In this assessment task you will write an assignment that (1) examines the application of Motivational Interviewing (MI) as an assessment tool and t

Topic overview

In this assessment task you will write an assignment that (1) examines the application of Motivational Interviewing (MI) as an assessment tool and then (2) explores the use ofonetherapy model (cognitive behavioural therapy, dialectical behaviour therapy, acceptance and commitment therapy, family therapy or narrative therapy) to develop interventions in keeping with the consumers stage of change.

Assessment criteria

This assessment will measure your ability to:

Introduce your topic, purpose, aims and structure of your assignment (3 marks)

Provide a detailed case study of a consumer including their stage of change (3 marks)

Present a discussion on the application of motivational assessment to change (10 marks)

Present an overview ofonetherapy model that would fit with this presentation (12 marks)

Consider future recovery recommendations for this consumer considering their stage of change and the work that will need to be conducted to facilitate recovery-oriented change (10 marks)

Conclude your assignment (3 marks)

Writing and use of literature to support your work (4 marks)

Guidelines

Follow these points to structure your assessment.

A title page.Use the cover sheet provided on the Assessment page.

Introduction.Introduce your topic and present the purpose, aims and structure of your assignment.

Case study.Provide a detailed, thorough and succinct case study that provides a clinical context for the ensuing discussion. This should include information that sets up the three main sections of the assignment.

Application of MI to assessment.Explore the principles of MI and theirapplication to theassessmentof a consumer's readiness for change.

Consider ONE therapy modelfor this consumer by exploring the literature and presenting an overview ofonetherapy model that would fit with their presentation and readiness for recovery-oriented change.

Examine future recovery recommendations for this consumer, considering their stage of change and the work that will need to be conducted to facilitate positive recover-oriented change.

Conclusion. Provide a conclusion that summarises the key points from your assignment.

Reference list.All references are to follow APA7 style. Students are encouraged to paraphrase sources of material in their own words wherever possible. Excessive use of direct quotes may result in a decreased grade. Non-acknowledgement of other authors is considered as plagiarism according to University policy and will result in a fail grade. Ensure your in-text reference citation equates to your end-text list of references.

NOTE: It is very important that you support your ideas with an adequate quality and quantity of relevant, contemporary literature (presented in APA7 format). As a clinician you are undoubtedly familiar with the catch phrase evidence based practice as being the essential foundation of contemporary mental health practice. In completing this assessment, you need to make sure that your work adheres to this catchphrase, and you do actually provide adequateevidence(in the form of literature) to service as abasisfor yourpractice-based discussion.

Submission format

.

You are required to write in academic format, in third person and utilising appropriate professional terminology.

Use the APA 7th edition referencing style for all in-text citations and your reference list.

Format your assessment with double-line spacing and 12-point font.

Set left and right margins at 2.5 cm.

Use appropriate section headings (as outlined in the assessment structure section above) to identify each section of the assignment.

Word count does not include reference list, title page or any appendices.

ead the following edited excerpt from a longer transcript of a conversation with William Miller about the origins of MI, which was published in the journalAddictions. Note how Miller indicates how MI is used well when it is used in conjunction with another type of therapy. Use your journal to make notes about the background of MI so you can understand the origins and influences. Make notes about the acronym FRAMES.

Answer the following question:

Can you think of an example of a use of MI and then a therapy that could be helpful for a person to make change in their life?

Note: in the below passage,A= words spoken by theAddictionseditor andWRM= words spoken by William R. Miller.

A:Okay. Lets talk about how you started to focus on motivation.

WRM:Well, its more happenstance. I went off . . . to Norway on my first sabbatical leave. This one I spent at an alcoholism hospital near Bergen, the Hjellestad Clinic . . . Jon Laberg, the director of the center, asked if I would also meet with a group of psychologists who were working there . . . I agreed, and we began meeting. What they wanted to do was to role-play some of the more difficult cases they were seeing.

A:Clinician role-plays usually are harder than real therapy.

