KNR 253

Cognitive TherapyAnger ManagementHumor

Overview

Cognitive Therapy Austin, 2009 McKay, Davis, & Fanning, 1981

Anger Management Dattilo & McKenney, 2011 Internet

Humor Dattilo & McKenney, 2011 Austin, 2009 Internet

Cognitive Therapy

Psychotherapy Started in 1960’s Aaron Beck Albert Ellis

Used with Depression Anxiety

Post Traumatic Stress Disorder Obsessive Compulsive Disorder

Anger Stress Others

Cognitive Therapy Based on…

1. All of your moods are created by your thoughts. You feel the way you do right now because of the thoughts you are thinking at this moment

2. Emotions have little to do with actual events. In between the event and the emotion is realistic or unrealistic self-talk

3. Emotions come from what you say to yourself…your interpretation of the event

4. If you are feeling depressed, your thoughts are dominated by pervasive negativity

5. Negative thoughts that cause emotional turmoil nearly always lead to gross distortions or distortive cognitions

Cognitive Therapy

Seeks to identify and change distorted unrealistic ways of thinking and influence behaviors and emotions

These thoughts occur rapidly while in middle of a situation or when recall events from past

These are thoughts we always say to ourselves in certain situations

Cognitive Therapy

These thoughts are …AutomaticRepetitivePessimisticUnrealistic expectationsOverly critical self evaluationsSelf-talk

Distorted Thinking

Filtering Take negative details & magnify them while filtering

out all positive aspects of the situation Only see the negative comments in your performance

appraisal and not see all the positive ratings

Polarized thinking Things are black or white, good or bad. You have to

be perfect or you’re a failure. There is no middle ground

If you are not perfect you must be a failure

Distorted Thinking

Overgeneralization You come to a general conclusion based on a single incident or

piece of evidence. If something bad happens once you expect it to happen over and over again

I’ll never learn to dance I’ll never be able to trust anyone again

Mind reading Without their saying so, you know what other people are feeling

and why they act the way they do. In particular, you are able to know how people are feeling toward you

Jump to conclusions that are true for you and assume others share your belief

He’s just acting that way because he is jealous

Distorted Thinking

Catastrophizing You expect disaster. You notice or hear about a problem and

start “what ifs.” What if a tragedy strikes? A small leak in your boat means it will sink A headache means that you have brain cancer

Personalization Thinking that everything people do or say is some kind of

reaction to you. You also compare yourself to others, trying to determine who’s smarter, better looking, etc.

A man whose wife complains about rising prices hears the complaint on an attack on his ability as a breadwinner

Distorted Thinking

Control fallacies If you feel externally controlled, you see

yourself as helpless, a victim of fate If you feel internal control you are responsible

for the pain and happiness of everyone around you

Distorted Thinking

Fallacy of fairness You feel resentful because you think you know what’s

fair but others won’t agree with you If you love me then you will help do the dishes If you love me you would go dancing with me

Blaming You hold other people responsible for your pain, or

take the other tack and blame yourself for every problem

The teacher is responsible for my poor grade because she didn’t give good directions for the project

Distorted Thinking

Shoulds You have a list of ironclad rules about how you and

other people should act. People who break the rules anger you and you feel guilty if you violate the rules

I should never make mistakes I should never be tired or get sick

Emotional reasoning You believe that what you feel must be true. If you feel stupid and boring, then you must be stupid and boring

Distorted Thinking

Fallacy of changeYou expect that others will change to suit you

if your just pressure or cajole them enough Global labeling

You generalize 1 or 2 qualities into a negative global judgment

A person who refused to help you with your project is a total jerk

Distorted Thinking

Being right You are continually on trial to prove that your opinions

and actions are right. Being wrong is unthinkable and you will go to any length to demonstrate your rightness

Heaven’s reward fallacy You expect all your sacrifice and self-denial to pay off,

as if there were someone keeping score. You feel bitter when the reward doesn’t come

McKay, Davis, & Fanning, 1981

What Is Your Most Used Distortion? Filtering Polarized thinking Overgeneralization Mind reading Catastrophizing Personalization Control Fallacies

