Monthly Archives: November 2013

CBT Homework Assignments

Cognitive Behavioral Therapy (CBT) Homework Assignments

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that has been empirically tested for the treatment of various mental health symptoms, including depression, anxiety and anger. Cognitive Behavioral Therapy (CBT) is an approach that focuses on the client’s current symptomatology, sets specific goals and devises a plan working with the client to meet these treatment goals. The client’s upbringing and history is addressed in therapy as it pertains to his current symptomatology. One’s learning history may be quite important in determining the etiology behind how someone thinks currently. A key component to effective Cognitive Behavioral Therapy (CBT) involves assigning the client assignments to be completed during the week before the next psychotherapy session. Meeting with a Cognitive Behavioral Therapist (CBT) alone is not nearly as effective as meeting with a therapist in conjunction with practicing the skills learned in therapy throughout the week.

Exposure Therapy Homework

In Cognitive Behavioral Therapy (CBT) there are various types of homework assignments that a therapist may give a client to complete throughout the week. For anxious clients, it is common for a Cognitive Behavioral Therapist (CBT) to assign exposure homework sessions. Exposure work sessions involve having the clients practice exposure to the feared stimulus on his own throughout the week. Exposure therapy with in the Cognitive Behavioral Therapy (CBT) session involves gradually exposing the client to the feared stimuli. Exposure may be imaginal or “in vivo” (in real life). If a homework assignment involves in vivo exposure, the client and therapist work collaboratively to come up with a realistic and doable homework assignment. If a client has a fear, for example, of social situations, he needs greet to complete a homework assignment involving gradually making social plans. If a Cognitive Behavioral Therapist (CBT) is using imaginal exposure, she may record the imaginal exposure therapy sessions and have the client listen to the recording a certain amount of times throughout the week, recording his anxiety level after each imaginal exposure session.

Cognitive Behavioral Therapists (CBT) often assign written homework assignments. During Cognitive Behavioral Therapy (CBT) sessions, a Cognitive Behavioral Therapist (CBT) helps to alleviate negative emotions by restructuring the clients belief system. This involves the Cognitive Behavioral Therapist (CBT) disputing clients maladaptive and unrealistic beliefs. As a homework assignment, a Cognitive Behavioral Therapist (CBT) may assign a client to dispute his own thoughts at home, documenting this thought disputation on a thought log. This type of homework assignment is important in Cognitive Behavioral Therapy (CBT) because it allows the client to learn the skills used in the therapy session in real life. Over time, the client will be able to dispute his own thoughts and no longer necessitate a therapist for this reason.

Another type of homework assignment that a Cognitive Behavioral Therapist (CBT) may assign as part of treatment involves having the clients document activities that occur during the week. For depressed clients, Cognitive Behavioral Therapist (CBT) emphasized the importance of filling up his schedule with activities that he finds pleasurable and one that he feels he has mastered. A Cognitive Behavioral Therapist (CBT) may work with the client to feel his weekly schedule with enjoyable activities, thereby alleviating depressive symptoms.

There are many types of homework assignments that a Cognitive Behavioral Therapist (CBT) may assign as part of effective treatment. However, there are certain techniques that he Cognitive Behavioral Therapist (CBT) may use to ensure homework completion. One common barrier is that clients in Cognitive Behavioral Therapy (CBT) failed to complete homework assignments, for various reasons. It is important for the Cognitive Behavioral Therapist (CBT) to work collaboratively with a client in determining a work assignment. Working collaboratively provides a gauge of whether or not a client will actually complete a homework assignment. It is up to the Cognitive Behavioral Therapist (CBT) to redact a homework assignment if the client has doubts about whether he will be able to complete the assignment. Before a Cognitive Behavioral Therapy (CBT) session is over, the therapist and client should be on the same page as to what the expectations are for the homework assignment and speak about any barriers to its completion. A Cognitive Behavioral Therapist (CBT) should offer suggestions the client about ways to make the homework assignment easier to complete. Homework assignments should be simple and involves practicing techniques that were used in the Cognitive Behavioral Therapy (CBT) session. If a client fails to complete a homework assignment, this should be addressed at the outset of a therapy session. It is helpful for Cognitive Behavioral Therapists (CBT) to work with the client to complete and incomplete homework assignment at the outset of each session, to emphasize its importance. When clients complete their homework assignments, they often feel more confident about the therapeutic process because they see the results more quickly than they would with therapy sessions alone.

