CBSST for Employment and Education - PowerPoint Presentation

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CBSST for Employment and Education

Improving quality of life through goal pursuit, CBT, social skills, and problem solving skills

Oregon Center of Excellence for Assertive Community TreatmentSlide2

Collaborative Goal Setting

Primary to getting buy-inWhich outcomes are most valued?Choice based on what would most improve quality of lifeSetting the goal is a meaningful first step

Consider living, learning, working, and socializationSlide3

Goal setting impacts -SPMI

Goal setting is a fundamental ability that may be impaired by SPMIWork to overcome such impairments to engage in rehabilitationSetting a relevant goal and tracking progress toward achievement of these goals can be a powerful intervention in and of itselfSlide4

Bridging the skill goal gap

Linking skills practice

Catch it check it change it at homeChanging unhelpful thinkingHomework IMR, CBT, DBT, etc.To recovery goalsHaving a girlfriend, getting a job, making a friend, taking a class, volunteering, moving to better housingSlide5

Identifying Long Term GoalsSlide6

Strengths/Enjoyment/Desire

MI around areas of changeConsider transforming areas of strength into long term goalsNon-linearSmall steps lead to larger achievement

CollaborateSlide7

7-7-7 Goal Jackpot!

When setting goals use this timeline to teach individuals how to break down big long-term goals into manageable goal steps that can be accomplished each weekSlide8

7-7-7 Jackpot Continued

Long term goals can take longer than 7 monthsShort term goals can be achieved in 7 weeksGoal steps are assignments that can be achieved in 7 daysSlide9

Specific Goal Setting Examples

Complete coursework (7 months)Learn to manage time

(7 weeks)Consider possible job, class options (7days)Complete SCALE worksheet (7 days)Check thoughts about managing money (7 days)Learn how to get an app or FAFSA (7 day)Slide10

Example continued…

Improve communication with building manager and roommates (7 weeks)Negotiate quiet hours with roommate (7day)Learn to express frustration (7 day)

Check thoughts about roommate (7day)Practice ADL’s (7 day)Slide11

Set SMART goal steps

S- Specific= Measurable terms that can be observedM- Meaningful= personal recovery goal chosen by the individualA- Agreed upon= Collaborative process by which individual and provider work

R- Realistic= attainable (if possible)T- Timely= target dates with 7-7-7Slide12

Meaningful Long Term Goals Are M

otivating… So Ask:Why do you want to____________

What would be different if you achieved_____________How would your life be betterSlide13

Symptom goals can be reframed…

As functional recovery goals by asking:How would you know if you weren’t sad anymore?How would you life be different?

What would you do?If you didn’t hear voices, what would you be doing differently with your lifeSlide14

Ask for feedback

How am I doing?Am I explaining things clearly?What did you find most helpful and least helpful? What did you think about the way we were setting goals?

Do you think it will help you achieve your goals?Slide15

Avoid these goals:

Symptom eliminationBehavior cessationStopping feelingsBehaviors that don’t pass the dead person goal testSlide16

Summarize the Session

Best ways to improve quality of life is goal setting. Small steps accomplish big goalsUnhelpful thoughts can hinder goal progress. They are just mistakes in thinking that can be corrected by testing them out and gathering all the facts

With best practices we achieve goals by learning skills and thinking about thoughtsSlide17

Thanks for your participation

Ben YoderOCEACT

byoder@optionsonline.org5416006102Content from the Practical Treatment Guide for Schizophrenia- Cognitive-Behavioral Social Skills Training by Granholm, McQuaid, and HoldenSlide18

CBSST Overview

Module based – goal setting session, five sessions that build on each other to teach a skills set.3 modules total – 6 sessions per moduleOriginally a group therapy (4-10), but individual is effective as well

Collaborative agenda settingLink skills to initial concernsSlide19

Overview Continued

Review at home practice, teach new skills, assign at home practiceProbe assumptions, clarify questions, rationale, reasons and evidence, explore alternative viewpoints and perspectives, implications and consequences

