Behavior Change

Behavior change tool that you feel would be helpful for clinical practice. 

Counseling Tool Presentation
– 25 points

You will also complete one presentation this semester about a behavior change tool that you feel would be helpful for clinical practice. As mental health providers, many of us ask our clients to complete activities outside of therapy to aid in their progress. But how do we find ideas for relevant activities? And how are they grounded in what we know about how people learn and change?

For this assignment, you will be locating or creating a homework activity for a client that is based in concepts of learning and behavior change. (This can be a real client you are working with or you can create a fictional client.) You will have 15 minutes to present the tool to your “base group,” discuss how it relates to course material, illustrate how you would use it with a real or fictional client, and lead a group discussion about it. Like with the other presentations, you will create a 1-2 page handout, upload it to Canvas (along with a copy of the behavior change tool), and distribute it to your “base group.” Your grade will come from the quality and clarity of the material on your handout.

My goal for this assignment is to help you familiarize yourself with resources that you can add to your “toolbox” and use in your clinical work. There are amazing books and websites for this, but you may be too busy at practicum or in your clinical practice to search for them later! This will also help you see how the theories and interventions you are learning about in class can apply to clinical practice, and allow you time to self-reflect about which particular interventions fit for you as a mental health provider.

Opportunities to locate homework activities include:

· Collecting resources at your practicum site (books, handouts, etc.)

· Searching for books of tools that you can access free from the UST library site (e.g. ‘Treatments That Work’ series; ACT Made Simple; books with “homework,” “treatment planning,” or “toolkit” in the title)

· Locating books about interventions for specific groups (e.g. children), theoretical perspectives (e.g. DBT, motivational interviewing) or diagnoses (e.g. anxiety, depression)

· Searching websites like actmindfully.com.au or therapistaid.com (free, but not as comprehensive as the above resources)

· I will also share many more resources with you in class!

· If you prefer, you can also create your own homework activity. This can be helpful if you are working with a real client at practicum and want to create or modify something that you feel is the right fit for that client.

Want ideas?
Here are some topics from previous students to help get you thinking:

· Client with Major Depressive Disorder: A handout of information about behavioral activation ideas and a sheet to rate and track their progress for the week.

· Client with Social Anxiety Disorder: A handout of tips for how to be assertive, along with a list of exposure activities they want to do that will require assertiveness. They will fill out a worksheet where they write down their thoughts and SUDS levels before and after behaving assertively.

· Child client with anger outbursts: An “anger thermometer” worksheet they will fill out with you during your therapy session to help them recognize the signs that they are starting to get upset. Their parent and their teacher at school will track their expressions of anger each day and give them a small reward each day they use the thermometer and don’t have an outburst of anger.

· A couple who want to improve their communication: A worksheet of how to phrase criticisms in a healthy way, which you will use to role play healthy and unhealthy communication in the session. Then they will use this on their own for a week and report back.

· Client with high levels of stress: Information about relaxation strategies and a worksheet for them to monitor their physical sensations of anxiety and anxiety-related thoughts before and after using the strategies.

Please use the following headings for your handout. A copy of the grading rubric is provided on Canvas.

· Citation (2 points)

· Include an APA-style citation of the book, website, etc. where you found the tool or citations for any resources you used to help you create your own tool.

· Client Description (3 points)

· Include a brief description of your client, including demographic information, presenting problem, and diagnoses (if you are using a real client, make sure the information is deidentified)

· Ethical and Diversity considerations (5 points)

· What are 1-2 ethical considerations AND 1-2 cultural diversity considerations that you feel are important regarding the use of this tool in clinical practice? Although of course there is an overlap between diversity and ethics, make sure you are addressing each area separately (for example, mentioning considerations for using it with individuals experiencing poverty and also mentioning concerns regarding confidentiality, nonmaleficence, boundaries of competence, etc.).

· Link to Course Material (5 points)

· How
specifically is this tool grounded in theories of learning and/or principles of behavior change? Make 2-3 clear connections, such as how a course term, theory, or concept might apply. (In some cases, your article might explicitly discuss this but in other cases you will need to make those connections yourselves.)

· Discussion Questions (5 points)

· Write at least 3 discussion questions that you feel will get your group members thinking about the tool on a deeper level.

