TRT PART 2
TRT PART 2
What are we there for?
Remember the ethical dimension of the interaction:
1) Helping them to describe their symptoms
2) Helping clients experiencing emotional / social / relationship problems
3) Face family difficulties
4) Help and empower
What is the intervention type?
The Cognitive Behavioural Approach
-Confrontation in a relationship
-Logical and rational approach
-Encourage the patient to have a realistic outlook
The Transactional Analysis Approach
-Notice the games people play
-Encourage Adult Behaviour
-Encourage creation of new strategies
Parent-ego-State (Behaviours, Thoughts and Feelings are copied from parents/ parental figures)
Adult ego-state (behaviours, thoughts and feelings are related to the here and now)
Child ego-state** (Behaviours, thoughts and feelings are replayed from childhood)
"A consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behaviour"
(Page 15 of Stewart and Joines, 2006)
Cognitive Behavioural Therapy for Tinnitus
(2010): In 6 studies no evidence was found of sig. diff in subjective loudness of tinnitus. BUT: sig improvement in depression scores & QoL were found (decrease in global tinnitus severity) in another 5 studies, so CBT is effective.
CBT aims not to eliminate auditory perception but to reduce or correct one's negative response to tinnitus. CBT identifies negative automatic thought and then evaluates its validity with the patient. Also aims to change negative automatic thought to more positive and realistic thought.
*Pioneered by Dr Aaron Beck in the 1960s, originally under term Cognitive Behavioural Therapy.
Cognitive Therapy seeks to alleviate psychological stresses by correcting faulty conceptions and self-signals. By correcting erroneous beliefs we can lower exccessive reactions (Beck, 1976)
Techniques that may be used:
-Cognitive restructuring of thoughts
Basic Cognitive Behavioural Model
Behaviour >> Event >> Cognitive Appraisal >> Emotion
Event A person who has tinnitus is invited to the pub.
Cognitive Appraisal I can't go. My tinnitus will stop me from hearing in the pub and I will look stupid.
Emotion Hopeless, frustrated.
Behaviour Avoids pub
Emotions are further affected by the appraisal. When you are feeling hopeless your thinking will be further distorted.
The behaviour of avoiding the pub further strengthens the belief in the thought: I can't go" there has been no opportunity therefore for the belief to be disproved.
"any behavioural act that enables an individual to avoid anticipated unpleasant or painful situations, stimuli or events" (Psychology Dictionary, 2015)
Intertwined 3 circles of: (Little Awareness), (Out of Control) & (Highly Believable)
In the short term, avoidance behaviours help reduce negative feelings and physical sensations but in the long term they can maintain and strengthen negative beliefs and assumptions. Silence is frequently avoided as there is the fear that one will not cope if fully exposed to tinnitus (McKenna et al, 2014)
It is not the event itself that causes negative emotion, it is the individual's interpretation of the event ie. the cognitive appraisal.
Beck termed these appraisals as "automatic thoughts"....
(CORE BELIEF) then (INTERMEDIATE THOUGHTS) then (NEGATIVE AUTOMATIC THOUGHTS)
Intermediate Thoughts/ Rules of Life
These are learned from early experiences and observations of others in early life.
Some are helpful and some are not.
Unhelpful rules tend to be fixed and irrational such as "I must never make mistakes"
-Deepest level of cognition
-Formed in childhood
-How we see ourselves, other people, the world, the future.
-Negative core beliefs arise from exposure to significant life events
-Negative core beliefs result in dysfunctional rules of life.
AIMS & Objectives:
-To develop an understanding of:
Cognitive Behavioural Therapy (CBT) model of tinnitus distress.
CBT in practice
Mental Filter >> Jumping to Conclusions >> ALL or Nothing >> Over-Generalisation
The Cost-Benefit Analysis
Costs vs Benefits
The Double Standard Technique
What would you say to a friend who had the same thing?
The Feared Fantasy Technique
What is the worst thing that could happen?
How likely is this to happen? (0-100%)?
What is more likely to happen
The Jury Exercise
Evidence For vs Evidence Against
The Survey Technique
Would other people agree with me?
GOAL OF CBT
1) Understand the effects of thoughts on emotions and behaviour.
2) Listen to what you are thinking
3) Identify positive and negative thoughts
4) Interrupt and stop negative thoughts
5) Challenge the truth and validity of your thoughts
6) Substitute negative thoughts with positive/logical thoughts.
Consultation about Behaviour Change
CBT for sleep hygiene?
Stage 1: Resistance vs Motivation
Stage 2: Importance vs Confidence
Stage 3: Readiness
Conditions for Information Processing
Motivation (concern, self-relevance, personality) & Capacity (cognitive ability, knowledge, freedom)...>> Combine to process the content of a message >> Attention to this can mean = Lasting attitude change!
(Smith & Mackie, 2000)
The Treatment / Clinical Contract
Contracts for change are an adult commitment to a well-defined course of action.
-Who it is between
-What they are going to do together
-The length of time
-The goal / outcome
-When it is known whether it has been achieved
-How will it benefit the patient
(Stewart and Joines, 2006)
We gather info through questionnaires, forms, historical information, specific recommendations, information from other agencies.
We need to ask questions- but we want to ENCOURAGE contributions from the interviewee....
Consider: Facial Expression
Effective Listening skills are reliant on the environment created....
Broad....>> to Specific >> Clarify.....>> Keep control (Williams, 2002)
The Model of Stages of Change
Ethical and Spiritual
& the Cycle of Enter - Precontemplative - Contempative - Determinism - Active Change - Maintenance - Relapse.