ExposureandResponsePreventionforOCD強迫癥的暴露反應預防

ExposureandResponsePreventionforOCD強迫癥的暴露反應預防第1頁/共121頁OrderofTopicsTheTwoManuals:OriginalForm&GroupFormTreatmentTechniques&theFormsAssessmentsUsesoftheFormsOverviewofTaskstobeAccomplishedWithintheGroupSessionbySessionOutline第2頁/共121頁UniversalGroupDynamics4StagesallgroupsgothroughtobecohesiveandsuccessfulForming:Groupmembersbecomeorientedtowardoneanother.Storming:Conflictssurfaceinthegroupasmembersvieforstatus&thegroupsetsitsgoals.Norming/Performing:Groupmembersmovebeyonddisagreementandorganizationalmatterstoconcentrateontheworktobedone.第3頁/共121頁UniversalGroupDynamicsForming–

Initialstage:Membersdevelopan“inorout”feeling.Thishighlightstheneedforthefacilitatoror,inpeer-to-peer,theco-facilitatortomaintainabasicpostureofconcern,acceptance,genuinenessandempathytowardthegroupmembers.***Nothingtakesprecedenceoverthisattitude!Yalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.第4頁/共121頁UniversalGroupDynamicsForming–contIfpossible,individuallymeetwithgroupmemberstoorientthemtothetherapyi.e.,relaytheefficacyoftheinterventionanddetermineiftheyaresuitablefortheintervention(e.g.,presenceofpersonalitydisordersthatcandisruptthegroupprocess).第5頁/共121頁UniversalGroupDynamicsForming–contFacilitator,orinthecaseofpeer-to-peer,theco-facilitatormustrecognizeanddeteranysituationthatmightdisrupttheformationofgroupcohesioni.e.,continuedtardiness,absences,subgrouping,disruptiveextra-groupsocializationandscapegoating*.第6頁/共121頁UniversalGroupDynamicsForming–cont*Scapegoating:“aprocesswherebyangerandaggressionaredisplacedontoanother,usuallylesspowerfulgrouporpersonsnotresponsiblefortheaggressor’sfrustration”(akadisplacementorprojection)Corsini,R.(Ed.).(2002).Thedictionaryofpsychology(pp.863).NewYork:Brunner-Routledge.第7頁/共121頁UniversalGroupDynamicsForming–contDuringthisstagethereishesitancyamongthemembersandtheywillbe“sizinguponeanotherandthegroup.Theyarewonderingiftheywillbelikedandrespectedorignoredandrejected.”The“memberswillbesearchingforapproval,acceptance,respect,ordomination.”第8頁/共121頁UniversalGroupDynamicsForming–contMemberswillbewondering“whatmembershipentails…h(huán)owmuchtheymustrevealofthemselves,whattypeofcommitmenttheymustmake.”Veryimportant:theywillbelookingtotheleader/facilitatorforstructure,answers,leadershipandforapprovalandacceptance.Yalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.

第9頁/共121頁UniversalGroupDynamicsForming–contThemembers’searchforsimilaritiesisverycommoninearlygroupsandgroupmemberswillbefascinatedthattheyarenotuniqueintheirmisery–thisispartofthefoundationforcohesiveness(discussedlater).Yalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.

第10頁/共121頁UniversalGroupDynamicsStorming

Conflictssurfaceinthegroupasmembersvieforstatusandthegroupsetsitsgoals.Thisiswhenthegroupshiftsfrompreoccupationwithacceptance,approval,commitmenttothegroup,definitionsofacceptedbehavior,thesearchfororientation,structure,andmeaning,toapreoccupationwithdominance,controlandpower.Theconflictcharacteristicofthisphaseisamongmembersorbetweenmembersandtheleader.

