Responding to Mental Health Issues
Within Drug & Alcohol Treatment
Clinician’s Training
Package
These training resources were funded by Drug Strategy Branch, Australian Government
Department of Health and Ageing through the National Comorbidity Initiative
Exercise 1: Who Here Do You Think…
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•
Loves The Simpsons?
Can change a flat tyre?
Exceeds the speed limit?
Snores?
Is kind to dogs?
Would tell you that you have bad breath?
Is trustworthy?
Exercise 2: How Are You
Thinking-Feeling-Doing?
• What are your THOUGHTS about working with
clients with comorbidity?
• What are your FEELINGS about this training?
• Notice how you BEHAVE when I say we have 2
days to get this on board?
A Snapshot: Training Modules
Module 1
Module 2
Module 3
Module 4
Introduction to
comorbidity
CBT
Pre session
preparation
Implementation
of Brief MH
Intervention
•PsyCheck Mental
Health Screen
•Theory of CBT
•Assessment
•Psychoeducation
•Context
•Principles &
application
•Case
Formulation
•Introduce CBT model
•Development
•CBT in practice
•Treatment
planning
•Implementation
•Scoring
•Self monitoring
•Identify thoughts
•Manage thoughts
•Relapse planning
•Termination
Module 1
Module 1
Introduction to Comorbidity &
PsyCheck Mental Health Screen
• To provide a context for the PsyCheck
Screening Tool
• To understand the development and
psychometric properties of PsyCheck
• To gain skills in implementation, scoring and
interpretation of PsyCheck
Module 1
Aims of Module 1
• Introduction to Comorbidity
• Development of PsyCheck
• Psychometric properties of the PsyCheck
Screening Tool
• Negotiating the Users Guide
• Administering the PsyCheck Screening Tool
• Mental Health Screen
• Suicide/Self-Harm Risk Assessment
• Self Reporting Questionnaire Tool
• Interpreting the PsyCheck Screening
Module 1
Overview of Components of Module 1
• Up to a third of mental health clients have an
AOD problem
• May be referred in to AOD services
• Up to 80% of AOD clients also have a cooccurring mental health problem
• Many more may have subclinical symptoms
• Rule rather than the exception in treatment
settings
Module 1
Introduction to Comorbidity
• Those that have comorbid AOD and mental
health problems have
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•
•
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Poorer prognosis
Higher risk of harm
Greater likelihood of relapse to both disorders
Greater use of health services
Module 1
Introduction to Comorbidity
1. Secondary Psychopathology Model
2. Secondary Substance Use Model
3. Bidirectional Model
Module 1
Models of Comorbidity
4. Common Factor Model
5. No Relationship Model
Module 1
Models of Comorbidity
• Comorbidity is the norm
• In both mental health and alcohol and drug
services
BUT
• Client group is very different in each service
Module 1
Comorbidity in Practice
• In Mental Health Services
• Mostly psychotic disorders with range of alcohol and
other drug issues
• In Alcohol and Drug Services
• Mostly high prevalence disorders: anxiety and
depression
• Often not able to refer to Mental Health Services
• Often have subclinical symptoms: often go
undetected
Module 1
Comorbidity in Practice
• Sequential
• Treat one problem first
• Parallel
• Simultaneous treatment in different service provider
• Integrated
• Integrated treatment by same service provider
• Best empirical support
• Client and clinician preference
Module 1
Treatment for Comorbidity
• Many AOD clinicians report training is
• Concentrated on acute low prevalence disorders
• Focused on relationship building with Mental Health
Services
Module 1
Comorbidity Training
• Designed for AOD clinicians with little or no
experience in mental health interventions
• But can still be used by experienced clinicians
• Focused on the disorders most commonly
encountered in AOD Services
• Anxiety, depression, some somatic symptoms
• Offers a screening tool and articulated
intervention
• Offers options for training and support through
clinical supervision
Module 1
PsyCheck Developed to Address Gaps
• Screening and intervention for anxiety and
depression among AOD clients
• Brief screening
• 4 session intervention
• Youth modifications
• Extension material
• Accompanying resources
• PsyCheck Screening Tool
