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Art Therapy CBT powerpoint
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11
Expressive Arts & Cognitive Behavioral Expressive Arts & Cognitive Behavioral Therapy (CBT)Therapy (CBT)
Treating Adolescent AnxietyTreating Adolescent AnxietyDidactics & Case StudiesDidactics & Case Studies
Roger Luscombe, MS, DKATI, RCC.
22
ResourcesResources
Approaches to Art Therapy, Theory & Technique Approaches to Art Therapy, Theory & Technique 22ndnd ed. Judith Aron Rubin, ed. ed. Judith Aron Rubin, ed.
Play Therapy, Theory & Practice, A Comparative Play Therapy, Theory & Practice, A Comparative Presentation, O’Connor & Braaverman, ed’s.Presentation, O’Connor & Braaverman, ed’s.
CBT Connections, Anxiety Disorders in Children & CBT Connections, Anxiety Disorders in Children & Adolescents: University of British Columbia Adolescents: University of British Columbia
Anxiety Disorder Association of British Columbia Anxiety Disorder Association of British Columbia (Anxiety B.C.)(Anxiety B.C.)
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Anxiety B.C.Anxiety B.C.five important elementsfive important elements
Anxiety is normal, everyone experiences it at timesAnxiety is normal, everyone experiences it at times
Anxiety is not dangerous, although anxiety feels Anxiety is not dangerous, although anxiety feels uncomfortable, it is temporary, and will eventually decreaseuncomfortable, it is temporary, and will eventually decrease
Most people cannot tell when you are anxiousMost people cannot tell when you are anxious
Anxiety is adaptive and helps us prepare for real danger or Anxiety is adaptive and helps us prepare for real danger or for performing at our best, it triggers our “fight-flight-for performing at our best, it triggers our “fight-flight-freeze” response preparing our body to reactfreeze” response preparing our body to react
Anxiety becomes a problem when our body reacts in Anxiety becomes a problem when our body reacts in absence of real dangerabsence of real danger
44
Key Issues in AnxietyKey Issues in Anxiety
Anxiety is about fearAnxiety is about fear
Clinical Anxiety is IrrationalClinical Anxiety is Irrational
Clinical Anxiety is LearnedClinical Anxiety is Learned
55
Anxiety Disorders: OverviewAnxiety Disorders: Overview
Most common mental health problemMost common mental health problem 12 – 20% of children affected12 – 20% of children affected Over 65,000 kids in B.C. with disorderOver 65,000 kids in B.C. with disorder Impact and morbidity not widely Impact and morbidity not widely
recognizedrecognized Girls often have more fears than boysGirls often have more fears than boys Number and types of fears across cultures Number and types of fears across cultures
are fairly consistentare fairly consistent
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Anxiety: Overview Anxiety: Overview ContinuedContinued
Presence of one anxiety disorder increases risk Presence of one anxiety disorder increases risk of developing additional anxiety disorderof developing additional anxiety disorder
Mom’s with any mental illness are 7 times more Mom’s with any mental illness are 7 times more likely to have a child with an anxiety disorderlikely to have a child with an anxiety disorder
Children and youth with anxiety disorders rarely Children and youth with anxiety disorders rarely receive appropriate or effective interventionsreceive appropriate or effective interventions
If left untreated there is a significant increase in If left untreated there is a significant increase in risk of depression & substance abuserisk of depression & substance abuse
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The Experience of AnxietyThe Experience of Anxiety
Body FearBody Fear
Mental FearMental Fear
Behavioral Indicators of FearBehavioral Indicators of Fear
88
Components of the Anxiety Components of the Anxiety ResponseResponse
Behavioral AvoidanceBehavioral Avoidance
