Mental health exam 4

Behavioral, behavior modification theorist? Client applications?
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Concepts and techniques of cognitive behavioral dialecticalSocial learning, modeling, self regulating, cognitive distortions, automatic thoughts, disputing irrational beliefs, cognitive restructuring, dialectical strategiesOccupational therapy group themes for cognitive behavioral dialecticalPsychoeducational groups, reading, films, discussion, role-playing groups, Worksheets and discussions, interpersonal effectiveness, emotional regulation, distress tolerance, mindfulnessBehavioral approaches are most ideal when addressing the need forLearning or changing client performance patterns in the occupational therapy practice framework domain and processCognitive behavior approaches are the top choice whenSelf control and self management are primary concernsOne of the most fundamental contributions of behaviorism is the concept of behavioral goals. only observable behavior was thought to be an appropriate focus for intervention. Therefore, behavioral goals and objectives should always be observable and measurable. The early behaviorist taught us to identify problems narrowly and specifically, so that focus intervention could be designed and it's effects measured. The goals for our occupational therapy groups should be written in specific, measurable terms, so that necessary documentation of progress is possible. Often, these goals are set by the client and therapist together, and progress towards the goals Is openly discuss with the group. In cognitive behavioral groups and evaluation of the group should be set up to see if goals are met.Long-term goals are not always measurable. Sometimes when we sit lifetime goals, such as "be successful" at my job, it is not clear what it is that success really means. Even when these goals are measurable, such as " become a millionaire by age 40," how these goals will be accomplish remains unplanned. Until these goals are broken down into smaller, doable steps, they were made only dreams. Short term, measurable goals are the actions and behaviors that help us and our clients make dreams a reality. A measurable goal is one that describes behavior that can be observed. For example, your goal might be to improve self-esteem. How can you tell when self-esteem has improved? What behaviors would you look for? What actions could you take? Some possibilities might be standing taller, taking more care and dressing and hygiene to look at your best, and verbalizing several positive aspects of yourself.One key to writing a measurable goal is the language use. Words like learn, understand, encourage, improve, handle, and manage are vague because they do not specify how these things can be accomplished. Measurable goals are usually specific and they incorporate behaviors that can be observed.Words like define, list, discuss, and complete refer to either words or actions that can be readily observed, heard, or read. In the cognitive behavioral frame of reference, thoughts are also considered to be behavior. However, thoughts must be verbalized in order to be measurable.Encourage decision making. Develop a better self-concept. Relate better to authority figures. Manage time better. Handled frustration. Are examples of measurable or not measurable goalsNot measurable goalsList one strength and One weakness. Discuss feelings about parents. Demonstrate pride and personal accomplishments. Are examples of measurable or non-measurable goalsMeasurable goalsPlan a weekend activity and carried it out. Complete a task within a time limit. Examples of non-measurable or measurable goalsMeasurable goalsDefine assertive behavior. Relieve stress. Take responsibility for behavior. understands yourself better. Are examples of measurable or non measurable goalsNon-measurable goalsStay on a diet 80% of the time. Attend school regularly. Plan time to study for a test. Eat a well-balanced diet. Examples of miserable or non-measurable goalsMeasurable goalsPavlov has been credited with identifying classical conditioning as a process through which much of human behavior is learned. When a piece of chocolate candy is placed in the mouth, the mouth waters, and the person experiences a pleasant taste sensation. The auto gnomic response is soon associated with the visual stimuli, so that it only takes a glance at the candy bar in the store window to make the mouth water. Likewise, many associations in the brain are formed that attach meaning to incoming stimuli. Pavlov was able to re-create this phenomenon in the laboratory, and he called it classical conditioning. Much of today's advertising uses this principle.Skinner identified a more complex, but less controlled form of learning, which he called operant conditioning. According to this principle, behavior that is reinforced by the environment tends to be repeated while behavior that is discouraged or ignored tends to be extinct or disappear. Humans are continually subjected to random or chance reinforcement As they go through life, causing maladaptive as well as constructive learning. Therapy, therefore, must involve the identification and control of environmental factors that reinforce a behavior, so that the stage can be said for positive behavior change.The development of habits is explained by the