Behavior Therapy Parenting

Behavior Management and Parenting

Parents often seek out psychotherapy services to help remediate their children’s behavior problems. There is little evidence to support that play therapy alone is an effective treatment for childhood behavioral problems. For childhood behavior problems to be effectively remediated, it is necessary for parents to be included in the treatment, if not be the sole participators in the psychotherapeutic process. Depending on the age of the child and symptoms, children may be included in very few sessions.

Parental Psychotherapy Intake

Parents first have an in take session for psychotherapy. It is common during the intake for behavior therapists to see a parent explain her child’s behavior problems, and place the blame on the child for the behavior, and frequently fail to see how their own actions or passivity have contributed to these problems. At the outset, parents should be made aware that they will be primary participants in the psychotherapy process. If behavior is the primary issue, behavior modification and parenting skills should be the primary treatment.

Behavior Modification

The first step in parenting skills and behavior modification for the treatment of childhood behavioral disorders is psychoeducation to the parents regarding the process and theory. It is important for parents to understand that every behavior has a specific function. Functions for behaviors are reviewed with parents. People behave for several reasons and for every behavior there is some type of reinforcement that a person is gaining, even if only for a second. People (and children) do not engage in a behavior unless it is in some way self serving.

Functional Behavioral Assessment

Each function of behavior should be explained to parents at the outset of therapy. There are five main behavioral functions that should be explained to parents. The first function of behavior is attention seeking. It is often the case in childhood behavioral disorders, in which the child’s behavior serves the purpose of gaining the parents’ attention. Parental attention may not always be positive. It may be reinforcing for a child to receive negative attention from his parent as well, such as a parent yelling at a child. The second function of behavior that is reviewed with parents is an escape/avoidance. This means, that a person may engage in a particular behavior to avoid undergoing a task that he finds aversive. It is important for parents to understand that if a child is engaging in a behavior to avoid a certain task, they must not give in and allow the child to avoid that take, but persist until the child completes the task that he was trying to avoid. Otherwise, the child will learn that by engaging in this behavior he is permitted to escape from doing what he is required to do. A third function of behavior involves getting something tangible. People go to work because they receive monetary gain. Children cry in a store because they receive candy. If a child receives something tangible for behavior, it is likely that is the function of the behavior. Fourthly, people engage in behaviors due to medical reasons. For childhood behavioral disorders, it is always important for a skilled therapist to rule out medical conditions as a function for specific behaviors. Finally, sensory issues may be the function behind behavior. If a child is flapping his hands for sensory stimulation, the function of the behavior is sensory. It is important for a behavior therapist to rule out sensory issues before beginning a behavioral management program.

Behavior Plans

Once parents understand the functions of their children’s behavior, they are ready to begin devising a plan to extinguish these behaviors. If it is determined that a behavior is attention-seeking, then parents are trained to ignore those behaviors. Parents should be warned that a behavior is likely to escalate before it extinguishes. This is known as an “extinction burst.” The behavior will get worse before it gets better. It is important to review with parents that their resiliency and remaining calm is crucial to successfully extinguishing and attention seeking behavior. Behavior therapists may teach parents deep breathing skills or other relaxation techniques to manage their own emotions when trying to extinguish their child maladaptive behaviors. If the function of behavior is determined to be escape/avoidance, the behavior therapist will work with parents on maintaining consistency and enforcing rules, as not to give into a child’s attempts at avoiding a certain task. It is important for two parents to both be consistent, as well as any other caretakers or babysitters that are involved in child care. Starting a behavioral management program involves setting up tangible reinforcers for the child. This means the child earned something tangible for engaging in specific behaviors. A reward chart is helpful in achieving this. Children may earn a certain number of stars or points, which add up to a specific prize. Similarly, a punishment system may also be put in place if the child disobeys or engages in negative behaviors.