Distorted BeliefsDistorted Beliefs
Over Predictions of FearOver Predictions of Fear
Attentional BiasAttentional Bias
Physiological RespondingPhysiological Responding
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Causes and Maintenance of Causes and Maintenance of Anxiety DisordersAnxiety Disorders
GeneticsGenetics
TemperamentTemperament
ParentingParenting
Cognitive FactorsCognitive Factors
Avoidance BehaviorsAvoidance Behaviors
1010
Types of Anxiety DisordersTypes of Anxiety Disorders
Social anxiety disorder (separation Social anxiety disorder (separation anxiety disorder)anxiety disorder)
Obsessive compulsive disorderObsessive compulsive disorder Specific phobiasSpecific phobias Generalized anxiety disorderGeneralized anxiety disorder Panic disorder w/o AgoraphobiaPanic disorder w/o Agoraphobia Post traumatic Stress disorderPost traumatic Stress disorder
1111
anxietyanxiety
Regina Lafay
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Anxiety, Regina LafayAnxiety, Regina Lafaywww.survivorart.comwww.survivorart.com
"One of the first pieces I did to express an "One of the first pieces I did to express an emotion I had not yet had diagnosed – a feeling emotion I had not yet had diagnosed – a feeling that I had known since I was a teen, yet nobody that I had known since I was a teen, yet nobody was available to explain it to me or help me was available to explain it to me or help me through it. I have only recently been diagnosed through it. I have only recently been diagnosed with Generalized Anxiety Disorder, among others. with Generalized Anxiety Disorder, among others. Words fail me, as they often do, so I choose art to Words fail me, as they often do, so I choose art to tell my stories. This image helped a group of tell my stories. This image helped a group of troubled teenage girls recognize that they are not troubled teenage girls recognize that they are not alone. I continue to be moved by their counselor’s alone. I continue to be moved by their counselor’s letters, as she and I still keep in touch."letters, as she and I still keep in touch."
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Cognitive Behavioral Cognitive Behavioral TherapyTherapy
Psycho educationPsycho education Managing body symptomsManaging body symptoms Healthy thinkingHealthy thinking Building toleranceBuilding tolerance Relapse preventionRelapse prevention Evidence basedEvidence based
1414
Evolution of CBTEvolution of CBT
Behavioral TherapyBehavioral Therapy
Social Learning TheorySocial Learning Theory
Cognitive TherapyCognitive Therapy
Cognitive Behavioral TherapyCognitive Behavioral Therapy
Dialectical Behavioral TherapyDialectical Behavioral Therapy
Family Cognitive Behavioral TherapyFamily Cognitive Behavioral Therapy
Cognitive-Behavioral Art TherapyCognitive-Behavioral Art Therapy
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CBT & Art TherapyCBT & Art Therapy
CBT not widely been accepted in the art therapy fieldCBT not widely been accepted in the art therapy field There has been the misconception that CBT focuses There has been the misconception that CBT focuses
only on the thinking processonly on the thinking process In reality imagery, visual thinking and creativity are In reality imagery, visual thinking and creativity are
aspects of cognitionaspects of cognition Personal constructs are non verbal as well as verbal Personal constructs are non verbal as well as verbal
and creating art can enrich personal constructs'and creating art can enrich personal constructs' Emotional components, as illuminated in art therapy, Emotional components, as illuminated in art therapy,
are an integral part of understanding a person’s are an integral part of understanding a person’s cognitive processcognitive process
Approaches to Art Therapy, RubinApproaches to Art Therapy, Rubin
1616
Core CBT ComponentsCore CBT Components
Cognitive restructuringCognitive restructuring
