mark can get temporary relief but he’s just suppressing his true emotions.

    I think some more information on the dynamics of the kind of friendship they had, would have been useful. We know Mark has a tendency to self-blame, even with Jeff, he thought Jeff didn’t want to go to lunch with him because Jeff doesn’t want to hang out with him. But in reality, Jeff was just busy. So, with Dave, there is a possibility that there could have been a different reason why he didn’t inform Mark about the game he wanted to go see. In adolescence, popularity and peer relationships tend to hold more importance and that could be the reason why the incident with Dave affected Mark so much. Exploring more evidence for this belief(Dave is more popular and doesn’t want me to be his friend because I am not that popular) could have been useful in understanding Mark’s core belief.

    Behavioral exposure techniques are mainly used in the early or middle phase of therapy to help clients deal with anxiety-related distress and help them cope better with stressors. Research has demonstrated the effectiveness of behavioral exposure techniques in treating anxiety-related disorders. It tries to target situations that the client is trying to avoid. These techniques also help clients change their behavior patterns which in turn helps them deal with the negative thought pattern. Exposure therapy can significantly reduce an individual’s anxiety symptoms and increase a person’s willingness to approach uncomfortable situations but facing your fears can be difficult and so exposure therapy can be uncomfortable and challenging. We don’t want to expose our clients to situations that they are not ready to face. Taking a small step at a time becomes important in order to avoid making the client feel more anxious or tortured. Exposing clients to situations where the level of anxiety is more than they can handle may lead to a client dropping therapy altogether. Not performing exposure therapy properly on the therapist’s part can lead to more trauma or fear.

    Reply

  10. Lexi
    Mar 24, 2022 @ 13:38:09

    The core belief flow chart was a helpful tool in this case in terms of understanding how the core belief developed. The flowchart asks questions that are effective at leading the client to identify origins of harmful core beliefs – it draws attentions to the events and people who Mark has interacted with / experienced that may have led to the formation and the maintenance of the harmful core beliefs that are now causing him distress. Core beliefs are formed early in life and can be rather rigid especially if the belief has been reinforced throughout the client’s life. The CBF-A helps identify these relationships. Mark talks a lot about his past, and experiences of feeling unpopular or rejected by members of his peer group in high school and in college which he seems to become aware contributed to his core belief of being unliked, or unlikable. This experience also identifies that Mark’s tendency to withdraw and to ruminate in response to these perceived rejections perpetuate and reinforce this belief of being unliked. This exercise is to helpful in establishing the things that contributed to the formation and maintenance of core belief and how our reactions can help to maintain those as well. The CBF-A can be used to assist clients who may be unaware of what factors contributed to their negative emotions and core beliefs.
    Additional historical information that could have been obtained in order to understand the development of the client’s core belief would be perhaps instances of perceived rejection from parents, teachers, or past romantic partners, maybe employers. Early relationships and the patterns of rejection, or of feeling inadequate would be helpful in learning more about the development of Mark’s negative core beliefs. I would like to know when Mark first started to perceive himself as unlikable, what age did he begin to view himself this way across different types of relationships.
    Behavioral exposure is effective for certain types of disorders or distress because it forces a client to “face their fears” and to ideally become desensitized and be able to build their perceived self-efficacy about their ability to cope with that stimulus that causes them distress in the future. This building of self-efficacy and coping skills in regards to the target stimulus is what makes this approach so effective at dealing with certain forms of mental disorder or psychological distress – notably anxiety disorder, panic disorder, phobias etc. Clients learn that they CAN cope with these situations and they are able to identify that their avoidance behaviors are more harmful than protective in many instances.
    When using behavioral exposure with clients a clinician should be aware of or cautious of the fact that for many clients, change needs to be gradual – and not to push the clients too much and cause them further trauma. If a client with PTSD or severe agoraphobia as an example is pushed too quickly, it may cause more harm than good. It is also always important in therapy to make sure the client understands the process and realizes that the goal is to create a life for them when they no longer need the assistance of a clinician to use these skills – they should not feel too reliant on the therapist instead they should feel empowered and confident in their own ability to cope with distress.

    Reply

    • Pilar Betts
      Mar 27, 2022 @ 00:46:21

      Hello Lexi,
      It’s an excellent idea to incorporate incidents of rejection involving teachers, his parents, past relationships and employers into the history of Marks core belief. This would give us an idea of whether he feels unlikeable in all social settings or only certain ones because so far he’s expressed mainly feeling rejected in social settings such as school, work, and in close friendships. Identifying how early these patterns would allow us see if this belief generalizes to all areas of Marks life or only some.

      I liked your explanation of behavioral exposure, I agree that changes need to be made based on the clients pace not a set timeline everyone is different and pushing the client too far too fast can be damaging and cause even more distress.