第11頁/共121頁UniversalGroupDynamicsStorming-contEachmemberattemptstoestablishhis/herpreferredamountofinitiativeandpower.Gradually,acontrolhierarchy,asocialpeckingorderemerges.Negativecommentsandintermembercriticismaremorefrequent;membersoftenappeartofeelentitledtoaone-wayanalysisandjudgmentofothers.第12頁/共121頁UniversalGroupDynamicsStorming-contAdvicefromthefacilitatorisgiveninthecontextofthesocialcodeofthegroup:socialconventionsareabandonedandmembersaretoldtofeelfreetomakepersonalcriticismaboutacomplainer’sbehaviororattitudes.Judgmentsmaybemadeofpastandpresentlifeexperiencesandstyles.Itisatimeofoughtsandshouldsinthegrouporatimewhenthe“peer-court”isinsession.Memberswillmakesuggestionsorgiveadviceasapartoftheprocessofjockeyingforposition.第13頁/共121頁UniversalGroupDynamicsStorming-contAtonetimeoranothertheremostlikelywillbeanemergenceofhostilitytowardthefacilitator–thisusuallyarisesoutofdisappointmentbythegroupmemberintheirprogress–Remember:Progresstakestime.Anothersourceofresentmenttowardthefacilitatoristhatthemembereventuallyrealizeshe/shewillnotbecometheleader’s“favoritechild.”Thisdoesnotarisefromafunctionofchildlikementalityorpsychologicalnaivete.

第14頁/共121頁UniversalGroupDynamicsStorming–cont

EncouragememberstoexpresstheirangerorannoyancewithyouorthepeerfacilitatorYalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.

第15頁/共121頁UniversalGroupDynamicsNorming/Performing

Thisisthestagewheregroupcohesivenesswilldevelop:recognitionofacommongoal,developmentofgroupspirit,consensualgroupaction,cooperation,mutualsupport,groupintegration,we-consciousnessunity,supportandfreedomofcommunicationaswellastheestablishmentofintimacyandtrustbetweenpeers.

第16頁/共121頁UniversalGroupDynamicsNorming/Performing-contInthebeginningthegroupwillexhibitmuchprideintheirunityandpossiblymuchcondemnationofthemember’sadversariesoutsidethegroup.Eventuallythisglowwillpaleandthegroupmustbeallowedtoexpressdifficulties,conflictsanddifferentiation–otherwisethegroupwillfail.第17頁/共121頁UniversalGroupDynamicsNorming/Performing-cont

Therearetwoaspectstothisphase:anearlyphaseofgreatmutualsupport(thegroupagainsttheexternalworld)and,amoreadvancedstageofgroupworkortrueteamworkinwhichtensionemergesasaresultofthemember’sstrugglewithhisorherownresistances.第18頁/共121頁GroupTherapy:TherapeuticFactorsElevenPrimaryTherapeuticFactorsInstillationofhopeUniversalityImpartingInformationAltruismCorrectiveRecapitulationofPrimaryfamilygroupDevelopmentofSocializingTechniquesImitativeBehaviorInterpersonalLearningGroupCohesivenessCatharsisExistentialFactors

第19頁/共121頁GroupTherapy:TherapeuticFactorsInstillationofHopeMostimportantatthebeginningoftheprocess.Instillinghopeinsomeoneistherapeuticevenbeforetherapystarts.Ifyouhaveopenenrollment,othermembersofthegroupcantellhowtheyhavebeenhelped.FacilitatormustbeveryconfidentandoptimisticYalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.

第20頁/共121頁GroupTherapy:TherapeuticFactorsUniversality“Youarenotaloneinthisproblem.”Althougheveryoneisuniqueandhashis/herownsetofproblems,withintheearlystagesofgrouptherapygroupmemberscometorealizethatothershaveproblemsanda“welcometothehumanrace”experienceor“we’reallinthesameboat”isapowerfulsourceofrelieftotheindividual.“Despitethecomplexityofhumanproblems,certaincommondenominatorsareclearlyevident,andthemembersofatherapygroupsoonperceivetheirsimilarities.”

第21頁/共121頁GroupTherapy:TherapeuticFactorsInstillationofHopeFromyoutothesupportgroupmember:theymaynotbeinformedaboutwhattheyhave,howcommonitisorhowtreatablethedisorderis.Thisisextremelybeneficialtotheindividual.Fromonesupportgroupmembertoanothersupportgroupmember:itisbeneficialtothenewcomerorongoingsupportgroupmemberforthemember’sreflectiononwhathe/sheaccomplished,e.g.,madetherightdecision.Ifyouunderstandtheproblemyoucanlearntocontrolit.