• PsyCheck Screening Tool User’s Guide
• PsyCheck Clinical Treatment Guidelines
Module 1
PsyCheck Overview
• Comprehensive capacity building
• 4 module workshop
• Clinical supervision
• Part of a whole organisation approach to
improving comorbidity services for our clients
• Managers resources (Implementation Guidelines)
• Clinical supervisors resources (Training and Clinical
Supervision Guidelines)
Module 1
PsyCheck Overview
• PsyCheck Screening Tool scientifically validated
• A general mental health screen, including
history of treatment
• A suicide/self harm risk assessment
• The Self Reporting Questionnaire (SRQ)
• World Health Organization instrument
• Assesses current symptoms of anxiety, depression
and somatic disorders
Module 1
PsyCheck Screening Tool
• Evidence based: drawn from empirically
supported treatment
• Intervention is designed to be integrated into
routine AOD practice
• CBT principles used in both AOD and mental
health
• Best practice in both sectors
• Easily integrated
• Easily manualised
• Focus on scientist-practitioner approach
• Hypothesis testing
• Reflective practice
Module 1
PsyCheck Intervention
• 120 newly engaged AOD clients
• PsyCheck Screening Tool compared to General
Health Questionnaire (GHQ)
• Both compared to a diagnostic instrument (CIDI)
• Results
• SRQ superior to GHQ in predicting anxiety and
depressive disorder
• Cut-off identified that indicates presence of disorder
• General mental health screen good indicator of
psychosis
Module 1
Psychometric Properties
• About the PsyCheck Screening Tool
• Statistical properties
• Decision tree
• Administration and scoring
• General mental health screen
• Suicide risk/self harm assessment
• Self Reporting Questionnaire
• PsyCheck Screening Tool
• Sample contingency plan
Module 1
Negotiating the PsyCheck User’s Guide
• Designed for routine screening (all clients)
• Administer the whole SRQ
• Other parts only if information not already collected
• Suicidality monitored over time
• Suicide assessment a framework not a checklist
• Clinical judgement is required
• Assess risk of harm to others in same way
Module 1
Administering the Screening Tool
• Work in groups of 3
• Select a celebrity square
• One person plays the celebrity
• 2 clinicians assist each other in administering the
PsyCheck Screening Tool
• Group Discussion
Module 1
Exercise 3: Celebrity Squares
• Intervention or further assessment is required if
• The client reaches 5 or more on the SRQ
• The client is at risk of suicide/self-harm
• The client has a mental health history
• Consider
• Readiness to change
• Current symptoms
Module 1
Interpreting the PsyCheck Screening Tool
Module 1
SRQ Interpretation
Total Score
0
Interpretation
Action
No symptoms present.
Re-screen using the PsyCheck after 4
weeks
1-4
Some symptoms of
depression, anxiety and/or
somatic complaints
indicated.
Offer Session 1
Re-screen after 4 weeks
Provide self-help material
5
or above
Considerable symptoms of
depression, anxiety and/or
somatic complaints
indicated
Offer Sessions 1-4
Re-screen after 4
If no improvement after rescreening, consider referral
Module 1
Decision Tree
• Work in the same groups of 3
• From the information you’ve collected refer to
the Decision Tree and determine what the next
steps would be for your celebrity client
• Think about
• Past mental health questions
• Suicide assessment, and
• SRQ score (and the types of answers endorsed)
• Group Discussion
Module 1
Exercise 4: Celebrity Squares - What
Next?
I’m never
going to
get this
I may as
well give
up now
I’m
useless
Module 1
What’s on Your Mind – Is It This…?
Module 1
Or This …?
I’m getting
some of
this
If I hang in
it will fall
into place
I feel
confident I
will get it
Module 1
Or Maybe This …?
This is too
easy…
What if I
get bored…
I’ll think
about how I
can use it in
my practice
Module 2
Cognitive Behaviour Therapy
• To understand the theory of CBT
• To understand the principles of application
underpinning the PsyCheck intervention
• To understand of the practice of CBT
Module 2
Aims: Module 2
• Introduction to CBT
• Theoretical underpinnings
• CBT Model
• Evidenced based practice
• CBT in practice
• Standard sessions
• Self-monitoring
Module 2
Overview: Module 2
Module 2
Exercise 5: What Works for You?