principle of operant conditioning. People repeat behaviors that are reinforced repeatedly until they become habitual, but once the habit is formed, reinforcement is no longer necessary. Habits or routine or customary ways of doing things. James explains that an " acquired habit, from my physiological point of you, is nothing but a new pathway of discharge formed in the brain, but which certain incoming currents ever after tend to escape" this statement implies that certain stimuli, when encountered in the environment, evoke predictable responses that have been conditioned or learned. Waking up in a familiar environment, most people can wash, dress, eat Breakfast, and otherwise get ready for the day, without much conscious thought. James rights that "habit diminishes the conscious attention with which our acts are performed".In the above example, the familiar objects in the environment serve as a stimuli for the habitual performance of these necessary tasks, so that brain energy is reserved For the more challenging task at work or school. Using this principle, cognitive rehabilitation six to reestablish habitual ways are performing functional test after brain trauma unfamiliar ways of accomplishing a task are no longer possible, new pathways must be formed the rehearsal and practice of the most efficient alternative strategies.Skinner once demonstrated, before a large audience, teaching a live pigeon to turn around using the technique of shaping. The pigeons cage was set on the stage, where it could be readily seen. Using the principle of operant conditioning, he waited until the pigeon turns slightly in the desired direction and reinforce his behavior with a pallet of food. each time the pigeon turned a little farther in the desired direction, it was reinforced again with the pallet of food. Within two or three minutes, the pigeon had learned to turn a full 360° before being reinforced. The technique of shaping requires that each step in a sequence be reinforced until the entire task is learned. When occupational therapist analyze activities, we break them down into component parts, or steps. Instructing a client and using a reacher, for example, we may begin with the correct grip, then practice the movements of the handle, and finally, practice picking up first lighter, then heavier objects. We may use approval or praise after each step is done correctly, without even realizing that we are using reinforcement to shape the clients behavior.Chaining refers to the learning of steps in a specific sequence, so that each action serves as the stimulus to provoke the next action. When a sequence follows along smoothly, A-B-C-D, Without hesitation or making a decision among alternatives, then the sequence has become a habit. James suggests that it is the sensation of the movement just finished that provides reinforcement and signals readiness for what comes next.forward chaininga method for teaching behavior chains that begins with the learner being prompted and taught to perform the fist behaivor in the task analysis; the trainer completed the remaining steps in the chian.Backward chainingA teaching procedure in which a trainer completes all but the last behavior in a chain, which is performed by the learner, who then receives reinforcement for completing the chain. When the learner shows competence in performing the final step in the chain, the trainer performs all but the last two behaviors in the chain, the learner emits the final two steps to complete the chain, and reinforcement is delivered. This sequence is continued until the learner completes the entire chain independently.From the discussion of behavioral concepts so far, it is evident that reinforcement comes in many forms. Early behavior is identified reinforcement as external to the individual. Positive reinforcement is a reward, something desirable to the individual; an edible treat, a gold star, a hug, words of praise, a paycheck. in negative reinforcement, something desirable is removed; privileges, freedom, participation in a social or recreational activity, or a holiday. Later behaviorist believed that reinforcement can also be internal. Bandura, a cognitive behavioral theorist, identify two kinds of internal reinforcers; vicarious and self produced. Vicarious reinforcers are symbolic such as a persons learned images of success and failure or reflections of his or her values and ideas. Self produced reinforcers come from the persons sense of competence, efficacy, and self-control. In other words, feeling good about oneself is reinforcing.Bandura's hierarchy of reinforcement is helpful in understanding and planning learning experiences for a client groups. The level of reinforcers progress from simple to more complex as they parallel the developmental sequence; Initial reinforcers referred to the external ones, such as food, attention, and approval. Symbolic reinforces are internal images or messages regarding probable consequences of behavior. an example of this is a child refraining from going outside in his yard because he remembers how angry his mother got the last time he or she did it. Social contract refers to more complex or role dependent behavior, such as performing a job or honoring one's marriage vows. Personal satisfaction is the best and most effective reinforcer in vendors opinion because it is the least dependent