Use Socratic questioning, neutralSlide20

Overview

Use “thought chaining” to uncover links between beliefs – attack the weakest link – usually those that are more periphery, not beliefs near an emotionally charged core belief about self or at the core of delusion.Slide21

Cognitive Skills – Module #1

Teaches how thoughts are related to feelings and behaviorsChanges unhelpful thoughts by using the 3 C’s (Catch it, Check it, Change it) skill, identifying mistakes in thinking and conducts behavioral experiments

Practice using the 3 C’s to challenge thoughts that interfere with recovery goal achievementSlide22

Catch it/ Check it/ Change it

Practice recognizing and Checking common and current automatic thoughtsCheck for if it is helpful or not helpfulIf not helpful Change itSlide23

3 C’s Example

- Afraid to meet someone newCatch it! – I’m not going to act right, so they will laugh at meCheck it! – I act right in CBSST class, lots of people don’t laugh at me, (fortune telling thinking mistake)

Change it! – I’ll try and test it out even though I’m scaredSlide24

3 C’s Example - Voices

Catch it! – The voices are powerful, I can’t control themCheck it! – Can you turn the voices off by humming, music, repeating the voices, taking medication?Mistakes in thinking –all or nothing- jumping to conclusions

Change it! – If I can turn these voices off and on then they must not be that strongSlide25

3 C’s Example - Working

Catch it! Unhelpful thought- they will never hire meCheck it! is it true? I used to do a similar job, I am a hard worker, experiment, go to interview, mistakes in thinking again fortune tellingChange it! Maybe I can get a job if I fill out an applicationSlide26

Thoughts, feeling, actions triangleSlide27

How CBBST works

Focus on changing automatic thoughts and observe changes in feelings and behaviors that ensueThought: Everyone likes meFeeling: Happy and optimisticActions: Try an activity or call a friendSlide28

Common Feelings Experienced…

Happy SadAfraidAngry

SurprisedDisgustedSlide29

Emotional Charades

To practice emotional speech prosody and facial affect expressionIndex cards with six basic emotions and a neutral descriptive sentenceThe group takes turn guessing the emotion that the player is trying to communicate

Variation: Player makes a facial expression.Slide30

Language and mistaken thoughts

Words you choose can pathologize or normalizeUsing “we” or “our” rather than “you” or “your” implies mistakes are a normal part of life. – We all make mistakes in thinking rather than stating You have incorrect thinkingSlide31

Common mistakes in thinking

All or nothingJumping to conclusionsFortune TellingMind Reading

CatastrophizingEmotional ReasoningSlide32

Label thoughts

HelpfulNot helpfulFeelings are one word, thoughts are usually more than oneUse common thoughts checklist in the backSlide33

Social Skills – Module #2

Explain how communication skills can help consumers achieve personal recovery goals. Apply skills to goal directed social interactions in the communityNonverbal skills and use role plays to teach four basic communication skills

Reduce defeatist performance beliefs about interacting with othersSlide34

Role Plays Practice

Making positive requestsNon verbal skillsListeningExpressing unpleasant feelingsSlide35

Making a positive request

Role play asking a support person to help you with your goal while the other person practices active listeningGoals: practice non-verbal communication ~ Form on Page 255Do 3 steps of positive requests- eye contact, what you want the person to DO, and how it would make you feelSlide36

Non-Verbal Skills

Eye contactPosture; relaxed but uprightGestures; movements of hand or bodyFacial expressions: match discussion

Nod headCheck out page 149 – Fun teaching Non-verbal skillsSlide37

Active Listening

NodSay uh-huh, OK, or I seeMore eye contactRepeat what the person said in your own wordsSlide38

Expressing Unpleasant Feelings

Can be used for pleasant feelings as wellRole play telling another person about something they did that made you feel either happy or sad (or you choose)

Goals: Non-verbal skill practice- remembering to say what they did – his or her actions and how it made you feelIf choose unpleasant – what should they do differentlySlide39

