Cognitive Interventions Essay Example for Free

Cognitive Interventions Essay Introduction Cognitive behavior therapy includes many types of therapy and can be applied in a variety of circumstances. Dialectical behavior therapy (DBT) is most commonly known for use on clients with borderline personality disorder (BPD). However, DBT is becoming more popular and often used when working with adolescents. Some adolescents participate in nonsuicidal self-injury (NSSI). Counselors find DBT is an effective therapy to help youth acquire the coping skills needed to stop NSSI. A review of DBT, and adolescents suffering with NSSI will better help one to understand why this technique is beneficial. NonSuicidal Self-Injury NSSI is defined as the direct and intentional destruction of ones own body tissue without an intent to die. Therefore, any form of self mutilation not intending to result in suicide qualifies as NSSI. The number of adolescents practicing NSSI is alarming. Youth practicing NSSI include both sexes and every racial and ethnic group. This alarming behavior is not secluded to any particular type of adolescent. NSSI often appears in the form of cutting with sharp objects, scratching, hitting, burning, and inserting objects under the skin. These behaviors typically develop between the ages of 12-14, indicating that adolescent years are particularly vulnerable to such practices. In addition to NSSI, these behaviors are often in conjunction with other self-harming behaviors like eating disorders, substance abuse, and depression. Puberty can be an extremely difficult time for many people and adolescents cannot reason and rationalize as adults can; therefore, youth often develop self-harming issues because they lack proper coping skills. Last, NSSI specifically refers to injuries not acquired while attempting suicide; however, 50-75% of those with a history of NSSI have also attempted suicide at least once. As one can see, NSSI is an alarming behavior that needs attention (Choate, 2012). Addressing the Issue NSSI is a prevalent and serious issue that must be properly handled. Counselors and people working with NSSI youth must have an understanding of the complexity of this matter and be familiar with treatment options. DBT is an excellent method to attempt to help adolescents overcome NSSI behavior. The effectiveness of DBT has been shown in at least seven controlled trials conducted by four independent research teams. DBT shows the most improvement, when compared to prior therapy options, to treat NSSI (Choate, 2012). DBT uses a comprehensive multimodal 16-week treatment approach for NSSI. The multimodal addresses skills for interpersonal effectiveness, self-regulation, and distress tolerance; provides structure to motivate, reinforce, individualize, and generalize these skills; and identifies and alters learned behavior patterns leading to NSSI. This therapy treatment includes individual therapy, family therapy, multifamily training groups, and telephone consultations for those involved in the process. Additionally, a support team for the counselors is a part of this process. Counseling NSSI adolescents is an extremely stressful position so it is important for counselors to have professional peers to share their thoughts. DBT therapy for NSSI adolescents can be practiced in many settings, including inpatient or outpatient treatment (Choate, 2012). Interventions and Techniques Individual Therapy A primary counselor is paired with the adolescent through the DBT process. The relationship between the primary counselor and the client is extremely important. The key goal for the counselor is to help the adolescent develop skills for coping with stressful thoughts, events, and emotions. An important aspect in the client therapist relationship is for the counselor to convey acceptance, validity, and trust. The primary counselor needs to remain calm and listen with interest yet without showing much emotion. A client must not see a counselor react to stories of self-harm in the way a parent or peer might react. The goal for the counselor is to show an understanding of the self-harming behavior while conveying acceptance and validating the adolescents thoughts and actions (Choate, 2012). The counselor shows acceptance; however, the goal is to create change. Although the counselor balances acceptance and change, the counselor continually challenges the client to alter any negative behavior hindering ones life quality. Ultimately the thought is that acceptance and validation will facilitate self-change while change will facilitate self-acceptance. If the adolescent is reluctant to change the harmful behavior, the counselor may spend more sessions building trust and showing validation before attempting change. Additionally, a client may find it difficult to trust the counselor is the client believes the counselor will report NSSI episodes to the adolescents parents. A balance must be created between client trust, parental rights, and confidentiality. With a proper balance allowing the youth comfort, yet abiding by