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09 February 2009 @ 04:21 pm
relapse prevention;  

::Problem Solving and Relapse Prevention::
This section is used to help with difficulties with independently analyzing what the problem is, what might be causing it, then devising and implementing solutions based on this information.

What causes behavior?

::Trait-Based Model::
+Believes the cause of the behavior is due to some characteristic
within the individual.
+Usually involves statements that suggest a person is "just that way"
or has a certain kind of personality.
+Is typical of how poeple talk about behavior in everyday life.
+Although traits are helpful to describe behavior, the are often
used to explain why behavior occurs.

Examples include:
- Will power
- Laziness
- Perfectionism
- Diagnostic labels


There are problems with using a trait-based model as the cause
of behavior. These include:
+It is misleading: You think you know the cause, but you really don't.
+It does not provide useful information for change.
+It leads to "circular reasoning."
+It does not take into account situational differences.
+It fosters a non-dialectical view of the problem.

::Biosocial Model::
Bio = Biology
Behavior, at least in part, is rooted in a person's biological make-up. Although we don't know exactly how - it is believed that genetic influences, problems during pregnancy, and early childhood events that effect the nervous system might be some of the way in which certain biologically-based dysfunctions and vulnerabilities develop.

Social = Learning
Behavior, at least in part, is a result of learning experiences over time. There are three types of learning processes - observational, operant, and respondent. Behavior can be a result of one or a combination of each of these processes. The type of learning that maintains a behavior may be different from that which originally developed it.

Observational learning is when you observe behaviors in others and use them as a model for your own behavior. Examples: Observing a dance instructor demonstrating new steps and then practicing them yourself; adjusting clothing styles to math current trends; children imitating the speech of a parent or sibling.

Operant learning is the result of what follow behavior (consequences). It is consistent with the law of effect which states that behavior that produces good outcomes tends to become more frequent where as behavior that produces bad outcomes tends to become less frequent. Examples: Whining and nagging result in getting something we want (whining and nagging lead to a positive outcome; getting what we want - hence whining and nagging are likely to occur in the future under similar circumstance. This would be a child who wants a candy bar at the grocery store and is crying and screaming for it. The parent gives in and buys the child the candy, and now the child learns that all he/she has to do is cry and scream in that store and he/she will get what he/she wants.

Respondent learning occurs through the pairing of a biologically based response (physical responses like emotions) with neutral cue to the point that the cue atomically produces the response. Examples: While running in your neighborhood you get bitten by a dog. Now every time you see a dog, you fear that the dog will bite you. Seeing a dog becomes a trigger for fear; being left alone as a child and feeling scared. Being alone or left rejected becomes associated with fear. As an adult thoughts of, or actually being alone and/or rejected triggers fear.

::DBT Model::
Emotion vulnerability (biology = nervous system sensitivity and reactivity combined with an invalidating environment (learning = no opportunity to learn adaptive coping skills and absence of validation or punishment of personal experience) results in:
1. Learning negative (in the long-term) ways to cope.
2. Setting unrealistic goals and expectations for one's self.
3. Giving up and giving in too readily.
4. Constantly looking to the environment for reassurance and help.
5. Extreme or blunted emotional and behavioral responses.

::Typical DBT Patterns::
Prompting event - problem emotion and problem thought - target behavior - short term consequence - long term consequence.

::Self-Management Skills::
Defining the Problem
Identifying and defining a behavior to be changed is the first step toward problem solving.
Step One: Use the "Miracle Question" - "If I were to wake up in the morning and all my problems were gone, what would be different?"
Step Two: Then define the problem behaviorally.

Goal Setting
Long-Term Goals vs. Short-Term Goals
Long-term goals are essential to success in life. However, if you only had long term goals, progress would be difficult to see and you'd give up more easily. Thus, goals should be broken down into small steps (short-term objectives) with rewards along the way.

The best way to ensure you achieve your goals is to make sure they are SMART:

[S]PECIFIC:
Goals are best achieved when you use specific behaviors you would like to see increased or decreased.

[M]EANINGFUL:
Goals should mean something to you. You are not likely to work toward goals that are purely for another person's benefit or that are not really consistent with what you want for yourself.

[A]TTAINABLE:
It is common to over simplify the ease of goal attainment. It is best to have a number of small goals that move you toward a larger goal. Goals should also be things that are under your control and do not depend on others for attainment. Make sure you are setting a "wise minded goal;" something that makes sense given your skills, resources, and environmental constraints.

[R]ECORDABLE:
Goals should be based on things that can be objectively measures and recorded.

Have a [T]IMELINE:
It is helpful to set a date for completion of your goal. If you have a series of goals, also lay them out in a timeline fashion. Be flexible with your timeline if you over - or underestimated the length of time to achieve your goal.


Self-Monitoring
::What to Gather?::
Where: Place the behavior occurs
What: frequency of the behavior, Duration of behavior, intensity of the behavior.
When: Time of the day.
Possibe Why's: Things that come before and after, the context of events, thoughts, feeling, behaviors, etc., that are porential influences.