Mistaken Monologue Game

To learn to identify unhelpful thoughts and behaviors, and to identify healthier responsesView sitcom dialogue then identify the following:Slide40

Identify…

Mistakes in thinkingPoor communicationPoor listeningPoor positive requests

Backhanded complimentsAggressive behaviorPassive communicationAny healthy communicationSlide41

Problem Solving – Module #3

Teach a structured, 5 step problem solving strategy (SCALE)Relate problem solving skills to the personal recovery goals of consumersPractice using SCALE to solve everyday problems and achieve goalsSlide42

SCALE

Specify the problem

Consider all possible solutionsAssess for the bestLay out a planEvaluate outcome, ExecuteSlide43

Scale a mountain of problems to achieve your goal

One step at a timeSlide44

Scale Worksheet

Break big problems into smaller onesAsk about defeatist attitudesBrainstorm don’t evaluate as you reach CSlide45

SCALE Example: Find Transportation

Specify: Define the problem and be specific – How can I get to the store to by a new shirt for my interviewConsider all solutions- brainstorm, don’t evaluate, Take the bus, walk, ask roommate for ride, ask counselor to take me, borrow a bikeSlide46

SCALE continued…

Assess the best solution, pick two you like the most and do pros and cons of each.Take bus, Pro: I don’t need to rely on others, I can go on my schedule Con: I don’t have bus fare, it’s a long rideAsk roommate, Pro: fastest Con: need to give him money and he may not go when I want toSlide47

SCALE…

Lay out a plan: what will you do 1st,2nd, and 3

rd? 1. Ask room mate his fee 2. set aside some money 3. Identify route 4. Choose time that is not conflicting with other obligationsExecute and evaluate: Did it work? How well? What went wrong? How can you fix it? Do you need to try another solution?Slide48

Comprehensive CBSST Modules Test PART 1 Social Skills

1. Name the five non-verbal communication behaviors.Slide49

Answer #1

GesturesEye contactBody postureBody orientationFacial expression

Speech pace and volume when verbalSlide50

Question #2

Why is it important to make eye contact when talking to someone?Slide51

Answer #2

It gets or keeps the persons attention and it lets them know you are talking or listening to themSlide52

Question #3

What can you tell from a person’s body posture and the direction he or she is facingSlide53

Answer #3

Whether they want to talk to you, is listening, is interestedSlide54

Question #4

Explain speech pace and durationSlide55

Answer #4

Short and sweet so people can understand you betterSlide56

Question #5

What are the important things to do and say to express unpleasant feelings to someoneSlide57

Answer #5

Look at the personSay exactly what they did that bothered you Say how it made you feelSay what you want to be differentSlide58

Problem Solving Module

Question #1What are the steps to follow when solving a problemSlide59

Answer #1

SCALESlide60

Question #2

What is the best way to specify a problem you want to solveSlide61

Answer #2

Something you can break down in simple steps and accomplish in a weekSlide62

Question #3

How do you come up with different solutionsSlide63

Answer #3

Generate and brainstorm several solutions without evaluating them as you goSlide64

Cognitive Skills Module Test Question #1

What is the main focus of the cognitive skills in CBSSTSlide65

Answer #1

Thoughts/beliefs/attitudes or how thoughts relate to actions and or feelings.Examining thoughts to get better or achieve goalsSlide66

Question #2

Name the 3 C’sSlide67

Answer #2

Catch itCheck itChange itSlide68

Question #3

What is a mistake in thinking?Slide69

Answer #3

A thought that is not accurate and no evidence for it; all or nothing, jumping to conclusions, mind reading, fortune telling, emotional reasoningSlide70

Question #4

What is a helpful way to deal with paranoid thoughts or suspiciousness?Slide71

Answer #4

Catch it Check it Change itDo reality checking to see if the thought is really trueCheck the evidenceSlide72

Ben Yoder OCEACT Trainerbyoder@optionsonline.org 5416006102