SOWK6190/SOWK6127

Cognitive Behavioural Therapy and Cognitive Behavioural Intervention

Week 8 – Additional Cognitive and Behavioural Techniques

Dr. Paul Wong, D.Psyc.(Clinical)

Outline

Problem-Solving Skills

Goal-Setting

Assertiveness Training

Treatment Planning

Problem-Solving

Stages of Problem-solving

1. Define the problems

2. Brainstorm possible solutions

3. Evaluate the possibilities

4. Select a solution

5. Plan the solution

6. Implement the plan

1. Define the problems

Define the problem in terms of WANTS.

E.g., Problem: “My job is boring, I want to quit my job!”

Could mean: “I want to make my job much more interesting.”

If you are not sure how to define a problem, ask yourself “What do I really want from this situation?”

2. Brainstorm possible solutions

Try to come up as many solutions as possible – quantity is more important than quality in here.

* No evaluation or criticism at this stage, pleaseNo evaluation or criticism at this stage, please.*

Put down the suggested solutions.

Be as CREATIVE as possible.

3. Evaluate the possibilities

By now, you should have a list of possible solutions;

Now, write down the pros and cons of each solution.

Then, put a “+” or “-” next to the solution.

“+” means “Yes, I’d be willing to try this solution”.

“-” means “No, I’d not be willing to try this solution.

4. Select a solution

• Often by this stage an appropriate solution has become obvious.

• More often than not, NO single solution is likely to be

sufficient to cope with the problem.

• E.g., I want to lose weight – by sensible eating, regular exercise, new method to cope with bad feelings etc.

• If you find difficulties in choosing the solutions, you might consider to go back to step 1 simply because the problem was too big in the first place.

5. Plan the solution

This crucial step is often missed.

Ask yourself this lists of questions might help: Who will do what? Where? By when? What resources are needed? From where will they be obtained? How? And so on.

6. Implement the plan

Follow your plan through, one step at a time.

Congratulations if you solve one of your problems.

If not, accept your disappointment. Try again and back to step 1.

Goal-Setting

Some benefits of having goals in life

Goals boost effort as you get close

Goals give direction/purpose to your life

Goals are the basis of self-discipline

Why people procrastinate?

1. “Not in the mood!”

2. The mastery model – “I am not as good as others!”

3. The fear of failure

4. Perfectionism

5. Lack of rewards6. Passive aggressiveness – meaning “as a revenge”

7. Unassertiveness – meaning “occupied by things that don’t want to do”

8. The lack of desire

Useful and usable goals

Are realistically challenging, given your abilities and life situation

Too many failures discourage, too easy won’t inspire

Express your interestsWhich may change overtime

Conform with your valuesSo you feel ethically and morally comfortable

Useful and usable goals

Are clear plans for concrete actionsExpressed as behaviours you intend to do

Have verifiable outcomes

Can be achieved reasonable soonOr be approached by sub-goals

Depend mostly on your own efforts

Are ones you were involved in setting

Writing goals

Usually begin with wishes or good intentionsE.g., I wish I can finish the marathon

E.g., I ought to do something to improve my GPA

Identify the verifiable outcome

How will I know when I have achieved this goal?E.g., I will finish the marathon within a certain time period, i.e., 1 hr 10 mins

E.g., I will see my GPA improve for a certain point, i.e., from 2.9 to 3.0

Writing goals

Specify what you will do to achieve the outcomeE.g., I will do three training sessions per week at the gym

E.g., I will spend at least an extra 1.5 hours per day revisiting things that I have learned in today classes

Do a check: realistically challenging? Interesting? Comfortable?

Getting started

For each significant life area, first identify a wish

Then write a useful and useable goal

You decide what areas are important in your lifeCareer?

Marriage/family?

Friends?

Education?

Recreation?

Health?

1. Choose the possible life areas

2. Specify the wants

3. Set useful and usable goals

4. Plan for implementation

5. Do a realistic and comfortable check, e.g., time and resources

6. Optional – contracting with yourself

7. Implement and evaluate

An example of a contract

To achieve my goal of improving my GPA by the end of this year, I plan to attend a “super memory course” provided by ….

Each week that I go to classes and complete any reading or assignments set that week, I will reward myself by going to the club with my friends on Friday night.

