Cognitive Behavioral Social Skills Training

Granholm- CBSST Practical Syllabus 1

Eric Granholm, Ph.D. UCSD Department of Psychiatry

Workshop Overview

Cognitive Behavioral Social Skills Training (CBSST) is a psychosocial rehabilitation intervention for consumers with schizophrenia or other forms of serious mental illness. In CBSST, consumers set very specific recovery goals related to living, learning, working, and socializing in their community of choice, and then learn cognitive, communication, and problem-solving skills to help them achieve these goals. CBSST can be delivered as a group therapy, individual therapy, or in the context of case management (e.g., assertive community treatment). This is a practical workshop that will provide a basic overview of the evidence-based cognitive behavior therapy (CBT) and social skills training (SST) interventions used in CBSST. The primary goal of this workshop is to provide novice to intermediate providers with a knowledge foundation and practical guidance on delivering CBSST.

Overview: Setting Recovery Goals Thought Challenging: The 3C’s: Catch It, Check It, Change It Communication Training: Expressing positive and negative feelings

Learning Objectives

1. Develop a basic understanding of CBT and SST principles and methods for SMI. 2. Choose CBSST treatment techniques to meet the unique needs of different consumers. 3. Develop a working practical knowledge of how to deliver the cognitive interventions (e.g., 3C’s) and role play communication training interventions used in CBSST.

Bibliography

Granholm, E., McQuaid, J.R., & Holden, J. (2016). Cognitive Behavioral Social Skills Training (CBSST): A Practical Treatment Guide. New York: Guilford Press. Bellack, A.S., Mueser, K.T., Gingerich, S., & Agresta, J. (2004). Social Skills Training for Schizophrenia: A Step-by-Step Guide (Second ed.). New York: Guilford Press. Kingdon, D.G., & Turkington, D. (2005). Cognitive Therapy of Schizophrenia. New York: The Guilford Press.

Granholm- CBSST Practical Syllabus 2 7-7-7 GOAL JACKPOT WORKSHEET EXAMPLE Name :__ Jane _ Date Long-Term Goal Set :_____ Oct. 1_____ Long-Term (Meaningful) Goal (7 months): Have a boyfriend______Short-Term Goals Related to the Long-Term Goal (7 weeks): 1. Improve hygiene 2. Improve conversations Steps (7 days): Steps (7 days): 1. Separate clean/dirty laundry Ö 1. Draft list of possible topics Ö 2. Do laundry 2X per week Ö 2. Practice starting conversations Ö 3. Brush teeth a.m./p.m Ö 3. Practice ending conversations 4. Shower daily Ö 4. Practice asking someone for a date

7-7-7 GOAL JACKPOT WORKSHEET Name:______Date Long-Term Goal Set:______

Long-Term (Meaningful) Goal (7 months):______

Short-Term Goals Related to the Long-Term Goal (7 weeks): (Ö-off steps when you complete them)

1. ______2. ______Steps (7 days): Steps (7 days): 1. ______1. ______2. ______2. ______3. ______3. ______4. ______4. ______

Start Date: ______Start Date: ______Date Reviewed: ______Date Reviewed: ______

Modified/Next Steps: Modified/Next Steps: 1. ______1. ______2. ______2. ______3. ______3. ______4. ______4. ______

Date Reviewed: ______Date Reviewed: ______

Modified/Next Steps: Modified/Next Steps: 1. ______1. ______2. ______2. ______3. ______3. ______4. ______4. ______Granholm- CBSST Practical Syllabus 3

The 3C’s: Catch-It, Check-It, Change-It

Situation: What was Feelings: How was I feeling at the happening? Where and when? time?

Actions: What was I doing?

CATCH IT: What was I thinking in this situation? What went through my mind? Which thought best explains how I was feeling and what I was doing?