WRM:Right no client is really as difficult as the client role played by a therapist but I did not know that then, so I just did my best. I noticed that they interrupted me frequently, which is related to the philosophical, reflective, analytic way in which psychologists tend to be trained in Europe. They would stop me and ask, What are you thinking now at this moment in this session?; You asked a question there. Why did you ask that question, because there are other things you could have asked?. They were really good questions. I began verbalizing a set of decision rules that I had been using that I was completely unaware of, that had to do predominately with having the client make the arguments for change. I was avoiding doing so myself, not being the person responsible to say, You have a problem and you need to do something about it. And, also, eliciting their confidence and hope, but especially having the client make the arguments for change. I began writing down these decision rules as they were emerging, and gave it the working title of motivational interviewing. If I had called it anything else, I think it would have been motivational conversation. I sent this to a few colleagues, for discussion and comments, including Ray Hodgson. To my surprise, Ray wrote that he wanted to publish it in Behavioural Psychotherapy, which he edited. I told him that I had absolutely no data but he said that was fine, he thought it was an important contribution and he would like to publish it. It appeared in 1983, and I figured that would be last I would hear of it. I came back to New Mexico and began conducting some studies on brief interventions designed to elicit motivation for change. That is how the Drinkers Check-up emerged.

A:So first you were still thinking that something structured needed to occur?

WRM:Yes, there is a lot of structure to that. I was thinking of this as something you would do to encourage people to get into treatment . . . The Drinkers Check-up arose because we had done a literature review on effective brief interventions . . .

We wondered, If it does not always work, what is true of the studies where the brief intervention did work? That is where FRAMES came from . . .

A:For people who do not know aboutFRAMES, would you run through the acronym?

WRM:FRAMESis an acronym for six things that often appeared in effective brief interventions: giving peopleFeedbackabout their individual status on assessment variables, emphasizing a personsResponsibilityfor change, clearAdviceto change and aMenuof options for doing so. The E isEmpathy, because whenever we asked authors about the counselling style, which often was not described in the articles, it was a supportive, empathic, respectful style; the S is support forSelf-efficacy.

Those things together in various combinations seemed to be there most of the time in the brief interventions that worked, so my thought was Let us be intentional about that and try to build something from the ground up that would beFRAMESfrom the very beginning. And that is where the Drinkers Check-up came from, which is a combination of the motivational interviewing style with giving people structured feedback from assessment, both pieces of which seem to have an independent impact.

In the first study with the check-up we gave people treatment referral information and expected a higher rate of entering treatment. It did not happen. Almost nobody went to treatment, but the people who had the check-up had the gall to do better on their own. We replicated that in a later study, finding that people responded rather well to a single session of what has now come to be called motivational enhancement. These first studies were with self-referred problem drinkers from the community, which might be considered an easy population, so the next question was what would happen with more severe populations. Here we had a series of three studies in which we assigned randomly people coming into a treatment program to either have a motivational interview or not. Janice Brown did one at a private residential treatment program, Tom Bien did his at the Veterans Administration adult out-patient program and Lauren Aubreys dissertation was done at CASAAs substance abuse treatment program for adolescents. They were conducted in different years by different investigators, but they all had the same basic design

A:These were all PhD students of yours?

WRM:Yes. Each study had a similar finding, which was essentially a doubling of the abstinence rate for people randomly assigned to receive the motivational interviewing session, in comparison to people receiving the same treatment program without an initial motivational interview. On virtually any drinking outcome variable, there was a much larger reduction in drinking in the MI group, even though both groups received the same treatment program otherwise . . .

So there were three studies with large effect sizes, and these effects were all in addition to treatment as usual. Something that we found later, in Jenny Hettemas meta-analysis of MI studies, is that you actually get the most enduring effects of MI when it is added to another active treatment, which is sort of surprising because you have beaten the effect of the active treatment itself. But what I think is happening is that motivational interviewing and the active treatment are both working better because they are synergistic.

Source: Miller (2009, pp. 887888; emphasis added)

mbivalenceAmbivalence is a central concept in MI that restson the assumption that people are ambivalent about change versus weak or resistant to doing so. Its an optimistic approach to change aimed at resolving this ambivalence through eliciting and reinforcing change talk. Ambivalence needs to be addressed for people to be able to change.

On one hand a persons current behaviour has some rewards, but on the other hand a change in behaviour is also appealing. Thus, there is a constant back and forth about making changes.MI attempts to tip the balance of this ambivalence into the change direction.

Lets take for example a person thinking about exercising more. A decisional balance exercise can help people to make decisions. These activities also reveal the persons willingness to change. They may say they want to / must change but the reality is they have more reasons to stay the same. If you look at the two lists below, you can see how ambivalence can occur. There are reasons to make a change but there are also reasons to stay the same; sometimes the reasons to stay the same simply outweigh the reasons to change. Do you think the person in the example below will make a change?

