Behavioral Activation Group Therapy Therapist Manual


Teach Patient the Role of Self-defeating Behavior and Aversive Environments in Negative Moods



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Teach Patient the Role of Self-defeating Behavior and Aversive Environments in Negative Moods

Purpose: To help the patient to understand the relationship between her/his behavior and moods and between the environment and moods. This helps the patient understand how s/he can make meaningful changes to improve moods. This requires explaining the ABC model to the patient.

A represents the antecedent to the behavior. This is whatever was happening just prior to the behavior that set up the behavior to occur.

B represents the behavior of interest. This is an observable behavior on the part of the patient.

C represents the consequences resulting from acting out the behavior. Consequence does not imply something bad. All behaviors have some consequence, whether good or bad.

It is important to focus on what the patient actually does (active behavior) rather than on what s/he failed to do.


Example: The patient describes a situation in which she stayed in bed all day and “did nothing.” It is important to put this incident in terms of what he did (actively) so that there is some behavior that occurred to focus attention on. Instead of talking about the behavior as doing nothing (as the patient talked about it), you might talk about it as staying home and sleeping and lying in bed all day starring at the ceiling.

A: feeling no motivation or interest to get out of bed to do anything; tired; wanting to avoid seeing others; no commitments to keep get you out of bed

B: slept and laid in bed

C: felt more depressed; felt worthless, tired, isolated, guilty; lower self-esteem


NOTES:

Encouraging an Active, Rather than a Passive Approach in

Specific Situations
Purpose: To focus the patient on the function of a behavior in terms of being productive or destructive.
Active behaviors are those behaviors that:

1) Serve to create pleasurable or meaningful experiences;

2) Serve to ameliorate aversive or unpleasant experiences.
Passive behaviors are those behaviors that:

1) Produce aversive or unpleasant experiences

2) Fail to ameliorate aversive or unpleasant experiences.
Example of Active Behavior: Problem solving is active behavior as it serves to remediate a problem, thereby lessening an aversive condition.
Example of Passive Behavior: Complaining is a passive behavior inasmuch as it rarely changes the aversiveness of a situation.
Example: The patient has a conflict at work with a coworker over job duties.
Passive response: The patient complains to family and friends. Results: the situation at work does not change; patient receives attention from family/friends; family/friends get annoyed and avoid patient.
Active response: The patient goes to the supervisor and asks for a clarification of her job duties.
NOTES:

Graded Task Assignment: Progressive Assignment of

Tasks of Increasing Difficulty
Purpose: To ensure success and combat the patient’s feelings of overwhelm. Make problems manageable and assignment doable.
Method:

1) Problem definition: useful definition of the problem in behavioral terms. Be very concrete and specific.

2) Stepwise assignment of tasks from simpler to more complex

3) Immediate and direct observation by the patient that s/he is successful in reaching a specific objective. If the patient does not know whether or not s/he has completed a goal, then the definition of the goal needs to be more concrete and specific.

4) Ventilation of doubts, reactions and belittling of achievement.

5) Celebration of achievements. It is important that the client recognizes and be recognized (particularly early in therapy) for successful completion of goals.


This intervention requires the therapist to break down a task into doable parts.

Example: A patient reports that he is no longer able to keep up with the housework because he cannot get himself to clean. Instead of focusing the client on cleaning the entire house, the therapist shifts the focus to doable tasks that make up cleaning the entire house. For example, the therapist might start with encouraging the patient to vacuum one room the first day. On the second day his goal would be to vacuum two rooms, etc. Within a short amount of time the patient is able to clean a substantial portion of the house. This approach works because it breaks the big task into many manageable little tasks that provide successes at short intervals. It is important for the therapist to emphasize to the patient that he complete one task before moving on to the next otherwise they tend to run together into one big task, which was the initial problem.


NOTES:



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