第22頁/共121頁GroupTherapy:TherapeuticFactorsAltruismBothrecipientandprovidercanbenefit.Seestorybelowforexample–“thereisanoldHasidicstoryofarabbiwhohadaconversationwiththeLordaboutHeavenandHell.“IwillshowyouHell,”saidtheLord,andledtherabbiintoaroomcontainingagroupoffamished,desperatepeoplesittingaroundalargecirculartable.Inthecenterofthetablerestedanenormouspotofstew,morethanenoughforeveryone.Thesmellofthestewwasdeliciousandmadetherabbi’smouthwater.Yetnooneate.Eachdineratthetableheldaverylong-handledspoon–longenoughtoreachthepotandscoopupaspoonfulofstew,buttoolongtogetthefoodintoone’smouth.Therabbisawthattheirsufferingwasindeedterribleandbowedhisheadincompassion.“NowIwillshowyouheaven,”saidtheLord,andtheyenteredanotherroomidenticaltothefirst-samelarge,roundtable,sameenormouspotofstew,samelong-handledspoons.Yettheirwasgaietyintheair:everyoneappearedwellnourished,plumpandexuberant.TherabbicouldnotunderstandandlookedtotheLord.“Itissimple,”saidtheLord,“butitrequiresacertainskill.Yousee,thepeopleinthisroomhavelearnedtofeedeachother!”

第23頁/共121頁GroupTherapy:TherapeuticFactorsTheCorrectiveRecapitulationofthePrimaryFamilyGroupMaleandfemaletherapists/facilitatorsbecome“mother”and“father”tothegroupmemberswhointurnbecomethe“children”or“siblings.”Re-evokessituationsinasettingwhereonecan“workonit”i.e.,maketheperson/groupmembermoreconscious(giveinsight).

第24頁/共121頁GroupTherapy:TherapeuticFactorsDevelopmentofSocializingTechniquesCanbeexplicite.g.,developsocialskillsinthegroup:developingvocabularyisonetoolforsocialskills.Canbeimplicite.g.,learningtobecomecomfortabletalkingaboutpersonalrelationshipshelpstolearntodothisoutsideofthegroupsetting.

第25頁/共121頁GroupTherapy:TherapeuticFactorsImitativeBehaviorUseofmodelsinthegroupe.g.,explicit:howitisdone;implicit:howtodoit.Buildingaconsensus:whenagroupmemberbringsupsomethingtheyneedtodiscussandiscutoffordisruptedbyanothergroupmember:Asktherestofthegroup(his/herpeers)ifthisperson(disruptee)iswrongorwhattheywanttodo,UseoftheSocraticmethod:whatdoyou(restofthegroup)thinkaboutthissituation?Becarefulnottohidebehindthegroupdecisionifitisthewrongdecision(aka:consensusbuilding).

第26頁/共121頁GroupTherapy:

TherapeuticFactorsThedevelopmentofgratifyinginterpersonalrelationshipsThegroupisa“socialmicrocosm”(i.e.aminiaturizedrepresentationofeachmemberssocialuniverse),aplacetolearnlessonsandthengeneralizethemtotheoutsideworld(theymayhaveproblemsrelatingtootherpeoplethatarecontributingtotheirpsychopathologies).Throughfeedbackfromothergroupmembersandself-observationthemembersbecomeawareofsignificantaspectsoftheirinterpersonalbehavior:theirstrengths,limitations,theirinterpersonaldistortionsandthemaladaptivebehaviorthatelicitsunwantedresponsesfromotherpeople.

