HOME TREATMENT/ASSESSMENT TEAM -PSYCHOLOGY GROUP PROGRAM- Weekly rolling program of combined psychoeducation and skills for service user recovery
Psycho-Educational Slides1. Duel Processing (‘rational’ and ‘emotional’ mind systems).2. DBT or third wave CBT idea of ‘wise’, ‘reasonable’ and ‘emotional’ mind state.3. Location of strong emotion/trauma memory in the brain.
1. Duel Processing The ‘Rational’ and the ‘Emotional’ mind systems‘Rational’ mind:Logical analysis, problem solving, impulse control.‘Emotional’ mind:Attentive of patterns/associations. It ‘plays safe’ – in that if itperceives anything even vaguely reminding it of risk of previousdangers (e.g. being attacked, or social dangers such as shame orembarrassment) it will quickly ‘flood’ the person with relatedemotions and urges to act in certain ways (e.g. avoid, fight, freeze up).
‘Rational’ and ‘Emotional’ mind
Where strong emotional and/or ‘trauma’ memories are stored
2. Mindfulness: Three primary states of mind‘Reasonable’ Mind• This is your ‘rational thinking’ and ‘logical’ mind.• It operates when you approach something intellectually, and think logically about something. Where you plan and focus your attention on solving a problem.• We need it to follow instructions, solve problems (IKEA furniture).• It is easier to access this state of mind when you feel good and relatively calm (emotionally) and harder when you don’t.• When people say “if I could think straight you’d be ok” they mean “if I could be in reasonable mind I’d be ok”.‘Emotion’ Mind• This is when your emotions are ‘in control’ – currently dictating and controlling your thinking, decisions, and behavior.• A certain amount of emotion mind is ok (e.g. intense devotion motivates staying with a hard task). But intense love or hate has fueled wars• Emotion mind is more likely when you are feeling physically ill, sleep deprived, using drugs/alcohol, or hungry.‘Wise’ Mind• This is the integration of emotion and reasonable mind• It has a certain sense of peace associated with it• No-one has wise mind all the time but everyone does have it• It may be the calm that follows the storm, grasping the whole picture when you only understood parts of it before, “feeling” the right choice in a dilemma
States of Mind and Problem SolvingReasonable Emotional Mind MindEqually Wise Mind In survival mode ourCut off cold thinking tends to beDismissing very protective e.g.Non understanding “what they have done to you!” - it is difficult to see others perspective 7
Group Agreements• Time keeping – Arrange to arrive a little early. If you are going to be more than 10- 15 minutes late it is better to call and cancel (as being this late will overly disrupt the group). Clients who are going to be late or miss a session must try to call “ahead of time”. Also, remember, the first minutes are usually quiet time/ practice of mindfulness so don’t interrupt this for others, wait until this part is finished.• Commitment- Try your best to commit attending the full total number of provided seminars (they compliment each other and should prove helpful ‘in combination’).• Mental State- Clients must not attend under the influence of alcohol or drugs.• Confidentiality- Information obtained within sessions, as well as the names of other clients, must remain strictly confidential. Only talk about what you have learned (with those outside the group membership) not at all about other group members!• Respect and sensitivity- Be sensitive and respectful of each other at all times when discussing issues. Remember, people may be at a sensitive and vulnerable point in their lives, they don’t want to be mocked or embarrassed for what they have said. There are ‘no stupid questions’, we are all here to learn… some of the ideas explored in the group are far from simple and can be understood in different ways. Allow others to have different views from you without taking offense or insisting they have to accept your viewpoint.
Overview - core skills to be taughtThe “3 Areas”Mindfulness (3 sessions)• Being in control of you own mind instead of your mind being in control of you.• Involves ‘what’ and ‘how’ we pay attention to and react toward certain things (including our own thoughts and feelings).Distress Tolerance (2 sessions)• Accepting and tolerating distress; on occasion trying to find ‘meaning’ for it.• Developing skills to survive distress in difficult situations without resorting to behavior that makes the situation worse (e.g. self-harming behaviors, aggressive outbursts).Emotion Regulation (3 sessions)• Skills to recognize and better manage painful emotions• You may currently find yourself feeling intensely angry, frustrated, depressed, anxious, suicidal – all these emotions impact how you behave.