upon external circumstances, and therefore the least vulnerable to extinction. When feelings of self satisfaction or self-worth result from particular behaviors, those behaviors tend to be repeated.A popular technique Associated with the behavioral approach is assertiveness training. This group activity requires the rehearsal and practice of newly learned assertive behaviors through group role-playing and subsequently, trying out the new behaviors in real life situations. The leader first uses self awareness exercises to help the members analyze their own habitual responses to difficult situations as either passive, aggressive, or assertive. Passive; the individual does not state his feelings or stand up for his rights, and usually does not get what he wants. Aggressive; the individual insists on his rights, lets his feelings explode, and gets what he wants by abusing the rights and hurting the feelings of others Assertiveness: the individual expresses his feelings and requested his rights be honored. He may not always get his way, but his behavior encourages me to respect an open communicationHypothetical situations may be presented by the leader, which are likely to be familiar, such as; "just as you reach the ticket counter at the movies after a 20 minute wait, someone cuts ahead of you in line." The group discusses Each situation with regard to the following; what would I typically do? Is my response passive, aggressive, or assertive? What would be an appropriate assertive response? The exact words of an assertive response are then practice by each member. The key is to focus on the verbal expression of feeling or statement or legitimate rights, followed by a request for change or action. Using incomplete sentences and asking each member to fill in the blanks might be a good place to start: " I feel _ when you _." Hypothetical and real situation's are rehearsed and practice through role-playing, group discussion, giving and receiving feedback, and homework. most people have difficulty behaving assertively, and people with disabilities are especially vulnerable. Assertiveness group members should be encouraged to provide one another emotional support when attempts at assertive behavior outside the group do not bring expected results. Reinforcement For assertive behavior must initially come from the group leader and members until it is practiced often enough, and with enough success, to become a part of the individuals habitual response repertoire.According to Posthuma, role-playing evolved from the practice of psychodrama, In which the client (protagonist )directs his or her On real life situation by choosing other members of the group to play the roles of significant others. As a behavioral technique, the structure of role-playing remains the same, but the focus is slightly different. In occupational therapy groups, playing roles provides a form for practice and rehearsal of new behaviors within a safe and supportive therapeutic environment. Members recall Or anticipate difficult situations in their own lives and bring them to the therapy setting in constructing the role-play. Each role-play has four parts according to Posthuma; Definition of the problem Assuming the roles Enactment DiscussionFor example, A client anticipating a return to work after a long absence may choose others to play coworkers, supervisors, or client/customers. The client tells each member how to play his or her role, and the furniture in the room can be rearranged to resemble the work setting for a more realistic effect. Although the protagonist may play himself for the first time through, it is often helpful for another member to play that role or to reversal roles. As a learning tool, role reversal has the advantage of helping the protagonist to see the situation from the others point of you. The purpose of role-playing is to practice new behaviors, develop insight into a situation, develop empathy with others, anticipate consequences, increase self-confidence, and or decrease anxiety. A discussion of the role-play allows the members of the group to give feedback and support to the protagonist and reveals its meaning for all the group members. Role-plays are also models for social learning.Systematic desensitization and bio feedback; these techniques have elements of both behavioral and cognitive theory. Systematic desensitization has been used successfully by clinical psychologist and interventions with phobias, such as fear flying, and it has been less successfully use to control addictions, like drinking or smoking. The first step in desensitization is to evoke a state of relaxation, usually using some form of resting muscle tension and release sequences combined with visualization. The " Progressive" part involves the introduction of images of the feared object/situation in greater degrees of severity. For example, the person with the fear flying would begin by visualizing the drive to the airport and gradually work up to the plane taking off, while maintaining a state of relaxation. The entire process requires a series of sessions, often over a period of several months. Psychologist are required to get special training before attempting this technique. However, the same concepts formed the basis of many group activities using occupational therapy. Progressive muscle relaxation takes on many forms