意象在認知行為治療應用培訓

IntegratingImageryWorkintoyourCBTClinical2015／7／13日—、、預是認知行為治療(Cognitive-behavioraltherapyCBT)的培訓班將根據(jù)《意向在認知行為治療中運用的指南》(TheOxfordGuidetoImageryinCognitiveTherapy,Hackmann,Bennett-Levy&Holmes,2011)中概述的治療技術的信心。該培訓特邀請悉尼大學心理學專業(yè)JamesBennett-Levy教授為大家講解，第二天下午邀請大學博士教授為大家、、JamesBennett-Levy,UniversityCentreforRuralHealth,UniversityofSidney,Australia.澳大利亞悉尼大學心理衛(wèi)生專業(yè)，他所創(chuàng)立的治療師技能培養(yǎng)的DPR模型和自我練習／反省訓練計劃（SP/SR）被學術界廣泛應用，并深刻影療手冊：TheOxfordGuidetoBehavioralExperienceinCognitiveTherapy(2004),theOxfordGuidetoLowIntensityCBTInterventions2010)andtheOxfordGuidetoInsideOut:ASelf-Practice/Self-ReflectionWorkbookforThes(Bennett-Levy,Thwaites,Haarhoff&Perry,2015)featurestheSP/SRapproachtotraining.、、07月13教授教授Prof.JamesBennett-意象應用的技Prof.JamesBennett-Prof.JamesBennett-07月14Prof.JamesBennett-、、、、 CBT的工作坊。CBT的一天，你想到了什么？Haveimageryaboutthatday?想象你最焦慮的體驗，maybeanexam,sometimesyoufeelreallyanxious.Maybejustcloseyoureyesforamoment.Doyounoticehowaboutfeelsinyourbody?Doanypicturescometomind?Ifyounoticethat,pleaseputupyourhand.Ashumanbeings,wehaveimages,picturesandordinarysensations,especiallywhenwehavestrongemotion,happyemotion,sademotion,anxiousemotion.Whatwehavelearnedatthelast15yearsisthatimageryaretermenslyimportantinwithpeoplewhohaveproblemswithanxiety,depression,eatingdisorders,OCD,bipolardisorder.Wehavelearnedthatworkingwithimagery,thepicturecanactuallybeinaquickerwaytogetchangethanjustbytalkingtherapy,becauseimagerieslinkdirectlytoemotionandthebodyfeeling.Wordsdonotnecessarilydoso.Afterwefindthatwealwayssaying,Iknowthisthingliterarily,butmyheartfeelsdifferent.That’sbecausewehavetwodifferentwaysofprocessinginformation,verbalandToday,we’llseethisforourselves.We’lldosome alexercises,soyoucanexperiencetheaffairsofimagery.Soyou’llunderstandforyourselfit'simportant.Andthatwillhelpyouuseimageryworkwithyourpatient.IFYOUHAVEANYQUESTIONS,ATANYTIMEINTODAY,PLEASEASKPUTUPYOURHAND.PLEASEWorkshopGoalsFirstofall,mygoalfortheworkshop?Giveyouanunderstandingmapofunderstandingimagery.Vividpicturesinourmind,auditoryimagery.Thinkaboutsomethingthatyourmothermightusedtowarnyouwhenyouwereachild.Hertoneandhervoice.Sothat’stheauditoryimagery.Nowyourmotherisn’tintheroom,butyoucanhearhervoice,herwords.WorkshopPlanMorningDo’sandDon'tsofImageryChangingNegativeImageryPostLunchChangingNegativeImageryPositiveImagery:CreatingNewWaysofBeingWhatreservationsdoyouhaveaboutusingimagerywith1 不是所有人的想象力都一樣好，有些人想象力貧乏，怎么辦2 有些人想象時情緒反應過于強烈，怎么辦3 子非魚焉知魚之樂。如果治療師理解錯了，怎么辦YOUR2minutes:yourgoalfortheworkshopWriteDownUSEOFWhatgetsinthewayfortheBellT.,Mackie,L.,&Bennett-Levy,J.(InPress,firstview).