· Make sure you also include a copy of the resource in PDF form. This is typically allowable under the “Fair Use” copyright guidelines for educational purposes. (5 points)

Behavior Change Paper
– 45 points

This assignment will provide you with the opportunity to engage in personal behavioral change and to reflect on your own change process. My goals of this assignment are for you to: A) experience what it is like to attempt to change a behavior, B) apply concepts of learning and behavior change, C) refine your skills at using APA style, and D) hopefully benefit personally by making healthy behavioral changes!

At the beginning of the semester, I will ask you to choose a behavior that you would like to work on changing over the course of the semester. Since you will be sharing the behavior with the instructor and a small group of your classmates, please choose a behavior that you are comfortable sharing in some detail. Please select a behavior that you have some reasonable motivation to change so that this activity is meaningful to you! You might choose to:

·
Start a behavior, such as beginning an exercise or weight-loss program; or starting to cook a new meal each week;

·
Increase/improve a behavior, such as reading course material before class more often, improving sleep hygiene, meditating more frequently, being more assertive, or eating mindfully more often;

·
Or decrease a behavior, such as reducing caffeine use, stopping biting your nails, decreasing phone usage, viewing less television, etc.

Over the course of the term, I am asking you to make a serious attempt to change the behavior using theories and interventions from the course. I recommend that you keep a journal to help you do this. During class, we will have regular discussions, activities, and reflection opportunities that you can include in this journal which will help you identify behavior change techniques you will use. You can continue to use the journal outside of class to track your progress and prepare to write this paper.

Optional: If your goal is related to any topics included in the ‘Learn to Live’ programs, you can use this resource as part of your behavior change plan. It is available free of charge by going to

www.learntolive.com/partnersLinks to an external site.

and entering the code ‘STTHOMAS.’ You will first complete a self-assessment to see which area(s) you may benefit from the most, and will have the opportunity to choose any program you would like to complete. Programs include: sleep, stress/anxiety/worry, social anxiety, substance use, or depression. All programs are completely confidential and I will not have access to your results.

Once you have spent several weeks implementing your behavior change plan, please write a 5-6 page paper, double-spaced, in APA format (7th ed.). Make sure you cite the readings and other course material throughout. Your paper should address each of the questions below, and each one is worth 5 points. The paper will be graded based on evidence of critical thinking, depth of analysis, and evidence of personal reflection.

Please answer the questions in the order listed, and include first-level headings for Baseline, Implementation, and Post-Intervention, with second-level headings for the eight sub-topics. A copy of the grading rubric is provided on Canvas.

Baseline

1) Behavior, Beginnings, and Goals

· Provide an operational definition of the behavior you want to change and your goal (ex: “I want to sleep at least 7 hours per night at least 5 days per week. I will measure the hours slept based on time in bed with my eyes closed, regardless of whether I am truly asleep.”)

· Provide a detailed measure of where you began (ex: “I tracked my sleep for one week before beginning this project. I averaged 5.5 hours of sleep per night, and the hours ranged from 4.5-7 hours per night. I tended to sleep more hours on the weekend and fewer hours during the week. I drink coffee daily to try to be more alert and rely on naps on the weekends to catch up with sleep. On a scale of 1-10, with 10 being very alert, I would estimate that I feel a 3 most days.”)

· Make sure you include quantitative measurements when possible (but qualitative ones are encouraged too!).

2) Functional Analysis

· Complete a functional analysis/ functional behavior assessment to understand some of the factors that may be influencing your
initial behavior at baseline. For example, your goal might be to exercise more, but your initial behavior might be not exercising at all.

· Include this functional analysis, including antecedents, your current behavior, and consequences in your paper and share what you learned from doing so. It may be helpful to include a chart in your paper to visualize this!

· Remember that your “A’s” are the things occurring in the environment that encourage your
initial behavior and make it more likely. So if your initial behavior is ‘eating a lot of junk food’ then increased stress or lack of time might be “A’s” that lead to that behavior. If your initial behavior is ‘not exercising’ the same things could apply.