and maybe use in occupational therapy groups dealing with stress management or as a coping strategy when faced with any situation that tends to evoke anxiety. guided fantasy is a form of visualization that is useful for group intervention. Although feared images should be avoided, pleasant ones may be very powerful motivators. For example the group members may begin by closing their eyes, breathing deeply, and imagining themselves lying on a sunny beach, listening to the rhythm of the ocean waves as they break along the shore. this visual image sets the Stage for relaxation and prepare them for learning other useful strategies for the control of anxiety, anger, frustration, and other causes of distress.Bio feedback refers to the monitoring of bodily functions, such as pulse, respiration rate, heart rate, and bodily temperature. Stein and Nikolic suggest using bio feedback in conjunction with other stress management techniques. Mechanical monitoring devices are used to give clients information about how their mental state affects them physically. Various mental strategies can then be learned to help gain control over their own physiological responses to stress. Bio feedback is often combined with visualization and relaxation techniques. It is also used in the bio mechanical approach to monitor the effects of movement and exercise and as a safety precaution to prevent over exertion and any physical strenuous activity.Acquisitional approaches- Trombly, Mosey, Denton; The above approach to the rehabilitation of physical disabilities has previously been called acquisitional by Mosey and others. Denton called it functional performance, and Trombly called it simply the rehabilitative approach. This refers to the process of re-learning loss skills and activities of daily living and other areas of occupation due to physical disability. rehabilitation and occupational therapy occurs on a continuum of restoration-adaption-compensation. That is, foundation skills of movement, strength, endurance, and perception are remediated or brought to the highest level of recovery possible within the limitations of the illness or injury. Adaptations in every day functioning are then made to maximize that level of recovery through using special equipment, changing the task demand, or altering the environment. when full recovery is not anticipated, compensatory strategies are then substituted for skills that have been lost or compromised. This practical approach to rehabilitation is so well known in occupational therapy that it has not really needed an official name. However, the 2002 addition of Trombley and Radomski elaborate on the approach using many names. One of these, the task oriented occupational therapy approach. Two related approaches worthy of mention here are moseys role acquisition and fiddlers lifestyle performance profileMoseys role acquisition. Mosie addresses the role acquisition approach to those individuals whose disability has stabilized and who continue to have difficulty in performance of task of their major social roles. she identifies the basic skills common to all social roles as task skills and interpersonal skills. These basic skills are necessary building blocks for the performance of self-care, family interaction, recreation, and work. Temporal adaption, or skill in the perception and use of time, serves to organize and balance a task of occupational roles on a daily basis. skills are Separately defined for family interaction, activities of daily living, leisure and work. Temporal adaptation, the ability to perceive and manage time, is defined as orientation, organization, planning, goalsetting, and establishing a schedule. Mosie suggests that interventions and task skill development begin on an individual basis. Group interventions can be effective in learning the more advanced task skills and in working on interpersonal skills. She suggests topical or thematic groups by design to address specific skillsMosey's Role acquisition: task skillsWillingness to engage in task adequate posture for task physical strength and endurance gross and fine motor coordination interest in task rate of performance ability to follow oral, demonstrated, pictorial, and written directions use of tools and materials acceptance level of neatness attention to detail ability to solve problems ability to organize task in a logical manner ability to tolerate frustration ability to be self directedMosey's Role acquisition: interpersonal skillsInitiate, respond to, and sustain verbal interactions express ideas and feelings be aware of needs and feelings of others participate in cooperative and competitive situation's compromise and negotiate Assert self take on appropriate group rolesVelde and Fidler's Lifestyle Performance Profile. This occupational therapy model and assessment tool was developed by Beth Velde and Gail Fidler. In it, skills for self-care and maintenance, self need/intrinsic gratification, and service to others are listed and assessed within the framework of age, culture and biology. Three contributing factors to lifestyle are motivation, well-being and quality of life, and the environment. an individuals motivation is strongest when engaging in occupations that are personally and socially relevant. Success may be seen in a satisfying end product. Concepts of well-being and quality of life