Strategies Used in CBT to overcome Negative Cognitions

Social Work Clinical

In detail, describe two behavioral techniques. Offer examples of the techniques by applying the techniques to a fictional client has a bipolar disorder.

Part 1

Activity scheduling (AS) is an effective behavioral treatment that actively involves clients by increasing their daily activities. The goal of AS is to increase client contact with the environment in a positively reinforcing way. Previously, AS involved scheduling only those activities that the client believed gave them pleasure and elevated their mood. However, any activity should be scheduled provided it offers the intention to socialize. Having a schedule is vital for clients with bipolar disorder since they prefer routines, and clients tend to avoid disruptions. Therefore, these clients should have a daily routine that involves work and rewards. With a set schedule, the client will rise and shine at the same time every day, assisting them to avoid disrupting the brain’s regulating system for waking and sleeping. Bipolar clients have mood shifts that can leave them feeling helpless as their mood moves from one extreme to another. Having a routine will assist in countering these helplessness feelings. The goal of AS in bipolar disorder is to reduce some of the uncertainty that could cause the client to have mood shifts. With time, the client learns to perform certain activities at certain times each day, and they look forward to doing those activities.

Malik was diagnosed with bipolar disorder type I last year, and he had been struggling with his daily activities where he does not have a schedule, and he operated based on what he feels like doing. He had constant mood swings and could not focus for long periods. However, after starting on AS, he has seen tremendous improvement in his daily mood, and he feels much better and happy most of the time. Malik was given a daily weekly schedule and weekend schedule that involved waking and sleeping times, activities planned for each hour of the day when he is awake, and time for meals. With the schedule, Malik can now focus better on his work. People who are unaware of his disorder do not believe him when he tells them he has bipolar because it does not interfere with his work or personal life. Malik has something to focus on with a schedule instead of a negative thought.

Relaxation training is used in behavioral therapy to reduce tension, anxiety, and stress. Relaxation training teaches clients to become aware of tension in their minds and bodies. The client can then incorporate systematic relaxation methods like progressive muscle relaxation, diaphragmatic breathing, or guided imagery. These techniques will assist in reducing the tension experienced by the client and allow them to change their thoughts. Malik can be trained to be mindful of these thoughts and become aware of what they are thinking and feeling. The purpose is to encourage him to stop being judgmental about his thoughts and feelings. Bipolar patients tend to focus on one thought and overly think about it negatively, forcing them to start believing and judging themselves. However, with relaxation training, Malik can learn how to embrace his thoughts and feelings, be aware of them, and remain nonjudgmental.

When one is aware of their thoughts, they can then modify their actions because they can pre-empt when they become depressed. Deep-breathing exercises can be taught to Malik to encourage him to perform deep-breathing at certain times of the day. With a routine, he manages to stay calm most of the time, and he can perform the deep-breathing exercises when he feels his mood is changing. In the daily schedule offered to Malik, there should be relaxation practices incorporated throughout the day. The goal is to reduce his stress and keep his mood even. Malik can be encouraged to take up yoga classes where he gets to practice yoga in a group setting. Yoga enables him to get in touch with his inner self and learn how to calm himself.

Part 2

Social Anxiety Disorder in Adolescence

To ensure the decisions made are not reliant on anecdotes, personal experience, and received wisdom, we must adopt an approach based on critical thinking and the best available evidence. Using such an approach, we can be certain the decisions we make are supported and referenced to ensure their trustworthiness (Gifford et al., 2018). In clinical practice, we have to make critical decisions all the time, and in some instances, the decisions can be questioned, especially those assumed to be based on intuition. For this reason, we have to ensure we can support the decisions we make with references from current literature on the topic. Also, with increased research on the topic, we get to learn more and increase our knowledge. Social workers should rely on decisions that will have the desired effect on the client. It’s unfair to take a client through therapy using strategies that have no evidence they will work for this client. There are different strategies to use to locate the best evidence, but the best would be to use Google Scholar for starters. Here one will receive a listing of all articles relating to the research being done, and they can filter the articles based on year. We rely on research done within the last five years for our case. The links offered have brief information on the article, allowing one to filter out the ones they would like to read more about and those that do not correlate with what we are searching. Clicking a link to an article will offer the abstract even if it is an article that needs credentials or purchased. The researcher can decide on the articles they would like and select those for further reading.

All selected articles should be categorized based on the population being studied to ensure an appropriate cultural mix in the selected articles. Ethical practices are determined based on the NASW Code of Ethics. Referring to the code of ethics is vital to ensure one adheres to the codes stated. The desired outcome or change being studied should respect clients and other social workers. Therefore, the Code of Ethics will guide us in determining if we are on the right track or some ethical principles are broken.