Reasons to stay the same

They really enjoy sitting in front of the TV watching Netflix.

They have paid for the gym before and not gone.

They dont have anyone to go to the gym with.

They dont really like working out with weights.

They have a very busy work schedule and tend to stay after hours. Reasons for change

They would like to lose a few kilos before they go on holiday.

Increasing activity could lower their blood pressure (which is consistently high).

Exercise classes could motivate them and make them feel part of a group.

They may feel better about themself and less tired if they regularly exercise.

Spirit of MI

MI is doneforandwitha person nottooronthem. MI involves compassion, which means to actively promote the others welfare and to give priority to their needs. Compassion is not just a feeling or emotional attachment but rather a commitment to pursue the welfare and the best interests of the other. MI also involves evocation, which means an exploration of the clients own beliefs this is important because motivation to change is elicitedfrom the person. Some tips for successful motivational interviewing are outlined below.

Assume the resources and motivation for change residein the client do much more listening than talking.

Listen and value the clients own ideas about what might work best for them this requires trust and letting go of the belief that the counsellor knows best.

Provide acceptance, which is comprised of four parts:

display unconditional positive regard (respect the person as they are)

autonomy (value the others right and capacity for self-direction)

affirmation (seek to acknowledge a persons strengths and efforts)

validation (display empathy and convey a sense of worth and belief in what the person is saying).

For MI to work, the clinician should foster a partnership dynamic with the client the distribution of power should feel balanced. While the client may not be motivated in the precise direction the clinician would like, well-executed MI involves connecting positive behavioural change with a persons goals, values, aspirations and dreams. To achieve this, the clinician needs to:

understand the clients perspectives

evoke the clients own reasons/arguments for making the change.

MI doesnotinvolve:

arguing that the client has a problem that needs to be changed

offering direct advice

prescribing solutions without actively encouraging the client to make their own choices

doing most of the talking and focusing solely on imparting information.

If you find yourself doing these things, youre not understanding the spirit of MI.

Learning journal: The spirit of MI

Use your learning journal to complete this activity. Thinking about the spirit of MI and its components partnership, acceptance, compassion and evocation when have you experienced these four components from someone in your own life? Who was person who did this for you? Explain what they did to convey this to you, and describe what you appreciated. Make notes under the four spirit components.

Partnership

Who surprised you by treating you as an equal, a collaborator? Who served as a guide for you?

Acceptance

Who communicated deep acceptance of you just as you were?

Compassion

Who was concerned for and committed to your wellbeing, maybe even placing it before their own?

Evocation

Who brought out the best in you? Who saw strengths or talents in you that you didnt know you had?

Now think about how you can incorporate these ideas into your own practice.

Adapted from: Miller & Moyers (2020, p. 4)

Topic 2: Motivational interviewing and change talk

Motivational interviewing (MI) is a style of counselling that can be utilised to work towards change. The major goal of this type of counselling is to have the client consider change and set their own goals towards this change. The technique works well with our understanding of the clinician/client therapeutic relationship. The clinician works as a facilitator to assist the client to look at their behaviours and the consequences of these behaviours. The client is then required to convey their goals to the clinician. Thus, the client is focused on a future goal and both the clinician and client are certain of this expected outcome.

MI aims to avoid traditional confrontational methods. It is client-focused; the client decides what changes they are prepared to make. This counselling style has many applications. It can assist the client to work towards abstinence or a reduction in drug use. However, because the style requires the client to make the choices, it may require adaptation in clinical settings where the client is expected to have a goal of abstinence.

It is important to note that change is a difficult thing to ask of a client. Think of a time when you have had to change something about yourself. Sometimes it is easy, sometimes you achieve it with difficulty, sometimes you may have had to adapt your goal so you can at least partly achieve the desired change, sometimes you may have given up all together. An example that springs to mind is dieting. How many people do you know who go on a diet? How many of them succeed?

MI requires a facilitation of consumer change talk and a reduction in sustain talk. Miller and Rollnick define change talk as any self-expressed language that is an argument for change (2013, p. 159) and sustain talk as the persons own arguments for not changing, forsustaining the status quo (2013, p. 7). People can do this in the same sentence here is an example:

Ive always wanted to give up smoking for good, (change talk) but I cant imagine a day without a cigarette (sustain talk).

We may assess that the person is not ready for change but by engaging with change talk we are asking the person to talk about change and not feel defeated before they even start. The clinician may say:

You are saying that giving up smoking has been a lifelong ambition of yours. Whats been stopping you from embarking on this change?