include the following; satisfaction in one's cognitive appraisal of one's lifestyle. Quality of life is higher when the individual can personally exert control of the environment. Occupations that produce a sense of well-being and quality of life must be defined by the individual.The environment maybe structured to respond to individual needs and interest. Elements of the environment can clarify reality and define expectations for occupational performance. An ideal environment supports autonomy, individuality, affiliation, volition, consensual validation, predictability, self-efficacy, adventure, accommodation, and reflection. In the lifestyle performance model intervention is required during the following; when illness or trauma affects occupation in any lifestyle domain. When lifestyle changes become necessary. When individuals desire to establish a more satisfying lifestyle. This profile can serve as an alternative basis for grouping clients with similar lifestyles, situation, and concerns, as well as similar deficits. Lifestyle changes and adaptations may be made more easily within a supportive, therapeutic group context.Cognitive rehabilitation approaches. Cognitive rehabilitation models were originally designed for people with traumatic brain injury or stroke, both sometimes referred to as acquired brain injury. Various frames of reference have been developed and studied, all having a strong scientific basis in neurophysiology and Neurobiology. In recent years, their approaches have also been used successfully for some mental health populations. The frames of reference reviewed here are Toglia's Multi contextual model, Giles neurofunctional approach, and Averbuch and Katz cognitive retraining model. Toglia also includes Allen's cognitive disabilities model in this group of occupational therapy cognitive rehabilitation approaches. However, in this text Allen is covered in chapter 7. Toglia's multi contextual approach the most widely research of these, is presented in greater detail because it's applicability with groups. A large body of evidence supports this approach, also known as the dynamic interaction of model.Functional brain areas. Cognitive rehabilitation with brain injured adults involves the reorganization of functional systems so that new methods of performing old behaviors are acquired. The retraining seeks to maximize the efficiency of information processing and involves repetitive exercises that place demands on the individual to perform skills of greater difficulty. Russian physiologist Alexander Luria identified six cognitive deficit areas; orientation, attention, visual processing, motor planning, cognition, and occupational behavior. In an approach called cognitive perceptual retraining Abreu and Toglia referred to Luria's Brain region classifications in their organization of perceptual and cognitive deficits. The first brain area described includes the brainstem and the old cortex, containing the midbrain, thalamus, hypothalamus, uncas, reticular formation, and cerebellum. These are the inner most portions of the brain and are responsible for attention, wakefulness, arousal, and response to stimuli. The second brain area Liria's defines includes the back most areas and is responsible for analysis, coding, and storage of information. It receives raw data from a sensory system and assigns meaning to it. Luria's is third functional area includes the frontal portions of the brain and is responsible for intentions, programs, and problem-solving. A distinction is made between the right and left hemisphere of the brain in terms of function.Cognitive impairments addressed. Toglia and colleagues present an updated list of cognitive impairments that commonly occur in acquired brain injury. However, they advise that while it is useful to discuss these impairments separately for learning purposes, in real life "cognitive problems are interrelated and rarely occur in isolation"Self-awareness: metacognition, ability to identify one's errors and accurately predict occupational performance Orientation: able to identify self and surroundings, including time, place, person, and situation Attention: including detection, selective attention, sustained attention, shifting attention, and mental tracking Memory: encoding, storage, and retrieval of information necessary for new learning; includes working (temporary) memory necessary during performance of activities, declarative (long term memory), and procedural memory (how to perform activities without conscious awareness) Executive functions: include volition, planning, purposeful action, self monitoring, organizing, and problem-solving Motor planning: Praxis, positioning, using body to perform skilled activities Spatial neglect: failure to orient to stimuli on the contralateral side of the brain lesion, not due to visual or motor deficits Visual processing: includes reception, organization, and assimilation of visual informationSelf awareness training. Taglia and Kirk identified two types of awareness self knowledge and online awareness. Self knowledge refers to the clients awareness of his own strengths and limitations sometimes referred to as insight. Online awareness refers to the ability to accurately judge tasks, anticipate the likelihood of problems, and change, adapt, or fine-tune one's behaviors during the performance of an