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Intro to CBT-p Model: Using CBT-p informed strategies for symptoms: STRUCTURE OF SESSIONS AND HALLUCINATIONS Harry Sivec, Ph.D. BeST Center, Northeast Ohio Medical University To get CME/CEU Attendance for today: Go to www.eeds.com or use eedsiPhone/Android App Enter in your information including type of license in the Degree field and your license number. The Activity Code for this Session​​ Complete EEDS NOW SECTION 1 Section 1 Review Foundations Putting together case info Case Review and Discussion Structure of session Hallucinations CNN Video- HW- give reactions Voice Hearing Activity Coping with Distressing Voices #1 Practice Coping with Distressing Voices #2 Practice BRIDGE FROM FOUNDATIONS (DAY 1) TO ROLE- SPECIFIC APPLICATION (DAY 2) • What stayed with you most from the foundational/ Day 1? • What would like clarified today? • Day 2 goals: apply skills to reduce distress/reach goals • Let’s talk about your most common challenges… CBT-p and recovery Apply strategies knowledge & to symptoms of strategies psychosis This Photo by Unknown Author is licensed under CC BY-SA ESSENTIAL RECOVERY ENHANCEMENT PRACTICES • View schizophrenia/psychosis w/ a Recovery Mindset. – Hope and Optimism • Develop a trusting relationship – Build from strengths, interests, values • Approach all concerns with an open and curious mind – Listen and reflect-back what you hear • Teach and learn together – Provide information that normalizes – Teach about Stress vulnerability and resilience – Show how cognitive model helps one understand experience – Solve challenges together- shared decision making! SOME SUGGESTIONS FOR LEARNING AND PRACTICING STRATEGIES Your Adaptive mode Welcome uncertainty Build from your Develop tolerance for not strengths knowing the answer, and to be ok with exploring options. Remember that you have a team supporting you! TEACHING AND LEARNING TOGETHER • The relational aim is to What do I wonder what you think? would happen if be a co-equal we tried this… • The task is to co- discover meaning and • To identify and check out new ways to think and act in situations HW REVIEW: THE CASE OF JOE- HANDOUT • What are possible engagement strategies? • Using the cognitive model : – What behaviors are problematic? – What history could inform us about this behavior? – What may he be telling himself (self-talk) that leads to his behavior? – What would you be curious to learn more about? REMEMBER: ORGANIZE CASE INFO TO GUIDE INTERVENTIONS Behavioral History Beliefs and Thoughts target What behavior is Recent and Thoughts lead to Behavior problematic or Remote getting in the What is this person saying way? to himself about the What events in this problematic behavior, person’s life may situation, or distress? That need to be have helped to addressed shape this behavior or What defeatist beliefs struggle might they hold about themselves? (adapted from Creed, T., and the Beck Initiative, 2014) GROUP CASE REVIEW OF CURRENT CLIENT Understanding is the first step to helping USE THE FORM TO GUIDE THE INTERVENTION- HANDOUT Client’s recovery goals: what does client really want to work on? What are the client’s strengths and supports? Symptoms/behaviors that interfere with meeting goals and how do they interfere? Current stressors: What would you like help with? Question for today’s consult What have you tried so far (attempted skills/action)? USE THE FORM TO GUIDE THE INTERVENTION What do we know about the client history, beliefs, behavior)? History: any life experience that helps us to understand the symptoms and behavior? Beliefs: What does client tell self that might affect the symptoms or behavior? Behavior: What does client do that helps or gets in the way of goals/values Consultation/team suggestions: Action plan: Skill/strategy to practice: POSSIBLE TREATMENT TARGETS? • As a case manager, what kinds of interventions might you think about doing? What is scope of practice for you? • How might you work with the therapist and prescriber in this situation? • As we review strategies today, think about how the strategies may apply to this case** STRUCTURE FOR SESSIONS Advantages and Disadvantages START STRUCTURE • Preview START model for next session – Preview START POWTOON – Identify areas for practice using START model Structure Task Observations Make it safe and comfortable to talk. Be Conversation starter kind and friendly and refrain from giving Area of interest identified or brought up Socialize advice unless asked Keep in mind the client’s recovery goals- Topic (specific)= pick 1-2 targets Explored topic with gentleness, curiosity Target/Topic You may talk about many things, but try to pick one thing to begin, to work on, Reflected content so client felt heard and to conclude. Explore client’s concern- LISTEN Expand client’s understanding: What was most distressing or interesting to client for Work on the task of the day or steps to action? Action with compassion address current concern; • Did client have choices? OR Steps to help client reach goal • Were decisions shared? Encourage client input Remember to • Was action