Personal Crisis Plan• Consider carefully what you will “choose to share” in the group, e.g. will it put you off coming back again if you say too much about a certain issue? Be aware of the impact of what you share upon you and also upon other group members (e.g. traumatic details).• Plan of how you will elicit support from your immediate non- professional support network (such as family and friends)• Plan and consider how you will access support from your professional support network (such as CMHT, GP) if you need it.• Above all to take personal responsibility for your behavior within the group and commit to keep yourselves safe.
Mindfulness is…• Being in control of your mind rather than allowing your mind to control you (warning – ‘control’ is perhaps not the best word, discuss…)• An approach taught throughout the program and practiced weekly with a mindfulness exercise at the start of every session.• Allows you to control your attention processes – what and how long you pay attention to something. Also, guides you in ‘how’ to pay attention (that is, with an “accepting, non-judgmental curiosity” of what you are currently noticing!)• The key to learning mindfulness is to practice, practice, practice and to have patience (as with any other skill)ExerciseGroup members to think about a situation where they have found it difficult to “stopthinking about things” – e.g. about the past, the future, current physical pain, currentemotional pain?
The ‘what’ and how’ of mindfulness• The “What” skills involve what to do when being ‘mindful’• There are 3 “What” Skills – Observing, Describing and Participating• We can only really do one at a time (not all three at once!)1st What- “Observing” (the hardest to do?)• This is directly sensing or experiencing something without mentally ‘describing’, ‘judging’ or ‘labeling’ the experience• It is simply noticing or attending to something.
2nd What- “Describing”• Describing is a ‘secondary process’ (using inner ‘words’ to represent what you observe, sense, and experience).• So, whereas Observing is like ‘sensing’ (i.e. there are no words, it is just noticing and attending) describing is a reaction to observing (by labeling what it is that you’ve observed!)• Describing a ‘thought as a thought’ requires you to notice that it is a ‘thought’ instead of a concrete ‘fact’.• It is the difference between thinking “I am an idiot” and being an idiot.• Ask participants to suggest other examples of differences between a thought and a fact?
3rd What- “Participating”• This is entering wholly into an activity and “becoming one with it” (absorbed in it, not self-conscious or distracted by passing worries or thoughts)• It is the ‘ultimate goal’ in mindfulness.• We mix observing and describing things in order to understand and improve our ‘participation’ in events and activities.Example: Participating is driving… but when we goabroad and drive on a different side of the road, wesuddenly need to stop and observe and describe in orderto fully participate.
Mindfulness “How” SkillsThe 3 “How” skills explain how to be mindful:i) “Non-judgmentally”ii) “One-mindfully”iii) “Effectively”• Whilst we can only do one “what” skill at any one time, we can apply the 3 “how” skills simultaneously.
1st How- “One-Mindfully”• This involves focusing on one thing with ‘full awareness of what you are currently doing’• It is the opposite to how people normally operate – most of us think if we do several things at once we will accomplish more (like washing dishes whilst talking on the telephone) but this is often not true.• It doesn’t mean you cannot switch from one thing to another and back again; the trick however is to focus completely on the one thing you are doing at this moment.
2nd How- “Effectively”• This involves focusing upon doing “what works” rather than focusing upon what is “right” or “wrong” or what is “fair” or “unfair.• Doing what works or what is effective requires you to first be clear what your goal or objective is!?
