Clinician’s Training Package

1
Clinicians Training Package

• Responding to Mental Health Issues Within Drug
  Alcohol Treatment

These training resources were funded by Drug
Strategy Branch, Australian Government Department
of Health and Ageing through the National
Comorbidity Initiative
2
Exercise 1 Who Here Do You Think

• Loves The Simpsons?
• Can change a flat tyre?
• Exceeds the speed limit?
• Snores?
• Is kind to dogs?
• Would tell you that you have bad breath?
• Is trustworthy?

3
Exercise 2 How Are YouThinking-Feeling-Doing?

• What are your THOUGHTS about working with clients
  with comorbidity?
• What are your FEELINGS about this training?
• Notice how you BEHAVE when I say we have 2 days
  to get this on board?

4
A Snapshot Training Modules
Module 1 Introduction to comorbidity
Module 2 CBT
Module 3 Pre session preparation
Module 4 Implementation of Brief MH Intervention

• PsyCheck Mental Health Screen
• Context
• Development
• Implementation
• Scoring

• Theory of CBT
• Principles application
• CBT in practice

• Assessment
• Case Formulation
• Treatment planning

• Psychoeducation
• Introduce CBT model
• Self monitoring
• Identify thoughts
• Manage thoughts
• Relapse planning
• Termination

5
Module 1
Module 1

• Introduction to Comorbidity
• PsyCheck Mental Health Screen

6
Aims of Module 1
Module 1

• To provide a context for the PsyCheck Screening
  Tool
• To understand the development and psychometric
  properties of PsyCheck
• To gain skills in implementation, scoring and
  interpretation of PsyCheck

7
Overview of Components of Module 1
Module 1

• Introduction to Comorbidity
• Development of PsyCheck
• Psychometric properties of the PsyCheck Screening
  Tool
• Negotiating the Users Guide
• Administering the PsyCheck Screening Tool
• Mental Health Screen
• Suicide/Self-Harm Risk Assessment
• Self Reporting Questionnaire Tool
• Interpreting the PsyCheck Screening

8
Introduction to Comorbidity
Module 1

• Up to a third of mental health clients have an
  AOD problem
• May be referred in to AOD services
• Up to 80 of AOD clients also have a co-occurring
  mental health problem
• Many more may have subclinical symptoms
• Rule rather than the exception in treatment
  settings

9
Introduction to Comorbidity
Module 1

• Those that have comorbid AOD and mental health
  problems have
• Poorer prognosis
• Higher risk of harm
• Greater likelihood of relapse to both disorders
• Greater use of health services

10
Models of Comorbidity
Module 1

• Secondary Psychopathology Model
• Secondary Substance Use Model
• Bidirectional Model

11
Models of Comorbidity
Module 1

• Common Factor Model
• No Relationship Model

12
Comorbidity in Practice
Module 1

• Comorbidity is the norm
• In both mental health and alcohol and drug
  services
• BUT
• Client group is very different in each service

13
Comorbidity in Practice
Module 1

• In Mental Health Services
• Mostly psychotic disorders with range of alcohol
  and other drug issues
• In Alcohol and Drug Services
• Mostly high prevalence disorders anxiety and
  depression
• Often not able to refer to Mental Health Services
• Often have subclinical symptoms often go
  undetected

14
Treatment for Comorbidity
Module 1

• Sequential
• Treat one problem first
• Parallel
• Simultaneous treatment in different service
  provider
• Integrated
• Integrated treatment by same service provider
• Best empirical support
• Client and clinician preference

15
Comorbidity Training
Module 1

• Many AOD clinicians report training is
• Concentrated on acute low prevalence disorders
• Focused on relationship building with Mental
  Health Services

16
PsyCheck Developed to Address Gaps
Module 1

• Designed for AOD clinicians with little or no
  experience in mental health interventions
• But can still be used by experienced clinicians
• Focused on the disorders most commonly
  encountered in AOD Services
• Anxiety, depression, some somatic symptoms
• Offers a screening tool and articulated
  intervention
• Offers options for training and support through
  clinical supervision