Fallacy of fairness Blaming Shoulds Emotional reasoning Fallacy of change Global labeling Being right Heaven’s reward fallacy

Cognitive Therapy Interventions

Goal is to help recognize and change distorted thinking Focus on present Problem solve Learn basic principles Learn specific skills

Thought stopping Listen to thoughts. When cognitive distortion occurs,

say “stop” to self or other person Restructure to a more realistic positive statement

Cognitive Therapy Interventions

Affirmations Positive, reasonable statements are made about

yourself They are stated in first person and in present tense

I am …

They are stated with conviction and should be repeated throughout the day

Helpful to place affirmations in places where they are visible and easy to read

Cognitive Therapy Interventions

VisualizationPractice desired behaviors in mind before

doing them Visualize yourself doing each component Ignore negative thought Relive successes instead of failures

Role play

Cognitive Therapy Interventions

Cognitive restructuring Systematic plan where distortions are

restructured into positive statements which are incompatible with distorted thought

1. Name your emotion

2. Describe the situation or event

3. Identify your distortions

4. Rewrite your distortions

Anger Management

Dattilo & McKenney, 2011

Anger Management

Is a cognitive-behavioral intervention Both learning and thinking are important in the

acquisition and maintenance of behavior Cognitive: based on distorted thinking; intervention seeks to

change thoughts Behavioral: problems based on environmental reasons that

result in poor social skills and not distorted thinking Cognitive-behavioral: intervention focuses on distorted

thinking and social deficits

Definitions

Anger Emotional excitement induced by intense displeasure

Grinding teeth, raised voices (behavior) Tense muscles, perspiration (physiological)

Aggression Anger often is a precursor to aggression Exhibition of actions toward people or objects with some intent to

hurt or injure Physical Verbal Gestures Bullying

Definitions

ViolenceViolence may come from aggressionFrequently seen in media

Murder Assault Rape

Anger Management

UsesBehavioral problemsMental health problemsLegal problems (incarcerated, probation)Others

Anger Management Interventions

Anger Control Program Anger Coping Program ZIPPER Strategy

Don’t Laugh at Me

ZIPPER

Z: Zip your mouth Hand motion stop, deep breath, finger across mouth like zipper

I: Identify the problem Deep breath, put finger to temple, identify problem

P: Put off what you want to do Pause, deep breath, “I may find a better way to handle this,” “Don’t get

angry.” P: Put yourself in control

“Stay cool,” put hands on hip, turn thumbs up, “I’m in control.” E: Explore other solutions

“What can I do?” Shrug shoulders, explore other options R: Return to what you were doing

“I’ve made it. Return to activity

Humor

Dattilo & McKenney, 2011

Have you ever benefited from using humor in your own life?

What are some ways humor might be beneficial in a TR setting?

Theoretical Foundations

Incongruity theoryDifference between what is expected and

what actually happensHas an element of unexpectedness

Psychological releaseRelease tension

Outcomes

Reduce anxiety & depression

Increase pain tolerance

Improve immune system functioning

Improve self-concept

Improve interpersonal relationships

Improve memory Assist with recovery

from surgery Assist ability to learn

Possible Uses in TR

Functional intervention/treatment Use with people receiving treatment for cancer,

dialysis, burns, etc. Use to help with memorization skills Others

Leisure education Humor development Humor appreciation Stress and humor

Possible Uses in TR

Recreation participationHumor roomsHumor cartsMoviesSkits produced by clients

Sample Programs

The Humor Project A Tonic You Can Afford The Healing Power of Humor How to Develop Your Sense of Humor The Comedy Club Humor Production Procedure Also provides a couple exercises

Activity: Add Some Nonsense

Making fun of problems can help people get new perspective and remove power of the problem Write 5 things that regularly cause you stress Number in order of least stressful to most stressful Write a short laugh sound after each sentence

“Ha ha” “Tee hee” Nobody ever listens to me….ha ha

Cognitive Therapy / Anger Management / Humor / Reminiscence Lab

Group session that enables group members to practice principles and techniques of cognitive therapy, anger management, humor, or reminiscence.