• Working individually complete the worksheet,
identifying which models you have an affinity with
• Then circle the main model you work with
• Now find someone else in the room that uses a
DIFFERENT model to the one you typically work
with and discuss with your partner
• Why you use this model/strategies you do?
• How you know it’s working ?
• Group discussion
• There is emerging evidence that a single
theory planned approach is more effective than
an ad hoc one
• Most effective to have a single framework or
philosophy about treatment and incorporate a range
of techniques and strategies that fit with your
philosophy
Cognitive Behavioural Approach
Module 2
Planned Approach
• Best evidence for CBT compared to other types
of therapies
• Most high level research (RCTs) and the most positive
research
• Effective for a wide range of mental health problems
including AOD, anxiety and depression
BUT
Whatever framework you use, you can create
your own evidence through measuring individual
outcomes – CBT emphasises this
Module 2
Evidenced Based Practice
• Umbrella term for a range of therapies with a
cognitive and/or behavioural focus
• Therapy examples
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Cognitive Therapy (Aaron Beck)
Relapse Prevention (G. Alan Marlatt)
Coping Skills Therapy (Peter Monti)
Mindfulness Therapy (Mark Williams)
Schema Therapy (Jeff Young)
Dialectical Behaviour Therapy
(Marsha Linehan)
Module 2
What is CBT?
• Strategy examples
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Problem Solving
Goal Setting
Cue Exposure Therapy
Thought stopping
Urge surfing
Activity scheduling…
• Solution-Focused Therapy
• An understanding of the past and cause of problem
not necessary for resolution of the problem
• Change occurs as a result of a focus on the future
without the problem
• Narrative Therapy
• Focus is on meaning, narrative and power
• Talking about the influence of problems enables talk
about their defeat via the new stories
Module 2
In Comparison…
• Gestalt Therapy
• Focus is on the present rather than past or future
• Central aim is awareness-raising and creating
conditions to de-construct dysfunctional fixed or
habitual patterns of interaction
• Change occurs through understanding and
acceptance of what is
• Psychodynamic Therapy
• Focus is on initial underlying causes
• Understanding and having insight into the
problem leads to change
• Therapeutic relationship is the key to change
Module 2
In Comparison…
• ‘Self-help’ oriented
• Clinician provides tools and framework for change
• Client’s responsibility to create and maintain change
• Skills oriented
• Attention to therapeutic process vital but not
sufficient in itself for change to occur
• Structured but not inflexible
• Clinical judgement necessary
Module 2
What is CBT?
CBT…
• is based on an ever-evolving formulation of
the client in cognitive terms
• requires a sound therapeutic alliance
• emphasises collaboration and active
participation
• is goal oriented and problem focused
• initially emphasises the present
Module 2
CBT Principles
CBT…
• is educative, aims to teach the client to be
their own therapist, and emphasises relapse
prevention
• is time limited
• sessions are structured
• teaches clients to identify, evaluate and
respond to their dysfunctional thoughts and
beliefs
• uses a variety of techniques to change
thinking, mood and behaviour
Module 2
CBT Principles
• From the cards you have been given, keep the
ones that represent the way you work (in the
majority) and trade unwanted cards for wanted
cards with other participants
• Either
• Line up on the cognitive/behavioural continuum to
show whether you work more in a cognitive or
behavioral approach, or
• Place your cards on the grid (cognitive/behavioural vs
skills/process)
• Group discussion
• Why did you put your card or yourself where you did?
• Did the cards fall in a pattern?
Module 2
Exercise 6: Mix ‘n’ Match
Module 2
The CBT Model
Early
Experience
Core beliefs
Trigger
Unhelpful
thoughts
Behaviour
Feelings
Module 2
Bruce: Eating Disorder
Absent father,
poor role models
I’m unlovable and
need food to
make me happy
Smell of
restricted food
Eating makes me
feel better
Over-eating,
relapse
Craving
Module 2
Bruce: Simplified CBT Model
Module 2
Bruce: ABC Model
• In pairs take it in turns to use the CBT model
worksheet, choose a simple target problem for
example, eating chocolate, public speaking,
learning a new skill
• Use a recent real example or a made up one
• Complete the CBT model sheet with thoughts
feelings and behaviours.
