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Tuesday, 17 September 2013

PsychologySalon at VPL: Achieving Your Vision

Tuesday September 24 at 7 pm

Vancouver Public Library

Central Branch, Alice MacKay Room (Beneath the concourse)

What do you want, really?  What would you be doing if you took your life seriously?

Life is like a sailing trip.  You want to enjoy the ride, but every now and then you have to look at the map and put your hand on the tiller.

How do you do it?  We all set goals, but often we don’t reach them.  Or we feel overwhelmed by the amount of effort it will take to achieve them.

Fortunately, psychology has discovered principles that help. This PsychologySalon evening covers the strategy, the concepts, and the traps along the way.

Bring pen and paper!  We’ll invite you to consider your own life goals and discuss how to work toward them.

Sunday, 15 September 2013

Stress Management: An Online Course on Diaphragmatic Breathing

For the past number of months we have been developing a 13-hour course for mental health professionals on how to treat depression in a group format.

This course has now launched and is available online, along with all of the documents required to run a group. Here’s the preview video:

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About the Protocol

The Core Program was developed at UBC Hospital in Vancouver Canada. Originally restricted to patients who had previously been hospitalized for major depressive disorder, it was designed to enhance self-care using cognitive behavioural principles.

The contents include:

  • An orientation to the CBT model, including an acceptance-based approach to difficult emotion.
  • Behavioural activation strategies, to be introduced in Session One and forming a major part of every session thereafter.
  • Psychoeducation about the nature of depression and the nature of stress.
  • Lifestyle management strategies, including specific recommendations in areas including diet, sleep hygiene, exercise, and enjoyable activity.
  • Cognitive material, including demonstrations of outside-awareness cognition, common forms of distorted thinking, and cognitive traps associated with both rising and falling moods.
  • Cognitive change strategies, including awareness, cognitive challenging, and a set of worry management strategies.
  • Social life enhancement, including strategies to build and deepen a social network, and core concepts regarding assertive communication.
  • Relapse prevention strategies including planning for future stressful periods, identifying risks for backsliding, and developing strategies for dealing with relapse should it occur.

Growth of the Program 

Our mandate was to implement the program on-site, then enable other mental health agencies to offer it in their own communities. The plan was to have it operating in three other communities in British Columbia. Once it had been instituted in over 50 communities we began to lose count.

The two-day training program has now been offered in communities across Canada and Australia, as well as in Hong Kong. Groups based on the model have been offered in China, the United Kingdom, the United States, and in South America.

The program has been translated into Arabic, Farsi, and Spanish, and an earlier edition is available in Chinese (traditional and simplified character sets).

Much of the material was also simplified and incorporated into a self-guided manual, The Antidepressant Skills Workbook, designed for family physicians to offer to patients newly diagnosed with depression.

Online Course Contents

The online course offers over 50 short lectures, most of them 5 to 20 minutes long to enable users to access the material they need in a brief and accessible format.

As well, a variety of ancillary documents are supplied in three different formats: US spelling on USLetter, Imperial spelling on USLetter (for Canada), and Imperial spelling on A4 (for other countries).

  • A complete set of slide handouts in both 3-per-page and 6-per-page format, totaling over 500 slides in all.
  • The complete 94-page Participant Manual designed to be distributed to clients – manual designed to work also as a set of separate handouts for use in individual therapy. This manual may be printed and reproduced for clients.
  • The 226-page Clinician’s Guide, with complete teaching instructions, in-session exercise ideas, and a Quick Reference composed of “cheat sheets” that the clinician can take into session as reminders.
  • A set of additional documents including goal-setting forms, cognitive challenging sheets, feedback forms, and an attendance form.
  • Free access to the Farsi, Arabic, and Spanish translations of the manual, and to the Antidepressant Skills Workbook (which is available to anyone online at no charge).

These materials (without the slide handouts) are also available for sale in digital ($55) or print ($90) format from the Changeways Store.

Group Rates

Group practices, employee assistance firms, HMOs, public agencies, and health regions may wish to purchase multiple spaces for their own employees. We are able to arrange discounts for groups of more than 5, with steadily greater discounts for groups of over 10, 50, 100, and 500 employees. To discuss the program or arrange a group discount, simply **contact us**.

