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Donald Meichenbaum By Andy Crosier, Jenny Underwood & Julia Chapman

Donald meichenbaum

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CBM

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Page 1: Donald meichenbaum

Donald MeichenbaumBy Andy Crosier, Jenny Underwood & Julia Chapman

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Donald Meichenbaum

• Distinguished Professor at the University of Waterloo, Ontario, Canada for 33yrs. • Voted one of the 10 most influential psychotherapists of the Century by North American clinicians. • Part of the ‘Cognitive Revolution’

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Donald Meichenbaum

• Founder of Cognitive-Behavioral Modification• In 1977 he published Cognitive-behavior

Modification: An Integrative Approach.• As an expert in the treatment of PTSD, as a

clinician and researcher, he has treated all age groups for traumas suffered from violence, abuse, accidents, and illness

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Cognitive Behavioral Modification

A technique which puts patients in charge of their own psychotherapy by modifying what they say to themselves - their so-called 'inner dialogue'

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Cognitive Behavioral Modification

According to Meichenbaum (1980), the premise of CBM is that individuals must develop the ability to notice (a) how they feel, think, and behave and (b) the impact their behavior has on others as a prerequisite to behavior change.

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Cognitive Behavioral Modification

• In Cognitive Therapy a therapist teaches a client to question his or her inferences but in CBM the therapist teaches a client to change them.

• CBM is less direct then REBT and utilises ‘self instructional training’ to help the client become more self aware of their self talk.

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Self-Instructional Training

• Meichenbaum believed that learning to control behavior begins in childhood, based on parental instruction

• This helped him create the idea of ‘Self-Instructional Training’(SIT), which remains today as a major part of self-control strategies.

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Self-Instructional Training

Meichenbaum 's SIT was originally developed to help impulsive children:1. Adult performs the task while speaking to the child (cognitive

modelling) 2. Child performs the task with adult supervision (external

guidance) 3. Child performs on his/her own while verbalizing the directions

out load 4. Child performs on his/her own while whispering to his/her self

(self-guidance)5. Child uses inside voice while performing the task (self-

instruction)

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Self-Instructional Training

In a therapy setting Self-instructional training is a cognitive technique which aims to give clients control over their behavior through guided self talk that gradually becomes covert and self generated.

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Self-Instructional Training

3 phases of behavior change: • self-observation• starting a new internal dialogue• learning new skills

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SIT in therapy• The client identifies the internal feelings and

the negative self-statements that are produced by a stressful situation.

• The client uses this a cue to initiate self-instruction

• A therapist rehearses with the client self-talk to counteract the negative self statements.

• The client is then taught to self-instruct a range of coping skills that help to alleviate the stress- (breathing, relaxation techniques, imagery etc)

• Finally the client is instructed to make self reinforcing statements- (“I’m doing it”)

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Cognitive Behavioral Modification

• CBM emphasises modifying thinking as a means of changing feelings and behavior

• Combines cognitive and behavioral learning principles to shape and encourage desired behaviors

• CBM in essence: You are what you think!

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Cognitive Behavioral Modification

According to Kaplan and Carter (1995), five characteristics distinguish cognitive behavior modification from other types of behavior management systems: • Participants themselves rather than external agents are the

primary change agents. • Verbalization is on an overt level, then a self-monitor level, and

then a covert level. • Participants are taught to identify and use a series of problem-

solving steps. • Modelling is used for instructional purposes. • Cognitive behavior modification facilitates self-control.

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Stress Inoculation Training

Stress Inoculation Training is a form of CBM.

It is based on the assumption that knowledge alone is often not sufficient in helping people to deal with stressful situations. Stress inoculation training can be used to teach a variety of physical and cognitive coping skills that will increase an individual’s ability to function under pressure, and ‘inoculate’ them against future stressors.

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Stress Inoculation Training• Helpful for a wide range of issues –

Managing anxiety reactionsCoping with physiological painPhobiasAnger management

• Used as a treatment to help people deal with the aftermath of traumatic events

• Used as a preventative measure, to equip people for the future

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Stress inoculation – 3 phases

1. The conceptual stage

2. The skills acquisition and rehearsal phase

3. Application and follow through

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Stress inoculation training

Phase 1 - Conceptualisation• Collaborative therapeutic relationship is established in which the

client and therapist get an overview of the client’s issues

• Client is taught the nature and impact of stress, e.g. the fight or flight response, and the vicious circle that they may have unknowingly entered in to

• Client learns to identify their helpful/unhelpful responses to stressors. These could be any self-defeating behaviours or internal dialogue

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Stress inoculation training

Phase 2 - Acquisition of skills and rehearsal

• Skills are tailored to specific stressors, e.g. work pressure, physical pain, relationship problems, military combat, surgery etc

• Practical coping skills are taught in the clinic or training setting at first, and are then rehearsed gradually using role-play and modelling with support and guidance from the therapist

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Coping skills include:

• Self-instructional training• Self-soothing and relaxation techniques• Cognitive restructuring• Problem-solving• Emotional self-regulation• Attention diversion procedures• Training in interpersonal communication skills• Using support systems • Doing activities that are meaningful to the

individual

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Stress inoculation training

Phase 3 - Application and follow through

• Client practises using their new coping skills in increasingly stressful situations

• Clients do experiments in the form of graded exposure, which reinforce their ability to cope

• Client implements relapse prevention measures, e.g. identifying warning signs and ways to cope with lapses

• Booster sessions

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Disorders Treated by CBM• Aggression

• Anxiety

• Panic disorders

• Substance abuse

• Schizophrenia

• Bipolar depression

• Borderline personality

• Depression

• Limited self-control

• Eating Disorders

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Treatment of Eating Disorders

• CBM is at the root of treatment for anorexia and other eating

disorders.• These behaviour modification techniques were first developed

by Donald Meichenbaum.• Through behaviour modification techniques, therapists are able

to help change attitudes about ideal body shape and weight, replace unhealthy eating habits with normalized eating patterns, and teach patients how they can resist the urge to binge and purge.

• Many eating disorder patients also experience anxiety and depression and a combination of behaviour therapy and cognitive therapy is also commonly used in the treatment of anxiety disorders so treatment by way of these techniques becomes even more powerful.

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Advantages of CBM

• Cognitive behavior modification can be performed individually or in group therapy sessions.

• High success rate of therapy.• In many instances, the complete elimination of the

undesirable behavior is achieved. • Even when a complete cure is not achieved, in the

majority of cases, dramatic improvements can be seen.

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Advantages of CBM (cont)• The results often last longer than therapy or

medication alone.• Deeply ingrained behaviors may require a longer

course of treatment, along with medication. However, most CBM programs can be completed in several weeks or months, where conventional talk therapy can require several years.

• Because the course of treatment is shorter than that of conventional talk therapy, CBM can be a less expensive means of obtaining mental health treatment.

• The self-help element also means that patients can work to maintain their own treatment even after formal therapy has ended.

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Disadvantages of CBM

• Extensive training required. • Can be exhausting for some people because they

have to constantly verbalize instead of just thinking.• Therapist may misuse power by imposing their ideas

of "rational" thinking on a client.• Therapists must take special care to encourage

clients to act rationally within the framework of their own value system and cultural context.

• Minimal attention to client's past experiences.

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Questions?