Module 2
Exercise 7: The Cognitive Model
• I: Review and feedback from last session
• II: Information and practice of session topic
• III: Summary and feedback from this session
Module 2
Typical Session Format
• Check-in past week, mood/drug use, homework
• ‘What’s been happening this week?’
• ‘How’s your [mood] been this week?’
• ‘How did you go with your homework?’
• Bridge from previous session
• ‘Remember last week we talked about [x]… did you
have any more thoughts about it?’
• ‘Were you able to get any practice of [skill]’
Module 2
CBT in Practice I: Review and Feedback
• Information about skill
• ‘last week we talked about [identifying thoughts]
this week I thought we’d talk about how to manage
those thoughts…’
• ‘Remember the cognitive model…the way I like to
think about it is…’
• Practice of skill in session
• ‘let’s try to do this together…’ [use whiteboard]
Module 2
CBT in Practice II: Info & Practice
• Summary and feedback
• ‘so what we talked about today was…’
• ‘how does that fit with you…?’
• Set homework tasks
• ‘it’s really important to practice these things
between sessions so they become second nature…
what do you think you could do that would help you
remember what we did?’
Module 2
CBT in Practice III: Summary & Feedback
• A. Watch video demonstration of basic
elements of a session
• Discussion about the elements as a group
• B. Practice the elements in pairs
• Feedback to each other good aspects and an area
for improvement
Module 2
Exercise 8: CBT Demonstration I
• Interventions are applied from the least to
most intensive
• Each step is incremental based on the client's
response to the previous one
• A stepped care approach can add flexibility to
treatment and improve outcomes
• CBT (and PsyCheck) facilitates the stepped
care approach
Module 2
Stepped Care Approach
• Therapeutic alliance vital
• Basis of ALL therapy
• Requires good counselling skills
• Necessary but not sufficient condition for change
• Collaboration and active participation by client
and clinician essential
• Requires good active and empathetic listening skills
• CBT builds therapeutic alliance through collaboration
and encouraging client involvement in their own
therapy
Module 2
The Therapeutic Relationship
• Clinical judgement is required, even though the
therapy is manualised
• Use PsyCheck as guidelines – follow steps only as
closely as you need to
• Use flexibly with extension material to tailor to
client’s needs
• Consider client’s needs
• Consider existing clinical practices and pathways
Module 2
Clinical Judgement
• PsyCheck designed to be integrated into
routine AOD treatment
• Techniques are deliberately similar to those in AOD
treatment
• Emphasise to the client the link between AOD
use and mental health problems
• Consider ways in which you can integrate into
what you already do
Module 2
Integrated Treatment
• In small groups (3-4) discuss how therapeutic
processes can be used in CBT
• What makes a good therapeutic alliance - list as
many elements as you can?
• What could happen if you don’t have a good
therapeutic alliance? Think about the client, the
practitioner and the therapy relationship
• Group discussion
Module 2
Exercise 9: Therapeutic Process
What have we learned so far…..?
Module 2
Let’s Take a Breather…
What brief practice at home would assist you
to consolidate the knowledge you gained in
this module?
• eg. Use the CBT model on your self
• eg. Further reading about CBT
• eg. Practice explain the CBT model to a
client/colleague
Next session you will be asked to share your
experience of self practice if you are willing,
(but not of the actual target problem itself if
you used yourself as a client)
Module 2
Homework
Module 3
Pre-Session Preparation: Assessment,
Formulation and Treatment Planning
• What did we do last time?
• What is your feedback about what we covered?
• Homework feedback
• Challenges in completing the homework?
• What was the effect of self-practice?
• Next step…?
Module 3
Before We Start…
• Work in groups of 3, you have just interviewed
your celebrity. Write a few lines using the
following criteria as if you were writing for a
trash magazine
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•
•
Their current problem
Their presenting mood/feelings
Thoughts
Behaviour
What’s driving the behaviour
Consequences of behaviour
• Present to the large group
Module 3
Exercise 10: The Young and The Restless
Trigger
Module 3
Example: Jen X
Jen X 38, an actor made a rare appearance
in public today after husband Y, a singer
Behaviour
was admitted to the famous Betty Ford
clinic. X hasn’t been seen for weeks.