Physical relaxationPhysical relaxation
Exposure, coping skillsExposure, coping skills
Social skills trainingSocial skills training
1717
Principals of CBTPrincipals of CBTTHOUGHTS
EMOTIONSBEHAVIOURS
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Myers – Briggs Type Myers – Briggs Type IndicatorIndicator
Carl Jung’s Carl Jung’s Psychological Psychological TypesTypes
Eg.Eg. ESTJ - Extraversion, - Extraversion,
Sensing, Thinking, Sensing, Thinking, JudgingJudging
INFP - Introversion, - Introversion, Intuition, Feeling, Intuition, Feeling, Perceiving Perceiving
Dichotomies
Extraversion Introversion
Sensing iNtuition
Thinking Feeling
Judging Perceiving
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Distorted ThinkingDistorted Thinking
All or nothing thinkingAll or nothing thinking Over generalizingOver generalizing Mental filteringMental filtering Disqualification of the positiveDisqualification of the positive Jumping to conclusionsJumping to conclusions Magnification (catastrophizing or minimizing)Magnification (catastrophizing or minimizing) Emotional reasoningEmotional reasoning ““Should” statementsShould” statements LabelingLabeling PersonalizationPersonalization
2020
Cognitive ApproachesCognitive Approaches
Identification of inner, private thoughtsIdentification of inner, private thoughts Use of positive self-talkUse of positive self-talk Techniques for challenging negative Techniques for challenging negative
self-talkself-talk Self-rewardSelf-reward Expectations of good things to happenExpectations of good things to happen Evaluation of own performance – Evaluation of own performance –
partial successespartial successes
2121
Physiological ApproachesPhysiological Approaches
Awareness of body cluesAwareness of body clues
Deep breathing exercisesDeep breathing exercises
Relaxation activitiesRelaxation activities
2222
Behavioral ApproachesBehavioral Approaches
Problem solving skillsProblem solving skills
Coping skillsCoping skills
Peer supportPeer support
Identification of pleasant eventsIdentification of pleasant events
ExposureExposure
2323
ExposureExposure
Interoceptive ExposureInteroceptive Exposure Deliberately bring on bodily symptoms Deliberately bring on bodily symptoms
of anxiety, e.g. spinning, breathingof anxiety, e.g. spinning, breathing In vivo ExposureIn vivo Exposure
Deliberately entering feared situations Deliberately entering feared situations e.g. movies, mallse.g. movies, malls
Naturalistic ExposureNaturalistic Exposure Deliberately engage in activities e.g. Deliberately engage in activities e.g.
exerciseexercise
2424
Role of Family & TeachersRole of Family & Teachers
Psycho education about anxiety and Psycho education about anxiety and treatments that worktreatments that work
Emphasize that well-intended intuitive Emphasize that well-intended intuitive responses may actually enable anxiety responses may actually enable anxiety problemsproblems
Consistency and firmness in follow through Consistency and firmness in follow through on planson plans
If family concurrent difficulties with If family concurrent difficulties with anxiety all members receive treatmentanxiety all members receive treatment
Assist with homeworkAssist with homework
2525
CBT ToolsCBT Tools
Thought and Mood ChartsThought and Mood Charts SUD’s Chart (subjective units of discomfort)SUD’s Chart (subjective units of discomfort) Fear Hierarchy ChartFear Hierarchy Chart Fear Monitoring FormFear Monitoring Form Grounding TipsGrounding Tips PTSD Impacts of Events ScalePTSD Impacts of Events Scale Brief Screening Instrument for Panic AttacksBrief Screening Instrument for Panic Attacks Relaxation Scripts Relaxation Scripts
Breathing, progressive muscle relaxationBreathing, progressive muscle relaxation
2626
Children’s CBT ResourcesChildren’s CBT Resources
Taming the Worry Dragons, Garland & Clark, B.C. Children's Hospital
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CBT Resources cont.CBT Resources cont.