This response should seek that the consumer goes deeper and questions their reluctance to change. We also engage in change talk because we do not want to give up on the person or make an assumption that they are just not trying hard enough or that they dont have the capacity to change.

Motivation to change

Morrison (2010, p. 310) asserted that to assess a clients motivation, a clinician must understand the interaction between:

an individuals beliefs, feelings and behaviour

past, present and future expectations and goals

the individual and significant others

personal and environmental resources, opportunities and constraints.

Morrison suggests that behaviour change especially long-standing behaviour that is embedded in the consumers underlying belief systems is more likely to happen if the clinician appreciates the underlying context and drivers of the behaviour. Iannos and Antcliff (2013) posit that:

It may not be helpful to think of [consumers] as being either motivated or unmotivated to change, but rather as continually dealing with motivational conflict between their desire to maintain the status quo and the desire for change . . . Understanding the meaning and strength of these conflicting motivations is essential to engaging and facilitating a persons readiness to change.

Morrison (2010) suggests that the task here for the therapy is to understand the context, meaning, strength and flux of conflicting motivations to be able to engage and assess for protective motivations of the consumer.

Dangerous assumptions to make about change

It is important to be a reflective clinician and remain client-focused. If you find yourself making any of the following assumptions, which were identified by Rollnick and Mason (1995, as cited in Australian Government Department of Health, 2004) as dangerous assumptions, you will need to reassess the relationship you have with your client.

This personoughtto make a change

This personwantsto make a change

This persons health is a prime motivating factor for change

If the person decides not to change, the intervention has failed

People are either motivated to change or not

Nowis the right time to consider change

A tough approach is most effective

Im the expert. He or she must follow my advice.

Eliciting change talk

Developing questioning strategies to elicit change talk is a key skill in motivational interviewing. Change talk has been defined as:

statements by the client revealing consideration of, motivation for, or commitment to change. In MI, the therapist seeks to guide the client to expressions of change talk as the pathway to change

(MIR, n.d., p. 5, as cited in Iannos & Antcliff, 2013)

The following table lists a range of key questioning strategies for evoking change talk and some examples of applications of these strategies.

Strategies for evoking change talk

Strategy Example

Ask evocative open questions:the answer to which is likely to be change talk. In what ways does this problem concern you?

How important is it for you to make this change? What/who needs to change?

So what do you think youll do?

Ask for elaboration/examples:when a change talk theme emerges, ask for more details. Ask the consumer to give specific examples. Tell me more about how you would manage living alone.

When was the last time you had a good day?

Give an example of what a good day looks like.

What do you notice about yourself when are having a good day?

Explore decisional balance:ask for the pros and cons of both changing and staying the same. What are the pros and cons of making changes in your life?

Looking back questions:ask about a time before the problem emerged. How were things better, different? How were things better/different before you lived alone?

Looking forward questions:Ask what may happen if things continue as they are (status quo). Invite the consumer to address their ambivalence and highlight the benefits of change and the negative consequences of not changing. How would you like your life to be five years from now?

How would things be better/different if you made changes?

If you were 100% successful in making the changes that you want, what would be different in your family?

Query extremes:explore the advantages and disadvantages of not changing. What are the best things that might happen if you do make this change?

What are the worst things that might happen if you dont make this change?

Use change rulers:to explore readiness to change. On a scale of 1 to 10, how important is it to you to change [the specific target behaviour], where 1 is not at all important and 10 is extremely important?

Follow up with: And why are you at a __and not a __ [higher number]? What might happen that might move you from a __ to a __ [higher number]?

Explore goals and values:ask what the consumers guiding values are. What do you want from life?

What does being a good person mean to you?

Come alongside:explicitly side with the negative (status quo) side of ambivalence to invite the consumer to argue for change. Perhaps drinking alcohol to cope is so important to you that you wont give it up, no matter what the cost.

Source: Adapted from Iannos & Antcliff (2013, Table 2)

MI tip of the day: hungry for change talk [02:56 min]

Watch the following video which has tips about engaging a person with change talk even when they are using sustain talk. Make notes in your journal of cues a consumer can give you and responses you could use that would evoke more change talk.