17
PsyCheck Overview
Module 1

• Screening and intervention for anxiety and
  depression among AOD clients
• Brief screening
• 4 session intervention
• Youth modifications
• Extension material
• Accompanying resources
• PsyCheck Screening Tool
• PsyCheck Screening Tool Users Guide
• PsyCheck Clinical Treatment Guidelines

18
PsyCheck Overview
Module 1

• Comprehensive capacity building
• 4 module workshop
• Clinical supervision
• Part of a whole organisation approach to
  improving comorbidity services for our clients
• Managers resources (Implementation Guidelines)
• Clinical supervisors resources (Training and
  Clinical Supervision Guidelines)

19
PsyCheck Screening Tool
Module 1

• PsyCheck Screening Tool scientifically validated
• A general mental health screen, including history
  of treatment
• A suicide/self harm risk assessment
• The Self Reporting Questionnaire (SRQ)
• World Health Organization instrument
• Assesses current symptoms of anxiety, depression
  and somatic disorders

20
PsyCheck Intervention
Module 1

• Evidence based drawn from empirically supported
  treatment
• Intervention is designed to be integrated into
  routine AOD practice
• CBT principles used in both AOD and mental health
• Best practice in both sectors
• Easily integrated
• Easily manualised
• Focus on scientist-practitioner approach
• Hypothesis testing
• Reflective practice

21
Psychometric Properties
Module 1

• 120 newly engaged AOD clients
• PsyCheck Screening Tool compared to General
  Health Questionnaire (GHQ)
• Both compared to a diagnostic instrument (CIDI)
• Results
• SRQ superior to GHQ in predicting anxiety and
  depressive disorder
• Cut-off identified that indicates presence of
  disorder
• General mental health screen good indicator of
  psychosis

22
Negotiating the PsyCheck Users Guide
Module 1

• About the PsyCheck Screening Tool
• Statistical properties
• Decision tree
• Administration and scoring
• General mental health screen
• Suicide risk/self harm assessment
• Self Reporting Questionnaire
• PsyCheck Screening Tool
• Sample contingency plan

23
Administering the Screening Tool
Module 1

• Designed for routine screening (all clients)
• Administer the whole SRQ
• Other parts only if information not already
  collected
• Suicidality monitored over time
• Suicide assessment a framework not a checklist
• Clinical judgement is required
• Assess risk of harm to others in same way

24
Exercise 3 Celebrity Squares
Module 1

• Work in groups of 3
• Select a celebrity square
• One person plays the celebrity
• 2 clinicians assist each other in administering
  the PsyCheck Screening Tool
• Group Discussion

25
Interpreting the PsyCheck Screening Tool
Module 1

• Intervention or further assessment is required if
• The client reaches 5 or more on the SRQ
• The client is at risk of suicide/self-harm
• The client has a mental health history
• Consider
• Readiness to change
• Current symptoms

26
SRQ Interpretation
Module 1
27
Decision Tree
Module 1
28
Exercise 4 Celebrity Squares - What Next?
Module 1

• Work in the same groups of 3
• From the information youve collected refer to
  the Decision Tree and determine what the next
  steps would be for your celebrity client
• Think about
• Past mental health questions
• Suicide assessment, and
• SRQ score (and the types of answers endorsed)
• Group Discussion

29
Whats on Your Mind Is It This?
Module 1
Im never going to get this
I may as well give up now
Im useless
30
Or This ?
Module 1
Im getting some of this
If I hang in it will fall into place
I feel confident I will get it
31
Or Maybe This ?
Module 1
This is too easy
What if I get bored
Ill think about how I can use it in my practice
32
Module 2

• Cognitive Behaviour Therapy

33
Aims Module 2
Module 2

• To understand the theory of CBT
• To understand the principles of application
  underpinning the PsyCheck intervention
• To understand of the practice of CBT

34
Overview Module 2
Module 2

• Introduction to CBT
• Theoretical underpinnings
• CBT Model
• Evidenced based practice
• CBT in practice
• Standard sessions
• Self-monitoring

35
Exercise 5 What Works for You?
Module 2

• Working individually complete the worksheet,
  identifying which models you have an affinity
  with
• Then circle the main model you work with
• Now find someone else in the room that uses a
  DIFFERENT model to the one you typically work
  with and discuss with your partner
• Why you use this model/strategies you do?
• How you know its working ?
• Group discussion