· Remember that your “C’s” are things occurring in the environment after your initial behavior. So if your initial behavior is ‘eating a lot of junk food’ then what happens after you do that? Do you feel relaxed? Do you have more free time than if you had prepared a healthy meal? If your initial behavior is ‘not exercising’ how do you feel after you choose not to exercise? What happens in your environment?

Implementation

3) Stages of Change

· What stage of change applied to your behavior initially? Did it change as you proceeded with the process? How did it influence the interventions you used along the way?

4) Interventions Used

· Please choose at least three interventions to try during the semester. Then, in your paper, tell us which interventions you utilized to change your behavior. Be specific about which ones you used and how they were utilized.

· Examples from the course might include: reinforcement/punishment, systematic desensitization/exposure, behavioral activation, Premack principle, stimulus control, modeling, increasing self-efficacy or self-regulation, changing schemas, scaffolding, incorporating the mesosystem, relaxation/meditation, urge surfing, values clarification, examining your motivation, etc.

· You are encouraged to employ cognitive principles in addition to strictly behavioral ones.

5) Problems and Challenges

· What problems and challenges did you encounter along the way and how did you respond to them?

Post-Intervention

6) Outcome

· Operationally define the outcome. (Ex: my goal was to increase my sleep to 7 hours per night at least 5 nights per week; I have been mostly successful because I now average 6 hours per night and sleep at least 7 hours 1-2 days per week)

· Do you feel you were successful?

· If you were successful, what benefits have accompanied the change? Are there any losses or negative consequences associated with the change?

· If you were unsuccessful, were there still some benefits or positive results

7) Future Considerations

· What do you see in the future for this behavior? What would help you maintain your progress or, if unsuccessful, what would help you be likely to make a change attempt again? What would you do differently if you had to initiate the attempt next semester?

8) Implications for Counseling

What have you learned from this process that you can take with you into your counseling work? I really want to hear your insights here! Please avoid the temptation to make this part very brief if you’re running out of room. Instead, make small edits to other areas to ensure you leave room for this part.

There will also be 5 points for APA style, so be sure to review how to format title pages, headings, references, etc. on Canvas.

Counseling Tool Presentation Handout

Counseling Tool Presentation Handout

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeCitation

2 pts

Included a correct APA-style citation of the book, website, etc. where you found the tool or citations for any resources you used to help you create your own tool.

1 pts

Included an APA-style citation with some errors.

0 pts

No citation was included.

2 pts

This criterion is linked to a Learning OutcomeClient Description

3 pts

Included a brief description of your client, including demographic information, presenting problem, and diagnoses

2 pts

Included a description but may have been too vague or was missing important demographic information.

0 pts

No client description was included.

3 pts

This criterion is linked to a Learning OutcomeEthical and Diversity Considerations

5 pts

Clearly addressed 1-2 ethical considerations AND 1-2 cultural diversity considerations that you feel are important regarding the use of this tool in clinical practice. Each area was addressed separately.

3.5 pts

Ethical and diversity considerations were addressed, but handout would have benefited from more detail or depth of critical thinking.

2.5 pts

Only clearly addressed diversity OR ethical considerations, or only very briefly addressed this section.

0 pts

Did not include ethical or diversity considerations.

5 pts

This criterion is linked to a Learning OutcomeLink to Course Material

5 pts

Clearly described how the homework activity was related to theories of learning, including several specific course terms/concepts. Showed a strong understanding of course material.

3.5 pts

Briefly described how the homework activity was related to theories of learning, including specific course terms/concepts. Would have benefited from including more detail or clarity to show strong understanding of course material.

2.5 pts

Only very briefly mentioned course material or only referenced broad theories of learning and not specific terms and concepts.

0 pts

Did not include a description of how the activity related to theories of learning.

5 pts

This criterion is linked to a Learning OutcomeDiscussion Questions

5 pts

Included at least 3 clear and thoughtful discussion questions that promote deep reflection of the material.

3.5 pts

Included at least 3 discussion questions but the handout would have benefited from more complex or thought-provoking questions.

2.5 pts

Only wrote 1 or 2 discussion questions or wrote questions that did not show a strong understanding of the resource or course material.

0 pts

Did not include any discussion questions.