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CBT Resources contCBT Resources cont
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CBT Case FormulationCBT Case Formulation
Brief demographicBrief demographic Problem identificationProblem identification Problem historyProblem history Family and social adjustmentFamily and social adjustment Main cognitive, physiological and Main cognitive, physiological and
behavioral components of major problemsbehavioral components of major problems Client’s perspectiveClient’s perspective Case formulationCase formulation
3030
CBT Treatment PlanCBT Treatment Plan
Prioritization of treatment targetsPrioritization of treatment targets Tracking of clients progressTracking of clients progress Methods of treatmentMethods of treatment Graduation from treatmentGraduation from treatment
3131
Case Study David Case Study David
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Case Formulation for DavidCase Formulation for David
Demographics:Demographics: Adolescent, rural isolation, single parented, Adolescent, rural isolation, single parented,
marijuana friendly community marijuana friendly community
Problem Identification:Problem Identification: Psychiatric Dx: Disthymic disorder with more severe Psychiatric Dx: Disthymic disorder with more severe
depression (double depression)depression (double depression) Academic, social and family stressorsAcademic, social and family stressors Substance misuseSubstance misuse General anxiety and social phobiaGeneral anxiety and social phobia
3333
Case Formulation cont.- 1Case Formulation cont.- 1
Problem History, Family & Social Problem History, Family & Social Adjustment:Adjustment: Unhappy as a babyUnhappy as a baby Ongoing depression last couple yearsOngoing depression last couple years History of family depression w/ History of family depression w/
hospitalizationhospitalization Poor relationship with bio dadPoor relationship with bio dad Daily use of marijuana for 5 yearsDaily use of marijuana for 5 years
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Case Formulation cont.- 2Case Formulation cont.- 2
Problem IdentificationProblem Identification CognitiveCognitive
Negative self image, self punishing, fears of Negative self image, self punishing, fears of future failure, downward spiraling thinkingfuture failure, downward spiraling thinking
PhysiologicalPhysiological Poor diet, lack of regular meals, lack of exercise, Poor diet, lack of regular meals, lack of exercise,
over sleeping, over sleeping, BehavioralBehavioral
School avoidance, social withdrawal, no School avoidance, social withdrawal, no employment, heavy marijuana use (self employment, heavy marijuana use (self identified)identified)
3535
Case Formulation cont.- 3Case Formulation cont.- 3
Client’s perspectiveClient’s perspective Depression, low self esteem, addiction Depression, low self esteem, addiction
acknowledgedacknowledged Sense that his personal history affects Sense that his personal history affects
his current statehis current state Goals include reducing fears, increase Goals include reducing fears, increase
self esteem, improve friendships, school self esteem, improve friendships, school graduation, and be drug free graduation, and be drug free
3636
Case Formulation cont.- 4Case Formulation cont.- 4
Case FormulationCase Formulation Psychiatrist had diagnosed depression and Psychiatrist had diagnosed depression and
recommended CBT treatmentrecommended CBT treatment CBT idea had hooked David, though CBT idea had hooked David, though
reluctantreluctant
some readiness present (Prochaska some readiness present (Prochaska stages)stages)
Positive male therapist transferencePositive male therapist transference Anxiety seen as possible core disturbanceAnxiety seen as possible core disturbance
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Stages of ChangeStages of Change
James Prochaska & Carlo DiclementeJames Prochaska & Carlo Diclemente Precontemplation StagePrecontemplation Stage Contemplation StageContemplation Stage Determination StageDetermination Stage Action StageAction Stage Maintenance StageMaintenance Stage RelapseRelapse
3838
CBT Treatment Plan for CBT Treatment Plan for DavidDavid
Psycho educationPsycho education Exploration of ABC triangleExploration of ABC triangle ReframingReframing Social exposureSocial exposure Expressive arts explorationExpressive arts exploration Stress reductionStress reduction Involve family in treatment Involve family in treatment Relapse preventionRelapse prevention Ten to Twelve independent sessionsTen to Twelve independent sessions
3939
Treatment Plan cont. - 1Treatment Plan cont. - 1
