presented by: alissa gleacher, phd the center for mental ... · written agreement for preventing...

Presented by:

Alissa Gleacher, PhD

The Center for Mental Health Implementation and Dissemination Science for Children, Adolescents and Families

at New York University Child Study Center

Empirically Supported Treatment (EST) ◦ CBT has been studied through research

◦ CBT has been compared to other therapies

◦ CBT has been found to be more beneficial than other treatments for specific disorders

Cognitive Behavioral Treatment

•Thoughts

•Thinking Patterns •Responses

•Behavioral Patterns

•Intervention

•Active

Type of therapeutic intervention

Model of how to view children’s problems

Provides a structure for sessions

Specific therapeutic techniques ◦ Set of techniques that when applied together in a

specific order and structure have been effective in treating many different disorders

Cognition Emotion Behavior

The CBT Model:

•“I am stupid”

•“I never do anything good”

•“No matter how hard I try,

it’s no use”

•Sad

•Disappointed

•Withdraw

•Get upset

•Throw Something

•Get Aggressive •Frustrated

•Angry

What factors are maintaining the child’s behavior?

What are the child’s strengths/weaknesses in coping?

What other factors influence the problem? Peers Parents School

Label problematic thoughts

Use emotion as a guide for thoughts

Identification of problem behaviors

Classes of problems:

Internalizing Anxiety

Depression

Shyness

Externalizing Impulsive

Aggressive

Oppositional

Internalizing Externalizing

Over-Controlled Under-Controlled

Think

Emotion

Do

Physical

Reaction

-“I can never do anything right” -“I am a failure” -“I am dumb” -“I hate school, I don’t want to do this”

-Yells

-Acts aggressive

-Defies authority

-Muscle tension

-Physiological arousal

-Frustrated

-Hopeless

-Angry

-“I don’t want to have a panic attack”

-“If I have a panic attack at school, no one will help me” -“Other kids will laugh at me” -“I am going to die” -“No one can make me go to school” -“No one understands”

Think

Emotion

Do

Physical

Reaction

-Avoid school and other locations

-Physiological arousal: shaking,

sweating, increased heart rate,

butterflies

-Anxious

-Panicked

-Worried

Let’s review another case:

◦ Please use the chat box to submit one of

your own case examples.

Agenda setting

Active approach

Homework

Socratic

Measurement

Present-focused

Components have no fixed length

All sessions start with agenda and HW review

Can thread multiple components together

Make sure you are using the evidence-base to make decisions about treatment

Who has time to learn all these different manuals?

Lots of manuals use the same technique, but present it slightly differently

Case in point: Problem Solving

Identify potential parent role in cycle of interactions

Examine maintaining variables

Contingency management training

Engage the parent in treatment process

Often a main catalyst for change

Integral to treatment process

Expert on their child

CONSULTANT -provide information CHEERLEADER

-provide encouragement COACH

-supervise/administer treatment components CLIENT

-target of specific aspects of intervention

Psychoeducation

Somatic Management

Cognitive Restructuring

Time out procedures

Contingency Contracts

Homework

Problem Solving

Didactic Instruction

Behavioral Shaping

Modeling & Guided Participation

Role Plays

Skill Training & Rehearsal

Problem Behaviors Goals Interventions

CBT Program Components Some for children, some for parents

Who has ever done problem solving with a client?

How do you do it?

What are the procedures?

Problem solving as part of protocols that you have learned before?

Please use the chat box to tell us which procedure you use for problem solving.

The STEPS to Problem Solving…

S- State the problem T- Think of solutions

E- Evaluate the solutions P- Pick the best one S- See how it works

Let’s use the STEPS to solve a problem…

Does anyone have a problem faced by one of their clients?

Please use the chat box to submit a problem.

Definition

Purpose

Actions

Written agreement for preventing and solving

problems

Collaborative – mutual rather than one-sided

Especially good for adolescents

Used for performance deficit versus skill deficit.

Behavioral contracts clearly delineate

expectations in order to avoid confusion.

I agree to: ◦ Be in my seat by 8:30am. ◦ Raise my hand before I speak. ◦ Complete morning assignments before lunch recess.

◦ Complete afternoon work before final recess.

I agree that if I do the above, I will earn: ◦ …extra time in the Art Room (10 mins.)

◦ …extra time at the computer station (10 mins. ) ◦ …points that I can trade for Pokemon cards

I agree that if I do not do the above each day, I will:

◦ …not be able to participate in recess activities

Attention Strategies: ◦ Attends

◦ Praise

◦ Active/Selective Ignoring

A technique of verbally describing positive behavior

Consistent external monitoring leads to increased

internal monitoring of behavior; Provides the child

with information about appropriate behavior

Consistent description of appropriate behavior that is

observed:

“Jason, you’re sitting at your desk quietly.”

Definition

Purpose

Actions

Positive reinforcement of a particular behavior

indicating approval or satisfaction

External reinforcement can lead to increased

intrinsic motivation to perform specific behaviors;

Provides information on appropriate behaviors

Verbal or non-verbal positive reinforcement:

“Jason, you’re doing a great job.”

Definition

Purpose

Actions

Briefly removing all attention from a particular

negative behavior (attention seeking behaviors) and

attention is given to appropriate behaviors

Behaviors will diminish if they are not rewarded;

Based on the principles of reinforcement

No eye contact or verbal response

Definition

Purpose

Actions

Active Ignoring Works Well For:

•Whining and Fussing

•Pouting and Sulking

•Loud crying/tantrums intended to punish others

•Loud complaining

•Continuous demands

Guidelines for Active Ignoring:

1. Briefly remove all attention from the child

2. Refuse to argue, scold, or talk

3. Turn head to avoid eye contact

4. Don’t show anger, or amusement in your manner or gestures

5. Pretend to be absorbed in another activity

6. Be sure that behavior does not result in a reward

7. Give the child lots of attention when the target behavior stops

Contact:

Alissa A. Gleacher, Ph.D. Assistant Professor

NYU Child Study Center | Department of Child and Adolescent Psychiatry

One Park Avenue, 7th Floor, New York, NY 10016

Tel: 646.754.5089 | Email: Alissa.Gleacher@nyumc.org

Use chat box to submit questions to panelists.

January 16th, 2013, 12PM What's your Compassion Index? Understanding

our Tolerance to Secondary Traumatic Stress and Compassion Fatigue

Presented by: Cheryl Sharp, ALF, MSW

***

February 13th, 2013, 12PM Engaging Children and Caregivers into Services

Presented by: Mary McKay, PhD

Questions or Comments:

lydia.franco@mountsinai.org

Additional information and resources

available at

www.ctacny.com