5 pts

This criterion is linked to a Learning OutcomeCopy of Resource

5 pts

Included a copy of the homework activity. Activity was clear and provided structure for clients to learn a skill or concept.

3.5 pts

Included a copy of the homework activity, but the activity handout was lacking clarity or was unclear how it would help the client learn a skill/concept

0 pts

Did not include a copy of the resource

5 pts

Automatic Thoughts

© 2013 Therapist Aid LLC Provided by TherapistAid.com

Our thoughts control how we feel about ourselves and the world around us. Positive thoughts
lead to us feeling good and negative thoughts can put us down. Sometimes our thoughts
happen so quickly that we fail to notice them, but they can still affect our mood. These are
called automatic thoughts.

Oftentimes, our automatic thoughts are negative and irrational. Identifying these negative
automatic thoughts and replacing them with new rational thoughts can improve our mood.

Trigger Automatic Thought New Thought

EXAMPLE: I made a
mistake at work.

“I’m probably going to be fired. I
always mess up. This is it. I’m no

good at this job.”

“I messed up, but mistakes happen.
I’m going to work through this, like

I always do.”

Midterm Review of Theory-Based Interventions

In small groups, read the case study below and answer some of the questions provided. You will only have time to

discuss a few of them, but the ones that you don’t answer in groups can be a helpful study tool for the exam!

You are working with a 20 year-old, Black, cisgender, female client named Angela who experienced a traumatic car

accident a few months ago where she was seriously injured. Since then, her physical injuries have healed, but she has

been having panic attacks and other anxiety symptoms, such as feeling “edgy.” She tells you the car accident was her

fault and since then, she has doubted her driving abilities and worries she will get into another car accident and could

possibly die or kill someone. As a result, she has been avoiding driving.

Angela works 20 miles away from her home and needs to continue working in order to help her family pay bills.

Unfortunately, there is not any public transportation between her home and workplace, so she has been relying on her

brother to drive her. Sometimes he is unable to do so, or is late, so her supervisor has been getting upset and she has

given Angela two written warnings. Angela tells you that she is upset and disappointed in her work performance, but

doesn’t think she’ll ever drive again because “the risk is too high.”

When asked to describe her mood, Angela reports feeling “low” and “sad.” She has been avoiding spending time with

friends because she does not feel she would be “fun to be around” and is spending most of her free time alone in her

apartment. She tells you that she has been having trouble sleeping, feels she is overeating, and is very upset that she has

gained 15 pounds in the past two months. Angela tells you that her health and her appearance is important to her and

she has been considering downloading the Noom app to help her lose weight. She has also been investigating the cost to

join the local Anytime Fitness.

Her diagnosis is:

 F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood

Her goals on her treatment plan are to:

 Learn skills for managing anxiety and panic attacks

 Improve mood

 Engage in healthy eating behaviors

There are many interventions that you could use to accomplish the goals in Angela’s treatment plan! Please choose

some of the questions to answer in groups, and feel free to add any information to Angela’s case that would be helpful

for you!

There are no right/wrong answers to these questions. They are here for you to reflect on the concepts and how they

may fit with a clinical setting.

Developmental and Cultural Interventions

 Even though she is 20, Angela may still be experiencing the personal fable or imaginary audience. How might

those things impact her driving ability or feelings about her driving skills?

 You feel that Bronfenbrenner’s Bioecological Systems Theory provides a helpful framework to understand the

forces that are impacting Angela and decide to explain it to her. Role-play how you might explain each part of

the theory to Angela and work with her to decide together how her microsystem, mesosystem, etc. are

impacting her. (One person in your group can play Angela and one person can play the therapist. The others can

provide feedback and suggestions after the role-play!)

Classical Conditioning Interventions

 You decide that exposure therapy would help Angela resume driving. Would you use imaginal exposure or in-

vivo exposure? Why? What factors would you consider in making this determination?

 How could you use counterconditioning instead of simple exposure therapy? What is the difference between

counterconditioning and exposure therapy?

Operant Conditioning Interventions

 How might you incorporate reinforcement to help Angela resume spending time with her friends and improve

her mood? What specifically would you use as the reinforcer? What type of reinforcer would that be? What

schedule of reinforcement would you use?