Sources close to the actor say she has been
increasingly worried about the singer’s
Feelings
behaviour. ‘She’s looking really drawn and a
Presenting
bit
depressed’
says
a
close
friend.
‘She
says
issue
she can’t bear to go out of the house and
it’s really starting to get to her’. It is thought
Thoughts that X’s two adopted children are being
cared for by family.
Consequences of
behaviour
• To understand how to screen for mental health
issues and prepare feedback
• To understand how to undertake a cognitive
behavioural assessment
• To understand how to collect sufficient
information to develop a cognitive behavioural
formulation
Module 3
Aims: Module 3
• Negotiating the PsyCheck Intervention &
Clinical Treatment Guidelines
• Undertake screening and preparing feedback
• Undertake a cognitive behavioural assessment
• Prepare a preliminary case formulation
Module 3
Overview: Module 3
• Designed for a range of experience and
background
• Manualised for new clinicians
• Use flexibly for experienced clinicians
• Use with
• Introduction to PsyCheck package
• PsyCheck Screening Tool and User’s Guide
Module 3
Negotiating the PsyCheck Clinical
Treatment Guidelines
• Three sections
• Principles of intervention
• Practice Guidelines
• Extension material
• Worksheets
• Modifications for young people
Module 3
Negotiating the PsyCheck Clinical
Treatment Guidelines
• Pre-session preparation: Reflection
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•
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Prepare feedback from the PsyCheck Screening Tool
Cognitive behavioural assessment
Cognitive behavioural formulation
Treatment planning
• PsyCheck intervention
•
•
•
•
Session
Session
Session
Session
1:
2:
3:
4:
Introduction
Identifying unhelpful thoughts
Managing unhelpful thoughts
Relapse prevention
Module 3
Practice Guidelines
• PsyCheck screening
• Snapshot of potential need
• Feedback
• Results of PsyCheck Screening Tool
• Any other information gathered
Module 3
Screening in Context
• Also known as ‘functional’ assessment
• Occurs during an assessment session and
continues through therapy
• Functional vs structural/diagnostic analysis
• Drivers vs descriptors of behaviour/problem
Module 3
Cognitive Behavioural Assessment
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•
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•
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Presenting issues
Pattern (onset and course)
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
Prognosis
Other factors
Module 3
Cognitive Behavioural Assessment: 7Ps
Bruce
• Discussion
• Identify elements of the functional assessment for
Bruce
Module 3
Exercise 11: Something Fishy
• Case formulation is
• Theory driven
• An interpretation - more than a case summary or
summary of presenting problems
• A working hypothesis to be reviewed
• Dynamic - as new information comes to hand, your
formulation is reviewed, added to, changed
• The case formulation puts the 7Ps into a
context
• Always present it to your client and ask for
their response
Module 3
CBT Case Formulation
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Clarifying hypotheses and questions
Understanding the overall picture
Prioritising issues and problems
Planning treatment strategies
Predicting responses to interventions
Identifying barriers to progress
Module 3
The Purpose of Case Formulation
Screening
Cognitive
Behavioural
Assessment
Case
formulation
Treatment Plan
Module 3
Assessment, Formulation and
Treatment Planning
AOD
Assessment
• Identify the components of formulation as a
group
• In small groups, use the information from the
earlier exercise, Something Fishy
• Write a formal formulation from this information
• Use the formal formulation to ‘translate’ this into
language suitable for a client
• Group discussion
Module 3
Exercise 12: Fishy Formulation
• Return to your small groups, use the previous
case formulation and develop the treatment
plan for Bruce including:
• Immediate strategies
• Longer term strategies
• Referral options
• One person in your group to role play Bruce
and share presenting the formulation and
treatment plan to him
• Think about the stage of change, insight and the
way you present it to him. Notice how he responds.
