Interventions For Individuals Flashcards
Progressive Muscle Relaxation
Progressive muscle relaxation is a form of relaxation training that reduces stress, tension, anxiety, and irritability/anger in a person’s body by having him/her slowly tense and then relax various muscle groups in the body. It helps them understand the difference between a tense state and a relaxed state so that they can cue relaxation at the first sign of distress.
Step 1: Ask client to sit in a comfortable position and scan body for tension.
Step 2: Ask client to tightly tense and relax various muscle groups on the body starting with hands. Ask client to tense hands by making a fist, hold for 5 seconds, and then relax hands.
Step 3: Ask client to repeat step 2 with different muscle groups such as neck and shoulders, abdomen, legs, and feet.
Homework: Encouraged client to practice PMR every day and during times when feeling _________.
478 Breathing
4-7-8 breathing exercise is a form of relaxation technique used to reduce anxiety in the individual. This technique has the individual focus on the inhalation and exhalation of breathing. It is helpful in managing daily anxiety and can be used during times of intense anxiety.
Step 1: Ask the client to sit with her back straight and to find a comfortable position and to close her eyes and exhale completely.
Step 2: Instruct the client to close his mouth and inhale through her nose for 4 counts, hold the breath for 7 counts, and to exhale through her mouth for 8 counts.
Step 3: Instruct the client to do this 3 times and report on how she feels after completing the exercise.
Homework: Use this breathing exercise at home when experiencing anxiety or daily. At the beginning of the following session, explore what this exercise was like for the client.
Pleasant Activity Schedule
Pleasant activity scheduling is a technique that can be used to treat depressive symptoms. It encourages the client to have more positive experiences which will in turn improve their depressed mood and feel more energized. This helps to increase positive mood by integrating activities that create a sense of mastery and pleasure to the client.
Step 1: Ask client to write down five activities such as…….. that he/she enjoyed prior to him/her feeling…………..
Step 2: Ask client to rate each activity on a scale of 1 (little pleasure) to 10 (very pleasurable).
Homework: Encouraged client to try at least one activity on his/her list before next session. Ask client to rate level of pleasure on a scale of 1 to 10 after experiencing pleasurable activity.
Coping cards
Coping cards is an intervention that provides a person with a plan of action to help manage certain thoughts, feelings, and behaviors.
Step 1: The client and I will decide on the thought, feeling, or behavior that will be targeted such as…..
Step 2: The client and I will explore a list of things that he/she can do/say when feeling/behaving/thinking__________.
Step 3: Ask client to write down at least 5 things he/she can do when feeling/thinking/behaving____________ on a pocket size index card.
Homework: Encouraged client to use coping card during moments of ________.
Thought Change Record
A Thought change record is a CBT intervention that is aimed at restructuring distorted patterns of cognition that contribute to mood disturbances such as depression. It helps to challenge and modify these distorted maladaptive thoughts and thus learn to alter their mood and behaviors into more positive ones.
Step 1: Present client with a chart that has 6 columns: Situation, Automatic Thought, Emotional Reaction, Behavioral Reaction, Modified Thought, and Outcome
Step 2: Collaboratively, client and will complete one chart in session. In Situation column, ask client to identify situation that led to unpleasant emotional response such as….. In Automatic Thought column, ask client to write down automatic thoughts that followed situation such as…….. In Emotional Reaction column, ask client to write down emotion that he/she experienced as a result of his/her thinking such as…….. Ask client to rate emotion on a scale of 1 (low intensity) to 10 (high intensity). In the Behavioral Reaction column, ask client to write down behavioral response to his/her thoughts and emotion such as…… In the Modified Thought column, ask client to think of a more rational thought to the situation such as……. In the Outcome column, ask client to write down new emotional and behavioral reaction to the modified thought. Ask client to rate new emotion on a scale from 1 to 10.
Step 3: Explore with client if he/she was able to make connection in how thoughts influence emotions and behavior.
Homework: Encourage client to fill out chart each day until next session.
Examining the evidence
In this intervention, the client and the therapist collect ‘evidence for’ or ‘evidence against’ the client’s distorted automatic thought. This process allows the client to clearly reflect upon how the irrational AT and dispute it and the validity of it.
Step 1: I would ask the client to identify a thought that made them feel _______ and write it down. Collaboratively I would ask the client to write out two columns: “Evidence For” and “Evidence Against”.
Step 2: We would collaboratively explore evidence that supports the AT. Then, we would explore evidence that against the AT. I would help probe the client to uncover unexplored evidence that they may not bring up for “evidence against” the AT.