Tracking of client’s progressTracking of client’s progress Home work check-ins, reading assignmentsHome work check-ins, reading assignments Thought & mood recordsThought & mood records Sleeping pattern changesSleeping pattern changes Socialization changesSocialization changes School attendance recordSchool attendance record Drug and alcohol consumption Drug and alcohol consumption Changes in family timeChanges in family time Diet & exercise changesDiet & exercise changes
4040
CBT Tools UsedCBT Tools Used
ABC triangle presentedABC triangle presented Distorted thinking examinedDistorted thinking examined Reading homework on depression & Reading homework on depression &
CBTCBT Thought records, challenging Thought records, challenging
depressive thoughtsdepressive thoughts
4141
Expressive Arts ExplorationExpressive Arts Exploration
Icebreaking, rapport makingIcebreaking, rapport making Invites cognitive conversationInvites cognitive conversation Provide creative outletProvide creative outlet Self esteem through art making / Self esteem through art making /
productproduct Insight acquisitionInsight acquisition Co-art making positive transferenceCo-art making positive transference Provides visible record of changeProvides visible record of change
4242
David’s Art Making & David’s Art Making & GamingGaming
Clay piecesClay pieces Biofeedback GameBiofeedback Game Sandtray WorldSandtray World Roofing Paper Medicine WheelRoofing Paper Medicine Wheel
4343
Clay - David
4444
Sandtray - David
4545
Biofeedback Stress Biofeedback Stress ManagementManagement
4646
Clay - David
4747
Clay - David
4848Roofing Paper - David
4949
Summary: David Case StudySummary: David Case Study
CBT model intrigued youthCBT model intrigued youth Psycho education around thoughts, Psycho education around thoughts,
emotions, behaviors very beneficialemotions, behaviors very beneficial Art therapy engaged and gave youth Art therapy engaged and gave youth
insight & increased self esteeminsight & increased self esteem Positive transference enabled Positive transference enabled
personal transformation processpersonal transformation process
5050
TF-CBT for Aboriginal Child TF-CBT for Aboriginal Child Trauma VictimTrauma Victim
Honoring Children – Mending the CircleHonoring Children – Mending the Circle SpiritualSpiritual MentalMental PhysicalPhysical EmotionalEmotional RelationalRelational Mending the CircleMending the Circle University of Oklahoma
Health Sciences Center
5151
5252
Case Study Sara Case Study Sara
Presenting Problem – General Presenting Problem – General Anxiety & Specific PhobiaAnxiety & Specific Phobia
Treatment ComponentsTreatment Components Play Therapy GenogramPlay Therapy Genogram Fears Assessment ToolFears Assessment Tool SUD’s Hierarchy ChartSUD’s Hierarchy Chart Fish Hook Diagram for anxiety attackFish Hook Diagram for anxiety attack
5353
Sara cont.Sara cont.
Play therapy family Play therapy family genogramgenogram
5454
Fears Assessment ToolFears Assessment Tool
Self Rating Questionnaire, 8 biggest Self Rating Questionnaire, 8 biggest fearsfears
FlyingFlying Punishment by motherPunishment by mother Criticized by parentsCriticized by parents Giving a recitalGiving a recital SnakesSnakes Mean dogsMean dogs Dead peopleDead people SpidersSpiders
5555
SUD’s Chart for Flying SUD’s Chart for Flying PhobiaPhobia
11 Looking at airplanesLooking at airplanes 22 Airplane play, sandtray, puzzlesAirplane play, sandtray, puzzles 33 Make airplane, clay, paper macheMake airplane, clay, paper mache 44 Going to local airportGoing to local airport 55 Going to Castelgar airportGoing to Castelgar airport 66 Getting near a planeGetting near a plane 77 Sitting in a planeSitting in a plane 88 Short flight on planeShort flight on plane 99 Long flight to HawaiiLong flight to Hawaii
5656
Panic Attack Fish Hook Model
5757
Summary of Cognitive Summary of Cognitive Behavioral - Art TherapyBehavioral - Art Therapy
CBT illustrates how thoughts & CBT illustrates how thoughts & emotions & behaviors co -influence emotions & behaviors co -influence each othereach other
CBT has particular treatment strategies CBT has particular treatment strategies to create healthy thinking, emotional to create healthy thinking, emotional awareness and positive actionsawareness and positive actions
Art Therapy accomplishes these same Art Therapy accomplishes these same goals and fits well with CBT treatment goals and fits well with CBT treatment strategies strategies
5858
In Memory OfIn Memory Of
Dr Peter Donald McLean,Dr Peter Donald McLean, CBT ConnectionsCBT Connections
Passed awayPassed away Nov 04, 2008Nov 04, 2008