Rational Emotive Behavior Therapy REBT for Anger Management

REBT is a form of CBT

Rational Emotive Behavior Therapy (REBT) is a type of Cognitive Behavioral Therapy (CBT) developed by psychologist Albert Ellis. Rational Emotive Behavior Therapy (REBT) has been shown to be an effective treatment in anger management. Emotive Behavior Therapy (REBT) is to not only define the trigger and emotional/behavioral consequence for one’s anger, but to identify the irrational beliefs associated with the anger response.

Rational Emotive Behavior Therapy (REBT) emphasizes four categories of irrational beliefs that lead to an angry response. It is important for a Cognitive Behavioral Therapist (CBT) to teach his clients that it is not a specific trigger that causes anger, but once irrational interpretations of the trigger that lead to the anger response. It is important for a client involved in Cognitive Behavioral Therapy (CBT) to understand that one of the main goals of treatment is to change his beliefs, more so than the trigger itself.

Awfulizing

In Rational Emotive Behavior Therapy (REBT) the first type of irrational belief that leads to an anger response is called awfulizing. Clients in treatment for anger management often exaggerates the level of hardship associated with any given trigger. They often view negative events as awful, horrible or terrible, rather than something they do not prefer for something that is unfortunate. It is the role of a Cognitive Behavioral Therapist (CBT) to teach clients that such evaluations are drastic and not based in reality. Therapy sessions may involve the client coming up with alternative words to describe various situations or triggers; words that are not so extreme. It is common for a Cognitive Behavioral Therapist (CBT), especially those practicing Rational Emotive Behavior Therapy (REBT) to use, and encourage the client to use, words such as “inconvenient” and “unfortunate,” even “very bad,” instead of extreme words such as horrible or awful. These are more realistic descriptors of common anger triggers. It is important for a Cognitive Behavioral Therapist (CBT) not to invalidate the client’s feelings during this process, but acknowledge that they are experiencing a negative emotion work with them collaboratively to come up with alternative ways to describe the triggering event.

Low Frustration Tolerance

The second type of irrational belief that often leads to an anger response, according to the theory of Rational Emotive Behavior Therapy (REBT) is referred to as a low frustration tolerance (LFT). It is quite common for a client seeking anger management to have a belief that they are unable to tolerate or deal with discomfort or unfairness. Client seeking a management will often say they “can’t stand” certain situations, which is a belief that is not based in reality. A Cognitive Behavioral Therapist (CBT) helps the client to see that in actuality they can tolerate a situation, just that they do not like it. A Cognitive Behavioral Therapist (CBT) helps the client to differentiate between not being able to tolerate something and disliking something. This helps the client to see the world more realistically.

Demandingness

A third type of irrational belief that is the target of Rational Emotive Behavior Therapy (REBT) is called demandingness. Clients seeking Cognitive Behavioral Therapy (CBT) for anger management are often triggered when another person does not adhere to his desires or dictates. Demandingness places inflexible and rigid demands on oneself or other people, which is not based in reality. Cognitive Behavioral Therapist (CBT) help clients to understand the difference between a preference and a demand. Demandingness often involves the belief that one should or must behave in a certain way, which is an irrational way of thinking.

Global Rating

People seeking anger management, often present with a tendency to overgeneralize about certain people. They tend to identify an entire person by one behavior. Clients may also identify themselves based on one behavior. A Cognitive Behavioral Therapist (CBT) helps clients to look at specific behaviors performed by themselves or other people, rather than generalize or stereotype person based on when behavior. It is important for people seeking anger management to recognize that all people to good and bad things, and it is unrealistic to judge or characterize a person based on one negative action.

Rational Emotive Behavior Therapy (REBT) used in anger management has a goal of reducing a clients anger response by first restructuring his irrational beliefs, specifically those irrational beliefs noted above. Beliefs are the way in which people talk to themselves. Teaching clients new semantics of their internal dialogue is a helpful way to restructure their beliefs, and ultimately decrease the anger that results from these beliefs. It is important for a Cognitive Behavioral Therapist (CBT) to not only emphasize these points within the therapy session, but to assign homework assignments for the client to complete throughout the week to practice the skills learned in the session. Clients will over time be able to identify which irrational belief is affecting his emotions and challenges own leads.