Step 3: We would collaboratively evaluate for evidence for both of the columns. I would ask the client to draw a conclusion based on the evidence we collected.
Step 4: I would ask the client if their thought was changed after completing this activity. I would explore with the client if they were able to make the connection on how challenging the AT can affect mood and behavior.
Homework: I would ask to practice this activity 1x day, when the client experiences an AT that provokes distressful beliefs/thoughts. I would ask the client to write down this down and identify how they feeling before and after completing it.
Responsibility pie
Responsibility pie is a technique that helps individuals to accurately perceive their responsibility to a situation by having them examine alternative explanations. This is a CBT intervention aimed at reducing excessive worry or guilt by highlighting how disproportionate the amount of responsibility is they have burdened themselves with and is contributing to their levels of anxiety
Step 1: Present client with a picture of a circle. Collaboratively, client and I will identify and explore a situation that he/she would like to gain a better perspective on such as……
Step 2: I will ask client to list as many possible reasons that may have contributed to his/her situation. I will ask client to assign a portion of the pie for each possible reason, with his/her responsibility being last.
Step 3: After all portions of circle has been assigned, I will ask client to interpret what pie says about his/her responsibility to the situation and how conclusion impacts his/her feelings of __________.
Homework: Encourage client to practice technique before next session.
Gratitude journal
Gratitude Journal is a technique that requires a person to focus on and report at least 3 positive things that they client is grateful for at the end of their day.
Step 1: Explained to client that his/her _______mood is being fueled by his/her constant negative thinking about his/her day and/or self (e.g., examples).
Step 2: Ask client to reflect on his/her day and to recall 3 things that went well such as……..
Homework: Encouraged client to reflect on his/her day and write down three things that went will in his/her day. Ask client to report how he/she felt during those positive moments in his/her day.
The ABC model of behavior
The ABC model of behavior is a technique that will help individuals understand how every behavior has consequences. It is used to help them understand how certain things may trigger them and then influence their behavior in consequential ways. When clients become aware, they are able to modify their behavior and experience more positive consequences a result.
Step 1: Present client with a chart that has 5 columns: Antecedents, Behavior, Consequences, Modified Behavior, Modified Consequences
Step 2: The client and I will complete one chart in session. In the Antecedents column, ask client to write down triggers to his/her ______ behavior such as…… In the Behavior column, ask client to write down behavior in response to triggers such as….. In the Consequences column, ask client to write down consequences that he/she experienced as result of behavior such as….. In the Modified Behavior column, ask client to think of a more helpful behavioral response to triggers such as… In the Modified Consequences column, ask client to write down consequences that he/she might have as a result of modified behavior such as..
Step 3: Explore with client to see if he/she was able to understand how his/her behavior influences the type of consequences he/she might experience.
Homework: Encouraged client to fill out chart each day until next session.
Time projection
Time projection is a technique that helps individuals to stop and consider the consequences of their actions so they can make better choices and decisions about their behavior. This intervention can help to instill hope that there is space for things to change and improve if they feel high distress.
Step 1: I would explore with the client how his/her ________ behavior has impacted his/her life such as…..
Step 2: I would ask the client to given an example of what is happening just before he/she engages in that __________ behavior.
Step 3: I would help the client identify triggers such as feeling _________ that precedes his/her actions. I would ask the client to practice asking him/herself a series of questions when he/she notices these feelings/reactions: How would you feel about the situation 1 hour from now? 5 hours? Tomorrow? A week?
Homework: Encouraged client to practice using this technique when he/she feels___________.
Cost benefit analysis
Cost-Benefit Analysis helps individuals consider the advantages/disadvantages of engaging in certain behaviors (or beliefs) that may be unhelpful. This tool is helpful to assist clients in considering the consequences of their actions so they can make informed decisions, which will reduce their distressing emotions.
Step 1: Ask your client if they are willing to try the Cost-Benefit Analysis. Explain that the purpose of this exercise is to help them slow down and make informed decisions that they can be satisfied with.
Step 2: At the top of the page, have your client fill in the behavior (or belief) they have been engaging in lately or which they are considering engaging in.
Step 3: Then create two columns with one being labeled as “Benefits” and the other as “Costs.” Then explore with your clients the advantages and disadvantages of engaging in the behavior(s). For example…____.
Step 4: After collaboratively filling out the columns, ask your client how they are viewing their behavior and whether they feel they can make an informed decision about engaging in this behavior in the future.