Module 3
Exercise 13: Gummy Shark
Let’s go back over what we’ve
done so far…
Module 3
Checking in Again…
Module 4
Implementation of Brief Mental Health
Intervention
• Write down your immediate response to the
following
•
•
•
•
•
•
Standing in a long line at the supermarket
A heavily tattooed woman
Someone throwing a cigarette out of a car
Running late
The beach
Case formulation
Module 4
Exercise 14: First Response
• Understand cognitive behavioural practice to
undertake the PsyCheck Intervention
Module 4
Aims: Module 4
• Negotiating the step-by-step guide to the 4session PsyCheck Intervention
• Session 1: Psychoeducation
• Session 2: Identifying unhelpful thoughts
• Session 3: Managing unhelpful thoughts
• Session 4: Relapse prevention
Module 4
Overview: Module 4
Module 4
A Snapshot: Practice Guidelines
Pre PsyCheck Preparation
Session 1
Session 2
Session 3
Session 4
Psychoeducation
Identifying
unhelpful
thoughts
Managing
unhelpful
thoughts
Relapse
prevention
•Present case
formulation to
client
•Links between
thoughts &
feelings
•Challenging
unhelpful
thoughts
•Provide info on
symptoms
•Identifying
unhelpful
thoughts
•Homework
•Explain CBT
•Homework
•Homework
•Identifying triggers
•Identify early warning
signs
•Breaking the rule effect
•Termination
•Rescreening
Module 4
Session 1
Presenting the Case Formulation and Beginning
Psychoeducation and Self Monitoring
• Psychoeducation can be about:
• Current symptoms
• What’s going on for the client (formulation)
• CBT model
Module 4
Session 1: Psychoeducation
1. Present case formulation to the client
•
Get feedback and modify as appropriate
2. Provide information about current symptoms
•
Use worksheets 1, 2 and 3
3. Explain CBT model to the client
•
•
Alternatively, use simplified version (extension
material)
Work through an hypothetical or personal
example depending on readiness to change
Module 4
Session 1: Psychoeducation
• Link the formulation and treatment
• Explain in detail how they are linked using personal
examples
• Develop a treatment plan with the client
• Identify areas for intervention and priorities based
on the formulation
• Emphasise revisiting both formulation and treatment
plan regularly
• Finalise and record treatment plan
• Give client a copy
Module 4
Session 1: Treatment Planning
• Use Worksheet 4: Self monitoring
• Explain the role of self monitoring
• A temporary tool until it becomes automatic
• Explain the process of self monitoring
• Work through example with client
• Give client a copy to take home
Module 4
Session 1: Introduce Self-Monitoring
• Large group discussion
• What assists clients to understand self monitoring?
• What can clinicians do to get in the way of effective
self monitoring?
• How do you know if you are being effective or
obstructive?
Module 4
Exercise 15: Self Monitoring
• Summarise content and ask for feedback from
the client
• Emphasise the importance of take home tasks
• Set homework – Self Monitoring
• Identify any difficulties with content
• Identify easiest method
• Immediate recording, once a day etc
• Emphasise importance
• Prepare for next step
• Outline next session topic
• Organise next appointment or discharge
Module 4
Session 1: Session Summary
• Simplified explanation of the CBT model
• Alternative explanation of CBT model: ABCs
Module 4
Session 1: Extension Material
• Work in groups of 3
• One person plays the client, one the practitioner
and one the observer
• Use the celebrity’s PsyCheck Screen and other
information you have gathered to inform this
session
• Together develop a formulation for your celebrity
and the practitioner then explains it to the client;
integrate any other psychoeducation material that
the client would benefit from
• Group discussion
Module 4
Exercise 16: Please Explain…
Module 4
Session 2
Identifying Unhelpful Thoughts
Module 4
What’s That Noise?
Must
be a
cat
OH NO!
There’s
someone
out there
•
•
Use the Unhelpful Thoughts Worksheet
What are your thoughts?
•
•
•
•
•
Are you a black and white thinker?
Do you jump to negative conclusions?
Do you catastrophise?
Are you a personaliser?
Are you a should/ought person?