36
Planned Approach
Module 2

• There is emerging evidence that a single theory
  planned approach is more effective than an ad hoc
  one
• Most effective to have a single framework or
  philosophy about treatment and incorporate a
  range of techniques and strategies that fit with
  your philosophy

37
Evidenced Based Practice
Module 2

• Best evidence for CBT compared to other types of
  therapies
• Most high level research (RCTs) and the most
  positive research
• Effective for a wide range of mental health
  problems including AOD, anxiety and depression
• BUT
• Whatever framework you use, you can create your
  own evidence through measuring individual
  outcomes CBT emphasises this

38
What is CBT?
Module 2

• Umbrella term for a range of therapies with a
  cognitive and/or behavioural focus

• Therapy examples
• Cognitive Therapy (Aaron Beck)
• Relapse Prevention (G. Alan Marlatt)
• Coping Skills Therapy (Peter Monti)
• Mindfulness Therapy (Mark Williams)
• Schema Therapy (Jeff Young)
• Dialectical Behaviour Therapy (Marsha Linehan)

• Strategy examples
• Problem Solving
• Goal Setting
• Cue Exposure Therapy
• Thought stopping
• Urge surfing
• Activity scheduling

39
In Comparison
Module 2

• Solution-Focused Therapy
• An understanding of the past and cause of problem
  not necessary for resolution of the problem
• Change occurs as a result of a focus on the
  future without the problem
• Narrative Therapy
• Focus is on meaning, narrative and power
• Talking about the influence of problems enables
  talk about their defeat via the new stories

40
In Comparison
Module 2

• Gestalt Therapy
• Focus is on the present rather than past or
  future 
• Central aim is awareness-raising and creating
  conditions to de-construct dysfunctional fixed or
  habitual patterns of interaction  
• Change occurs through understanding and
  acceptance of what is
• Psychodynamic Therapy
• Focus is on initial underlying causes
• Understanding and having insight into the
  problem leads to change
• Therapeutic relationship is the key to change

41
What is CBT?
Module 2

• Self-help oriented
• Clinician provides tools and framework for change
• Clients responsibility to create and maintain
  change
• Skills oriented
• Attention to therapeutic process vital but not
  sufficient in itself for change to occur
• Structured but not inflexible
• Clinical judgement necessary

42
CBT Principles
Module 2

• CBT
• is based on an ever-evolving formulation of the
  client in cognitive terms
• requires a sound therapeutic alliance
• emphasises collaboration and active participation
• is goal oriented and problem focused
• initially emphasises the present

43
CBT Principles
Module 2

• CBT
• is educative, aims to teach the client to be
  their own therapist, and emphasises relapse
  prevention
• is time limited
• sessions are structured
• teaches clients to identify, evaluate and respond
  to their dysfunctional thoughts and beliefs
• uses a variety of techniques to change thinking,
  mood and behaviour

44
Exercise 6 Mix n Match
Module 2

• From the cards you have been given, keep the ones
  that represent the way you work (in the majority)
  and trade unwanted cards for wanted cards with
  other participants
• Either
• Line up on the cognitive/behavioural continuum to
  show whether you work more in a cognitive or
  behavioral approach, or
• Place your cards on the grid (cognitive/behavioura
  l vs skills/process)
• Group discussion
• Why did you put your card or yourself where you
  did?
• Did the cards fall in a pattern?

45
The CBT Model
Module 2
Early Experience
 
Core beliefs
 
 
Trigger
Unhelpful thoughts
     
Feelings
Behaviour
 
46
Bruce Eating Disorder
Module 2
47
Bruce Simplified CBT Model
Module 2
48
Bruce ABC Model
Module 2
49
Exercise 7 The Cognitive Model
Module 2

• In pairs take it in turns to use the CBT model
  worksheet, choose a simple target problem for
  example, eating chocolate, public speaking,
  learning a new skill
• Use a recent real example or a made up one
• Complete the CBT model sheet with thoughts
  feelings and behaviours.