Mindfulness ‘what’ and ‘how’ Quiz
How to Live in the 'Here-and-Now'? Content adapted from Paul Jones \"How to Live in the here and now\"Some advantages of learning to be more in the 'hear-and-now’:• More able to cope effectively (with the here-and- now situation)• Increased concentration and focus• More present and connected with others (rather than distracted and ‘absent’).• More able to enjoy and appreciate the moment• Other advantages…
\"Uptime\" & “Downtime\":• These two terms come from neuro-lingustic programming, but basically they are ways of saying someone is currently being ‘mindful’ or ‘un-mindful’.• “Downtime”- where we drift into a dream-like internally-directed focus, e.g. “in our own imagination”, not mindfully focused on the here- and-now external situation or activity.• “Uptime”- where we are fully ‘awake and attuned to’ our current external reality or activity.
Important implications of our limited working memory and attention span• We have a maximum attention capacity for 7 bits of information at a time (i.e. the limit of our short-term or 'working' memory).• Actually, many of us can only juggle around 5 ‘bits of info’ at a time (especially if we are depressed or traumatized).• Now, think about this statement: “What we attend to at any given moment is our current world, our reality\" (reflect on this for a few minutes/discuss possible meaning and life implications?).
The four 'dissociations'• Aim to become the \"here and now man/woman\"
Set you attention/senses to default (moreoften) to \"uptime\" (by using what psychologists call an anchor, trigger, or cue):
Home practice1. When you find yourself \"drifting into your head\", i.e. \"elsewhere/past/future/otherminds\", you will use your current bodily senses as your anchor to quickly return you to the “here-and-now”.2. Rehearse this many times, in different situations, so the new association becomes strong and well practiced.3. When you notice you are (or have) drifting(ed) into \"downtime\" perhaps squeeze you thumb and finger together and mindfully bring yourself into an awareness of your current five senses i.e. \"uptime\".4. Another thing you could do is have a watch/mobile bleep every 15 mins to remind you to \"ground yourself in the here-and-now\" using this simple and memorable strategy.
More home practice guidance• Mindfully notice “I’m wandering”, or “I’m passing judgement on myself”, etc, and gently, as best you can, “let it go”, coming back to your direct experience (your senses).• Practice learning to direct your “monkey mind”, the wild puppy/horse (whatever your metaphor is)…. Rather than it simply “going its own way” with you following passively….
REBT• Today overview of small part of rational emotive behaviour therpay ideals.• Why? Because help you recogise when increasingly mindful, or passing rules in own mind and how upsets you…
FACT
Problem Solving Slides (weeks….)
What is a problemIn Group• Definition of a problem - What is a problem? – A matter or situation regarded as unwelcome or harmful and needing to be dealt with and overcome: • they have financial problems • the problem of ageism in Hollywood (Oxford Dictionary)• Can people generate types of problems they have had over the past few weeks
Defining the Problem Actually defining the problem can be really helpful?Is the problem the thickness of the damn or the intensity of the water flow? Is the problem debt or impulsivity?
How the group will go• Share your own possible solutions to the problem but remain neutral to if person uses them or not.• Assess advantages and disadvantages of all the solutions suggested• Ask the people to report back the following week on the results• Re-visit the solutions to see if they can be improved
How the group will run in next module• Review home activity.• For first 30 minutes we will cover new information –• Then we will identifying problems.• We will then discuss this in the group and generate a hierarchy of problems• Agree on the first problem to be solved if there are a number• Discuss steps towards achieving a solution to the problem – brainstorm solutions
States of Mind and Problem SolvingReasonable Emotional Mind MindEqually Wise Mind In survival mode ourCut off cold thinking tends to beDismissing very protective e.g.Non understanding what they have done to you it is difficult to see other perspective 35
ExamplesReasonable Mind Emotional Mind Wise Mind 36
PRESSING THE PAUSE BUTTON• BEFORE ACTING CAN I PRESS PAUSE• WHAT DOES PRESSING PAUSE MEAN?• DOES ANYBODY HAVE A PAUSE BUTTON?
How to Solve a Problem There are 4 steps in problem solving: Defining the problem. Explore how we know the there is a problem. Then think what is the problem. Generating potential solutions What is my goal? What are the solutions to me getting my goal? Selecting and planning the solution. What are my options? Implementing and monitoring the solution. How am I going to achieve my goal? How did this go?
