Class Log 421, Summer 2022
this page is under prepetual construction
7-7-22 last class: close "time for you to go out to the places you will be from" (Closing Time, Semisonic)
"Frieda Fromm-Reichmann . . . was inspired in childhood by the writings of the great sixteenth-century rabbi Isaac Luria on tikkun, the collective task of rescuing the sparks of the divine that were shattered at creation . . . Luria taught that to help another human being was inherently redemptive. According to the principle of tikkun, 'To redeem one person is to redeem the world.'" (Williams, 2004, p. 283).
discussion Beck et al. (2021) pp177-230 led by Alondra
revirw: course, textbooks
ACT
Macon, token economies, generalization (transfer & maintenance)
discussion of Practice Assingment 18
the ethics of behavior change
looking at our past: Rekers & Lovaas (1974); Barlow & Agras (1973); Moan & Heath (1972)
the evolution of behavior therapy
"first wave": Conditioned Reflex Therapy, Systematic Desensitization, Flooding, Applied Behavior Analysis, Percision Teaching, behavior modification, behavior therapy, (Implosive Therapy)
"second wave": Cognitive Therapy, Rational Emotive Therapy (RET), cognitive behavior modification, cognitive behavior therapy
"third wave": ACT, DBT, MBSR, MBCT, etc
"fourth wave": ?
7-5-22
Feelings are the very revelation to each indivudal mind of the status of life within the respective organism, a status expressed along a range that runs from positive to negative. . . . Feelings are the subjective experience of the state of life--that is, of homeostatis--in all creatures endowed with a mind and a conscious point of view. We can think of feelings as mental deputies of homeostatis. (Damasio 2018, p. 25)
As the Buddhist Nun Thubten Chodren has asserted in a recent book title, both Buddhist psychology and CBT suggest, "Don't believe everything you think" (2012). As such, healthy speech involves our understanding that the words we use with ourselves, as well as with others, carry strong influences upon our behavior and emotions. By bring mindfulness, acceptance, and compassion to our speech, we are following the Eightfold Path, and moving towards liberation of suffering in both Buddhist psychology and CBT terms.(Tirch, Siberstein, & Kolts, 2016, p. 53)
discussion Beck et al. (2021) pp 103-176 led by Lauren
video:: Donald Meichenbaum "Cognitive Behavioral Therapy"
6-30-22
system interventions: parent training
discussion Beck et al. (2021) led by Elli
Ivan
Ivan assignment: in your journal, develop an initial home behavioral program for the Rumples
a) at least one positive goal: working to increase desirable behavior
b) identify a clear behavioral target (objective, countable)
c) lay out their program for the week (what the parents are to do)
d) make some attempt to evaluate results of 1st week
show & tell: Miller (1975); Patterson (1968, 1975); Tharp & Wetzel (1969)
6-28-22: 12th class: cbt cbt-r
As noted, emotion regulation is mediated by three evolved emotion systems: one focused on responding to threats, one focused on pursuing and attaining resources, and one that helps us to feel safeness and contentment in the context of affiliative relationships. These systems are involved in powerful emotional responses (e.g., fear, anger, anxiety, ambition, lust, quiescence, calm) that organize our minds in very different ways--involving distinct patterns of thinking, imagery, motivation, emotional experience, and bodily sensation--patterns of organization that can serve to keep us trapped in the emotion we're experiencing if we don't have awareness of this process. (Tirch, Siberstein, & Kolts, 2016, p. 133)
discussion of Beck 227-303 led by Lauren
discussion of Beck pp 303 to 377 led by Emily
system interventions: parent training
Ivan
6-23-22 class cancelled
6-21-22: 11th class: CBT
"Here's a quote that has been attributed tp several sources that sumes this up nicely: What your thoughts. They become words. Watch your words. They become actions. What your actions. They become habits. What your habits. They become character. Whatch your character. It becomes your destiny." Judson Brewer, J. (2021). Unwinding Anxiety: New science shows how to break the cycles of worry and fear to heal your mind. NY: Avery.
discussion Beck pp. 160-227 led by Autumn
video: J.S. Beck (2006), Cognitive Therapy. APA Systems of Psychotherapy, series 1
assignment: Practice Assignment 15 caterpillar butterfly. Record results in your journal.
show & tell: Robert Friedberg & Jessica McClure (2002) Clinical Practice of Cognitive Therapy with Children and Adolescents: Second Edition: The Nuts and Bolts; Jon Hershfield & Tom Corboy (2013). The Mindfulness Workbook for OCD: A guide to overcoming obsessions and compulsions using midnfulness and cognitive behavioral therapy. Oaklnnd CA: New Harbinger; Niklas Torneke (2017). Metaphor in Practice: A professional's guide to using the science of language in psychotherapy. Oakland, CA: Context Press; Richard Stott, Warren Mansell, Paul Salkovaskis, Anna Lavender, & Sam Cartwright-Hatton (2010). Oxford Guide to Metaphors in CBT: Building cognitive bridges. Oxford, UK: Oxford University Press. .
activity: reviewing cognitions
handout: Miller (2018), Miller flowchart
books that aren't about therapy but might make you a better therapis:L Gina Rippon (2019). Gender and Our Brains: How new neuroscience explodes the myths of male and female minds. NY: Pantheon Books. [I actually disagree with her overall conclusion that there are no biologically based differences in male and female brains but agree with most of her particular points and aguements. Just because you think someone is wrong doesn't mean that they don't have ideas worth thinking about.]