•
How do you manage these unhelpful thoughts
•
Group discussion
Module 4
Exercise 17: Spot the Unhelpful
Thought
• Client didn’t understand the task
• More explanation AND practice
• Task was too difficult
• Simplify
• Task was too time-consuming
• Do in stages or in parts
• Do on some days
• Readiness to change
• Motivational approach
Module 4
Homework Non-Completion
• Reiterate the CBT model
• Explain negative bias/interpretation
• Use monitoring to identify areas of
(mis)interpretation of events
• Make personal link between thoughts and
feelings and behaviours
Module 4
Session 2: Information
• Identify unhelpful thoughts
• Use self monitoring sheets as examples
• The aim is to raise awareness about when unhelpful
thoughts occur
• Focus is on catching thoughts as they occur rather
than allowing them to create negative mood
• Label unhelpful thoughts
• Use Worksheet 5
Module 4
Session 2: Practice
• Behavioural activation
• Very important especially for depression when
people often withdraw and lose interest in usual
activities
• Focus both on pleasant activities and usual daily
activities (showering, washing up)
• Guidelines for better sleep
• Especially important for those with anxiety and
depression who often have difficulty sleeping
• Relaxation
• Helpful for anxiety and depression
Module 4
Session 2: Extension Material
• Watch the video of Richard and Lynn
discussing the thinking-feeling-doing cycle
• In small groups, one person plays the celebrity
while the others explain the thinking-feelingdoing cycle using the celebrity’s information
that you have gathered previously and to
identify some of their unhelpful thinking
• Group discussion
Module 4
Exercise 18: CBT Demonstration II
Module 4
Session 3
Managing Unhelpful Thoughts
• How to challenge unhelpful thoughts
• Go through Worksheet 6 with examples
• Two main strategies for challenging thoughts:
• Is this a misinterpretation?
• Is there another way to think about this?
• If not, is it helpful to think this way?
• Even if it is true perhaps it doesn’t help me if I think this
way
Module 4
Session 3: Information
• Practice challenge unhelpful thoughts
• Use monitoring sheets completed for homework
• Assist client to practice the process from monitoring
sheet
• Use Worksheet 6 as a reference
Module 4
Session 3: Practice
• Communication skills
• Assertive communication skills are important for
those who are anxious in social situations and for
those who are depressed and have withdrawn from
public
Module 4
Session 3: Extension Material
• Work in groups of 3
• One person plays the client, one the practitioner and
one the observer
• Use the celebrity’s previous CBT model to assist
• Help the celebrity identify and challenge one of their
unhelpful thoughts
• Use Worksheet 4 & 7 to assist you
• Group discussion
Module 4
Exercise 19: Celebrity Challenge
Module 4
Session 4
Preventing Relapse
• Discuss triggers and early warning signs
• Use Worksheet 8 to explain the ‘breaking the
rule effect’
• Use Worksheet 9 to emphasise looking after
yourself
Module 4
Session 4: Information
• Develop a relapse prevention plan
• Explore ways the client can regulate thoughts and
feelings
• Emphasise the need for additional skills and
supports
• Remind the client to self-reward
• Encourage the client to take care of themself
Module 4
Session 4: Practice
• Summarise content of sessions 1-4 and ask for
feedback from the client
• Reinforce gains and effort
• Re-emphasise the importance of continued
practice
• Reminder about tasks to continue with
• If continuing AOD treatment check homework in
subsequent sessions
• Prepare for next step
• Manage concerns using a motivational approach
• Consider and discuss referral options
• Boosters/continued intervention
Module 4
Session 4: Termination
• Problem solving
• Seemingly irrelevant decisions
Module 4
Session 4: Extension Material
• Work in groups of 3
• One person plays the celebrity client, one the
practitioner and one the observer – swap roles from
last exercise
• Summarise for the client and develop a relapse
prevention plan
• Group discussion
Module 4
Exercise 20: Celebrity Survivor
• Rescreening has benefits for both the clients
and clinician:
• Monitoring client progress with the client can assist
to build the client’s self efficacy as they see
themselves improving
• Clinicians can monitor and reflect on their own
practice using objective ‘data’
• Clinicians can reorient therapy if no improvement
and reflect on potential gaps in treatment
Module 4
Rescreening
• Optimal supervision:
•
•
•
•
A single consistent supervisor to build a relationship
Weekly or fortnightly supervision preferable
Individual supervision as a minimum
Group and/or peer supervision as an adjunct
Module 4
Support: Clinical Supervision
• What aspects of the training do you feel
comfortable with?
• What areas will you need to work on?
• What will you do differently in your practice
• In the next few weeks?
• In the next year?
Module 4
Lights… Camera… ACTION…