Chapter 6: Behavioral work/ increasing skills

Question 1

Behavioral elements: 2 broad categories

Answer 1

1. Behavioral change strategies that increase knowledge, skills, and change-enhancing behaviours
2. strategies that decrease avoidance and self-defeating or problematic behaviours

Question 2

Behavioral interventions to increase skills (2)

Answer 2

1. activity scheduling

2. skills training and practice

Question 3

activity scheduling

Answer 3

• primarily developed for depression
• goal: help people increase the quantity and quality of positively reinforced behaviour, improve coping behaviours to deal more adaptively with negative life situations
• often used early in therapy bc typically results in improved mood, higher levels of energy, and greater self-efficacy
• demonstrate that activity leads to increased motivation: motivation and energy are a consequence of increased activity rather than a requirement for it

Question 4

activity recording

Answer 4

• sheet listing the days of the week and the times of the day
• electronic calendar on a smartphone
• verbal reports (may be biased)

Question 5

skills training (5)

Answer 5

1. communication skills training
2. self-care skills
3. relaxation skills
4. sleep skills
5. problem-solving skills

Question 6

skills training: communication skills training

Answer 6

• group settings can be helpful
• include the teaching and practice of:
  1. basic verbal skills
  2. nonverbal communication skills
  3. the identification and reduction of extraneous or habitual vocal patterns, such as “uhms” or “ahs”
  4. tone of voice, which can portray the speaker’s affect and intention (e.g., a questioning or blaming tone)
  5. the use of appropriate body language

Question 7

social skills exercise inventory

Answer 7

e. g., listening skills (remember what the other person said)
- what is appropriate disclosure, what is not
- coping with silence by others
- awareness of tone of voice
- giving and receiving compliments/criticism
- making a phone call and leaving messages
- making mistakes on purpose

Question 8

social skills training methods and strategies

Answer 8

1. offer specific feedback with concrete examples
2. point out consequences of problematic skills
3. use video feedback
4. use modelling (coping rather than mastery model)
5. give suggestions for change
6. use role-play exercises
7. encourage risk taking and effort rather than perfection

Question 9

skills training: self-care skills

Answer 9

• e.g., poor time management (overcommitment, dropping ones own activities to do tasks for others), insomnia, poor sleep routine, poor eating or exercise habits, or unbalanced and unhealthy lifestyle
• help client to set SMART goals
• help to identify barriers to change
• help with interfering thoughts
• help to begin and maintain behaviours

Question 10

skills training: relaxation skills

Answer 10

e.g., progressive muscle relaxation, breathing retraining, autogenic relaxation, or visualisation exercises

Question 11

why are relaxation skills beneficial?

Answer 11

• personal self-care activity
• decrease physical tension through progressive muscle relaxation
• attend to internal sensations
• hyperventilation, or those with panic attacks and/or panic disorder, who may benefit from breathing retraining

Question 12

relaxation: primary goal and secondary effects

Answer 12

• reduce baseline anxiety and provide immediate relief
  1. provide new skills
  2. increase self-efficacy
  3. possibly reduce efficacy of exposure therapy?

Question 13

behavioural experiments: primary goal and secondary effects

Answer 13

• change beliefs
  1. approach avoided situations
  2. increase self-efficacy
  3. develop new skills
  4. solve ongoing problems

Question 14

exposure therapy: primary goal and secondary effects

Answer 14

• approach avoided situations
  1. increase self-efficacy
  2. change beliefs
  3. increase distress tolerance
  4. provide new learning/ habituation

Question 15

mindfulness and acceptance therapy: primary goal and secondary effects

Answer 15

• distress tolerance/ increase awareness of present moment
  1. accept negative emotions or sensations
  2. create distance from negative emotions
  3. change relationship with thoughts
  4. make decisions more in line with personal values

Question 16

skills training: sleep skills (4 steps)

Answer 16

• insomnia = disturbed sleep that is persistent and causes other problems such as with poor concentration, lack of alertness, or fatigue
• 4 steps:
  1. stimulus control
  2. sleep restriction therapy
  3. cognitive therapy
  4. relaxation and sleep hygiene

Question 17

sleep skills: stimulus control

Answer 17

bed only associated with sleep or sex

Question 18

sleep skills: sleep restriction therapy

Answer 18

calculating sleep efficiency, which is the percentage of time asleep relative to the time lying in bed –> goal is to get to 90% sleep efficiency, so go to bed later to increase sleepiness or get up earlier

Question 19

sleep skills: cognitive therapy

Answer 19

assessing clients beliefs about sleep and create behavioural experiments or challenging their thoughts in another way

Question 20

sleep skills: relaxation and sleep hygiene

Answer 20

• Lifestyle suggestions, e.g., reducing caffeine and substance use before bed, having an optimal sleep environment (e.g., far, quiet, cool), formal relaxation therapies, creating a buffer zone, which involves taking an hour or two to unwind

Question 21

skills training: problem-solving skills process

Answer 21

1. identify problem(s)
   a) name and clarify
   b) assess its parameters, e.g. how often, how long
   c) determine outcomes
2. Generate alternative problem solutions: brainstorming
3. Decision making and solution choice
   a) cost-benefit analysis , key criterion: how likely is it to solve the original problem
4. solution implementation : discussion of precise way to implement the strategy
5. assessment of outcome
   - if solved: next issue
   - not solved: cycle back to the start and reavulate the problem and the strategies that might now be attempted

Question 22

common problem-solving strategies

Answer 22

e. g., - communication skills training
- Job finding and interview skills
- developing social support
- relaxation methods
- physical exercise
- sleep strategies