6-16-22: 10th class: CBT
A typical human heart beats between sixty and a hundred times a minute. In the modern world, where we are the beneficiaries of advanced medicine and nutrition, humans live on average for about as twice as long as West's scaling laws would predict. Call it 3 billion heart beats. Three billion isn't such a big number. What are you going to do with your heart beats?" (Carroll, 2016, p. 389)
pause, questions?
text: JB 1-70 led by Sarah
What matters: Beck pleasure and mastery
Kahneman: happiness and satisfaction
Self-Determination Theory (Deci & Ryan): autonomy, competence, and relatednesss are organismic psychological needs" (Reeve, 2018, p. 125)
natural regulators of mood: exercise, social engagement, satisfying activities
assignment:
video: M. Fefergrad & A. Zarelsky (2013). Cognitive Behavioral Therapy for Depression. Psychotherapy Essentials To Go, NY: Avery.
show & tell: Ledley, D.R., Marx, B.P., & Heimberg, R.G. (2018). Making Cognitive-Behavioral Therapy Work: Clinical process for new practitioners, 3rd ed. NY: Guilford; Schuyler (1991). A Practical Guide to Cognitive Therapy. NY: Norton; D. Greenberger & C.A. Padesky (2016). Mind Over Mood: Change how you feel by changing the way you think, 2nd ed. NY: Guilford; C.A. Padesky (2020). The Clinician's Guide to CBT Using Mind Over Mood, 2nd ed. NY: Guilford; Beck, Rush, Shaw, Emery (1979), Cognitive Therapy of Depression, NY: Guilford.
handouts: BDI; 7 Column Thought Record; Thought Record Sheet-7 column; Friedberg & McClure forms
6-14-22 9th class: Cognitive Behavior Therapy
Men are disturbed not by things, but by the view which they take of them. Epictetus (55 — 135 AD)
heat day
text: JB 1-70 led by Elle
Kelly's fixed-role therapy
books that aren't about therapy but might make you a better therapist: Steve Silberman (2015). NeuroTribes: The legacy of autism and the future of neurodiversity. NY: Avery.
6-9-22 8th class: social skill training/behavioral activation cont.
“Do. Or do not. There is no try.” Master Yoda The Empire Strikes Back
agenda, questions?
discussion of MDH-D pp. 109-189 led by Meghan
video: McMain & Wiebe (2013). Dialectical Behavior Therapy for Emotional Regulation. N.Y.: W.W. Norton. conclude
handout: Using Visual Metaphores to Accept Your Worries and Distressing Thoughts; How to Use Imagery to Help Your Clients Identify Their Underlying Thoughts
show & tell:
books that aren't about therapy but might make you a better therapist: Howard Rachlin (2014). The Escape of the Mind. Oxford: Oxford University Press.
6-6-22 7th class: social skill training/behavioral activation cont.
Rather than view negaive affect as an internal event to be feared, learning to identify and label negative affect can cue the patient as to where problems exist in their day-to-day life and direct their efforts toward solving them. This technique ("viewing emotions as cues") is one of the specific techniques included in Nezu and Nezu's approach to problem-solving therapy. (Nezu, Nezu, & Lombardo, 2004, p. 195)
set agenda
questions, issues? discussion of practice discussion of reading MDH-D pp 60-109 led by Autumn workPersonal Effectiveness Group
DBT cont.
hierarchy of therapy goals
life threatening behaviors
therapy interferring behaviors
quality of life behaviors
interpersonal effectiveness goals
achieving your goals
maintaining relationships
maintaining your self-respect
cognitive/perceptual issues in social skill enactments
video: McMain & Wiebe (2013). Dialectical Behavior Therapy for Emotional Regulation. N.Y.: W.W. Norton.assignment: read/skim and consider Bell, Mackie, & Bennett-Levy (2014).
turn in journals
handouts: Valued Living Questionnaire (VLQ); notes on McEvoy et al., (2018); Universal Human Values; Spiegel & Spiegel smoking cessation protocol; Bell, Mackie, & Bennett-Levy (2014).
show & tell: McEvoy, Saulsman, & Rapee (2018). Imagery-Enhanced CBT for Social Anxiety Disorder. NY: Guilford; Zylowska & Mitchell (2021); Safren, Sprich, Perlman, & Otto (2017); Williams, Fennell, Barnhofer, Crane, & Silverton (2015).
questions, summary, close
books that aren't about therapy but might make you a better therapist: Joseph LeDoux (2019). The Deep History of Ourselves: The four-billion-year story of how we got conscious brains. NY: Viking.