50
Typical Session Format
Module 2

• I Review and feedback from last session
• II Information and practice of session topic
• III Summary and feedback from this session

51
CBT in Practice I Review and Feedback
Module 2

• Check-in past week, mood/drug use, homework
• Whats been happening this week?
• Hows your mood been this week?
• How did you go with your homework?
• Bridge from previous session
• Remember last week we talked about x did you
  have any more thoughts about it?
• Were you able to get any practice of skill

52
CBT in Practice II Info Practice
Module 2

• Information about skill
• last week we talked about identifying thoughts
  this week I thought wed talk about how to manage
  those thoughts
• Remember the cognitive modelthe way I like to
  think about it is
• Practice of skill in session
• lets try to do this together use whiteboard

53
CBT in Practice III Summary Feedback
Module 2

• Summary and feedback
• so what we talked about today was
• how does that fit with you?
• Set homework tasks
• its really important to practice these things
  between sessions so they become second nature
  what do you think you could do that would help
  you remember what we did?

54
Exercise 8 CBT Demonstration I
Module 2

• A. Watch video demonstration of basic elements of
  a session
• Discussion about the elements as a group
• B. Practice the elements in pairs
• Feedback to each other good aspects and an area
  for improvement

55
Stepped Care Approach
Module 2

• Interventions are applied from the least to most
  intensive
• Each step is incremental based on the client's
  response to the previous one
• A stepped care approach can add flexibility to
  treatment and improve outcomes
• CBT (and PsyCheck) facilitates the stepped care
  approach

56
The Therapeutic Relationship
Module 2

• Therapeutic alliance vital
• Basis of ALL therapy
• Requires good counselling skills
• Necessary but not sufficient condition for change
• Collaboration and active participation by client
  and clinician essential
• Requires good active and empathetic listening
  skills
• CBT builds therapeutic alliance through
  collaboration and encouraging client involvement
  in their own therapy

57
Clinical Judgement
Module 2

• Clinical judgement is required, even though the
  therapy is manualised
• Use PsyCheck as guidelines follow steps only as
  closely as you need to
• Use flexibly with extension material to tailor to
  clients needs
• Consider clients needs
• Consider existing clinical practices and pathways

58
Integrated Treatment
Module 2

• PsyCheck designed to be integrated into routine
  AOD treatment
• Techniques are deliberately similar to those in
  AOD treatment
• Emphasise to the client the link between AOD use
  and mental health problems
• Consider ways in which you can integrate into
  what you already do

59
Exercise 9 Therapeutic Process
Module 2

• In small groups (3-4) discuss how therapeutic
  processes can be used in CBT
• What makes a good therapeutic alliance - list as
  many elements as you can?
• What could happen if you dont have a good
  therapeutic alliance? Think about the client, the
  practitioner and the therapy relationship
• Group discussion

60
Lets Take a Breather
Module 2

• What have we learned so far..?

61
Homework
Module 2

• What brief practice at home would assist you to
  consolidate the knowledge you gained in this
  module?
• eg. Use the CBT model on your self
• eg. Further reading about CBT
• eg. Practice explain the CBT model to a
  client/colleague
• Next session you will be asked to share your
  experience of self practice if you are willing,
  (but not of the actual target problem itself if
  you used yourself as a client)

62
Module 3

• Pre-Session Preparation Assessment, Formulation
  and Treatment Planning

63
Before We Start
Module 3

• What did we do last time?
• What is your feedback about what we covered?
• Homework feedback
• Challenges in completing the homework?
• What was the effect of self-practice?
• Next step?

64
Exercise 10 The Young and The Restless
Module 3

• Work in groups of 3, you have just interviewed
  your celebrity. Write a few lines using the
  following criteria as if you were writing for a
  trash magazine
• Their current problem
• Their presenting mood/feelings
• Thoughts
• Behaviour
• Whats driving the behaviour
• Consequences of behaviour
• Present to the large group

65
Example Jen X
Module 3

• Jen X 38, an actor made a rare appearance in
  public today after husband Y, a singer was
  admitted to the famous Betty Ford clinic. X
  hasnt been seen for weeks. Sources close to the
  actor say she has been increasingly worried about
  the singers behaviour. Shes looking really
  drawn and a bit depressed says a close friend.
  She says she cant bear to go out of the house
  and its really starting to get to her. It is
  thought that Xs two adopted children are being
  cared for by family.