CHECK IT: Check to see if the thought is accurate by listing the evidence that supports or disputes it. Also, check to see if the thought is a mistake in thinking. EVIDENCE EVIDENCE FOR MISTAKES IN THINKING AGAINST (Check any that apply)

 All or Nothing  Mind Reading  Fortune Telling  Jumping to Conclusions  Catastrophizing  Emotional Reasoning  Other:______

CHANGE IT: What would be a more accurate and helpful thought? If there was mistake in thinking or if the thought was inaccurate, develop a more helpful thought based on the evidence you listed. Granholm- CBSST Practical Syllabus 4

3C’s Example:

Situation: What was happening? Feelings: How was I feeling at the Where and when? time?

Going to community college to Pessimistic; hopeless sign up for a class. Actions: What was I doing? Didn’t sign up for the class; went back home CATCH IT: What was I thinking in this situation? What went through my mind? Which thought best explains how I was feeling and what I was doing?

“I will fail the class.” CHECK IT: Check to see if the thought is accurate by listing the evidence that supports or disputes it. Also, check to see if the thought is a mistake in thinking. EVIDENCE EVIDENCE FOR MISTAKES IN THINKING AGAINST 1. I got a bad grade 1. I have had good in the last class I Jumping to conclusions grades before. took. 2. Some classes 2. People tell me Fortune telling are easier than school will be too others. hard for me. CHANGE IT: What would be a more accurate and helpful thought? If there was mistake in thinking or if the thought was inaccurate, develop a more helpful thought based on the evidence you listed.

“It may be hard, but I may learn something if I try.” Granholm- CBSST Practical Syllabus 5

Communication Skills

Throughout these classes, you will be learning how to communicate your needs, problems, desires and feelings. Good communication skills are very important to achieving your goals. Good communication involves the following:

Eye Contact Look in the eyes but don’t stare.

Posture Stand and sit up straight. Look relaxed, but upright.

Body Movements/Gestures Use appropriate body movements and gestures when talking. Gestures refer to movements of the hands or body that often emphasize what is being said verbally.

Facial Expressions Facial expressions should be in tune with the topic at hand. Occasional smiling and head nods when listening are important.

Voice Volume Voice volume should be pleasant, not too loud or soft, and the pitch of your voice should go up and down naturally. Avoid speaking in a monotone.

Short and Sweet Make sure sentences make sense and stick to the topic. Be specific, but brief, in stating what you want to say. Use “I” statements.

Energy Level Overall energy level should show enthusiasm when appropriate and you should show interest in the topic being discussed. Granholm- CBSST Practical Syllabus 6 Expressing Unpleasant Feelings At least once during the week, use the Expressing Unpleasant Feelings Skill. Fill out the first 3 boxes of the form now with your provider, then fill out the last 2 boxes when you practice at home. Describe situation in which you are going to practice the skill (Who will be there, When will it take place, Where will you be, What will you be doing, etc.):

My thoughts or expectations before practicing the skill (What will happen when I practice the skill? What reactions am I expecting to get from the other person?)

How will I do? (Mark an ‘X’ on the line)

0 5 10 I will fail/do badly Not Sure? I will succeed/do great! The Priority Communication What I am going to say or do? Skills I am going to practice (The 4 steps for Expressing Unpleasant Feelings): (eye contact, voice volume, etc): Expressing Unpleasant Feelings Skill: 1. MAINTAIN EYE CONTACT. SPEAK FIRMLY. 2. SAY EXACTLY WHAT THE PERSON DID THAT UPSET YOU. 3. SAY HOW IT MADE YOU FEEL. 4. SUGGEST WHAT THE PERSON SHOULD DO TO PREVENT THIS FROM HAPPENING AGAIN. My thoughts and reactions after practicing the skill (Did anything get in the way of practicing? Were my thoughts or expectations before I practiced the skill accurate?)

How did I do? (Mark an ‘X’ on the line)

0 5 10 I failed/did badly Not Sure? I succeeded/did great! How did it go? What can I do to improve next time? Did I do better than I thought I would (compare before and after ratings)? Maybe if I think I will succeed, I will!