6-3-22 6th class: social skill training/behavioral activation
"In the Nichomachean Ethics, Aristotle draws a helpful distinction between the clever man and the wise man. the clever person is one who knows the best means to any given end; the wise individual is the one who knows which ends are worth seeking." (Hinman, 2000, p. 423)
set agenda
questions, issues? discussion of practice discussion of reading MDH-D pp 1-60 led by Ava work: Personal Effectiveness Group DBTYou're perfect just the way you are, and you could use a little improvement (Suzuki, 2006)
individual sessions (validation & change, chain analysis, exposure)
telephone coaching
skill training (mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness)
team meeting (maintaining treatment fidelity)
show & tell: Koermer (2012); Swales & Heard (2009); Lewinsohn, Munoz, Youngren, & Zeiss 1986); Goldfried & Davison (1976).
summary, close
books that aren't about therapy but might make you a better therapist: Joshua Green (2013), Moral Tribes: Emotiona, Reason, and the gap between us and them. NY: Penguin. [I'm not sure about his solution (read this book while watching the remake of Brave New World on TV) but he lays out the problem, and the neurobiology, quite well.]
5-31-22: 5th class: social skill training, emotional arousal concluded (kind of)
Good therapy thus involves helping the client to make sense of how the world really works; this means both the person's internal and external worlds, and represents a substantial chnage from the inflexible set of negative beliefs that characterize emotional disorders. (Stott, Mansell, Salkovskis, Lavender, & Cartwright-Hatton, 2010, p. 38)
questions, set agenda, review tasks 5, 6, 10
conclusion of DHELN led by Emily
Three storiesselling magazines
Jackson V.A. component studies of assertiveness
U of Miss Medical Center studies of heterosocial skills
social behavior & socia skilll training
reciprocity
Liberman's view of social skills Actualization Through Assertion: A Behavioral Approach to Personal Effectiveness
Personal Effectiveness Group
show & tell: Alberti & Emmons (1974); Dawley & Wenrich (1976); Liberman, DeRisi, & Mueser (1989); Meichenbaum (2012)
handouts: Koerner ch. 4 (2012); Grandin & Bavron (2005, p. 119); Liberman handouts
summary, close
books that aren't about therapy but might make you a better therapist: Joshua Green (2013), Moral Tribes: Emotiona, Reason, and the gap between us and them. NY: Penguin. [I'm not sure about his solution (read this book while watching the remake of Brave New World on TV) but he lays out the problem, and the neurobiology, quite well.]
5-26-22 4th class: addressing issues of arousal, emotional regulation, fears,
"Likewise, modern clinical practitioners are advised to be careful not to make mindfulness itself an end goal, or to make it some kind of sacred thing, or to become a 'militant for mindfulness.' The history of psychology is already too full of pompeting cult-like schools of thought. After we cross a river using a raft, we don't need to carry the raft around on our backs all the time, and we don't need to preach to other why they too should all carry rafts on their backs. There is no need to become attached to the concept of mindfulness--it is simply a concept that describes a natural human process.
Mindfulness is a tool we can use for ourselves and for our clients to wake up to the present moment. When you put this book down, ask yourself, 'What am I experiencing right now?' When you meet with a client, ask, 'How may I help you?'" (Sears, Tirch, Denton, 2011, p. 162)
set agenda
questions, issues, confusion? discussion of practice discussion of reading, DHELN by Ava catching up work Systematic Desensitization emotive imagery handout: example of desensitization record case: treatment of complex case--OCD, fears, poor self-esteem, nonassertivenessquestions summary close Assignments 5 and 6 practice: selecting a target behavior/problem for next week: Assignment 10show and tell: Resick & Schnicke (1996); Foa, Hembree & Rothbaum (2007); Spiegel & Spiegel (1978); Resick, Monson, & Chard (2017()
handout: systematic desensitization record
books that aren't about therapy but might make you a better therapist: Sean Carroll (2016). The Big Picture: On the origins of life, meaning, and the universe itself. NY: Dutton.