activity or occupation. Online awareness changes with each task, while self knowledge builds from a variety of experiences over time. A significant number of clients with brain injury are unaware of their limitations in occupational performance, causing them to attempt activities that are beyond their post injury capability and raising issues of judgment and safety. Impairment and self knowledge results in missed judgment of the task one may attempt. This means judgment may expose clients to significant danger, such as driving with a visual impairment, or failure to use or need a cane or walker when walking outdoors. Bandura notes that self efficacy, or a belief in one's own ability or control over a situation, is necessary in order to sustain motivation to work toward a goal. Errors in judgment and lack of self-awareness can lead to unexpected consequences in a erode a persons self efficacy. According to Gillan, impaired self awareness also "presents obstacles to adjustment, collaborative goalsetting, goalsetting, and active participation in intervention."Awareness training begins with familiar task and contexts that present a just right challenge. In performing familiar occupations, clients can more easily compare previous experience with current occupation and performance, therefore discovering for themselves their own areas of difficulty. Training increases self-awareness (metacognition) by (1) acquiring knowledge of one's own processes and cognitive capacities and (2) by developing self monitoring strategies. Self monitoring skills include the ability to do the following Evaluate task difficulty Predict consequences of action Formulate goals Plan for anticipated problems Monitor one's on performance Recognize errors Demonstrate self-control Taglio stresses that without self-awareness people are unable to initiate and use either remedial or compensatory strategies. Therefore, the skills should be worked on significantly during therapy. Some suggested techniques for increasing self-awareness and monitoring are Self prediction: person rates task difficulty on a scale of 1 to 5 (very easy to very hard), then compares estimate to actual performance. Specific goal ratings: daily or weekly self ratings of individual goals targeting use of clearly defined behaviors (ex planning ahead) or specific strategies (ex using a checklist) using collaboratively defined criteria can help clients maintain focus on goals Videotape feedback: therapist guides clients in evaluating the performance of an activity as we experienced by watching themselves on video. Self evaluation: after completion, person asks "have I checked work for accuracy/completion? Have I paid attention or maintained focus? How confident do I feel about the results?" journaling: clients keep a narrative journal of their activities, focusing on what they have learned about their own abilities and difficulties Taglia suggests that self-awareness has such a profound effect on new learning that this ability should be addressed in groups first before attempting to teach remedial or compensatory strategies. In one experiment on memory training for people with traumatic brain injury, group discussion and education about awareness of one's own performance increased accuracy of predictions by 50% on a recall tasks. Slotnick and colleagues used a combination of Taglio's awareness training and will take multicontextual approaches with adolescents with traumatic brain injury; results show that participants gained full awareness of their own limitations and made significant improvement in mobility, self-care, and graphomotor ability using these approaches. In a systematic review Schmidt Landon Fleming and Osworth report positive outcomes generally when feedback (such as in groups) interventions target self-awareness deficits.Bandura's social learning theory. The following are major areas of focus in Bandura work The role of internal and external reinforcers Mediating environment and person interactions Modeling and observation learning Self-control and self-regulation Alternative sources of motivation Bandura's hierarchy of reinforcement, mention earlier, spans a range of a both external and internal reinforcers. Regarding reinforcement, Bandura contends that the person as well as the environment determines behavior. A social learning interaction involves three factors; person, behavior, and environment. External reinforcers are measurable outcomes from the environment, such as getting a grade on a test. The persons interpretation and expectations are considered equally important; these are the internal reinforcers. Examples of external reinforcer is our money, material goods, social approval or privileges, and penalties. Self reinforcement develops with maturity in the enactment of internal values and self expectations.In recent years Bandura has expanded his views of social learning to incorporate the research coming from the field of neuroscience that confirms the social nature of learning in multiple brain studies. Bandura has published many descriptions of this model as it applies to a broad range of contemporary therapeutic and public health dilemmas. In 2001, Bandura use social cognitive theory to explain human agency(act done intentionally), a concept similar to self determination, one of the central beliefs of occupational therapy's clients