第27頁/共121頁GroupTherapy:

TherapeuticFactorsThedevelopmentofgratifyinginterpersonalrelationshipsInterpersonalsequence:Displayofpathology(behavior)Feedbackfromothermembers&selfobservationresultin:Betterwitnessesofhis/herownbehaviorAppreciatetheimpactofthisbehavioron:FeelingsofotherpeopleOpinionsothershaveofthemOpinionshe/shehasofhimself/herself第28頁/共121頁GroupTherapy:

TherapeuticFactorsGainingInsightInsightoccurswhenonediscoverssomethingimportantaboutoneself–aboutone’sbehavior,one’smotivation,orone’sunconscious.Results:individualrealizestheyhavethepowertochangetheirbehavior.

第29頁/共121頁GroupTherapy:

TherapeuticFactorsGroupCohesivenessThemostcommonfactor(thisisthesameasthetherapeuticrelationship)Cohesivenessbroadlydefined:Theresultofalltheforcesactingforallthememberstoremaininthegroup,ormoresimply:Itreferstotheconditionofmembersfeelingwarmthandcomfortinthegroup,feelingtheybelong,valuingthegroupandfeeling,inturn,thattheyarevaluedandunconditionallyacceptedandsupportedbyothermembers.Inconditionsofacceptanceandunderstanding,memberswillbemoreinclinedtoexpressandexplorethemselvestobecomeawareofandintegratehithertounacceptedaspectsofself,andtorelatemoredeeplytoothers.Yalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.第30頁/共121頁GroupTherapy:

TherapeuticFactorsCatharsisAstrongemotionalreactionoftenduetosuddeninsightofthenatureandcausesofdeeplyhiddenpainfulmemories.Anepisodeofemotionalreleaseanddischargeoftensionassociatedwithbringingintotheconsciousrecollectionpreviouslyrepressedofunpleasantexperiences.

第31頁/共121頁GroupTherapy:

TherapeuticFactorsExistentialFactorsRecognizingthatlifeisattimesunfairandunjust.Recognizingthatultimatelythereisnoescapefromsomeoflife’spainandfromdeath.Recognizingthatnomatterhowclosewegettootherpeople,wemuststillfacelifealone.第32頁/共121頁GroupTherapy:

TherapeuticFactorsExistentialFactors–contFacingthebasicissuesofourlifeanddeath,andthuslivingourlivesmorehonestlyandbeinglesscaughtupintrivialities.Learningthatwemusttakeultimateresponsibilityforthewayweliveourlivesnomatterhowmuchguidanceandsupportwereceivefromothers.Yalom,I.D.(1995).Thetheoryandpracticeofgrouppsychotherapy(4thed.).NewYork:BasicBooks.第33頁/共121頁GroupTherapy:

Basic’sIdeally,nomorethan7to8ineachgroupDecideifyouwantanopengrouporaclosedgroupSometimesyoumustsacrificeonememberforthegoodofthegroupItisthegroupthatistheagentofchange(thisisthenormtostrivefor)第34頁/共121頁GroupTherapy:

Basic’sYourgroupwillhaveitsownculturewithnorms,expectations,behaviorsandmores.Youbuildtheoutcomeyouwant.Normsofyourculture:activeinvolvementinthegroup,nonjudgmentalacceptanceofothers,extensiveselfdisclosure,dissatisfactionwithpresentmodesofbehavior,desireforself-understanding,andeagernessforchange.第35頁/共121頁GroupTherapy:

Basic’sSafety–youcansaywhatyouwantwithoutridicule,harassment,orbeinglookeddownupon.Respectofmembertomember.**Attendance.PayingAttention.Foodanddrinks–maybenotisbest(whenthesearepresentseriousconversationsrarelytakeplace=notconducivetotherapeuticgoals).第36頁/共121頁ProblemSeverityRecentstatisticsshow15%ofbothsexesaged65-yearsandoldersufferwithclinicallyrelevantdepressivesymptoms19.6%ofbothsexesaged85-yearsandoldersufferwithsamesymptoms (FederalInteragencyForumonAging-RelatedStatistics.2006.OlderAmericansUpdate2006:KeyIndicatorsofWell-Being.Pp.27)第37頁/共121頁BehavioralActivationTechniquesforDepressionAparsimonious,multidimensionalholisticapproachtotreatingdepression.Easilyadaptabletoavarietyofpracticaluses.Behavioraltechniquesconcentrateon:IncreasingpositivereinforcementReducingor“undermining”punishmentfromtheenvironmentActivationisthedirecttargetforchange第38頁/共121頁DefinitionBehavioralactivationtechniquesinvolvethefollowing:Identificationofindividualizedtargetbehaviors,goalsandrewardsthatservetoreinforcenondepressiveor“healthybehavior”Increaseexposuretopositiveconsequencesofhealthybehaviortherebyincreasinglikelyreoccurrenceofsuchbehaviorandreducinglikelihoodoffuturedepressedbehavior

