Montana Integrated Behavioral Health Webinar: Behavioral - PowerPoint PPT Presentation

Montana Integrated Behavioral Health Webinar: Behavioral Activation Monday, September 11 th , 2017 2-3pm MST

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Be ha vio ra l Ac tiva tio n I nstitute fo r F a mily He a lth Gio rg io Cha te la in, L CSW-R

De pre ssio n Cyc le L ac k of ac tive De pr e ssive e ngage me nt in Symptoms e nvir onme nt

Cor e Pr inc iple s of Be havior al Ac tivation (BA)  Cha lle ng e s in life c a n le a d to de pre ssio n.  Be ha vio r vs. Mo tiva tio n  BA he lps pe o ple c ha ng e wha t the y do in o rde r to de c re a se the ir de pre ssio n.  BA fo c use s o n c re a ting struc ture a nd sc he duling a c tivitie s tha t fo llo w a pla n.  BA suppo rts ide a tha t c ha ng e is e a sy whe n yo u sta rt sma ll  BA e mpha size s re -e ng a g ing the pa tie nt in a c tivitie s tha t the y pre vio usly e njo ye d  T he pra c titio ne r a c ts a s a c o a c h a nd  T ro ub le sho o ts po ssib le b a rrie rs to a c tiva tio n

T he E VIDE NCE BASE for BA  Ro b ust e ffe c ts ha ve b e e n fo und in re vie ws o f b e ha vio ra l a c tiva tio n fo r de pre ssio n  L a rg e -sc a le tre a tme nt studie s with yo ung e r pe rso ns fo und BA to b e mo re e ffe c tive tha n Co g nitive the ra py a nd e q uiva le nt to me dic a tio n fo r tre a ting de pre ssio n.  Re se a rc h with o lde r a dults fo und simila r re sults, indic a tio n tha t o lde r individua ls re spo nd we ll to BA.

What is Be havior al Ac tivation  BA ta rg e ts pa tte rns o f avoidanc e , awal , a nd inac tivity withdr  BA is struc ture d – a pla n is c re a te d  BA is b rie f a nd e a sy to use  BA he lps de pre sse d pe o ple impro ve the ir mo o d b y e ng a g ing in ple a sura b le a c tivitie s.

Be havior al Ac tivation Goals  Re -e sta b lish ro utine s tha t ha ve b e e n dro ppe d due to de pre ssio n  I nc re a se po sitive e xpe rie nc e s to b re a k de pre ssio n c yc le  Be a b le to a pply skills le a rne d in the future to de c re a se re c urre nc e o f de pre ssio n

T re a tme nt Ra tio na le I nc re a se d he a lthy b e ha vio r Po sitive I mpro ve d T ho ug hts & Mo o d E xpe rie nc e s De c re a se de pre sse d b e ha vio r

Ste ps in the Be havior al Ac tivation Pr oc e ss  Ac tivity Monitor ing Ho w is the pa tie nt spe nd ing the ir time no w?   Ac tivity Sc he duling F o c us o n id e ntifying wha t the pa tie nt use d to like to d o tha t  the y a re no t d o ing no w Wha t po sitive a c tivitie s c o uld b e a d d e d into the ir d a y to b o o st  mo o d ?  Cr e a ting Ac tivity Pla ns Be a s spe c ific a s po ssib le re : a c tivity, d a y, time e tc .   Re vie wing Pr og r e ss At e a c h visit re vie w lo g , c he c k mo o d a nd id e ntify ne w a c tivity 

Ste ps in the Be havior al Ac tivation Pr oc e ss  Ac tivity Monitor ing  Ho w is the pa tie nt spe nding the ir time no w?  Re vie w b o th po sitive a nd ne g a tive  E xplo re wa ys to minimize ne g a tive b e ha vio r b y de c re a sing it  E xplo re wa ys to inc re a se po sitive b e ha vio rs

Ac tivity Monitor ing  Se lf-re po rts a re no t a s a c c ura te a s a lo g o f a c tivitie s ke pt b e twe e n me e ting s. De pre sse d pe o ple te nd to unde r re po rt po sitive e xpe rie nc e s, e mpha size ne g a tive pe rc e ptio ns, a nd fo c us mo re o n fa ilure s tha n o n suc c e sse s  T he Ac tivity L o g fo rm c a n b e use d in ma ny se tting s

Ac tivity Monitor ing  Ha ve the c lie nt fill in his/ he r a c tivitie s fo r e a c h time b lo c k b e fo re the me e ting .  E nc o ura g e the c lie nt to write in a c tivitie s tha t a c tua lly o c c urre d , no ma tte r ho w munda ne . E .g . b a thing , dre ssing , e a ting , tra ve ling , ta lking with o the rs, wa tc hing T V a nd sle e ping .  Ask the m to ra te (simple 1-10 sc a le ) the de g re e o f e njo yme nt e xpe rie nc e d fo r e a c h, o r the se nse o f ma ste ry o r a c c o mplishme nt tha t wa s a sso c ia te d with the a c tivity.