centered approach. In this view, there are three types of agency personal (autonomy), proxy (others acting for the person,) and collective (group actions and advocacy). " people are producers as well as products of social systems". The process of directing one's own life course requires "functional consciousness", enabling people to make good judgments about their own abilities. They must be able to anticipate the probable effects of different events and courses of action, size of sociocultural opportunities and constraints, and regulate their behavior accordingly" four core features of social cognitive theory as apply to human Agency are intentionality, forethought, self reactive-ness, and self reflection.Intentionality: a representation of a future course of action, including an expected outcome and a commitment to bringing it about. Forward thinking goals, however, can seldom be achieved alone, but requires the shared intentions of others. Forethought: people motivate themselves and guide their actions in anticipation of future events. Self reactiveness: The ability to shape courses of action, regulate behaviors in accordance with one's values and beliefs. A sense of personal identity invests activities with purpose and meaning. Moral agency, based on one's value system, can be both inhibitive and proactive Self reflection: the meta-cognitive ability to evaluate the "correctness of their predictive and operative thinking against the outcomes of their actions." Self reflection is the forerunner of Bandura's well known concept of self efficacy, or belief in the effectiveness of one's own's beliefs. These four capacities, culminating in self advocacy, guide the persons ability to choose which challenges to undertake, and what types of activities and environment in which to involve themselves. In this way, social cognitive theory helps occupational therapist understand what conditions are necessary for clients to make the occupational choices that give meaning to their lives. In order to set occupational goes, clients must not only understand their own abilities and limitations, but also they must comprehend what is possible within their social, political, and cultural environments.Becks cognitive distortion in automatic thoughts. Aaron Beck developed his methods of cognitive behavioral therapy in the 1960s and 1970s through his work with clients with depression. His approach is founded empirical investigation: he treats the clients maladaptive interpretations and conclusions about events and hypotheses to be tested. Beck collaborates with the client in conducting behavioral experiments, verbal examinations of alternate interpretations, reality testing, and problem-solving, with the goal of correcting cognitive distortions of reality. From his clinical findings, Beck concludes that psychological disturbances frequently stem from automatic thoughts, which reflect habitual errors in thinking. This cognitive model does not assume that the cognitions operate exclusively of bio chemistry or behavior symptomatic of psychopathology. Cognition is considered the problem and not the cause. The structure and process of cognition therapy includes setting the agenda for the session, eliciting feedback, setting goals for therapy, operationally define problems, testing hypotheses, problem-solving techniques, and assigning homework. This structure lens itself very well to occupational therapy groups, which can address through activities the cognitive roadblocks to functional performance.Ellis exposing irrational beliefs. Albert Ellis is well known for his work in rational emotive therapy. Although Ellis and Beck develop their techniques over approximately the same time, each has his own somewhat eclectic basis of which traditional behavior therapy is only a part. Like Beck, Ellis considered thinking to be a legitimate behavior that could be learned and modified using behavior modification techniques. A distinguishing feature of rational emotive therapy is its systematic exposition of irrational beliefs that result in emotional and behavioral disturbances. Ellis spends most of his energy looking for "unconditional shoulder" and "absolute must." He contends that clients take "simple preferences", such as desire for love, approval, and success, and make the mistake of thinking of them as as dire needs. Ellis's view of human nature is somewhat humanistic: he believes people have inborn tendencies toward growth and actualization. He takes for granted, however, that humans are fallible and often make mistakes resulting in "crooked thinking" and "self-defeating" behavior. Rational emotive therapy has developed into a kind of structured challenging and disputing of irrational beliefs. It's confrontive methodology, such as the use of exaggeration, absurdity, and humor is not at all humanistic.Cognitive restructuring. Ellis suggest a philosophical restructuring process involving a series of steps, all of which require high level thinking. This method reflects both humanistic self determination and the supremacy of rational thinking in controlling and directing human behavior: Acknowledging our responsibility for creating our own problems Accepting our ability to change our own problems Seeing that emotional problems stem from irrational beliefs Clearly perceiving our beliefs Working hard to change beliefs