Hi there!
Welcome to this week’s blog post on This is How We Do at Step2.
Many of you reading this are either aspiring PWPs, trainees, newly qualified, or even close to qualifying. This week, I want to delve into a breakdown of step 2 LICBT interventions, mainly guided self-help.
These interventions include:
Behavioural Activation (BA) for Depression
Worry Management (WM) for GAD
Graded Exposure (GE) for Panic and Phobia
Cognitive Restructuring (CR) for Negative Thoughts (CR)
Exposure and Response Prevention (ERP) for OCD
Sleep Management
Stress Management
Problem-solving (PS)
Note:
It is important to stick to one protocol and many of you would know (trainees and qualified PWPs), however, if you feel that there’s a need to add other interventions'/tools, discuss this at supervision and remember to have a rationale behind it. Below I am only providing you with the treatment plan for each intervention and more detail for each one will be mentioned in the coming blog posts.
*******Disclaimer:******
These are only my suggestions, along with what one of my previous supervisors agreed with (they shared this with me when I was a trainee), however, there's always a need for adaptations.
The structure helps to know where you are (the PWP), but that won't always be the case as there are many things that come in treatment sessions that require flexibility and adaptations, such as extending session time, more sessions, etc.
Behavioural Activation for Depression
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Baseline Diary
Session 2 - Review Diary, Identify RNP activities, create difficulty hierarchy, new diary
Session 3 - Review Diary, engagement, difficulty, break it down, COM-B
Session 4 - Mid-treatment review - what’s working, what’s not working, explore barriers
Session 5 - Troubleshooting problems, add-on tools (CR, WM, PS, Stress, Sleep, & Relaxation)
Session 6 - Relapse Prevention (Staying Well Plan)
Worry Management for GAD
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Worry Diary
Session 2 - Review Diary, Classify Worries, if more (H) start WT, if more (P), PS
Session 3 - Review technique (WT or PS), explore barriers, COM-
Session 4 -Review technique (WT or PS), move on to the other technique
Session 5 - Troubleshooting problems, add-on tools (Relaxation, CR, BA, Stress, Sleep)
Session 6 - Relapse Prevention (Staying Well Plan)
Graded Exposure for Panic and Phobias
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Panic/Phobia Diary
(Panic Diary - look at - Physical Sensations, Catastrophic Misinterpretations, and Behaviours (Avoidance))
Avoidance - Graded Exposure
Catastrophic Misinterpretations - Cognitive Restructuring
Physical Sensations - Relaxation Training
(This is specifically for panic, not phobia. Please discuss with your supervisor if you’re struggling with a panic/phobia client).
Session 2 - Review Diary - start Graded Hierarchy & 4 Principles - Most Feared Situations - Task: Start with Least-Feared Situations/Places (Easiest)
Session 3 - Review Task - COM-B, Troubleshoot challenges - set task/weekly goal
Session 4 - Mid-treatment review - Keep moving up the hierarchy and address barriers
Session 5 - Troubleshooting problems, add-on tools (Relaxation, CR, BA, Stress, Sleep)
Session 6 - Relapse Prevention (Staying Well Plan)
Cognitive Restructuring for Negative Thoughts (CR)
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Thought Diary
Session 2 - Identifying NATs, then Hot Thought, Emotions, and Negative Thinking Styles (cognitive biases) - Tasks: practice noticing NATs and cognitive biases
Session 3 - Thought Challenging (evidence for and against) then formulate alternative/balanced thought - Task: practise CR with other NATs
Session 4 - Mid-treatment review - what’s working, what’s not working, explore barriers
Session 5 - Review and Troubleshoot
Session 6 - Relapse Prevention (Staying Well Plan)
Exposure and Response Prevention for OCD
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: OCD Diary
Session 2 - Review OCD diary, Understanding compulsive behaviours, Grading hierarchy and 4 principles
Session 3 - Start of a hierarchy of feared situations - graded and a plan to repeat, prevention response (no compulsions)& prolong
Session 4 - Mid-treatment review - Keep moving up the hierarchy and address barriers
Session 5 - Troubleshooting problems, add-on tools (Relaxation, Sleep, etc)
Session 6 - Relapse Prevention (Staying Well Plan)
Sleep Management
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale (Sleep Hygiene) - Task: Sleep Diary
Session 2 - Review Sleep Diary (decide on specific techniques: Stimulus Control and Sleep Restriction)
Session 3 - Review Technique and Sleep Diary
Session 4 - Mid-treatment review - what’s working, what’s not working, explore barriers
Session 5 - Troubleshooting problems, add-on tools (CR, WM, PS, Stress, & Relaxation)
Session 6 - Relapse Prevention (Staying Well Plan)
Stress Management
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Stress Diary
Session 2 - Stress Balance (Stress Bucket, BA)
Session 3 - Problem-solving
Session 4 - Letting Go (Worry Time)/ Cognitive Restructuring
Session 5 - Relaxation and Compassion
Session 6 - Relapse Prevention (Staying Well Plan)
Problem-solving
This is your standard treatment overview:
Session 1 - Psychoeducation and intervention rationale - Task: Problem Diary
Session 2 - Use the 8 steps to problem-solve
Session 3 - Review problem-solving technique
Session 4 - Troubleshooting problems, add-on tools (Relaxation, CR, BA, Stress, Sleep)
Session 5 - Relapse Prevention (Staying Well Plan)
NOTE:
Everything I have just mentioned is part of the intervention protocols. When you read about session 5 and add-ons, please discuss this with your supervisors, because in mid-treatment review and session 5, you usually get an idea of what extra add-ons you might use if needed to help the client make further progress, and ultimately, meet recovery.
Tip of the week
“Learn about these intervetnions by both applying them (your experience) and reading about them in the literature (theoritcal knowledge through textbooks, GSH materials like CEDAR and others, and journal articles). When you read the materials from cover to cover you will be able to come up with your own way of explaining the intervention to your clienrts and you will understand each one better and their structure.”
What’s Coming Next
In the coming week, I will begin explaining each intervention in detail and learning how to summarise your rationales and psychoed, as well as dealing with ambivalence and using motivational interviewing to evoke positive behaviour change as a PWP.
Also, write down in the comments what you would like to be mentioned in this newsletter.
You’re Not Alone
Recently, trainees have received their emails confirming that they’ve passed the course (CONGRATULATIONS!!!!!!!!!!!) and many are struggling to secure a qualified role (some services haven’t received funding or for whatever reason). This sucks and is extremely frustrating. Don’t lose hope. I have provided below three of my supporting statements that have led me to interviews and two of them secured me a qualified role. Use it as an example for you to write a legit supporting statement that will hopefully get you the role you want at the service you want to work at.
If you didn’t get the role at the service you wanted, that means there’s a better service for you. Don’t let that rejection make you feel that you’re incompetent. If you are qualified, that means you’re competent and can be an outstanding practitioner.
Don’t hesitate to message me if you need any tips and advice.
Keep it up!
Resources
Free
Paid
Trainee PWP Application Guide: Everything You Need To Succeed (Paperback)
Thank you for being part of this community. If you’re new here, then welcome to the Step2 community!
Remember to take good care of yourself at work, when you’re off duty and on the weekend.
Yours truly,
Hashil
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