Ac tivity Monitor ing  Simple ta sks mig ht re c e ive hig h ra ting s  Clie nts sho uld try to g ive the mse lve s c re dit fo r sma ll a c c o mplishme nts, b e c a use pro g re ss is g e ne ra lly ma de in sma ll, inc re me nta l ste ps.  L o w ra ting o f ple a sure sho uld b e e xpe c te d fo r two re a so ns  If the r e is little involve me nt in ac tivitie s that most pe ople would c onside r highly ple asur able and  If the c apac ity for e xpe r ie nc e joy or ple asur e is blunte d

Que stions to Stimulate T hinking  Are the re pe rio ds o f time yo u e xpe rie nc e e njo yme nt o r ple a sure ?  Wha t kinds o f a c tivitie s se e m to g ive yo u ple a sure  Are the re c e rta in time s o f da y whe n yo u fe e l le ss ple a sure ?  Wha t a c tivitie s did yo u do in the pa st tha t ha ve b e e n sto ppe d o r re duc e d?  Are the re a c tivitie s yo u ha ve tho ug ht a b o ut do ing b ut b e lie ve tha t yo u c a nt?  T a ke the pa tie nt do wn me mo ry la ne b y a sking the m to re c a ll me mo rie s o f pa st ple a sa nt a c tivitie s o r e ve nts.

Ste ps in the Be havior al Ac tivation Pr oc e ss  Ac tivity Sc he duling  Ge t po sitive a c tivitie s sc he dule d in  T ra c k pro g re ss (T ra c king F o rm)  So c ia l / physic a l a c tivitie s te nd to b e mo st po te nt mo o d b o o ste rs  T re a tme nt will a lso fo c us o n inc re a sing da ily ple a sa nt e ve nts

Ac tivity Sc he duling  Onc e the pa tie nt se e s re la tio nships b e twe e n a c tivity a nd mo o d , the g o a l is to inc re a se tho se a c tivitie s like ly to ha ve the mo st po sitive impa c t o n the ir mo o d . Ho w d o we d o this?  Ge ne ra te a list o f ple a sura b le a c tivitie s. Inc lude o ne s fro m the  mo nito ring e xe rc ise ( Ac tivity L og ) tha t ha d the hig he st ra ting s fo r ple a sure Bra insto rm with the pa tie nt to list so me ne w id e a s tha t ma y b e  wo rth trying ( T m ). r a c king F or  mine s whic h a c tivitie s to a d d to the ir d a ily ro utine . T he Pa tie nt de te r  Se le c t spe c ific time s a nd write the m o n the sc he d ule a s a pla n ( Ac tivity Sc he dule L og )

Ac tivity L o g 1 Write in e a c h b o x: 1:Ac tivity 2: Mo o d Ra ting (1-10) T ime M T We d T h F Sat Sun 6-7a m 7-8a m 8-9a m 9-10a m 10- 11a m

T ra c king F o rm-Ple a sa nt E ve nts a nd Mo nito ring Yo ur Mo o d Ple asa 1 2 3 4 5 6 7 nt E ve nts 1 2 3 4 5 T o ta l Mo o d Sc o re y sad 1 2 3 4 5 6 7 8 9 Ve r ve r y happy

Re spo nding to Re sista nc e  State me nt I do n’ t ha ve a ny mo ne y!  I a m in a whe e l c ha ir, so the re is no thing I c a n do !   I do n’ t like to do a nything ! I’ ll ne ve r b e a b le to do it!  It is just to o ha rd!   Re sponse s  Are the re thing s yo u e njo y tha t do n’ t c o st mo ne y? Is it true tha t pe o ple in whe e l c ha irs do n’ t pa rtic ipa te in a c tivitie s?  Wha t wo uld yo ur fa mily/ frie nds sa y yo u like to do ?  Is the re a no the r wa y o f lo o king a t this situa tio n?  Wha t is the b e st thing tha t c o uld ha ppe n?   Ho w do e s this wa y o f thinking a ffe c t yo u?

Ma king the Spe c ific Ac tivity Pla n T he mo r e de taile d the plan the mo r e like ly it is to be fo llo we d I n the pla n c o nside r:  Da te o r da ys o f the we e k  Wha t time o f da y  Ho w lo ng  With who m  Othe r a spe c ts tha t ne e d to b e pla nne d  Ba c k up pla n

Ste ps in the Be ha vio ra l Ac tiva tio n Pro c e ss  Re vie w Pr og r e ss  Id e ntify suc c e sse s Mo dify the list o f a c tivitie s b a se d o n fe e db a c k  Sc he dule ne w a c tivitie s. (Ac tivity Sc he dule L o g )  •Re vie w a ll ta sks •Pra ise suc c e ss - a sk a b o ut ho w the a c tivity e ffe c ts the ir mo o d •Disc uss thing s tha t d id n’ t wo rk •Wha t o b sta c le s g o t in the wa y? •Ma yb e we pic ke d the wro ng a c tivity? •Wha t mig ht wo rk b e tte r? •Se t ne w g o a ls a nd c o ntinue suc c e ssful o ne s

Mo dify  Mo dify sc he duling b a se d o n fe e db a c k, b a rrie rs, c ultura l c o nside ra tio ns, a nd wha t wa s suc c e ssful fo r the pe rso n  Wha t a c tivitie s a c tua lly impro ve d the ir mo o d is the ke y q ue stio n – to a sk a nd o b se rve a s pa tie nt re te lls the ir e xpe rie nc e