Homework: Have your client take home a copy of the worksheet completed in session as an example. Instruct your client to complete new cost-benefit analysis worksheets to help them make informed decisions.
Written ventilation
Written ventilation is an exposure-like technique that requires an individual to recall a traumatic/negative experience and focus on the thoughts and emotions that arise, which over time will lead to a decrease in distress/negativity. Often this is accompanied by a decrease in the negativity and distress and will help the ct able to better understand certain aspects of the experience and will give her a newly acquired sense of control over the situation, thus allowing her to move past it.
Step 1: Ask client to recall his/her traumatic/negative event of _______.
Step 2: Ask client to write down all of his/her thoughts and feelings associated with traumatic/negative experience. Ask client to think about what part of experience was most difficult, what memories are most painful, and what thoughts/emotions he/she has now.
Step 3: Ask client to share his/her thoughts/feelings about his/her experience. If comfortable, ask client to read what he/she wrote and ask how he/she felt reading it out loud.
Homework: Encouraged client to read what he/she wrote 3x during the week and ask him/her to write down his/her thoughts and feelings.
Exposure and response prevention
Exposure and response prevention is a technique that allows individuals to confront their fears and prevents them from engaging in safety or escaping behaviors. Exposure over time will lead to less anxiety.
Step 1: Explain technique/rationale and inform client that anxiety level will increase, but as they stays with task, anxiety level will decrease. Explain to client that they will not be allowed to engage in safe/escaping behaviors.
Step 2: Collaboratively, the client and I will make a list of objects/situations that trigger distressing thoughts/emotions. Ask client to rate each item on a scale from 1 (low distress) to 10 (high distress). Arrange list in a hierarchal fashion with least anxiety-provoking item being first. (Give example)
Step 3: Expose client to least anxiety-provoking object/situation and ask client to rate intensity on scale 1 to 10 during exposure. Ask client to stay in anxiety-provoking situation until anxiety drops by half. Ask client to share thoughts/feelings during exposure. Prevent client from engaging in safe/escaping behaviors.
Step 4: After activity, ask client to share thoughts/feelings about experience.
Homework: Encourage client to try this technique 2x/day for the first item on his/her list and encourage client to not engage in any safe/escaping behaviors.
Role play
Role playing is a form of social skills training that helps individuals practice different social skills so they can gain greater confidence to initiate interactions with others. This intervention is particularly useful for depressed or anxious individuals who struggle during social interactions.
Step 1: Start with psychoeducation regarding communication skills for interacting with others. These should be tailored to your client’s own difficulties. Skills may include focusing on nonverbal cues, sharing interests with others, or observing and taking social cues from others.
Step 2: After your client has a good understanding of these concepts, you would take on the role of someone your client has described a desire to interact with (or someone with whom the client experiences conflict). You should strive to make this interaction as realistic as possible.
Step 3: Use this intervention as a graduated task by starting off simple and increasing the level of difficulty as time goes on and your client has gained more practice and confidence. For example, ______. Subsequent role-plays would include more challenging interactions until your client has learned to apply these skills in a worst-case scenario.
Step 4: Provide feedback to your client and gently address areas for improvement. Have them also address areas where they would like to improve.
Homework: Once your client has greater confidence in session during role-plays, have them gradually begin testing the use of the social skills in situations outside of therapy. Have them report back next session.
Self monitoring
Self-Monitoring is a CBT technique that involves learning to pay careful and systematic attention to your problem behaviors and habits. It also helps the client become aware of the stimuli that triggers them to engage in these problematic behaviors and habits. Self-monitoring can reduce the frequency of a negative behavior. Self-monitoring gives the client the opportunity to react differently to triggers.
Step 1: Client will identify the behaviors they would like change. For example, reduce compulsion of washing hands. Explore with client how self-awareness of unwanted behaviors can give power to the client in
Step 2: Client will be given a chart that will allow them to record the date and time they find themselves doing the unwanted behavior and a space to describe what occurred or how they felt before and after each time that behavior occurred. The chart would have 5 columns labeled: Time/Date, Situation, Thought, Feeling, Behavior.
Step 3: To be sure the client understood the task we will practice in session on how to fill in the chart. Go through the chart as an example. After completing the chart in the next session, go over coping strategies that client can use for triggers such as breathing exercise, thought stopping, etc.
Homework: The ct is to monitor their behavior every day until the next session. They will be encouraged to think about what themes do their behaviors fall into. For example, the ct may find that they do their behavior more frequently at a certain time of day or when they are feeling sad, etc.