::How to Gather?::
You need a formal recording device (example: diary card): It should include ample space and appropriate headings so that detailed information can be collected. Should be relatively quick and easy to use.
Principles of self monitoring: The sooner you record the information, the better. It is best to record the information at the same time each day. Don't give up too quickly - it is important to problem solve obstacles to gathering data. Example of obstacles: remembering, too complex, doesn't seem helpful.

::The A-B-C Model::
A (antecedent) -> B (behavior) -> C (consequence)

A – The event (internal or external), situation, or outcome that precedes or leads up to the behavior.

B – The behavior you wish to change, sometimes called the “Target Behavior.” The behavior you want to increase or decrease. The one you will count and record information about.

C – The event (internal or external), situation, or a specific stimulus that comes after or follows the behavior.

::Chain Analysis::
1. Identify
+The target behavior to analyze.
+The prompting event (what event set off the sequence of steps leading up to the target behavior?).
+Vulnerability factors ( what made you more vulnerable to engaging in the target behavior?).
+The “links in the chain” leading up to the target behavior (events, thoughts, emotions, sensations, and actions (yours or others) in “excruciating detail!”).
+Consequences of the target behavior (did the behavior take away something negative or lead to a positive event?).

2. Develop ideas about what is causing behavior based on the biosocial model.
3. Implement solutions based on your ideas.

::Four solutions to any problem::
1. Fix the problem: Either get out of the problem altogether, in a way that is in keeping with your ultimate goals, or problem-solve the situation.

2. Feel better about the problem: Work on changing your feelings about the problem, see the up-side to the problem, reframe the problem – make lemonade out of lemons.

3. Accept the problem and the negative feelings: Radically accept the problem exists, accept that problems and the negative feelings are just part of life.

4. Stay miserable: by default.

::Modify your thinking::

PREDICTIONS:
All or nothing thinking: seeing things in black or white categories (ex: I perform perfectly, or I am a failure).
Extreme words: always, never, will, won’t completely, absolutely, everything, everyone.
Overestimating the probability: predicting a low probability event as a high probability event or even a certainty.
Expecting the worst.
Mind reading: make negative assumptions about others’ responses without finding out how they really feel.

STANDARDS:
”Shoulding” on yourself or others: should, must or ought to statements.
Playing master of the universe: writing rules about how you or others “should” be.
Owning others’ problems: thinking that you “should” be able to solve others’ problems.

LABELS:
Overgeneralization: assuming that one event is actually a pattern
- Disqualifying the positive – filtering out or rejecting positive experience.
- Ignoring the negative – disregarding negative behaviors.
Labeling a person rather than describing a behavior.

::Identifying alternative thoughts::
Predictions
- What are the facts?
- What is the actually chance?
- What other outcomes are just as likely as my alarming prediction?
- Am I mistaking a possibility for a certainty?
- What have I survived before? Am I underestimating my ability to cope with the problem/emotions/etc?
-Do I have any options for preventing the worst possible outcome?

Labels
- How could I be less hard on myself or others?
- How could I describe the behavior without labeling the person?
- What are other possible explanations for behavior other than that they are a jerk, incompetent, idiot, worthless, etc?
- Am I making this worse than it is? What are more realistic alternatives to describing self, other or situation? (ex: instead of “worthless” maybe “struggling,” instead of “disaster” maybe “nuisance” or “hassle,” instead of “hopeless” maybe “difficult but manageable.”)

Standards
- Remember the serenity prayer
- Apply the following formula to your standards
Acronym: PUT A FRESH SPIN ON IT
Preference + Facts + Strengths + Options = more flexible, realistic standard.

::Check your “VITALS”::
These skills are helpful for getting yourself to “approach not avoid” or to do anything you don’t want to do.
V = validate the “I don’t want to.” Validate your current situation and vulnerabilities. Substitute this for harsh and punitive methods of self-motivation. Then try a “Pros and Cons” of procrastinating or doing the behavior.

I = imagine yourself doing the behavior peacefully and productively (imaginal practice). Research has shown this to be very effective in decreasing resistance and improving performance.

T =take small steps. Break the behavior down into the smallest steps you can. When you do that, break each of those steps in half. The idea is to make each small step easy enough to do that it doesn’t feel like big obstacle.
- The “Swiss Cheese” method: Do anything at all that is remotely related to the task you want to accomplish. Gradually take larger chunks or holes in the task until it’s easier to do.
- “Worst first” approach: Identify the most difficult part of the task and break that into smallest steps.
- “5-Minute Plan”: Take a task you have been putting off and work for just five minutes at some step. Once you finish five minutes, you can decide to do another five minutes.

A = applaud yourself. This is the skill of self-encouragement or cheerleading. Whenever you take even a small step toward your goal, acknowledge it and validate that you are doing a new behavior and moving toward your long=term goals. No step is too small to applaud!

L = lighten your load. This is a maintenance skill so things don’t pile up. Returns books when due so you don’t get a fine, buy smoke detectors so you don’t worry about fire, etc…

S = sweeten the pot. Add something during or just after the behavior that will be reinforcing for you. Reward yourself, (even a small reward) for taking the step.