Cognitive-behavioral therapy (CBT) is the best clinical practice for treating social anxiety in adolescents. The clients will undergo a cognitive restructuring that involves the identification of distortions and learning to develop realistic thoughts. There are numerous studies conducted to support the use of CBT for treating social anxiety in adolescents, and the goal is to encourage its continued use by providing support to the program through current studies. It is anticipated that using CBT can improve program outcomes as we will train the adolescents to modify their thought patterns and become more aware of their negative thoughts. According to Salzer et al. (2018) exposing the client to the social fears they have encourages them to see there is nothing to fear, and with time they can learn to cope and stop being fearful. Combining exposure therapy with skill training is effective for children between ages 6 and 14 (Lu et al., 2021).

Based on the research we find regarding the use of CBT for treating adolescents, we will compile a list of the best articles and create recommendations based on what the authors have noted. Categorization will be done based on themes we identify that are similar in the studies and views expressed by the different authors. Translating the research findings to effective practice will involve making recommendations to the key decision-makers on the effectiveness of CBT in treating social anxiety in adolescents, and we will incorporate an executive summary demonstrating our findings. The program outcome will demonstrate that the use of CBT can reduce social anxiety in adolescents by almost 80%, and we can assist most adolescents exiting from foster care to face the world confidently. As social workers, we have an ethical requirement to competence to conduct appropriate research before recommending a standard of practice. Researching CBT with adolescents and offering support from existing research will formulate a standard for use in foster care where numerous adolescents are suffering from social anxiety (Salzer et al., 2018).

Quality evidence-based research will offer vital insights to the professional and other professionals in that there will be a point of reference and supporting documents for the practice. Without offering support, other professionals will find it hard to believe the use of a particular program since they are not certain why it is being pushed or recommended. According to the NASW Code of Ethics (2017), social workers have an ethical responsibility as professionals to base practice on recognized knowledge. Therefore, evidence-based research needs to have empirically relevant information regarding practice before pushing for its use (Crowley et al., 2018).

Searching in the organization’s library and online using Google Scholar is best to locate quality research. When an article is found, the first step is reading its abstract to confirm it will fit the research requirements. You do not need to read the whole article to determine if it is worth including. The sheer number of articles available makes it hard to review all of them fully, which is why we rely on abstracts. Secondly, we should ensure the articles are current by filtering and including only those articles that have been published in the last five years. To have current knowledge, we should adhere to this principle since these articles will be updated and have information applicable to current clinical practices (Lu et al., 2021). Only articles from professional or peer-reviewed journals will be included for the evidence-based research. We can include articles from education and mental health journals with adolescents with social anxiety.

Life-long learning will involve actively reading new articles published on the topic of interest. In our case, it will be social anxiety in adolescents. Scheduling to increase knowledge by searching and finding recently published articles allows us to keep abreast of social anxiety. Reading online articles can also assist as we will read on advancements being made, proposed changes, and the way forward regarding social anxiety. Based on what we read online, we can then search to see if any credible journals have published any research on what we have read online. Also, it is vital to attend conferences on social anxiety because we can interact with other professionals and learn about what they are doing or what is working with their clients. To remain current with childhood anxiety disorders, we can read about them in professional journals and interact with professionals in social work dealing with childhood anxiety disorders. Sharing ideas with other professionals allows one to determine if they are on the right track and how they can change what they have been doing.

Sharing with other professionals the findings we have based on existing research and how it has improved our clinical practice can be done through publishing our study or sharing the information in one of the social workers’ conferences. As with any other study or information being shared, we should ensure we do not include any identifiable patient information and where possible, we should modify the clients’ names by giving them pseudo names. The presentation will demonstrate the reason behind the need for clinical practice change by presenting the challenge faced. Then, it will move to finding evidence and categorizing the articles found. Implementing the findings and the results will be last.

Part 3

1. What CBT techniques were used? What was done well?

The CBT techniques used were exposure therapy and cognitive restructuring or reframing. In exposure therapy, the therapist tried to get the client to confront their fears by asking them questions like “What is the worst that could happen?” where the client thinks about the situation and expresses his fears. Using this technique, the therapist slowly exposes the client to things that provoke their fear in approaching a sensitive topic. In the video, the client was afraid of confronting their coworker, and when asked the question, they gave a response on what they fear will happen, and the therapist guided them on how they could approach the coworker and express what is bothering them. With continued exposure, the client gets to see and confront their fears, and they can gain the confidence to act on what they want or need. Avoiding confronting the coworker worsens the situation and his feelings because they still have to perform the coworker’s part. The therapist brought this technique so well that the client couldn’t notice it. The question asked was similar to what a friend would ask, and the client approached it like they were talking to a friend.

Cognitive restructuring looks at the client’s negative thought patterns and tries to get the client to reframe their thoughts. The therapist tried to get the client to see how their thoughts affected his mood and feelings at work. The client was asked how they could approach the issue, and they gave a detailed explanation of how they could do it. Using this strategy, the client noticed how he could approach the issue instead of approaching it with anger. Identifying the negative patterns allowed the client to reframe how they could approach the issue, and they were given a timeframe of one week for them to role play in their next therapy session.