regulations, an adolescent will be able to build the relationship required to develop change (Choate, 2012). Assessments should be conducted during the initial interviews with the client. These initial evaluations are either conducted informally with an interview or formally with a structured interview and self-report tool. The DBT model allows the counselor to integrate assessment results into four DBT target treatment areas. Specific behaviors and areas are written into a treatment plan with goals for the client (Choate, 2012). Target areas: A) Decreasing life-threatening behaviors B) Decreasing behaviors that interfere with therapy C) Decreasing behaviors that interfere with life quality D) Increasing behavioral skills (Choate, 2012). As the treatment begins, the goal is to help the client determine the events, thoughts, or feelings one has prior to the NSSI occurrence. If one can determine factors contributing to the negative behavior, one can start to alter circumstances leading to NSSI and ultimately change the behavior. Clients are asked to maintain diary cards documenting behaviors and actions surrounding NSSI behavior. The diary cards address problem behaviors, immediate prior events leading to problem behavior, vulnerability factors, entire chains of events prior to problem behavior, and consequences from the behavior. Upon review of the cards the counselor can help the client identify triggers of NSSI behavior and find alternative life choices or thoughts to cope better with given situations (Choate, 2012). Multifamily Skills Training Groups The individual session emphasizes focus on assessment, client trust, and identifying the problem. Along with identifying problems, individual therapy does encourage behavior change. However, multifamily group therapy focuses on skill sets needed to facilitate change. To implement behavior changes and develop coping skills, the adolescents must be aware of thoughts, feelings, and actions; tolerate the pain and stress associated with unpleasant life events, regulate emotions better, and become effective at communicating emotions. The DBT approach focuses on building four essential skills: A) Mindfulness B) Distress tolerance C) Emotion regulation D) Interpersonal effectiveness Additionally, a fifth skill was added: Walking the middle path (Choate, 2012). Skill Sets Skill Set One: Core Mindfulness Mindfulness is acknowledging ones emotions, thoughts, and physical experiences without trying to end them, numb them, or avoid them. Learning to observe, describe, and experience emotions without judgment and while in control of ones attention is the core of mindfulness. As adolescents become more aware of emotions in the present, they develop a better understanding of their own emotions and reactions (Choate, 2012). DBT uses a model with three states of mind to teach mindfulness. The three mind-states are reasonable mind, emotion mind, and wise mind. Reasonable mind is controlled primarily by logic. Emotion mind is regulated significantly by emotions. Wise mind synthesizes all the ways of knowing to develop knowing through intuition, using deep inner wisdom. Often time groups sessions will use acting or charades to have participants learn to understand these types of mindfulness (Choate, 2012). Group members are taught to observe their thoughts by awareness. The clients are encouraged not to multitask but rather to focus on one task at a time. The exercise of focusing on one task at a time is referred to as one-mindfulness. Focusing on one aspect at a time allows the client to recognize and understand the emotions related to the specific task. Skill Set Two: Emotion Regulation Emotion regulation helps group members learn to recognize, observe, and describe emotions. Additionally, this skill set teaches one to regulate intense and painful emotions, regulate vulnerability to negative emotions, and increase positive emotions. The clients begin to realize they have control over their emotions and behaviors. When one learns to alter responses to emotions it is both empowering and liberating (Choate, 2012). Ways of teaching emotion recognition often include listening to music or watching a movie. The goal is to have the client react to something, recognize, and observe ones own emotion. As clients recognize emotions they are asked to discuss the responses both mentally and physically connected with the emotional reactions. Group members are taught to respond to ones own emotions with self-compassion and acceptance. Often one may believe an emotional response is wrong, silly, or unjustified. Once one understands that every emotion is justified one can accept the emotion and find a healthy response to that emotion (Choate, 2012). Another aspect of emotion regulation includes reducing vulnerability by maintaining better physical health. Eating well, sleeping sufficiently, exercising regularly, and avoiding substance abuse will help one regulate emotions by maintaining physical health. Ones physical health can weaken ones mind-state, and the person will be more vulnerable to NSSI