66
Aims Module 3
Module 3

• To understand how to screen for mental health
  issues and prepare feedback
• To understand how to undertake a cognitive
  behavioural assessment
• To understand how to collect sufficient
  information to develop a cognitive behavioural
  formulation

67
Overview Module 3
Module 3

• Negotiating the PsyCheck Intervention Clinical
  Treatment Guidelines
• Undertake screening and preparing feedback
• Undertake a cognitive behavioural assessment
• Prepare a preliminary case formulation

68
Negotiating the PsyCheck Clinical Treatment
Guidelines
Module 3

• Designed for a range of experience and background
• Manualised for new clinicians
• Use flexibly for experienced clinicians
• Use with
• Introduction to PsyCheck package
• PsyCheck Screening Tool and Users Guide

69
Negotiating the PsyCheck Clinical Treatment
Guidelines
Module 3

• Three sections
• Principles of intervention
• Practice Guidelines
• Extension material
• Worksheets
• Modifications for young people

70
Practice Guidelines
Module 3

• Pre-session preparation Reflection
• Prepare feedback from the PsyCheck Screening Tool
• Cognitive behavioural assessment
• Cognitive behavioural formulation
• Treatment planning
• PsyCheck intervention
• Session 1 Introduction
• Session 2 Identifying unhelpful thoughts
• Session 3 Managing unhelpful thoughts
• Session 4 Relapse prevention

71
Screening in Context
Module 3

• PsyCheck screening
• Snapshot of potential need
• Feedback
• Results of PsyCheck Screening Tool
• Any other information gathered

72
Cognitive Behavioural Assessment
Module 3

• Also known as functional assessment
• Occurs during an assessment session and continues
  through therapy
• Functional vs structural/diagnostic analysis
• Drivers vs descriptors of behaviour/problem

73
Cognitive Behavioural Assessment 7Ps
Module 3

• Presenting issues
• Pattern (onset and course)
• Predisposing factors
• Precipitating factors
• Perpetuating factors
• Protective factors
• Prognosis
• Other factors

74
Exercise 11 Something Fishy

Module 3

• Bruce
• Discussion
• Identify elements of the functional assessment
  for Bruce

75
CBT Case Formulation
Module 3

• Case formulation is
• Theory driven
• An interpretation - more than a case summary or
  summary of presenting problems
• A working hypothesis to be reviewed
• Dynamic - as new information comes to hand, your
  formulation is reviewed, added to, changed
• The case formulation puts the 7Ps into a context
• Always present it to your client and ask for
  their response

76
The Purpose of Case Formulation
Module 3

• Clarifying hypotheses and questions
• Understanding the overall picture
• Prioritising issues and problems
• Planning treatment strategies
• Predicting responses to interventions
• Identifying barriers to progress

77
Assessment, Formulation and Treatment Planning
Module 3
Cognitive Behavioural Assessment
AOD Assessment
Screening
Case formulation
Treatment Plan
78
Exercise 12 Fishy Formulation
Module 3

• Identify the components of formulation as a group
• In small groups, use the information from the
  earlier exercise, Something Fishy
• Write a formal formulation from this information
• Use the formal formulation to translate this
  into language suitable for a client
• Group discussion

79
Exercise 13 Gummy Shark
Module 3

• Return to your small groups, use the previous
  case formulation and develop the treatment plan
  for Bruce including
• Immediate strategies
• Longer term strategies
• Referral options
• One person in your group to role play Bruce and
  share presenting the formulation and treatment
  plan to him
• Think about the stage of change, insight and the
  way you present it to him. Notice how he responds.