I realize that this contract is an aid to my motivation, to help me achieve a goal I want but expect to find difficult so, if I cheat on this contract, I only cheat myself.

Date……. Signed …………………………….(A supportive friend can witness your contract, if you want, and be the person you report your

progress to)

Assertiveness Training

The “Diagnostic” Model

Look for the early warning signs of a developing argument, and put the brakes on early.

If you are the one getting angry or upset, you should put the brakes on. If someone else is getting angry or upset and she hasn’t put the brakes on, you can.

Warning signs: increasing volume, pace of speech, people beginning to interrupt, talk over each other.

If you are the one getting angry

Stop the action!– Can we pick up the discussion better, straight

away? – Should we start again?– Or am I too upset to go on sensibly now?

If anyone is too upset to continue sensibly, take time out from the discussion

Make an appointment to come back to the issue;

Don’t be conned into fighting by someone who won’t accept your suggestion of time out.

Use the time out to cool down.

Reduce conflict in organization

Share important decisions by collaborative decision making;

Be assertive with each other, especially if you are a manager or supervisor;

If you use incentive schemes, use group-based ones, not individual;

Announce policies clearly and stick to them consistently; and

Don’t try to change too much too fast; start with the important changes.

Assertion

Submission – keeping your thoughts, opinions and feelings to yourself, letting others take away your rights;

Aggression – sticking up for yourself in ways that show no regard for the rights or feelings of others; and

Assertion – sticking up for yourself in ways that take account of the rights and feelings of others, as well as your own.

Preparing yourself to be assertive

• Belief No.1: Assertion, rather than submission, manipulation or aggression, leads to more satisfying and successful interpersonal relationships and so enriches your life.

• Belief No.2; Everyone is entitled to act assertively, and to express his or her honest thoughts, feelings and beliefs.

Self-statement

“I expect to feel anxious when I assert myself, because most people do. I would feel disappointed if it doesn’t work, and I might feel embarrassed or frightened if the other person overacts; but I know I can cope with any of those feelings, and the chance of them happening is not a good reason for me to surrender my rights. It’s important to me to assert myself reasonably and responsibly, so I will consider the rights and feelings of all the people in any situation before I assert myself. But it is genuinely important to me, I will then assert myself”.

The SIX steps in being assertive

1.Listen to others

2.Think about the situation

3.Work out how you see the situation

4.Assert yourself

5.Think assertively

6.Review the situation afterwards

1 Listen to others

Responsible assertion involves showing respect for the rights and feelings of others in the situation;

If you don’t listen first, you can’t know what they are on about and you can’t begin to show real respect; and

“Listen” to non-verbal parts of the other’s messages.

2. Think about the situation

• Responsible assertion involves flexibility, choosing for assertion the situation where your personal rights are genuinely threatened, as distinct from situations that are just not quite how you would like them;

• “what are the rights of all the people in this situation?”;• Are my rights really threatened here?; and• Is this a situation where it’s genuinely important to me to

assert myself?

3. Work out how you see the situation

• Set your goals for asserting yourself in this situation as realistic as possible;

• The main goal to be assertive is to influence others to change some part of their behavior, but only set that goal when you think there is a reasonable chance of obtaining it; and

• Aiming to change the behavior of people who are obviously not going to change only says you up for disappointment.

4. Assert yourself

• Make your initial response. Expect most people to be defensive at first, but try to stick to being assertive, while listening to them.

5. Think assertively

• If the other person gets angry, think: “Stay Calm, I don’t have to get upset. If he wants to, that’s his problem”.

• If you get angry, think “Relax, I am in control.

6. Review the situation afterwards

• If you stuck to being assertive, give yourself a pat on the back.

• If you slipped into being submissive, or aggressive, see what you can learn from the mistake, and then forget about it.

Assertion in different situations

• Making request: make clear, precise requests, for observable behaviors; try to be positive and non-defensive; ask for what you want the other person to do, not for what you want her to stop doing. Keep eye contact and speak clearly and audibly.

• Refusing request: be non-defensive, refuse promptly. If you are silent after receiving a request, they might think you accept their request.

Treatment Planning

Please refer to pp.287-292

Also refer to an example provided in the last session