DiscoverCounselor Toolbox PodcastContextual Cognitive Behavioral Therapy
Contextual Cognitive Behavioral Therapy

Contextual Cognitive Behavioral Therapy

Update: 2020-02-011
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464 – Contextual Cognitive Behavioral Therapy


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Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director: AllCEUs Counselor Education

Host: Counselor Toolbox Podcast

Objectives

• Define and review the concepts of contextual cognitive behavioral therapy

• Explore the impact of context on people’s phenomenological reality

• Explore how addiction and mental health issues can be influenced by context

• Explore how acceptance, awareness, mindfulness and psychological flexibility can be used transdiagnostically.


Why Contextual

• Addiction and mental health issues are often intergenerational

• Addiction and Mental Health issues are strongly correlated with:

• Each other

• Adverse childhood experiences (history of and children with)

• Impaired occupational and social functioning

• Health problems

Contextual Approaches

• Encourage mindfulness in the present moment

• Accept each person’s “truth” is constructed from their schema and the resulting interpretation of the current moment

• The goal is to consider the context and function of the past and present issue and empower the person to make a conscious choice toward their valued goals

• Remember that the prefix RE means to do again

• REpeat

• REdo

• REgress

• RElapse

• REaction


Childhood Context and Development

• The family context can be a preventative or risk factor for the development of issues

• Children develop schema about themselves, others and the world through these early interactions

• In later life people continue to develop schema influenced by their past learning.


Caregiver Requirements for Secure Attachment and Healthy Development

• Consistent Age-Appropriate Responsiveness

• Trust

• Autonomy

• Industry

• Identity

• Empathy

• Compassion

• Effective Communication Skills

• Unconditional Love


Think About It

• What is it like for a child growing up in a house in which one or both parents has:

• An addiction

• A mental health issue

Common Addicted Characteristics

• Difficulty dealing with life on life’s terms

• Difficulty dealing with distress (poor coping)

• Impulsivity / lack of patience and distress tolerance

• Neglectfulness

• Hostility

• Defensiveness

• Blaming

• Manipulation

• Withdrawal

• From others/disconnected

• No pleasure in other activities

• Justification/minimization/denial

• Low self-esteem

• Guilt and shame


Common Characteristics in People with Mental Health Issues

• Difficulty dealing with life on life’s terms

• Difficulty dealing with distress (poor coping)

• Impulsivity / lack of patience and distress tolerance

• Neglectfulness

• Hostility

• Irritability


• Withdrawal

• From others/disconnected

• Apathy

• Low self-esteem

• Guilt and shame

• Fatigue

• Sense of hopelessness or helplessness


The End Product

• People’s REactions to things are based on prior learning + present moment.

• Bridges

• Stress

• Depression

• Self-esteem


Core Concepts in Contextual CBT

Mindfulness

• Improves people’s ability to be present in the present

• Shift from automatically reacting to thoughts and feelings based on schema to being aware of ALL experiences in the present to provide more flexibility


Encouraging Acceptance of Internal Experiences

• Accepting thoughts, feelings, sensations without having to act on them

• Radical Acceptance

• Unhooking

• Dialectics

• I can be a good person AND be divorced

• I can be happy AND grieving

• I can stay sober AND be stressed

Acceptance of Internal Experiences

• Accepting thoughts, feelings, sensations without having to act on them

• Distress Tolerance

• ACCEPTS

• Activities

• Contributing

• Comparisons

• Emotions (opposite)

• Push Away

• Thoughts

• Sensations

Focus on Adding vs. Eliminating

• Help the person define a rich and meaningful life and make choices based on that vs. eliminating a problem

• Depression

• What do we do to eliminate depression?

• What are we left with when we eliminate depression?

• How do you prove the absence of depression?

• Addiction

• What do we do to eliminate addiction?

• What are we left with when we eliminate addiction?

• How do you prove the absence of addiction?

• Accepting feelings thoughts and reactions and changing your relationship with them


Creating a Rich and Meaningful Life

• Increasing Awareness

• For each of the following areas identify which are important in your RML and what that looks like now and what you want it to look like


Changing Your Relationship

• Radically accept feelings, thoughts and urges

• Think of them like road signs

• You can take them under advisement and decide what to do.

• Speed limit/Anger

• Construction/Giving up

• No passing/Addiction

• Rest stop/Depression

Motivational Enhancement (Functional)

• Understanding motivation for change as well as no change in the context of the person’s RML in order to motivate purposeful action


Use a Broad Functional Approach

• Transdiagnostic

• Common mechanisms underlying an array of difficulties: Depression, Low Self-Esteem, Addiction

• Shoulds and Shouldn’ts (Acceptance)

• I should feel

• I shouldn’t think

• I should be

• Lack of Awareness of Needs/Wants (Mindfulness)

• Vulnerabilities

• Autopilot or Rigid Thinking (Psychological Flexibility)

• A willingness to accept all aspects of ones experience without unnecessary avoidance—Emotional, Cognitive, Behavioral, Physical

• The ability to ponder multiple possible actions and thoughts and consciously choose

Difficulties with Self-Processes

• Difficulty with self esteem or self efficacy may cause or maintain problems

• Self-as-content – Narrative about one’s self and attributes

• Being overly attached to the conceptualized self can prohibit flexibility

• Ex. Being a good worker in a bad job

• Ex. Being a good daughter but getting a divorce


Addressing Self as Content

• Who do you want to be?

• Explain why each of those is important?

• In what ways does the current situation prevent you from being who you want to be?

• What areas in your life are going as you want them to? (addressing global attributions)

• Are there other ways to achieve or conceptualize the same end?

• Examples

• A size 3 (attractive/lovable)

• A doctor (successful)

• Not divorced (not a failure)

• Loyal/dependable (not a quitter)


Difficulties with Self-Processes cont…

• Difficulty with self esteem or self efficacy may cause or maintain problems

• Self-as-process

• Awareness of internal experience

• Many people have difficulty attending to their internal experience in a flexible way

• Handling urges, feelings

• Identifying thoughts, feelings, urges, sensations etc.

Addressing Self-As-Process

• Mindfulness journals/logs

• Meditation to increase awareness

• CBT Exposure-Noticing / In-Vivo Logs

• Anger

• Fear

• Craving

• Relapse prevention plans to handle internal processes

• Make a committed action worksheet for each thing that is important to you.


Difficulties with Self-Processes

• Difficulty with self esteem or self efficacy may cause or maintain problems

• Self-as-context

• Adopting the perspective of the self in the past, present and future—Who you were-are-want to be

• Ability to take the perspective of others

• Rigid self as context—or inability to take perspective may inhibit effective problem solving.

• I am and always will be a failure/an addict/depressed

Addressing Self-As-Context

• Increasing Perspective

• Looking at your definition of a RML, what does your…

• Past self tell you about your current situation? (schema)

• What might your future self tell you about your current situation? (Flexibility)

• What might you tell someone else in a similar situation?

• How do your current thoughts, feelings, behaviors help you move toward what is important to you?


Summary

• Contextual CBT involves understanding people’s phenomenological truth

• Problems can arise when people

• Thinks/feels that they are not who they should be or things are not as they should be

• Are unaware of their internal feelings, thoughts, urges

• Are unaware of the motivation (in context) of their feelings, thoughts, urges

• Use rigid problem solving and conceptualization without considering context or perspective

• Contextual CBT uses awareness, mindfulness, radical acceptance and psychological flexibility activities to help people move toward a rich and meaningful life instead of trying to escape or avoid discomfort.

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Contextual Cognitive Behavioral Therapy

Contextual Cognitive Behavioral Therapy

Charles Snipes