Transtheoretical model or the stages of change

The principles of thetranstheoretical model also called thestages of change model have often been used in tandem with motivational interviewing (DiClemente & Prochaska, 1998). The transtheoretical model identified five components of the change process:pre-contemplation,contemplation,determination,actionandmaintenance.It is important to note that the change process is not always linear; people may jump forwards and backwards between these stages. The task for therapy is to understand which stage of change the person is at and to tailor the response accordingly, with the clinicians goal being to support consumers as they move towards theactionanddeterminationstages to facilitate real change in their lives and behaviour (Iannos & Antcliff, 2013).

Consumers may have multiple issues they want to change and might be at various stages of change across those issues, but it is unrealistic to expect clients to change overnight. The transtheoretical model can be a useful tool for the clinician to use in identifying where the person is at with change. While each client will move through the stages of change within a different timeframe, the goal is to get the client to action as soon as possible. The figure below outlines the stages of change. Click on the plus signs to explore the different stages of change.

Source: Adapted from Prochaska & DiClemente (1982)

The stages of change model [02:35 min]

The following video illustrates the stages of change/transtheoretical model. Use your journal to make notes about this and think about a situation where a person was in each stage of change.

Nine steps to motivational interviewing

Opening

As always, commence the interview with a greeting, introduce yourself and then establish the reasons why the interview is taking place. You may also like to place a timeframe on the interview.

Decisional balance

Explore with the client the good things about their drug use and then explore the not-so-good things. You may need to ask probing questions to help the client to tell their story.

Summarise

Tell the client what you have heard and seek confirmation of this. If you are ever stuck during the interview, an effective summary of what has occurred tells the client that you have heard their message and provides the client with permission to continue.

Positively reinforce

Make sure you acknowledge the client for thinking of change or any movements towards change. Remember change is a difficult process and clients need to hear that they are doing well.

Use paradox

You can try asking the client how the rest of the world views them when they are using drugs. Maybe walk them through a situation with their family.

Focus on the future

Ask about their future plans and how their drug use will fit into or hinder these goals.

Explore goals

Consider goals that are appropriate and manageable.

Explore willingness to goal set

Ask the client how difficult it will be to achieve their goals. Discuss the problems that might occur along the way and discuss possible solutions (e.g. a client who has a social function coming up where they will be in contact with a drug of choice may wish to explore alternatives to using this drug, or ways of cutting down so they dont use to excess).

Obtain commitment

Give the client a task to complete (e.g. reflective diary) until your next session. If you want the client to be honest, the client needs to be aware that the exercise is for self-discovery. Make it clear that the diary will not be used to judge their patterns of use at the next session.

Note

Most importantly through each the above steps, the client should be doing most of the talking. If you find this is not happening, utilise open questions, reflective listening and summary, and try interpreting their body language. Remember: when in doubt, or if you feel the conversation is in the doldrums, summarise, summarise and summarise again to keep the client moving.

Motivational interviewing good example Alan Lyme [09:23 min]

View the following video and make notes in your journal of the key questions this clinician uses to engage the person with a MI for assessment. Note how the conversation keeps intercepting with change talktype questions.

Activity: Case study Liz

Liz is a 39-year-old single woman who works as a waitress. She has been referred to you from the local general practitioner for help with her amphetamine use. She lives alone in rental accommodation and has a cat as a companion. She has a strong relationship with her parents, who are only recently aware of her drug usage and are concerned.

Liz has been using amphetamines over the past two years. This use has escalated in the past nine months. Currently she uses daily, often alone in the morning, socially with friends and at work (to get through the shift). She is now overcommitted financially and unable to pay her expenses and maintain her habit. She has never looked at change or her patterns of use in the past.

At what stage of change is Liz? What is the reason for your answer?

Utilising the nine steps to motivational interviewing, formulate a question to ask Liz under each of the following headings:

Opening

Decisional balance

Summarise

Positively reinforce

Use paradox

Focus on the future

Explore goals

Explore willingness to goal set

Obtain commitment

Multiple-choice example question

To help you in preparing for the quiz (Assessment 1), there will be an example multiple-choice question at the end of each topic; these will give you an example of the sorts of questions you should expect to find in the quiz. Here is the exaple MCQ question for Topic 2.

Last modified: Thursday, 3 August 2023, 2:34 PM

Topic 3: Using motivational interviewing principles and skills to facilitate change

Engagement

In motivational interviewing the clinician should focus on developing trust and rapport toengagethe consumer before working towards change. Morrison (2010, pp. 321322) noted that MI should be conducted in a collaborative spirit that motivates [people] to engage in the [change] process, and which enables them to identify their strengths whilst feeling to take ownership of their difficulties.