80
Checking in Again
Module 3

• Lets go back over what weve done so far

81
Module 4

• Implementation of Brief Mental Health Intervention

82
Exercise 14 First Response
Module 4

• Write down your immediate response to the
  following
• Standing in a long line at the supermarket
• A heavily tattooed woman
• Someone throwing a cigarette out of a car
• Running late
• The beach
• Case formulation

83
Aims Module 4
Module 4

• Understand cognitive behavioural practice to
  undertake the PsyCheck Intervention

84
Overview Module 4
Module 4

• Negotiating the step-by-step guide to the
  4-session PsyCheck Intervention
• Session 1 Psychoeducation
• Session 2 Identifying unhelpful thoughts
• Session 3 Managing unhelpful thoughts
• Session 4 Relapse prevention

85
A Snapshot Practice Guidelines
Module 4
Pre PsyCheck Preparation
Session 1 Psychoeducation
Session 2 Identifying unhelpful thoughts
Session 3 Managing unhelpful thoughts
Session 4 Relapse prevention

• Present case formulation to client
• Provide info on symptoms
• Explain CBT
• Homework

• Links between thoughts feelings
• Identifying unhelpful thoughts
• Homework

• Challenging unhelpful thoughts
• Homework

• Identifying triggers
• Identify early warning signs
• Breaking the rule effect
• Termination
• Rescreening

86
Module 4

• Session 1Presenting the Case Formulation and
  Beginning Psychoeducation and Self Monitoring

87
Session 1 Psychoeducation
Module 4

• Psychoeducation can be about
• Current symptoms
• Whats going on for the client (formulation)
• CBT model

88
Session 1 Psychoeducation
Module 4

• Present case formulation to the client
• Get feedback and modify as appropriate
• Provide information about current symptoms
• Use worksheets 1, 2 and 3
• Explain CBT model to the client
• Alternatively, use simplified version (extension
  material)
• Work through an hypothetical or personal
  example depending on readiness to change

89
Session 1 Treatment Planning
Module 4

• Link the formulation and treatment
• Explain in detail how they are linked using
  personal examples
• Develop a treatment plan with the client
• Identify areas for intervention and priorities
  based on the formulation
• Emphasise revisiting both formulation and
  treatment plan regularly
• Finalise and record treatment plan
• Give client a copy

90
Session 1 Introduce Self-Monitoring
Module 4

• Use Worksheet 4 Self monitoring
• Explain the role of self monitoring
• A temporary tool until it becomes automatic
• Explain the process of self monitoring
• Work through example with client
• Give client a copy to take home

91
Exercise 15 Self Monitoring
Module 4

• Large group discussion
• What assists clients to understand self
  monitoring?
• What can clinicians do to get in the way of
  effective self monitoring?
• How do you know if you are being effective or
  obstructive?

92
Session 1 Session Summary
Module 4

• Summarise content and ask for feedback from the
  client
• Emphasise the importance of take home tasks
• Set homework Self Monitoring
• Identify any difficulties with content
• Identify easiest method
• Immediate recording, once a day etc
• Emphasise importance
• Prepare for next step
• Outline next session topic
• Organise next appointment or discharge

93
Session 1 Extension Material
Module 4

• Simplified explanation of the CBT model
• Alternative explanation of CBT model ABCs

94
Exercise 16 Please Explain
Module 4

• Work in groups of 3
• One person plays the client, one the practitioner
  and one the observer
• Use the celebritys PsyCheck Screen and other
  information you have gathered to inform this
  session
• Together develop a formulation for your celebrity
  and the practitioner then explains it to the
  client integrate any other psychoeducation
  material that the client would benefit from
• Group discussion

95
Module 4

• Session 2Identifying Unhelpful Thoughts

96
Whats That Noise?
Module 4
OH NO! Theres someone out there
Must be a cat
97
Exercise 17 Spot the Unhelpful Thought
Module 4

• Use the Unhelpful Thoughts Worksheet
• What are your thoughts?
• Are you a black and white thinker?
• Do you jump to negative conclusions?
• Do you catastrophise?
• Are you a personaliser?
• Are you a should/ought person?
• How do you manage these unhelpful thoughts
• Group discussion

98
Homework Non-Completion
Module 4

• Client didnt understand the task
• More explanation AND practice
• Task was too difficult
• Simplify
• Task was too time-consuming
• Do in stages or in parts
• Do on some days
• Readiness to change
• Motivational approach

99
Session 2 Information
Module 4

• Reiterate the CBT model
• Explain negative bias/interpretation
• Use monitoring to identify areas of
  (mis)interpretation of events
• Make personal link between thoughts and feelings
  and behaviours