‘Venturingtowardsthedarkside’:theuseofimageryinventionsbyrecentlyqualifiedcognitive-behavioralthes.ClinicalPsychologyandPsychotherapy,inpressalexperienceof(Lackof)PerceivedExpertise/WhatmightClientsWhatmightColleaguesItmightgetoutofHarperCollinsDictionary:“Animageisamentalrepresentationofsomething(especiallyavisibleobject)notbydirectperception,butbymemoryorimagination”.A.T.Beck(1970):thereisclinicalevidencethat‘unrealisticpictorialimagesexertsignificantinfluencenotonlyonaffectandmotivation,butalsoonthepatient’sovertbehavior.’Jung(1935)”Whenyouconcentrateonamentalpicture,itbeginstostir,theimage enrichedwithdetails,itmovesanddevelops.”EXERCISE:PinkElephantonyourDon’tsuppressthestrongimage.Weneedtosupportourpatient.Ifdistract,theimagecancomeback.IMAGERYinPartofBehaviorTherapysince1950s系統(tǒng)脫敏)Differentkindsofimagery:Whenyouaskthepatient,pictureorbodysense,theyareallimagery.WhenpatientssayIhavenoimager,dosomeexercises/behavioralexperimental,bitealemonorremembertheirhouses,thedoors,thewindows,thetablesandsoon.Increasingevidencebaseacrossdisorders(anxietydisorders,depression,eatingdisorders,psychosis,painetc.)癥狀越嚴重，想象越生動。TheDo’sandDon’ts:Formulate–whatdoeshavingtheimagemeantoCanPatientsmaywanttoknowWHAT&WHYtheyareng.對PTSD患者而shoulder些碎片化。Wecanapproachtheimagery,understandit,andworktogethertochangeit.在運動心理學中，imageryisveryhelpfultobuildnewskills.Forpatientswithsocialanxiety,theycanexerciserole-playandpracticeintheirmindsduringsessions.PutclientatCollaborativee.g.eyesclosedornotForewarnre-possibleaffect恐懼癥患者可能會想象到他們感覺非常害怕That’squitenormal.”TheDo’sandDon’ts:Using ,presentTense(“IamFeelingandBodyHowdoyouWherenoticethatinyourTheDo’sandDon’ts:EnhancingVividnessandDetaileddescriptionofenvironment豐富的細節(jié)Canyou lmealittlemoreabout…Beclearaboutthetime(where,Makeimagesmultisensory(sight,sound,touchRichdetailofactionexperienceslowmotion對PTSD閃回的碎片化拼成整個事件，gothroughthestoryasithappened.Afterngthat,haveadeepbreath.Experience‘fromtheinside’first (notobserve)–orbothTheDo’sandDon’ts:SessionStructureofImageryLeaveenoughtimeincludingFirsthalfofsession?DiscusswiththeOftenacrosssessionsTheDo’sandDon’ts:ProcessTherapeuricEngagementSocraticQuestions(提問法)–client’sEmpathy?Before/After.Butnotduringtheimagery,becauseweneedtodragthemoutofKeepcheckingwiththeclient–“Whatareyouseeing?What’shappeninginyourbodynow?”Bealerttonon-verbalSafeplaceReflectdelightinvoice(positive3PTSD，5年前倫敦沉船事件幸存的安全員，由于未能救上一位老人。在對該患者進行意象治療時，將其之前的拼湊起來。Q1:A11～2sessions.A2:這種時候治療師要做的事情是對其的意義進行重構，changethemeaningoftheimagery/experience.例如，因遭遇而不再接近汽車的患者，他因為當dying這種留下來了。因此，我們要做的事情就是重構該意義，rationallyandGoalSettingusing mendedbysomeCBTthes(e.g.JudyBeck),sportsDifferencefromusualgoalPresentNeedtocreatecontext–e.g.“Imageit’s6monthstime…you’refeelingontopofworld…you’veachievedwhatyouwantedetc.”Preparestate(relaxed,leguncrossed,glassesoffUsepresentCreateemotionalconditions(feelgood,successfulworkshop…h(huán)owfeel?What’sgoingthroughyourmind?)Makeimagesmultisensory(emotion/sensory/Beclearabouttimeandenvironment(imagingyou’resittinghereinayear’stimeandyouhavenowgreatlyexpandedyourskillsandconfidenceinusingimagery…reflectonthatworkshopayearago,howwasithelpful?Whatdidyoucomeawaywith?WhatdidyoudotomakethemostofthatdaytoenhanceyourGoodSocraticQuestions(e.g.Whatdoyounoticeyourselflearningduringtheworkshop?Whatdoyounoticeyourselfngtohelpyoutolearnwell?etc)1、讓來訪者自己對Goalsetting2、當來訪者感覺緊張時，可能是因為他們并不知道接下來會發(fā)生什么，因此程應該slowdown。 