 Role-play creating a token economy to help Angela meet one of the goals on her treatment plan. Have one

group member play “Angela” and have one member play the therapist. Work with Angela to determine a set of

“rules,” what she will use as “tokens” (stickers on a worksheet, checkmarks in a planner, etc.), and determine a

variety of backup reinforcers she can choose from (see pg. 104 in your textbook).

Social Cognitive Interventions

 Which self-regulation strategies do you think Angela would benefit from using to achieve one of the goals on

her treatment plan? How would you recommend that she implement them?

 What could you do to help increase Angela’s self-efficacy surrounding healthy eating?

 You decide to teach Angela some breathing techniques that she can use when she feels anxious. Role play how

you would use modeling and guided mastery to help her learn the techniques. One person in your group can

play Angela and one can play the therapist. The others can observe and provide feedback and suggestions after

the role play! (If no one in your group knows how to do any breathing techniques, you can substitute a

mindfulness or meditation skill or other relaxation/anxiety management technique.)

Motivational Interviewing/ Stages of Change Interventions

 What stage of change do you think that Angela is currently in regarding changing her eating behavior? What

stage do you think she is in regarding changing her driving behavior?

 What processes of change may you want to use based on her current stage(s) of change?

 Role play using the motivational interviewing “OARS” with Angela. One person in your group can play Angela

and one can play the therapist. The others can observe and provide feedback and suggestions after the role

play! The therapist should ask ‘Angela’ to talk about her problem and her feelings about making changes and use he OARS skills during the discussion.

MIDTERM STUDY GUIDE

This study guide is intended to help you focus your studying. Please keep in mind that the material that was

presented in class which also appears in the Ormrod ‘Human Learning’ text or other assigned readings has the

highest probability of appearing on the exam. However, there is always some material that is only in the book

that will be on the exam, as well as material that we only covered in class.

The exam will be a combination of multiple choice and short answer/brief essay questions. There will be

approximately 20 multiple choice questions (20 points) and you will choose approximately 5 of 8 short answer

questions to answer for four points each (20 points).

STUDY TIPS

Because I want you to be able to apply what you learn to your future career, I want you to know about the

topics on this study guide in depth. In other words, try to do more than simply memorize the definition –

understand why it is important, be able to discuss an example, know how you would use the material in

clinical practice, etc. Some ways to help you do this are:

 Create a detailed outline for all the information below. Include the definition (in your own words), an

example, and also extra information to help you understand the concept in depth. For example, why is

it important? How does it apply to clinical practice?

 If two terms seem similar, write down the difference between those terms.

 Give a “mini lecture” (aloud or in your head) explaining what you learned about each concept. If you

feel like you could teach it to someone, you’ll do well on the exam!

 Make a study group. Have each member be the “expert” on one chapter and teach it to the others in

the group.

Week 1 / INTRODUCTION TO LEARNING AND BEHAVIOR CHANGE (Ch. 1; Hays article)

 Defining learning and how we know a client has ‘learned’

 Advantages and drawbacks of theories

 Plasticity, neurogenesis, and consolidation

 ADDRESSING framework and culturally responsive CBT (from Hays article)

Week 2 / CULTURAL CONTEXTS OF LEARNING AND BEHAVIOR CHANGE INTERVENTIONS (Ch. 9 page 284-

301; Ch. 10 page 312-325; selected article about culture/interventions)

 Constructivism, schemes (and accommodation and assimilation), equilibration

 Piaget’s stages

 Imaginary audience and personal fable

 Types of thinking in post-formal thought

 Erikson’s stages and focus of each stage

 Self-talk/private speech and inner speech

 Internalization

 Zone of proximal development and scaffolding

 Mediated learning experiences

 Bronfenbrenner’s theory

 How the above concepts could apply to the therapy environment

 Be able to discuss one of the articles related to adapting interventions to a specific population

Week 3 / CLASSICAL CONDITIONING (Ch. 3; Ch. 4 page 87-101; Supplemental Article)

 Orienting reflex and habituation

 Be able to label the terms in an example about classical conditioning

 The ‘Little Albert’ classical conditioning study

 Contiguity vs. contingency

 Generalization and discrimination

 Counterconditioning

 Extinction

 Self-monitoring (from assigned article)