100
Session 2 Practice
Module 4

• Identify unhelpful thoughts
• Use self monitoring sheets as examples
• The aim is to raise awareness about when
  unhelpful thoughts occur
• Focus is on catching thoughts as they occur
  rather than allowing them to create negative mood
• Label unhelpful thoughts
• Use Worksheet 5

101
Session 2 Extension Material
Module 4

• Behavioural activation
• Very important especially for depression when
  people often withdraw and lose interest in usual
  activities
• Focus both on pleasant activities and usual daily
  activities (showering, washing up)
• Guidelines for better sleep
• Especially important for those with anxiety and
  depression who often have difficulty sleeping
• Relaxation
• Helpful for anxiety and depression

102
Exercise 18 CBT Demonstration II
Module 4

• Watch the video of Richard and Lynn discussing
  the thinking-feeling-doing cycle
• In small groups, one person plays the celebrity
  while the others explain the thinking-feeling-doin
  g cycle using the celebritys information that
  you have gathered previously and to identify some
  of their unhelpful thinking
• Group discussion

103
Module 4

• Session 3Managing Unhelpful Thoughts

104
Session 3 Information
Module 4

• How to challenge unhelpful thoughts
• Go through Worksheet 6 with examples
• Two main strategies for challenging thoughts
• Is this a misinterpretation?
• Is there another way to think about this?
• If not, is it helpful to think this way?
• Even if it is true perhaps it doesnt help me if
  I think this way

105
Session 3 Practice
Module 4

• Practice challenge unhelpful thoughts
• Use monitoring sheets completed for homework
• Assist client to practice the process from
  monitoring sheet
• Use Worksheet 6 as a reference

106
Session 3 Extension Material
Module 4

• Communication skills
• Assertive communication skills are important for
  those who are anxious in social situations and
  for those who are depressed and have withdrawn
  from public

107
Exercise 19 Celebrity Challenge
Module 4

• Work in groups of 3
• One person plays the client, one the practitioner
  and one the observer
• Use the celebritys previous CBT model to assist
• Help the celebrity identify and challenge one of
  their unhelpful thoughts
• Use Worksheet 4 7 to assist you
• Group discussion

108
Module 4

• Session 4Preventing Relapse

109
Session 4 Information
Module 4

• Discuss triggers and early warning signs
• Use Worksheet 8 to explain the breaking the rule
  effect
• Use Worksheet 9 to emphasise looking after
  yourself

110
Session 4 Practice
Module 4

• Develop a relapse prevention plan
• Explore ways the client can regulate thoughts and
  feelings
• Emphasise the need for additional skills and
  supports
• Remind the client to self-reward
• Encourage the client to take care of themself

111
Session 4 Termination
Module 4

• Summarise content of sessions 1-4 and ask for
  feedback from the client
• Reinforce gains and effort
• Re-emphasise the importance of continued practice
• Reminder about tasks to continue with
• If continuing AOD treatment check homework in
  subsequent sessions
• Prepare for next step
• Manage concerns using a motivational approach
• Consider and discuss referral options
• Boosters/continued intervention

112
Session 4 Extension Material
Module 4

• Problem solving
• Seemingly irrelevant decisions

113
Exercise 20 Celebrity Survivor
Module 4

• Work in groups of 3
• One person plays the celebrity client, one the
  practitioner and one the observer swap roles
  from last exercise
• Summarise for the client and develop a relapse
  prevention plan
• Group discussion

114
Rescreening
Module 4

• Rescreening has benefits for both the clients and
  clinician
• Monitoring client progress with the client can
  assist to build the clients self efficacy as
  they see themselves improving
• Clinicians can monitor and reflect on their own
  practice using objective data
• Clinicians can reorient therapy if no improvement
  and reflect on potential gaps in treatment

115
Support Clinical Supervision
Module 4

• Optimal supervision
• A single consistent supervisor to build a
  relationship
• Weekly or fortnightly supervision preferable
• Individual supervision as a minimum
• Group and/or peer supervision as an adjunct

116
Lights Camera ACTION
Module 4

• What aspects of the training do you feel
  comfortable with?
• What areas will you need to work on?
• What will you do differently in your practice
• In the next few weeks?
• In the next year?