The clinician can achieve this by listening to the consumer empathically and reflectively (to understand their point of view), and by avoiding argumentation and conflict (both of which may serve to strengthen the persons resistance to change; Iannos & Antcliff, 2013).

We will now outline two useful mnemonics devices you can use to remember strategies to use in motivational interviewing: REDS principles for working with ambivalence and OARS for eliciting change talk.

REDS principles

The mnemonic REDS, which is outlined below, will help you remember four basic strategic components of motivational interviewing:roll with resistance,express empathy,develop discrepancy andsupport self-efficacy.

Click on the below headings to reveal further information.

Roll with resistance

Express empathy

Develop discrepancy

Support self-efficacy

OARS skills

Clinicians can apply the following four skills/techniques to facilitate the REDS principles with consumers (represented by the acronym OARS):open-ended questions,affirmations,reflective listening andsummarise.

Click on the below headings to reveal further information.

Activity: The OARS approach

Considering the OARS approach and using your journal to make notes read the following consumer statement, answer the questions and make any notes you feel appropriate about OARS.

I have been feeling really unhappy lately in my relationship. I have been with my husband for 15 years and I love him, but I dont know if Im in love with him anymore. Hes a wonderful father, and I dont think I want a separation or anything because I dont want to do that to my children. Its not like hes an awful husband either. Im just not happy. Im only 43 years old, Im not ready to give up and just be unhappy for the rest of my life, and if things stay the way they are right now thats what my future looks like. I feel so stupid because I have a really good life. I wish I could just get over it and learn how to be happy.

What would be your OARS response to the following questions?

What reflections might you offer?

What could you appreciate and affirm what was said?

What open questions might you ask?

What summary would you offer of what was said?

Source: Miller & Moyers (2020)

Multiple-choice example question

To help you in preparing for the quiz (Assessment 1), there will be an example multiple-choice question at the end of each topic; these will give you an example of the sorts of questions you should expect to find in the quiz. Here is the example MCQ question for Topic 3.

Discussion: Use of motivational interviewing

Discussion

In this discussion you willcomplete a quick search of evidence to support the use of MI in a variety of settings and consider MIs use in your clinical specialty.

Your task

Reflect on and answer the followingquestion(s):

MI has been used in a variety of ways. What evidence exists for its use in substance useorpsychosisordepressionorcoachingormotivating students or eating disordersorengaging people for a COVID-19 vaccine?

Thinking about your own clinical specialty, how has MI been used in practice?

Choose to either attend the online tutorial to discuss the above questions, or post your response to the discussion forum below.

CBT

Topic 1: The behavioural and cognitive approaches to therapy

Explore the origins of the cognitive therapy model and explore its influences and the principles and concepts central to this model

Explore the origins of the behavioural therapy model and explore its influences and the principles and concepts central to this model

Topic 2: REBT and CBT and principles

Identify and explore the key principles and practices associated with the REBT approach

Identify and explore the key principles and practices related to the CBT approach

Explore the application of CBT and discuss the way it is used in treating consumers

Topic 3: CBT practice and allied health

Examine two pieces of literature that provide examples of the use of CBT in allied health mental health practice

Weekly tutorials (non-compulsory)

This subject will have weekly online tutorials commencing in Week 2 of the term and running to Week 5. There are no tutorials in Weeks 1 or 6.

In this subject you have a choice to participate in the online tutorial or you can do this work autonomously by posting to the discussion thread and reading other peoples comments. We recommend that you attend the tutorials but they are non-compulsory and the same discussion can be conducted asynchronously via the weekly discussion thread.

These sessions are live and about the weeks' content andnot assessment. There are discussion threads for each of the assessment points. We strongly recommend that students attend the session; however, if you are unable to make the session time, you are able to post to the weekly discussion thread on this weeks topic question.

If no students are in the session 15 minutes post the session start time the session will be cancelled.

Below are links to the various topics in this week of learning. Click on Topic 1 to get started with the learning for this week. If you have already started this week of learning, you can resume your studies at any of the below.

Arrows at the bottom of the topic pages will take you to the next page within a topic, or the next topic. Otherwise you can return to this weekly landing page or the home page of this subject by using the tiles on the navigation bar on the left of this site.

Good luck with your studies this week!