important to client? collaborate and to share decision • Was relevant education or normalization shared? making • Connected interest to value to goal Ask client for feedback: What did client take away from meeting? What was helpful/not helpful today? Review What sticks with you the most today? Anything we missed? What would you like to work on What is one valued action to do before the next meeting? between now and the next time we Take-home work meet? 16 START WITH DIALOG+ PROMPTS- HANDOUT Structure Prompt Observations How was your week? What was one thing you were most satisfied with / proud of this week? Casual conversation around this topic Socialize What would you like for us to work together on today? OR if already have a target, can we check on X from last time? *What is most distressing? Reflect back response; can you tell me more? Target *So, based on what you’ve said, is it ok if we work on ______ today? (distress item or goal/task to work on) What is working? OR how have you gotten this far? Looking to the future, what is the best-case scenario here? Action What would you like to be different? What is the smallest improvement you could see? -What are you willing to try? -What could I do? -Anyone else could help? What was helpful/not helpful today? What sticks with you the most today? Review What is our plan of action before our next meeting? Your task; My task; other person’s task Preibe, et al., 2015 Take-home work START APPLIED Case example • S- Relationship connection first • T- Find something to work on – Understand concern / question • A- Explore options – Find out what has been working (MOBILIZE RESOURCES) – What gets in the way – Work together to find some small action step • R- review learning • T- take home-work: commit to action plan Breakout rooms COPING STRATEGIES- HALLUCINATIONS Start with strengths Offer options 19 VOICE HEARING The following activity is optional. Please review the disclaimer. If you elect not to participate, please respond accordingly in the poll we will post after disclaimer has been read. Disclaimer The following exercise was developed to reflect voice hearing experiences. As such, you will hear a variety of voices and some voices will be confusing, critical, and potentially very distressing. This activity is not recommended for individuals who have a history of voice hearing. In order to simulate authentic voice hearing experiences, the audio may contain profanity and explicit language that some may find to be offensive. It is by no means our intention and the BeST Center of NEOMED is not responsible or liable for any distress caused. We advise that you exercise your right to withdraw from the simulation exercise, at any point, should you wish to. Voice Hearing Disclaimer Poll (Zoom Poll) Please click accept in the poll to indicate that you have read and understand the disclaimer and wish to participate in the exercise, or you may elect to not participate (turn off sound and watch until exercise has completed). We will return on this slide: Training participants are encouraged to also discuss their experience of the simulation exercise (positive or negative) with another staff member who has completed this exercise. In group training we have found that talking about this experience with others to be very helpful. You may also speak with your team leader or the BeST Center consultant trainer assigned to your team if you have any questions or concerns. Activity begins on next slide. You have 30 seconds to answer Question 1 Which one of these math equations is correct? A. 24 * 5 = 110 B. 468 / 12 = 37 C. 857 – 29 = 828 D. 100 + 40 + 1000 + 30 + 1000 + 20 = 3090 You have 30 seconds to answer Question 2 / Answer in chat box Select the 5 most recent past presidents of the United States. A. B. Clinton E. R. Reagan B. G. Ford F. B. Obama C. G.H. Bush G. D. Trump D. G. W. Bush H. J. Biden You have 30 seconds to answer Question 3 Which of these 5 words were previously mentioned? A. Cigar, Snow, Damage, Cat, Book B. Rain, Hazard, Cigar, Cat, Book C. Cigar, Rain, Cat, Damage, Book D. Book, Dog, Rain, Cigar, Snow HOW DOES VOICE HEARING AFFECT AN INTERVIEW? FORMING A RELATIONSHIP? • What did you experience? • What did you observe? • What strategies did you use as voice-hearer? BARRIERS TO ENGAGEMENT: MENTAL HEALTH PROVIDER FACTOR • When observing voice hearing, what were your thoughts/beliefs about – The client and – Yourself? • What emotions did you experience? • What did you do? (that helped/hindered engagement) CNN – EXERCISE IN EMPATHY HTTPS://WWW.YOUTUBE.COM/WATCH?V=YL9UJVTGPZY 1. WHAT WE UNDERSTAND ABOUT VOICES • Hearing voices is common – Human brains are vulnerable to psychotic like symptoms such as hearing voices or experiencing a presence – So under certain circumstances, almost anyone could experience hallucinations ❑Sleep disruption ❑Illnesses ❑Certain stressful situations ❑Sleep deprivation ❑Medical conditions ❑Trouble separating internal ❑Medications events from external events ❑Illicit drugs ❑Feeling judged or criticized by ❑Neurohormonal issues others 28 1.
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