 Be able to discuss how classical conditioning could lead to the development of a mental health disorder

and how classical conditioning techniques could help treat a mental health condition

Week 4 / OPERANT CONDITIONING (Ch. 3; Ch. 4 page 87-101; Supplemental Article)

 Be able to identify the differences between classical and operant conditioning

 Law of effect

 Positive/negative reinforcement and positive/negative punishment (be able to label examples)

 Schedules of reinforcement and types of reinforcement

 Shaping vs. chaining

 Premack principle

 Generalization and discrimination

 Active and passive avoidance learning

 Be able to discuss how operant conditioning could lead to the development of a mental health disorder

and how operant conditioning techniques could help treat a mental health condition

Week 5 / SOCIAL COGNITIVE THEORY (Ch. 5)

 Vicarious reinforcement and punishment

 Outcome and efficacy expectations

 Reciprocal determinism/ causation

 Modeling and the facilitation, inhibition, and disinhibition effect

 Self efficacy

 Guided mastery

 Self-regulation and strategies to improve it

 How the above concepts could apply to the therapy environment

Week 6 / TRANSTHEORETICAL MODEL OF CHANGE & MOTIVATIONAL INTERVIEWING (Two supplemental

articles)

 Stages of change

 Processes of change

 Four principles of motivational interviewing and OARS of motivational interviewing

 Be able to identify examples of the above terms and how they could relate to the clinical environment

Week 7 / LEARNING AND BEHAVIOR CHANGE TOOLS FOR CLINICAL PRACTICE

 There were no readings for this week.

NOTE: You are not expected to read all of the additional articles on Canvas that your group members

presented to you. Just know a basic description of the interventions (flooding, behavioral activation, and assertiveness skills).

********************************SAMPLE MIDTERM EXAM. *************

The following are examples of multiple choice and short answer/brief essay questions related to

material from the first half of the semester. None of these are actual exam questions but will give you

an idea of the types of questions that may be asked.

1) In Pavlov’s study of classical conditioning, salivation to meat was the ______________ and

salivation to a buzzer/bell was the ________________.

A. Unconditioned response; conditioned response

B. Conditioned stimulus; conditioned response

C. Unconditioned response; unconditioned stimulus

D. Unconditioned stimulus; unconditioned response

2) After being attacked by a dog, Marcus begins to fear dogs. His therapist is concerned about this,

so the therapist repeatedly shows Marcus dogs in the neighborhood without allowing him to get

attacked. In other words, the therapist is repeatedly presenting the CS without the UCS. Marcus’s

therapist is using which principle?

A. Relativistic thinking

B. Mediated learning experience

C. Spontaneous recovery

D. Extinction

3) You are working with a young child, Pa, who is displaying many disruptive behaviors, including

cursing. You and Pa’s parents decide that the next time she curses, her parents will take away Pa’s

videogame time for one week. By taking away videogame time, Pa’s parents are using:

A. Negative punishment

B. Positive punishment

C. Negative reinforcement

D. Positive reinforcement

4) You are working with a client who has a diagnosis of Gambling Disorder. You know that reducing

gambling behavior can be a challenge because slot machines, scratch-off lottery tickets, and most

other forms of gambling pay off based on what schedule of reinforcement?

A. Fixed ratio

B. Variable ratio

C. Fixed interval

D. Variable interval

5) When an older sibling models the behavior of ‘appropriate dinnertime behavior’ to their younger

sibling, it increases the frequency of appropriate dinnertime behavior in the younger sibling. This is

referred to as:

A. Disinhibition effect

B. Facilitation effect

C. Inhibition effect

D. Modeling effect

6) According to Bronfenbrenner, society’s norms and culture are a part of our:

A. Microsystem

B. Mesosystem

C. Chronosystem

D. Macrosystem

Answers for 1-6: A, D, A, B, B, D

8) Define positive reinforcement and negative reinforcement in your own words. Describe an example

of how they could each be used to increase the frequency that a therapy client would complete

‘homework’ assignments.

9) How might you implement self-monitoring with a client to help them improve their social skills?

10) According to Erikson’s ‘Industry vs. Inferiority’ stage of development, what are some challenges

you may see in a client who is 10 years old?