Cognitive behaviour therapy (CBT)

The term cognitive behavioural therapy is ubiquitous in the contemporary Australian mental health system, and while its applicability and effectiveness are widely accepted, the complexity inherent in the term CBT is less clear. CBT is more accurately described as an umbrella term for several different therapies that share common elements. Cognitive and behavioural therapy (CBT) involves an integration of a combination of techniques that draw upon the principles of both cognitive therapy and behaviour therapy models along with much of the elements of REBT. All these models are founded on the belief that healthy thinking leads to healthy feelings and behaviours, and as such, CBT has a high success rate because it combines the techniques of these effective therapies.

Built on the premise that negative and unrealistic thoughts can cause distress and result in problems, CBT argues that when an individual suffers with psychological distress, the way in which they interpret situations becomes skewed, which in turn subsequently results in a negative impact on the actions they take. CBT, therefore, aims to help individuals develop greater insight into:

their core beliefs

the way in which these core beliefs influence negative interpretations and thoughts associated with the situations facing them

the effect this has on their behaviours, which will often actually reinforce the distorted thinking.

This tends to follow the following process:

The individual experiences inaccurate, irrational or negative thoughts in a particular situation that contribute to their experiencing emotional distress.

These inaccurate, irrational or negative thoughts result in the individual experiencing psychological or emotional distress, which can, in turn, lead to unhelpful or harmful behaviours that are engaged to reduce the level of distress the individual experiences.

Over time, these inaccurate, irrational or negative thoughts and their resulting behaviours become entrenched and become the default pattern of thinking and behaving for the individual (along with the harm that these cause).

This cycle can be broken by the individual identifying the irrational or negative thoughts that they hold (and can therefore exert some control over) and learning how to address and change these patterns, replacing them with healthier, more functional thoughts, which will lead to changes in their behaviours which in turn can help reduce future distress.

Adapted from: Corey (2020); Raypole (2019)

Principles of CBT treatment

CBT therapists use an individual formulation to guide treatment for each client. This formulation is essential to developing a sound therapeutic relationship, setting goals, planning treatment and selecting interventions. These are guided by the following fourteen core tenets of effective CBT:

CBT treatment plans are based on an ever-evolving cognitive conceptualisation.

CBT requires a sound therapeutic relationship.

CBT continually monitors client progress.

CBT is culturally adapted and tailors treatment to the individual.

CBT emphasises the positive.

CBT stresses collaboration and active participation.

CBT is aspirational, values based and goal oriented.

CBT initially emphasises the present.

CBT is educative.

CBT is time sensitive.

CBT sessions are structured.

CBT uses guided discovery and teaches clients to respond to their dysfunctional cognitions.

CBT includes action plans (therapy homework).

CBT uses a variety of techniques to change thinking, mood and behaviour.

Adapted from: Beck (2020)

Uses for CBT

CBT is used for a wide variety of mental health issues and conditions in the Australian mental health system, with a particular emphasis on the following conditions (Healthdirect, 2019):

anxiety disorders including generalised anxiety disorder, panic, phobias and social anxiety

obsessive-compulsive disorder

post-traumatic stress disorder

depression

eating disorders

relationship issues

anger and stress-related issues

substance use and abuse issues.

That said, potential uses for CBT are very broad, given its inherent flexibility, focus on the present, and emphasis on the clinician and the consumer collaborating on the development of a treatment plan that meets the consumers unique needs. Ultimately, CBT is a relevant treatment option in any situation where the consumer is experiencing irrational, unhelpful thoughts, which are, in turn, leading to unhelpful, problematic patterns of behaviour, which are causing them problems in their life. This means that while CBT might not be effective as an intervention to directly treat the intensity or frequency of psychotic symptoms in a consumer with schizophrenia, it may well be very effective in assisting them in identifying, challenging and changing unhelpful thoughts and behaviours associated with their lived experience of having a major mental illness.

The core practices associated with cognitive behavioural therapy

As previously discussed, CBT is not a single-treatment approach. Rather, it draws on a wide range of different techniques from the schools of behaviour therapy, cognitive therapy and rational emotive behaviour therapy. As indicated in the 14 core tenets above, there is no singular approach that is mandatory with CBT; instead, CBT therapists will utilise a wide variety of different techniques that are most likely to help the consumer that they are working within any given situation. According to the American Psychological Association (2017), CBT focuses on identifying and changing unhelpful thinking patterns and their associated behaviours utilising the following strategies.

CBT strategies to challenge irrational and unhelpful thinking

Supporting the consumer to learn how to recognise the distortions in their thinking that are creating problems in the way they behave, and then assisting them to review and revise these in light of reality.