一般來說，治療師不需要進入來訪者的意象，但是在SafePlaceImagery時例外。如果治療師是來訪者唯一的safeplace，那么治療師就需進入來 Imageryaside. 此時來訪者的strategies使用不當成為了obstacles覺得你這個方有什么問題嗎？”Map1:ImageryasFunctionalEquivalenceIt’sacausal(maintenance)NegativeimagesmaykeepproblemsPositiveimagesmaykeepmotivationgoing(thoughnotalwaysinthedirectionyoumaywant)Changingimagesmaychangeemotion,feeling,motivation,behaviour.Map2:WhyImageryissoimportant:ItsrelationwithGoals(Conway,Meares&Standart,Emotion(Holmes&Mathews,2005,Map3:NegativeandPositiveImagery:ImageryinCBTCBT:Usualfocusnegativeimagery(+transformation)“Imagesareusuallyquitebriefandoftenupsetting;manypatientspushthemoutoftheirmindquickly”(J.Beck,1995)“Imagesinpsychopathologytendtobehighlyintrusive,distressingandrepetitive”(Hackmann,1998)Map3:ImageryinSportsPsychology:Creative,PositiveFocus(WATCHATransformingNegativeCreatingPositiveNatureofHighlevelofnegativeElicitpositiveemotionsexcitement,warmth,ProcessofEvokeandunpack Re-liveusingnewReflectiveConstructpositiveReviewandReflectiveFocusof negativescenariosSimulatewiderangeofto ToalleviatenegativeNofurtherinvoluntaryrecallofnegativeimagesNewwaysofbeing WhatthethesHelptheclientstobewiththeirHelptheclientslthetruthortheChangetheclients’Map4:ATaxonomyofImageryDirect AssessmentincludingEvocationManipulationofDiscriminationbetweenimageryandTransformativeEmotionalbridge PositiveImageryImagerytoEnhancePerformance(goalsetting,skilldevelopment,problemsolving)CreatingNewWaysofEXERCISE:ImageryinUsingmusiccanbeveryhelpfulandpowerfulintheimagery,tohelpclientaccesstothespecialemotion.Selectyourownmusic.Selectdifferentmusicindifferentmood.Map5:TheLewin/KolbexperientiallearningcircleappliedtoExposuretorealorimaginedcuesPlantocheckoutortest

Imagerycontent,meaning,significance,emotion,impact,andassociatedonthevalidityoftheappraisalsimageryandreactionstoConsider Map6:KeyProcessofTransformingNegativeMakinganEmotionalBridgetotheAssessmentofPatientstendto lustheirflash-backRule1:Ifyoudon’task,youdon’tResponse(maintainingWhatisthecontentoftheWhatishappening?-Whatleduptothis?-Whathappensnext?–Whatdoesthismeanaboutyou?Otherpeople,theworldetc?ExaminingthesignificancegiventoimageryRealisticreflectionofWarningorCapableofaffectiveWillleadtoimpulsiveActuallysomethingreal?EmotionalImpactinthehereandnowMaintainingFactorsWhat’stheresponsetoHowdoesthe reacttoit?What’stheeffectof ’sreactiontotheWhathappenstotheimageandappraisalsofit?What’sthesourceofthisimage?Whenintheirlifecantheclientrememberhavingthesortofsensoryandemotionalexperiencedepictedintheimages?Whendotheyrememberhavingthoughtsandfeelinglikethis?