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Cognitive Therapy
Anger Management
n   Cognitive Therapy
    ¨ Austin,
    ¨ McKay, Davis, & Fanning, 1981
n   Anger Management
    ¨ Dattilo& McKenney, 2011
    ¨ Internet
n   Humor
    ¨ Dattilo& McKenney, 2011
    ¨ Austin, 2009
    ¨ Internet
Cognitive Therapy
n   Psychotherapy
    ¨ Started in 1960’s
    ¨ Aaron Beck
    ¨ Albert Ellis
n   Used with
    ¨ Depression
    ¨ Anxiety
       n   Post Traumatic Stress Disorder
       n   Obsessive Compulsive Disorder
    ¨ Anger
    ¨ Stress
    ¨ Others
Cognitive Therapy Based on…
1.   All of your moods are created by your
     thoughts. You feel the way you do right
     now because of the thoughts you are
     thinking at this moment
2.   Emotions have little to do with actual
     events. In between the event and the
     emotion is realistic or unrealistic self-talk
3.   Emotions come from what you say to
     yourself…your interpretation of the event
4.   If you are feeling depressed, your
     thoughts are dominated by pervasive
5.   Negative thoughts that cause emotional
     turmoil nearly always lead to gross
     distortions or distortive cognitions
Cognitive Therapy
n Seeks to identify and change distorted
  unrealistic ways of thinking and influence
  behaviors and emotions
n These thoughts occur rapidly while in
  middle of a situation or when recall events
  from past
n These are thoughts we always say to
  ourselves in certain situations
Cognitive Therapy
n   These thoughts are …
    ¨ Automatic
    ¨ Repetitive
    ¨ Pessimistic
    ¨ Unrealistic expectations
    ¨ Overly critical self evaluations
    ¨ Self-talk
Distorted Thinking
n   Filtering
    ¨ Take  negative details & magnify them while filtering
      out all positive aspects of the situation
        n   Only see the negative comments in your performance
            appraisal and not see all the positive ratings
n   Polarized thinking
    ¨ Things are black or white, good or bad. You have to
      be perfect or you’re a failure. There is no middle
        n   If you are not perfect you must be a failure
Distorted Thinking
n   Overgeneralization
    ¨   You come to a general conclusion based on a single incident or
        piece of evidence. If something bad happens once you expect it
        to happen over and over again
         n   I’ll never learn to dance
         n   I’ll never be able to trust anyone again
n   Mind reading
    ¨   Without their saying so, you know what other people are feeling
        and why they act the way they do. In particular, you are able to
        know how people are feeling toward you
         n   Jump to conclusions that are true for you and assume others share
             your belief
         n   He’s just acting that way because he is jealous
Distorted Thinking
n   Catastrophizing
    ¨   You expect disaster. You notice or hear about a problem and
        start “what ifs.” What if a tragedy strikes?
         n   A small leak in your boat means it will sink
         n   A headache means that you have brain cancer
n   Personalization
    ¨   Thinking that everything people do or say is some kind of
        reaction to you. You also compare yourself to others, trying to
        determine who’s smarter, better looking, etc.
         n   A man whose wife complains about rising prices hears the
             complaint on an attack on his ability as a breadwinner
Distorted Thinking
n   Control fallacies
    ¨ If you feel externally controlled, you see
      yourself as helpless, a victim of fate
    ¨ If you feel internal control you are responsible
      for the pain and happiness of everyone
      around you
Distorted Thinking
n   Fallacy of fairness
    ¨ You   feel resentful because you think you know what’s
      fair but others won’t agree with you
       n   If you love me then you will help do the dishes
       n   If you love me you would go dancing with me
n   Blaming
    ¨ You  hold other people responsible for your pain, or
      take the other tack and blame yourself for every
       n   The teacher is responsible for my poor grade because she
           didn’t give good directions for the project
Distorted Thinking
n   Shoulds
    ¨ You have a list of ironclad rules about how you and
      other people should act. People who break the rules
      anger you and you feel guilty if you violate the rules
       n   I should never make mistakes
       n   I should never be tired or get sick
n   Emotional reasoning
    ¨ You  believe that what you feel must be true. If you
      feel stupid and boring, then you must be stupid and
Distorted Thinking
n   Fallacy of change
    ¨ You  expect that others will change to suit you
      if your just pressure or cajole them enough
n   Global labeling
    ¨ You generalize 1 or 2 qualities into a negative
      global judgment
       n   A person who refused to help you with your project
           is a total jerk
Distorted Thinking
n   Being right
    ¨ You  are continually on trial to prove that your opinions
      and actions are right. Being wrong is unthinkable and
      you will go to any length to demonstrate your
n   Heaven’s reward fallacy
    ¨ You   expect all your sacrifice and self-denial to pay off,
      as if there were someone keeping score. You feel
      bitter when the reward doesn’t come
              § McKay, Davis, & Fanning, 1981
What Is Your Most Used
n   Filtering            n   Fallacy of fairness
n   Polarized thinking   n   Blaming
n   Overgeneralization   n   Shoulds
n   Mind reading         n   Emotional reasoning
n   Catastrophizing      n   Fallacy of change
n   Personalization      n   Global labeling
n   Control Fallacies    n   Being right
                         n   Heaven’s reward fallacy
Cognitive Therapy Interventions
n   Goal is to help recognize and change distorted
    ¨ Focus on present
    ¨ Problem solve
    ¨ Learn basic principles
    ¨ Learn specific skills
n   Thought stopping
    ¨ Listen to thoughts. When cognitive distortion occurs,
      say “stop” to self or other person
    ¨ Restructure to a more realistic positive statement
Cognitive Therapy Interventions
n   Affirmations
    ¨ Positive,     reasonable statements are made about
    ¨ They are stated in first person and in present tense
       n   I am …
    ¨ They  are stated with conviction and should be
      repeated throughout the day
    ¨ Helpful to place affirmations in places where they are
      visible and easy to read
Cognitive Therapy Interventions
n   Visualization
    ¨ Practice desired behaviors in mind before
      doing them
       n Visualize yourself doing each component
       n Ignore negative thought