and other self-harming episodes (Choate, 2012). Skill Set Three: Interpersonal Effectiveness The goal of interpersonal effectiveness is for one to maintain personal values and beliefs while improving relationships. An example of teachings in this module is that group members are often asked to remember the acronym DEAR MAN to help remember the key components of this skill set. The components: Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, and Negotiate. The best method for learning this skill set is role play. Often the facilitator will pair up group members and role play a variety of situations using DEAR MAN (Choate, 2012). Skill Set Four: Distress Tolerance Stress tolerance relates to ones ability to effectively accept emotional pain, in any given situation, that cannot be changed at the time. Once one can tolerate and accept unpleasant situations, one can more effectively cope. Further skills would help the client to self-soothe and distract from emotionally painful situations (Choate, 2012). Distress tolerance skills have two categories. The first category is skills for accepting reality, and the second is skills for crisis survival. Skills for accepting reality teach clients how to accept everyday life even when it is unpleasant. Deep-breathing is a common practice for this skill. Skills for crisis survival follows more of a distraction method. The goal may be for the client to find an alternative task, practice self-soothing, or take a break. Whatever the activity change is, the goal is to distract one from the crisis and prevent self-harming behavior (Choate, 2012). Skill Set Five: Walking the Middle Path This particular skill set works with the adolescent and family members to help those involved alter polarized thinking and live a more balanced lifestyle. The first step is to encourage participants to abandon black and white thinking and recognize the gray area. People often need to realize that any given situation can be viewed in multiple ways, and often everyone would benefit from viewing incidents through multiple perspectives (Choate, 2012). Common issues between adolescents and parents include strict or lenient parenting; thinking lightly of serious matters, or judging harshly common adolescent behavior; and pushing away, or holding too tightly. Adolescents and parents are asked to determine where they believe themselves and others to be regarding these topics, and try to come to an agreement regarding how to alter behavior and meet in the gray area (Choate, 2012). Communication and listening are key factors involved in developing this skill set. Positive reinforcement is taught to be used whenever possible as parents often think to punish negative behavior rather than reward the positive actions. Reconciling family differences can be a key component when attempting to help an adolescent stop NSSI behavior (Choate, 2012). Effectiveness of DBT for NSSI The treatment for NSSI that has the most positive support is DBT. DBT is the high standard of therapy for reducing suicide and self-destructive behavior among clients with BPD. The effectiveness of DBT has been shown in many trial studies. Not as many studies have been conducted regarding DBT and NSSI with adolescents; however, a DBT model has been created for adolescents and shows very promising results. DBT is the highest regarded method for at risk youth. Certainly, much can always be learned regarding human nature and therapy, and not all people will respond to the same treatment; therefore, this method is certainly not effective every time, but it does seem very beneficial (Choate, 2012). Summary Nonsuicidal Self-injury is a serious issue. As one can see, action needs to be taken to save youth from such harmful behavior patterns. Cognitive behavior therapy, specifically dialectical behavior therapy, has many excellent interventions and strategies to help adolescents facing NSSI (Choate, 2012). DBT uses individual therapy, group therapy, and family therapy to help adolescents with NSSI. Individual sessions focus on trust with the counselor, and identifying and acknowledging negative emotions, and behavior patterns. Additionally, the primary therapist will help the client find healthy ways to change behavior patterns and cope with life stressors (Choate, 2012). Group therapy focuses on building the skills needed to accomplish the desired changes. The five core skills sets include: core mindfulness, emotional regulation, interpersonal effectiveness, distress tolerance, and walking the middle path. Many methods are used to teach and practice these techniques (Choate, 2012). Studies continue to determine the effectiveness of DBT with adolescents involved in NSSI. However, DBT is the standard therapy for adults facing similar issues with BPD. Additionally, DBT seems very promising as an effective method for treating NSSI adolescents. References Choate, L. H. (2012, January). Counseling adolescents who engage in nonsuicidal self-injury: A dialectical behavior therapy approach.. Journal of Mental Health Counseling, 34(1), 56-71. EBSCOhost.