Supporting the consumer to gain a better and more accurate understanding of the intentions and motivations behind the behaviour of others, seeking to challenge irrational beliefs about the motives of others.

Supporting the consumer to learn and use problem-solving skills that will help them manage difficult situations more effectively.

Supporting the consumer to develop a greater sense of confidence in their own abilities, particularly as their abilities grow with the support of the therapy.

CBT strategies to challenge unhelpful and problematic behaviours

Supporting the consumer to face their fears rather than avoid them.

Supporting the consumer by using the technique of targeted role-play to help them to prepare for potentially problematic interactions with others.

Supporting the consumer to develop techniques such as deep breathing, mindfulness and progressive muscle relaxation to help them calm their mind and relax their body.

CBT also places a strong emphasis in therapy on what is going on in the individuals life at the present time, rather than focusing on the historical events and experiences that led up to their current difficulties. Some information about an individuals history is needed to help with context, but this should not become the main focus; CBT focuses on working in the here and now in order to help the individual in developing more effective ways of coping with life.

CBT also promotes the importance of individuals learning to develop skills that are not reliant upon the involvement of others, thereby allowing them to become their own therapists. To accomplish this the exercises conducted in the therapy sessions, as well as the homework exercises set outside of sessions, are all designed to support consumers in developing self-reliant coping skills and strategies that will allow them to continue to change their own thinking, problematic emotions and behaviours as these arise in the future. In this sense, CBT fits exceptionally well with the recovery model, which also seeks to promote consumer independence and control rather than ongoing reliance on mental health service providers.

Adapted from: APA (2017)

CBT involves the use of a wide range of techniques depending on the needs of the individual. These will vary from person to person, but the most common techniques include:

Guided discovery and questioning: this technique involves exploring and questioning the assumptions that an individual holds about themself or about their current situation. They can begin to consider different viewpoints and use these to challenge any irrational or unhelpful beliefs they may hold.

Journalling: this technique involves asking the consumer to write down and describe any negative beliefs that come up between sessions (include the situation in which they occurred) as well as asking them to reflect and write down any potential positive beliefs that they could adopt instead (exploring the effect this might have).

Self-talk: this technique involves asking the individual what they tell themself about a certain situation or experience, exploring the evidence to support their negative self-talk and then challenging them to replace negative, critical self-talk with compassionate, constructive self-talk and exploring how this affects their thinking and behaviour.

Cognitive restructuring: this technique involves asking the consumer to examine any cognitive distortions currently affecting their thoughts; this might include things such as black-and-white thinking, jumping to conclusions or catastrophising. Once the consumer has identified any that exist, the focus will move to examining and then disputing and unravelling them.

Thought recording: this technique involves asking the consumer to identify any independent, unbiased evidence that provides support for their negative belief as well as any independent, unbiased evidence that argues against it. This evidence will then be examined, with the lack of evidence supporting the consumers irrational core belief along with the evidence supporting a more realistic belief used to help them challenge irrational, unhelpful thoughts.

Setting and reviewing SMART goals: this technique involves using SMART goals (being specific, measurable, achievable, realistic and time-limited) to provide a clear structure for planning and developing new thoughts and behaviours that the consumer will apply moving forwards.

Positive activities: this technique involves asking the consumer to schedule a rewarding activity each day that has no purpose other than it makes them feel good. Positive activities help to increase the consumers overall sense of positivity and enjoyment of life and, as such, can have a positive impact upon their mood.

Behavioural activation: this technique involves a brief intervention that aims to increase engagement in activities that will elicit a positive response from the individual (usually linked to the experience of pleasure or mastery) while minimising the time spent by the individual on activities that increase negative thoughts and emotions (such as staying in bed all day ruminating about their issues).

Situation exposure / systematic desensitisation: this technique involves asking the consumer to identify situations or things that cause them distress and organise these things in an ascending order based upon the level of distress they cause the individual. Once this has been agreed upon, the consumer is gradually asked to engage in each situation until they lead to fewer negative feelings.

Setting and reviewing homework: this technique is a central aspect of CBT regardless of the other techniques being used, as it supports the consumer to practise and develop the skills they worked on in the therapy session to ensure these are carried out into the consumers real world where they can be tested and revised as needed.

Activity: A CBT session in action

The following video provides you with an opportunity to observe a CBT session being simulated in a fairly accurate manner (interjected with some areas of explanation as well). For this activity you need to watch the video and then respond to the following questions. [23:09 min]