(EmotionalBridgeTechnique)Micro-formulationof Summary:withanyimageryCASE:RecurrentDepressionRecurrentdepressionsinceAcuteepisode–started2weeksprevioustoappt.Feeloutofcontrol,Nomotivation–sittingwatchingTV,eating,feellikeleavingfamily,efforttogotosupermarket,offwork“Beendisconnectedfromthefamilyallmy“Beenthinkingalotaboutmyrelationshipwithmyfamily”(ororigin)…memoriesContext:Earlyinherlife,shewaswithherBF,gotpregnant,6months.Shelostherbaby.Shehadverybadrelationshipwithhersister.Hersistersaid,“It’sjustaswellyoulastyourbaby.You’renotmarried.”Dadwasdrunk,Sisterwasenvy,Motherwasbusyoftakingcareofherdad.Shethoughtnobodycaresabouther.Nowsheisahappywifewith3kids.Herhusbandsometimesgotopub,don’thavetimewithher,whilehersister’swordsappears.Sometimesshecan’thelptothinkofthat.Shedoeverythingtoavoidit.Butthememoryrecurs.ShehearswhathersistersaidinherPictureofSister-“JustasPictureofSister-“JustasLosing

NoonelooksforAvoidmemory

EXERCISE:Micro-formulateanFormintopairsorgroupsofChooseaclient’simage(oryourown):Micro-formulateContent:whatisitfor?Appraisalsandemotions–aboutthecontentAppraisalsandemotions–abouthavingimageryImpact&maintainingfactorsOriginDiscussinyourpairorgroup:Howusefulwasthis?HowmightitbehelpfulinManipulationofTypesofMeta-beliefTypesofManipulationTheimagerealTypesofMeta-beliefTypesofManipulationTheimagerealManipulateimageintodemonstrateitexternalonlyamentalSuppressingimagewillkeepitat Allowingimageintomymindmakememad,TestwhethertheimagescanmakeonemadorbeIfIhavethisimageinmind,I’llactonoritwillaffectTesttherealityofthought-eventandthought-action分：<3；3～5；5～7；≥8。請<3和3～5分的學員自己的意象。3、Discuss&Share4、Q&A臨床經驗中，很多人會把“電視機”與“貞子”聯(lián)系起來，使得情電視機比等更易給人一種控制感。最重要的，是給感。DiscriminationofDiscriminationusuallytakestheformofBehavioralOftentwokeyDoestheImagereflectDiscriminatingThenvs.Now-sameordifferent?CASE::Imagesvs.Reality:BirdPhobiaIfImakeeyecontactthebirdwillseefearinmyeyesItwillfetchitsfriendsTheywillallattackMyheartwilljumpoutofmyLikelysource?–HavefrightenedbyaflappedbirdwhenshewasaBehavioralTestwhethertheirimagewillturnouttobereality.Testwhethertheirbeliefsreflectthereality.CASE:SocialPhobia:observerimageofselfTheyhaveverystrongimages.Imageofownface,vividlyredandBulliedatImageofownface,vividlyredandBulliedatschoolforSelfSelffocused,Hidesface,I’muglySenseselfandappearanceBeforeconversation,lettheclientpredicthisredlevelofbrushing.Make CASE:Thenvs.Now:MRIEnclosedbyBreathingDangerofBreathingdifficultonNoNo-onetoPhysicallyEnclosedbyBreathingNodangerofBreathingcalmonControlviapushSympatheticdoctorNotphysicallyImageherselfisgoingintotheConsequence:Nodangerwithherbodyinthescanner.Thescannerisdifferentfromtheaccident.Practiceafewtimes.ThentheclientcangetintotheEXERCISE:TransformationofimagesandPrinciple:ProvideawiderUpdateaspectsoftheimagetomakeitmore ygeneratingpositiveimagesofthefutureCASE:IntrusivememoriesinPTSDIntrusionsarerecurrentfragmentsofmemory.TriggeredautomaticallyRetrievedwithouttime-codeorcontextPTSDWork:Identify‘Hotspots’(Grey,Young&Holmes,2002)Hotspots=Worstpartsofthememory=Mapcloselyonto=Momentswhenthemeaningchanged,usuallyfortheworsePTSDWork:3stagesmodel(Ehlers,Clark,2000)Reliving–identifyappraisals/meaning,Gothroughthewholestory,slowly.Identifythemeaningofthehotspotsfortheclient.ThePTSDpatientsmayhavestrongemotionalandsimilarphysicalbodyfeelings.Don’tdoimagerynow.Justtalking,discussing.