      Reply

    • Jeremy
      Mar 27, 2022 @ 19:24:02

      Hey Lexi,
      I agree that we should be looking for this pattern of thought to see where and anywhere it may arise. This defiantly means that exporting how it may manifest in specific environments will be helpful to know as the client attempts io find the sources of the problem.
      I liked your explanation on behavioral exposure and agree that a big focus should be on the client self-actualizing and not feeling dependent on the therapist, a large part of the therapy focuses on teaching that the client is capable of coping by themselves.

      Best,
      Jeremy

      Reply

  11. Sandra Karic
    Mar 24, 2022 @ 15:49:10

    I think the Core Belief flowchart was very effective at gathering information that demonstrated how the core belief formed, events and relationships that solidified the belief, what protective factors were present in the past, and how the additional stress at work activated it recently. I think Mark talking about how his friend ditched him during high school and the “I’m too cool for you” attitude definitely helped show how the belief developed. I also valued the information about how the events in college that seemed to bring up the belief were mitigated by the forced socialization aspect of college life. It’s a lot harder to withdraw from people when you’re living in a dorm, but as an adult Mark has been able to socially withdraw to a much greater degree than before. The ability to withdraw coupled with the increased stress at work affecting Mark and his coworkers, as well as some inconsistency with his friends really illustrated how the belief was exacerbated recently. I think some additional historical information that could have been useful would be some more information about the type of expectations Mark’s parents had. I was wondering how they reacted to him during moments of achievement and failure, and how that might have contributed to the pressure Mark puts on himself. I also wondered what Mark wants or wanted to accomplish, but that may be more beneficial to dig into later in therapy.

    Behavioral exposure is very effective with disorders that involve anxiety and fear. One of the reasons it is so effective is because it breaks the pattern of avoidance and negative reinforcement. This allows clients to actually face the feared stimuli. Fear cannot kill you; I think a lot of clients worry about passing out, having a heart attack, or “losing control” in regards to panic attacks specifically. However, there is no way for them to learn on an emotional level that this won’t happen without directly confronting the feared stimuli. I think one of the main things to be cautious of with this intervention is not moving too quickly. If a client participates in an exposure exercise to soon, or in one that’s too scary too soon, the intervention could backfire and confirm that the situation is as unpleasant as the client believes it to be. That’s why I think making the hierarchy and having a broad range of situations (ones with low levels of apprehension and high levels) is so important. Additionally, I think this intervention would not work well if the therapeutic relationship is not strong. The client needs to trust the therapist and the rationale for the intervention if they are to follow through with it. Finally, it is important to balance supporting clients with not fostering dependency.

    Reply

    • Emily Barefield
      Mar 25, 2022 @ 11:04:43

      Hey Sandra,

      I enjoyed reading your post this week! I liked how you talked about events that occurred in the past both that contributed to the creation of the belief and that acted as protective factors. You also did a great job go explaining the more recent events that have activated the belief and how these events differ from those in the past. I do think that exploring parental expectations could certainly be beneficial for understanding the pressure Mark puts on himself. Exploring this could help determine if the pressure is internal or external nature.

      You did a great job highlighting that behavioral exposure is so effective because it breaks the patten of negative reinforcement that is responsible for maintaining the behavior. I agree that timing and the therapeutic relationship are important to consider. Also avoiding fostering dependency and becoming a safety behavior as a therapist is also an important consideration.

      Reply

    • Pilar
      Mar 27, 2022 @ 00:59:46

      Hello Sandra,
      I also noted the fact Mark talked about college not allowing for him to distance and isolate himself whereas in adulthood it is easier to isolate himself. This was a really interesting parallel of life before and his life now him being able to notice the way he is coping isn’t helpful in combatting the core belief shows how far Mark has come in therapy. Including more history on how his parents expectations influenced Marks core beliefs would definitely be helpful in further understanding where those beliefs originated because before friendships Mark most likely looked for validation from his parents first.

      I liked your discussion of having different ranges of exposure and build up to the more intense/harder exposure situations yo allow for the client to not feel rushed and overwhelmed. Reiterating the importance to maintain your clients trust is also an important factor when using behavioral exposure.

      Reply

  12. Jeremy
    Mar 24, 2022 @ 17:08:24

    This method was beneficial for mark as it allowed him to consider the broad scope of things that has shaped his core belief over time. He was able to look at events over his life to identify the formation of his core belief, and also was able to consider how his coping skills and stressors played a role in maintaining his brief. The conversation naturally leads into a good mindset to discuss current events and recent stressors through a more understandable and full lens that can lead to an aha moment or allow them to gain better insights. Certainly, Marks’s college years are a significant stressing event, it may be possible to identify earlier childhood and familial interaction that could have reinforced his behavior. I would also be curious to see how his more recent social practices are presenting, what spaces does he avoid because they make him more uncomfortable and prevents him from making consistent out of work friends.