       n Relive successes instead of failures

n   Role play
Cognitive Therapy Interventions
n   Cognitive restructuring
    ¨   Systematic plan where distortions are
        restructured into positive statements which
        are incompatible with distorted thought
        1.   Name your emotion
        2.   Describe the situation or event
        3.   Identify your distortions
        4.   Rewrite your distortions
Anger Management
Dattilo & McKenney, 2011
Anger Management
n   Is a cognitive-behavioral intervention
    ¨ Both learning and thinking are important in the
      acquisition and maintenance of behavior
       n   Cognitive: based on distorted thinking; intervention seeks to
           change thoughts
       n   Behavioral: problems based on environmental reasons that
           result in poor social skills and not distorted thinking
       n   Cognitive-behavioral: intervention focuses on distorted
           thinking and social deficits
n   Anger
    ¨   Emotional excitement induced by intense displeasure
         n   Grinding teeth, raised voices (behavior)
         n   Tense muscles, perspiration (physiological)
n   Aggression
    ¨   Anger often is a precursor to aggression
    ¨   Exhibition of actions toward people or objects with some intent to
        hurt or injure
         n   Physical
         n   Verbal
         n   Gestures
         n   Bullying
n   Violence
    ¨ Violencemay come from aggression
    ¨ Frequently seen in media
      n Murder
      n Assault

      n Rape
Anger Management
n   Uses
    ¨ Behavioral problems
    ¨ Mental health problems
    ¨ Legal problems (incarcerated, probation)
    ¨ Others
Anger Management Interventions

n Anger Control Program
n Anger Coping Program
n ZIPPER Strategy

n   Don’t Laugh at Me
n   Z: Zip your mouth
     ¨   Hand motion stop, deep breath, finger across mouth like zipper
n   I: Identify the problem
     ¨   Deep breath, put finger to temple, identify problem
n   P: Put off what you want to do
     ¨   Pause, deep breath, “I may find a better way to handle this,” “Don’t get
n   P: Put yourself in control
     ¨   “Stay cool,” put hands on hip, turn thumbs up, “I’m in control.”
n   E: Explore other solutions
     ¨   “What can I do?” Shrug shoulders, explore other options
n   R: Return to what you were doing
     ¨   “I’ve made it. Return to activity
Dattilo & McKenney, 2011
n   Have you ever benefited from using humor
    in your own life?

n   What are some ways humor might be
    beneficial in a TR setting?
Theoretical Foundations
n   Incongruity theory
    ¨ Differencebetween what is expected and
      what actually happens
    ¨ Has an element of unexpectedness

n   Psychological release
    ¨ Release   tension
n   Reduce anxiety &       n   Improve interpersonal
    depression                 relationships
n   Increase pain          n   Improve memory
    tolerance              n   Assist with recovery
n   Improve immune             from surgery
    system functioning     n   Assist ability to learn
n   Improve self-concept
Possible Uses in TR
n   Functional intervention/treatment
    ¨ Use  with people receiving treatment for cancer,
      dialysis, burns, etc.
    ¨ Use to help with memorization skills
    ¨ Others
n   Leisure education
    ¨ Humor  development
    ¨ Humor appreciation
    ¨ Stress and humor
Possible Uses in TR
n   Recreation participation
    ¨ Humor   rooms
    ¨ Humor carts
    ¨ Movies
    ¨ Skits produced by clients
Sample Programs
n The Humor Project
n A Tonic You Can Afford
n The Healing Power of Humor
n How to Develop Your Sense of Humor
n The Comedy Club
n Humor Production Procedure
n Also provides a couple exercises
Activity: Add Some Nonsense
n   Making fun of problems can help people get new
    perspective and remove power of the problem
    ¨ Write 5 things that regularly cause you stress
    ¨ Number in order of least stressful to most stressful
    ¨ Write a short laugh sound after each sentence
       n   “Ha ha” “Tee hee”
       n   Nobody ever listens to me….ha ha
Cognitive Therapy / Anger Management /
Humor / Reminiscence Lab

n   Group session that enables group
    members to practice principles and
    techniques of cognitive therapy, anger
    management, humor, or reminiscence.

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