5-24-22: 3rd class: hierarchies, & successive approximations; desensitization
The easiest way to eat the elephant in your path is in many little pieces. African proverb
set agenda
questions, issues, confusion? discussion of practice discussion of reading, DHELN led by Meghan work hierarchy buildingdemonstration: hierarchy construction
practice
alternative arousal management techniques
cue conditioned relaxation, differential relaxation systematic desensitization & flooding/response prevention/prolonged exposure AWARE (Beck, 1995) imagery relaxing images: swimming pool, mountain scene, personally relaxing image containment: putting issues away ego strengthing: challange/overcoming images clearing imagery: thought stopping, SCT (distress tolerance vs. emotional regulation skills) breathing (possible reference: James Nestor (2020). Breath: The new science of a lost art. NY: Riverhead Books. diaphragmatic breathing heart rate variability box breathing counting demo: child relaxation Raggerty Ann/Andy questions summary close treatment of OCD assignments: practice assignments assignment 4 (Cautela's SCT); begin daily sitting 10', record in journalfor the next two weeks, trying sitting (meditation) daily for 10 minutes, record experience in journalturn in journals a week from today
discussion of text on Thursday, lead by Ava.
you will need an interpersonal problem for the next two weeks: something involving a situation you would like to turn out better, something real, something possible (you will need to practice in real life as well)
show & tell: Benson (1975); Kabat-Zinn (1994); Hayes, Follett, & Linehan (2004); Roemer & Orsillo (2009)
books that aren't about therapy but might make you a better therapist: Robert M. Sapolsky (2017). Behave: The biology of humans at our best and worst. NY: Penguin Press.
5-19-22: 2nd class: arousal management cont.: variations on PMR; imagery and suggestion; meditation
"It is not necessary to do the practice and make it work; it is only necessary to do the practice and trust that you are planting seeds that in time will take root." Morgan & Morgan, 2005, p. 90
set agenda
questions, issue, confusion? discussion of practice and assignments discussion of reading, House: DHELN ch 1-3 work demo and practice: PMR/focus and release only sensory focus imagery/suggestion review questions closeAssignments:
Journal assignment 3 (construct a personally relaxing image)for Tuesday: practice passive (relax only) PMR on your own, record efforts in journal
find someone to practice practice passive (relax only) PMR with, record efforts in journal
You need a fear for next week, something that bothers you more than you think it should; most of us have 5 to 7 irrational fears. Pick one you wouldn't mind having discussed in class (potentially) and worked with. Something real and meaningful to you will be more interesting. Simple fears (snakes, spiders, small spaces, heights) work well; as do social anxieties (speaking up in class, disagreeing with your professor) and blood/injury worries (dental work, injections); find something you can work with.
Meghan leads discussion of reading on Tuesday, D. et al., pp 65-158 (sessions 1-4)
show & tell: ; Smalley & Winston (2010); Pollak, Pedulla, & Siegel (2014); Feldman & Kuyken (2019); Carrington (1977)
handouts: Physically Passive Neuromuscular Relaxation;
books that aren't about therapy but might make you a better therapist: Kahneman, D. (2011). Thinking, Fast and Slow. New York: Farrar, Straus, & Giroux.
5-17-22 1st class: orientation and anxiety (arousal) management
In the beginner's mind there are many possibilities, but in the expert's there are few. Shunryu Suzuki (1970), Zen Mind, Beginner's Mind
open
set agenda
your goals for class figure 1.1 my goals for class work of class your work for next time review questions close demonstration: traditional PMR ("tension-release"; "discrimination training")practice: PMR
handouts: Syllibi/421 Syllabus 2022.html, Wolpe's PMR; PMR training sheets; Relaxation Protocol (191); Appendix (Lazarus, 1977); Push-Release Technique (1989); Morris & Kratochwill (1998) Relaxation Protocol
assignments:
begin Journal Assignment #1 (self-monitor SUD's until Thursday's class)
discussion of text assignment next Thursday, lead by House; discussion of text assignment next Tues., lead by:
for Thursday: 1) find someone to practice PMR with:
a) collect SUD's rating from them before and after
b) note any difficulties you have or unusual aspects of experience
c) record results in your journal and bring to class Thursday2) practice doing PMR yourself once this evening and tomorrow
a) collect SUD's rating from them before and after
b) note any difficulties you have or unusual aspects of experience
c) record results in your journal and bring to class Thursdayshow & tell: Wolpe & Lazarus (1966); Bernstein & Borkovec (1973); Cautela & Groden (1978): Lazarus (1977)
Aftab: Any words of advice for psychiatry trainees and young psychiatrists?
Harrington: My answer might surprise you, but it is an answer that you might expect from an historian rather than a clinician! It is to try sometimes to read the literature, including textbooks, against the grain. That is to say, do not just read to absorb the information being offered, but look also for possible gaps, contradictions, or incidental references to factors or issues that are not pursued, and then ask why not. This comes back to the point I made earlier: with every new chapter in the field, there is a risk that we don’t just become smarter, but also more ignorant. Reading against the grain can be a very effective way for every field—not just psychiatry—to better recognize its implicit biases and blind spots. (an interview with Dr. Anne Harrington, June 27, 2019 )