    Behavioral exposure works by repeatedly exposing the individual to stressful stimuli in small and approachable ways, this makes it very beneficial to disorders that are primarily reinforced by withdrawal and avoidant behavior, The most obvious example being targeting specific Phobias. These skills are best because it teaches these individuals that they are capable to deal with stress and exposure. erapists need to be cautious when implementing behavioral exposure because. It is important not to expose them quickly and without proper psychoeducation. Overexposure can cause more harm than not doing the exposure, slowly starting the process and gradually increasing the level of exposure is a good way to get the client familiar with the process.

    Reply

    • Emily Barefield
      Mar 25, 2022 @ 11:12:53

      Hi Jeremy,

      You did a great job highlighting that the core belief flow chart technique allowed Mark to look at a wide range of events, stressors, and coping skills that contributed to the development and maintenance of his core belief. Discussing various patterns of thoughts and behaviors that have contributed to the core belief helped Mark gain more insight regarding his distress. Exploring Mark’s childhood and familial interactions could certainly be interesting. Perhaps his desire to be liked and please others comes from an early social or familial interaction. Examining his patterns of avoidance could also be beneficial.

      Behavioral exposure is beneficial in helping individuals learn that they can cope with stressful or feared situations. Proper psychoeducation and ensuring the process is not rushed are important considerations when conducting behavioral exposure techniques.

      Reply

    • Sandra Karic
      Mar 27, 2022 @ 23:12:40

      Hi Jeremy,
      Good job explaining how the core belief flowchart showed the many different events that contributed to Mark’s negative core belief and the effects of current stressors, such as the increased pressure at work. I also think it would be interesting to look at how early familial factors may have been involved. Lastly, I think you did a great job explaining how behavioral exposure targets avoidance behaviors. I also think that the risks of overexposure are something to be mindful of when utilizing this intervention.

      Reply

  13. Pilar Betts
    Mar 24, 2022 @ 18:56:43

    The Core Belief Flowchart part A is a helpful step towards working with the client to form new beliefs, the questions in the first section of the chart require that the client answer questions that help to reveal possible precipitating events that lead to the core beliefs creation. In the video with Mark, when he was asked about some past events that could have confirmed or reinforced his core belief. Dr. V was able to ask leading questions based on the chart which helped to reveal other times Mark has felt unlikable such as with his friend Dave in highschool and his college roommate . I thought it was really interesting how Mark began talking about the past immediately when asked what he likes about himself. And when asked what he likes to do he started talking about traits he possesses and past activities he has enjoyed. Both times he had to be redirected to the question. By doing this activity Mark is able to connect relationships he’s had in the past to the current relationships and see how his behaviors and thoughts were similar in both situations and was able to talk through and identify that in response he tends to withdraw and acknowledges that in college it was a lot harder to withdraw compared to now in adulthood. I think this was a very important realization for Mark that the withdrawal behavior was always present; it just weighs on him heavier now. It would have been nice to know more about the history of how he felt he needed to do well to keep his parents well because this involves those feelings of worthlessness and to the pressure he puts on himself. This would help to build more on why that reassurance Mark looks for in relationships is present. He looks for cues that people like him and that he is doing well in work. Which we see demonstrated when he talks about how awards and grades were validation that he was doing well in college but at work there are no grades or awards so he feels pressure to do well at work. Having a more detailed account of the history of the dynamic between him and his parents would be valuable insight for his current behaviors.

    Behavioral exposure is effective for certain disorders such as certain anxiety and phobias because the situations being avoided will continue to be avoided until they are confronted. By helping the client to confront the distress they will gradually be able to learn to cope in the future when exposed to that stressor. Behavioral exposure shouldn’t be used for certain disorders such as agoraphobia and panic disorder. It is also important to make sure the client isn’t using some of the breathing and coping exercises as a mean to cope with the stressor before it occurs, this is important because this is still a form of avoidance and behavioral exposure forces the client to experience the stress and then learn how to cope with it as it is happening and that way they can truly work towards reducing or removing that stressor in their life. While at the same time you don’t want to go overboard with behavior exposure, a therapist should make sure to continually check in with the client to make sure they are ready to move forward in the process, to much too soon can be damaging if you aren’t careful so it is helpful to take things step by step and talk through those thoughts and feelings frequently.

    Reply

    • Sandra Karic
      Mar 27, 2022 @ 23:07:39

      Hi Pilar,
      Great job explaining how the core belief flowchart illustrated the creation of Mark’s negative core belief. I also thought it was very interesting that Mark immediately began listing things he “used to” like about himself instead of things he currently liked about himself. Additionally, I agree with you that it was important for Mark to see how long he has been withdrawing and it’s effects. Finally, I think you did an awesome job explaining how behavioral exposure is really helpful for some disorders.

      Reply

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Adam M. Volungis, PhD, LMHC

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