AdaptedfromLejuezetal.(2001),p.257第39頁/共121頁AGoodResearchModelBehavioralActivationGroupTherapyinPublicMentalHealthSettings:APilotInvestigation.Porter,J.,Spates,C.,&Smitham,S.(2004).ParticipantsmetcriteriaforDSM-IVdiagnosisformajordepressivedisorder.ExclusionCriteria:diagnosisofbipolarorpsychoticsub-typesofdepression,panicdisorder,currentalcoholabuse,pastorpresentschizophrenia,schizophreniformdisorder,organicbrainsyndromeandmentalretardation.第40頁/共121頁AGoodResearchModelTreatmentmodality:BAGT(Behavioralactivationgrouptherapy)sessions:Groupformat,95-minutesessions,weeklyfor10weeks2CotherapistsGroupsize6–10participantsMeanage=44-yrsoldBDI-IIadministeredateverytherapysessiontomonitorprogressonaweeklybasis第41頁/共121頁AGoodResearchModelTreatmentmodality:BAGTtherapysessions–InTheBeginning:Explainanddefinethetherapeuticagentofpositivereinforcementanditsimportance.Explaintheuseoftheformsutilizedwithinthetreatment.Explaintheimportanceof“homework”ontheclient’spart.Explaintheimportanceofnottryingtochangethecognitionoftheclient.Explaintheimportanceof“theclient”pickingoutactivitiesthathe/sheenjoysandnotbeingdirectedbythefacilitator.Toshowtheemphasisonthismodalityisontheidentificationofbehaviorsandactivitiesthatprovidetheclientwithpleasureandinterestthatiscurrentlymissingfromhis/herlife.第42頁/共121頁AGoodResearchModelTreatmentmodality:BAGTtherapysessions-inthebeginningcont:Obtainabaselinefromwhichtomeasureprogressi.e.,theGeriatricDepressionScale(isinthepublicdomain)whenworkingwithindividualsaged55yearsandolder(youdonothavetousetheBDI-IIwitholderadults,theGDSismuchmoreefficacious).

第43頁/共121頁AGoodResearchModelTreatmentmodality:BAGTtherapysessions–cont:Cotherapists/cofacilitator(you)shouldreviewBDI-IIscores(GDSorGeriatricDepressionScaleisbetterforolderadultsandonecanswitchbetweenshortformandlongformtocombatpracticeeffects,mayalsousetheCUDOS)atbeginningofeachsessiontomonitorprogress.Formsareinyourhandoutsinthebackaswellasscoringinstructions.第44頁/共121頁AGoodResearchModelTreatmentmodality:BAGTtherapysessions-cont:GroupdiscussionsfocusedonBAprinciplesToexplainanddefinethetherapeuticagentofpositivereinforcementanditsimportance.BAisbasedonthepremisethatincreasedactivity(i.e.,activation)andtheresultingcontactwithpositiveconsequencesissufficientforthereductionofdepressivesymptomsandthesubsequentincreaseofpositivethoughtsandfeelings.