The PsychologySalon Discount

Take 25% off the standard course fee simply for accessing the course through PsychologySalon.  The coupon code for the discount is “core2.” Here’s the link to the course.

Tuesday, 10 September 2013

Therapy and Personal Change Tasks: Significant Versus Do-able

A completely unrelated photo from PsychSalon Farms:
Suspicious damage in the orchard, September 2013.

Sometimes people present for therapy saying that they don’t know where they want to go or what they want to achieve. Therapy becomes a process of generating and winnowing the possibilities.

But often people know exactly what they would like, only the task seems too immense. Find a career. Overcome my fear of heights. Deal with the past trauma. Leave home. Graduate.

Contemplating these enormous goals they feel the energy drain out of them like air from a balloon. Or they feel so overwhelmed that a sense of pointless futility overtakes them.

In therapy, we often try to identify the “Ultimate Goals” – essentially “What would you like, eventually?” And then we break these down to “Immediate Goals.” “What could you do this week that might take you toward one of those Ultimate Goals?”

And here we get stuck. The person can’t think of any Immediate Goals. Or they are dismissive of any ideas that come up. Or the therapist suggests a possibility only to sense the client pulling back and away.

And the culprit, 20 feet away,
anxiously watching the harvest.
In my experience, the most frequent problem is that the person is trying to arrive at an Immediate Goal that meets two criteria:

1. It is small enough that it feels achievable.
2. It is large enough to feel like a significant step.

People are looking for the middle path – the “sweet spot” between something so big it’s overwhelming and so small it feels trivial. They’re trying to find a goal that sits in the gap between the two.

The trouble is, usually there is no gap. No sweet spot. If a goal is big enough to seem significant, it’s too big to accomplish with the person’s existing amount of energy and motivation. If it’s small enough to accomplish, then it’s too small to seem like real progress. This trap often explains why the person has felt stuck – perhaps for months, perhaps years.

The way out is simple and unsatisfying. Pick something small enough to be achievable, knowing that it will seem insignificant and trivial. In other words, keep the first criterion above, and relinquish the second.

So a person who wants to overcome their fear of escalators might go to a shopping mall food court and sit near the escalator to watch it for an hour, forbidden from using it personally. A person who wants to become more social might take a newspaper to a coffee shop to read rather than sitting with it at home. Someone wishing to clean up a neglected house might focus only on the bathroom sink.

There is an emotional cost to doing this. Inevitably, a part of the person’s mind will snort with derision. “This is ridiculous, any idiot should be able to do this. This isn’t getting anything important done, it’s just reminding me of how incapable I am. It’s too small, and I’ll never get to my bigger goal at this rate. And frankly my therapist who is suggesting this is an idiot too.”

This happens sufficiently often that we can propose it as a rule. If we are on the right track, an early goal in personal change should feel trivial, insignificant, foolish, and unsatisfying. If it feels challenging, we’ve chosen something too big.

Ultimate Goals often feel questionable. Will I ever have a partner? Will I really graduate? Will I truly feel comfortable in crowds?

Good Immediate Goals, however, are those that feel completely achievable. “Of course I can step outside my front door for five minutes.” “Yes, I can leave home without unplugging the coffee grinder.” “Okay, I can vacuum the front hall.”

But for a person who has felt stuck, any goal that seems achievable will also seem faintly idiotic. Rather than fighting this sense of idiocy, we can mark it and treasure it.

Idiocy isn’t a barrier. It’s the way out of the trap.

Online Course

Behavioral activation is a major component of the cognitive behavioral treatment of depression. If you are depressed, consider seeking the help of a qualified psychotherapist trained in cognitive behaviour therapy.

In addition, our clinic has developed a cognitive behavioral guide to self-care for depression. Though not a substitute for professional face-to-face care, UnDoing Depression may be a useful adjunct to your efforts.  The preview is below. For 50% off the regular fee of $140 USD, use coupon code “changeways70” when you visit our host site, here.

We also have courses for professionals and for the public entitled What Is Depression, What Causes Depression, Diagnosing Depression, Cognitive Behavioral Group Treatment of Depression, How to Buy Happiness, and Breathing Made Easy. For the full list with previews and substantial discounts, visit us at the Courses page of the Changeways Clinic website.