resulting in disturbed emotion and behavior Continue cognitive monitoring and restructuring over our lifetimeCognitive restructuring includes the process of questioning our decisions in life structures and considering alternatives. It is very much a skill development process to be used over one's lifetime. When emotional problems are identified, therapy consists of defining problems and thinking that contribute to the distressing emotions or behaviors in finding alternative, more realistic, and pragmatic ways of conceptualizing those life circumstances. The therapist acts as an educator facilitator in collaborating with the client to achieve a specific goals.Building self efficacy. In occupational therapy groups, when we use a psycho educational approach, our role as educator facilitator is similar to that outlined by Ellis and Beck, within the context of activities, occupational therapist can use cognitive restructuring principles to teach clients how to apply a scientific approach to thinking. Our goal is to teach skills that could be generalized by clients after they leave therapy groups. Groups that focus on pain management, time management, leisure planning, and health education/prevention are examples of occupational therapy groups using a cognitive behavioral approach. Discussion of the problems clients have in the performance of activities often leads to exposure of faulty thinking. In our higher functioning client groups, occupational therapist can help the clients change their attitudes toward disability or ability as it affects performance. We can teach our group members to challenge each other into encourage their use of rational thinking to solve problems.Linhan's Dialetic StrategiesDBT was developed by Dr. Marsha Linehan over the past 15 years as an intervention specifically for borderline personality disorder. People with this disorder are frequently seen in hospitals they are burdensome to the healthcare system because there is no effective medical treatment. It is suspected that many more "undiagnosed" borderline personality disorder patients enter hospitals with a host of other diagnoses because of their tendency to exaggerate symptoms and their proneness to substance abuse and suicide attempts. Dr. Linehan translates the core of the disorder into cognitive behavioral terms, by emphasizing its pattern of behavioral, emotional, and cognitive instability and dysregulation. Dialectic is defined by as pertaining to logical argument and includes conversation revealing the truth through use of logic, juxtaposition of conflicting ideas, or forces and debate over a constantly changing reality. Those who are familiar with borderline personality disorder will recognize immediately why this term was chosen. Hallmark symptoms of this character disorder include a tendency to distort reality, to either idolize or condemn others, to create drama and conflict in relationships, and to continually redefined their own identity. acceptance of the nature of life as a constant struggle involving balance and imbalance of opposites is an important part of DBT. The dialectic approach to intervention meets the person with borderline personality disorder on his own turf and teaches a logical approach to self regulation.Dialectic behavior therapy groups. In DBT Linehan has identified specific issues that need to be addressed by people with BPD, which she defines as a disorder of self regulation. These are dysregulation of emotions, interpersonal relationships, behavior, cognition, and sense of self. Group intervention has traditionally been the treatment of choice for individuals with BPD because of their difficulty with authority, their need for peer feedback, and their desirability of avoiding the power struggles that are inevitable in one-on-one relationships, therapeutic or otherwise. Lionhead has designed a workbook for a cycle social skills training which outlines specific group exercises in four major categories Core mindfulness Interpersonal effectiveness Emotion regulation Distress toleranceCore mindfulness this teaches the mind to focus on one thing at a time, to pay attention to all the information available in a situation, and to refrain from quick judgments, jumping to conclusions, or acting on the basis of emotional responses. A useful technique is writing; taking time to describe conflict situation's in words delay the response and leads away from the emotional and into the rational, analytical mind. Awareness of beliefs and attitudes one typically uses and analyzing these applying logic, labeling behaviors, and emotions as harmful and destructive or helpful and productive in accomplishing ones objectives in the conflict situation are also a focus group exercises in the mindfulness category. Interpersonal effectiveness skills for achieving specific objectives in relationships, getting and keeping the relationships, and maintaining self-respect in relationships are learn and practice in these group exercises. Recognition of the factors that interfere with relationships, strategies for challenging these negative factors, and self reinforcing positive responses are also included. Exercises for expression of feelings and opinions negotiating, reciprocating, and making specific request help to build a repertoire of skills for building and maintaining healthy interpersonal relationships