(Hopkoet.al.(2003).Abriefbehavioralactivationtreatmentfordepression:Arandomizedtrialwithinaninpatientpsychiatrichospital.BehaviorModification,27(4),458-469.)第45頁/共121頁AGoodResearchModelTreatmentmodality:BAGTtherapysessions-cont:SolicitinggroupmemberdisclosureInvolvememberstotalkaboutactivitiestheyhavenotdoneandwhye.g.,toohard,toodepressed,etc.Planning&evaluatinginterventionsThisisthetimetoreviewindividual’schosenactivitiese.g.,weretheytoohard?,notfeasible,etc(trytomonitorthisattheverybeginningwhentheyarechoosingactivitiestoavoidupset.Inotherwords,theyshouldnottryto“reachforthemoon”–makesureactivitiesareeasyenoughtobeaccomplished.Providingfeedbacktogroupmembers.第46頁/共121頁TheBATDManualforGroupTherapyPorter,J.,Spates,C.R.,&Smitham,S.(2004).Behavioralactivationgrouptherapyinpublicmentalhealthsettings:Apilotinvestigation.ProfessionalPsychology:ResearchandPractice.35(3),297-301.Email:jeffreyporter@forBAGTmanuals(bothTherapistmanualandclientworkbook).Itisfundamentallyimportantforyoutoobtainthismanual.第47頁/共121頁TheBATDManualinitsoriginalformABriefBehavioralActivationTreatmentforDepression:TreatmentManual.Lejuez,C.,Hopko,D.,&Hopko,S.(2001)Excellent,easilyimplementedstructuredtreatmentmanualusefulforindividualtreatmentandmodifiabletogroupmodality.TreatmentmanualCanbedownloadedfrom:/~dhopko/BATDmanual.pdfAgain,ofextremeimportancetoobtainthismanualsothatyouhaveagoodunderstandingofthistherapymodel.第48頁/共121頁TreatmentTechniques

&TheFormsOrientationtotherapyInstillationofhope&explanationofhowtherapyworksDailyActivityRecordEstablishpatternofactivityforprevious7daysFunctionalAssessmentEstablishbaselineLifeActivitiesChecklistLifeAreasAssessmentBehaviorContractActivityHierarchy第49頁/共121頁TreatmentTechniques

&TheFormsActivityIdentificationRankingRewardsListWeeklyBehavioralCheckoutMasterActivityLogActivityGraphDepressiveSymptomSeverityGraph第50頁/共121頁TypesofAssessmentTherapist/Facilitator-administeredassessmentsInterviewtodeterminesuitabilityforgroupmembership(seepreviouscriteriai.e.,exclusioncriteria).MentalHealthAssessment–presenceofdepressivesymptomology(seefunctionalassessment)第51頁/共121頁TypesofAssessmentCont.Self-reportmeasurestoestablishbaselineand/orsuitabilityforgroupmembership(i.e.,MMSEand/orSLUMS)BeckDepressionInventory(BDI-II)ClinicallyUsefulDepressionOutcomeScale(CUDOS;availableonline),orRevisedHamiltonRatingScaleforDepression(RHRSD)GeriatricDepressionScale(GDS)MiniMentalStatusExam(MMSE)and/orSt.LouisUniversityMentalStatusExam(SLUMS;availableonline)第52頁/共121頁OverviewofSessionInterventions:FunctionalAssessmentPurpose:Establishdailyactivity/routineToassesswhichactivitiesintheclient’slifeprovideasenseofpleasureand/ormastery.Clientkeepsadailyactivitylogofactivities.Teachtheclienttheroleofself-defeatingbehaviorandAversiveEnvironmentsinNegativeMoods.Tohelptheclienttounderstandtherelationshipbetweenhis/herbehaviorandmoodsandbetweentheenvironmentandmoods.Thishelpstheclienttounderstandhowhe/shecanmakemeaningfulchangestoimprovemoods.第53頁/共121頁SessionInterventionsOverviewcont:MasteryandPleasureRatingsofActivitiesPurpose:Toassesswhichactivitiesintheclient’slifeprovideasenseofpleasureand/ormastery.Clientkeepsadailyactivitylogofactivitiesandratesthedegreeofpleasure/mastery(0-5)experiencedaftercompletingtheactivity.Laterinthetherapytheclientselectsthoseactivitiesratinghighoneithersideofthescaletoincreaseviahomeworkassignments.Goal:fortheclienttoscheduleactivitiesduringthedaysothatthereissomesenseofstructureandcontrolonthepartoftheclient.Thisalsohelpstheclienttoidentifywhathe/sheisdoingandtorealizethathe/sheisdoing“nothing.”Adaptedfrom