Example• Annoyed• Best friend has not borrowed £10 two weeks ago• I want my money back• Options pros/cons – If I don’t ask I will be annoyed and will fall out with them – If I do ask I will feel awkward• Solution – Bring conversation around to money – ask for money back• Money back???
Problem Solving Week 2• key steps – Strong Feelings (orientation/cue) – What was my problem (problem definition)? – What did I want (goal setting)? – What were my options? – What was my plan? – How did I do (evaluation)?
The 4 Steps• Defining the problem: • Select and Plan the Solution: – The problem may not be obvious. – Select the best solution to fix the Beware of thinking that the problem is problem. This is a process of elimination the behavior itself. Use focus on other technique – what is going on in her – Come to consensus on solution best for mind to make her do this?’ all & compromise• Now the problem’s defined, analyze • Implement the solution: it i.e. gather information – Write down clear, measurable steps to• Generate Potential Solutions: reach goal – Begin to develop possible solutions. – Check on progress and evaluate the This is creative & practical; every outcome. Don’t blame each other for possible solution is identified lack of success. This is a joint responsibility• There aren’t wrong answers & judgments shouldn’t be made
When to Solve a Problem• We all solve problems. This should be when calm & can take an unemotional view. DON’T try to solve problems when emotional• Top Tips: – Try to be calm & logical – You might need to discuss it with someone you trust first – Attitude is key. Embrace problems. The more you solve, the greater your experience – If you’re too emotional, take a break. Every problem has a solution – Stop thinking about what you can't do & think about what you can do
Distress Tolerance (2 week)• Distress tolerance skills can help us get through distressing moments in life when i) we can’t 'change the situation' or ii) when we can’t 'sort out our feelings/change how we feel' (emotional regulation). They are admittedly then 'short term' solutions but they are nevertheless crucial skills to have and to develop.• They are ways to help us survive during terrible situations without resorting to behaviours that could make the situation worse, such as using aggression, drugs, alcohol or maybe self-harming.• We all have to tolerate pain and distress in life but we also always try to avoid pain, which can lead to more problems.
Distress tolerance Crisis Survival StrategiesWe will focus on two crisis survival strategies:1. Distracting2. Self-soothing• These strategies are only meant to temporarily ‘get us through’ a crisis situation and the overwhelming emotions we may feel at times. These skills are ways to ‘survive’ intense painful emotions.• Not meant to be a cure for all our problems (so the benefits may only be temporary) but it’s an achievement to use them nevertheless.• They are not ways to regulate our emotions (because they won’t reduce or end our painful emotions- these things will be taught in the emotion regulation module).
Crisis Survival Strategies1. DISTRACT (with “Wise Mind ACCEPTS”)• Activities• Contributing• Comparisons• Emotions• Pushing away• Thoughts• Sensations2. SELF-SOOTHE (with the FIVE SENSES)• Vision• Hearing• Smell• Taste• Touch
Self SoothingUsing:• Vision• Hearing• Smell• Taste• Touch
Distress tolerance (home plan)• Crisis Survival Strategies Diary Card• Personal Relaxation Plan• Pros and cons of tolerating distress worksheet
Emotion Regulation (3 week)GOALS OF MODULEUNDERSTAND EMOTIONS YOU EXPERIENCE• Identify (observe and describe) the emotion• Understand what emotions do for youREDUCE EMOTIONAL VULNERABILITY• Decrease negative vulnerability (vulnerability to emotion mind)• Increase positive emotionsDECREASE EMOTIONAL SUFFERING• Let go of painful emotions through mindfulness• Change painful emotions through opposite action
ST model of healthy human emotional developmentAll human beings have core emotional needs:1.Protection/safety2.Self-expression3.Self-esteem4.Connection to others5.Autonomy6.Realistic limits
What are schemas?• A collection of memories, emotions, bodily sensations and thoughts that revolve around childhood themes.
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