“BehavioralActivationGrouptherapy;therapistmanualbyPorter,J.&Spates,R.(2004)第54頁/共121頁SessionInterventionsOverviewcont:VerbalReportsofActivitiesPurpose:Tounderstandwhatactivitiesthepersoniscurrentlyengaginginwhichreflectscurrentfunctioning.Thetherapistisabletoassesswhethertheclientisactinginwaysthatarelikelytomakethedepressionworse(i.e.,self-defeatingbehaviors).Alsogivesthetherapistanideaoftheclient’sinterests.Asktheclienttoreportonwhathe/shedidatspecifictimesduringtheday.Adaptedfrom

“BehavioralActivationGrouptherapy;therapistmanualbyPorter,J.&Spates,R.(2004).第55頁/共121頁SessionInterventionsOverviewcont:SymptomReportsfromDepressiveMeasure(GDS)Purpose:Tounderstandwhatsymptomsofdepressiontheclientisexperiencingsothatthetherapistcanchooseappropriatetargetsforintervention.Lookoverthemeasureatthebeginningofthesessionandfocusprimarilyonstrongbehavioralandmoodsymptomsiftheyarepresent.Adaptedfrom

“BehavioralActivationGrouptherapy;therapistmanualbyPorter,J.&Spates,R.(2004).第56頁/共121頁SessionInterventionsOverviewCont:DailyActivityScheduleReviewPurpose:Toassessthetypeandquantityofactivitiestobetterunderstandtheclient’sroutinesandregularactivities.Thishelpsthetherapisttobetterunderstandwhythepersonisreceivinglittlepleasurefromlife.IntroducetheDailyActivityScheduletothegroupmembersduringagroupandexplainthatitcanbeveryvaluabletokeeparecordofone’sactivitiesthroughoutthedaysothatsuggestionsforchangesinbehavior,basedonthisinformation,canbemade.Adaptedfrom

“BehavioralActivationGrouptherapy;therapistmanualbyPorter,J.&Spates,R.(2004).第57頁/共121頁SessionInterventionsOverviewCont:AssessmentofIn-SessionBehaviorPurpose:Toobservefirst-handboththedepressivebehaviors,aswellasthehealthybehaviors,thattheclientengagesinduringthetherapysession.Theseobservationscanbebroughtupastheyaremadeoratalatertime.Thisisaneffectivewayofdemonstratingthefunctionalrelationshipsbetweentheenvironment,behavioranditsconsequences.Observetheclient’sbehaviorintermsoftypicalsymptomsofdepressionaswellasintermsofgenerallyunhealthybehavior.Observetheclient’sbehaviorintermsofhealthyandproductivebehavior.Examinewhatishappeningwhenproblembehaviorsorhealthybehaviorsoccurandwhattheresultsofthebehaviorsare.Adaptedfrom

“BehavioralActivationGrouptherapy;therapistmanualbyPorter,J.&Spates,R.(2004).第58頁/共121頁SessionInterventionsOverviewCont:AssigningActivitiestoIncreaseSenseofMasteryorPleasurePurpose:Toactivetheclientinsuchawaythathe/shefeelsmoreeffectiveinhis/herenvironmentandconsequentlyreceivesmorepleasurefromactivities.Activitiesthatarelikelytoimprovenegativeaspectsoftheenvironmentoronesthatwerepreviously(beforethedepression)reinforcing.第59頁/共121頁SessionInterventionsOverviewCont:TeachClientRoleofSelf-DefeatingBehavior&AversiveEnvironmentsinNegativeMoodsPurpose:Tohelptheclienttounderstandtherelationshipbetweenhis/herbehaviorandmoodsandbetweentheenvironmentandmoods.Thishelpstheclientunderstandhowhe/shecanmakemeaningfulchangestoimprovemoods.Itisimportanttofocusonwhattheclientactuallydoes(activebehavior)ratherthanonwhathe/shefailedtodo.YoumustexplaintheABCmodeltotheclientAistheante