“Patientsknowthefactinmind,butnotinheart.”Updatehotspots–Insertnewmeaning:AndwhatdoyouknowaboutthatInsert/Changethemeaningofhotspots.The,“Whatdoyouknownowthatyoudidn’tknowatthatmoment?”Dotheimageryagain,lyourselfwhatyoudidn’tknowbefore.WorkingwithIntrusiveMemoriesinDepression(Brewin,Wheatley,Paetal,IntrusivememoriescommoninEmphasisonloss& alPresencepredictscourseofdisorder(Brewin,Reynolds&Tata,Bringmemoryfullyintoawareness:elicitsensoryexperience,StageSuggestsBringmemoryfullyintoawareness:elicitsensoryexperience,StageandmeaninggiventoStageAskwhatneedstohapped(intheimage)inordertofeelStagePracticeversionsofnewimageuntilaffectdrops&beliefsStageIdentifyanyadditionalintrusiveimagesthatemerge,andCASE:workedonMiscarriageThe:“Whathappenedhappened.Notaboutexcusingthem.Wecan’taltertheexperience(whathappened),butcanaltertheexperienceoftheexperience.”6SessionSession1 Identifiedruminationsre-familyoforiginanelement-intrusive2PreparationforimageryrescriptingGoalsettingusing3IRofchosenmemory;–imagery4“Can’tgetpassangerwhenpracticingimagery”–Morecouragetospeaktosister.“Spokenwithsupervisoratwork.Resolved.”PossiblevisitbyRehearsedwhatwould5–PerseveredwithIR.Work,Homebetter.PregnancyterminationmemorytoopainfulforIR.So:TherapeuticWriting.LetterstoMother,Sister,Father.Client’sendoftreatmentreflectionsonIcan’tchangewhat’shappened.Inowseeitinadifferentway.We’reallchildrenatheart.Iguessthere’ssomeformofforgiveness.Itwasn’tanidealway,butweallmakemistakes.I’msuretheydeepdownknowthattheycouldhavedoneabetterjob.ImagerytoTransformPhase1:Reliving(5Selectanexperiencewhereyoueither:(1)experiencesembarrassment(andstillfeelabitcringyaboutit)or(2)byaccidentcausedamilddegree(NB)ofhurtorupsetphysicallyorpsychologically(stillfeelabitcringy,butnotresidualeffects)Noticefeelings(physical/emotional)asyourunitthoughyourmind.Whatdidyouconcludeaboutyourself/otherPhase2:VerbalRe-appraisals(5Phase3:UseTransformationalStrategy(5e.g.Discrimination–Whatdoyouknownow(vs.then)?Different(e.g.fromanother orview)?Manipulateimage(smaller/larger,fade,shatteretc.)Debrief(5mins):Howdoesthatfeel?Anydifference?Whatdifference?MakinganemotionalBridgetotheExplorethecurrent‘feltsense’(bodysensations,emotions,visualorauditoryimagery,thoughts,useofmetaphoretc).UsethecurrentsensetofeeltheAsk“Wheninyourlifedoyou(first)rememberfeelinglikeOftenprovidesaccesstosalientupsettingmemories,thatcarryover-generalizedmeaningCASE:theMiscarriageWomanHusbandgoingtopubtowatchBossatworkblamingstaffforaproblemwhichwasherownngMeaning:Peopleareneverthereforme.Myfeelingsnevercountforanything.Emotion:Letdown,sadness.Q1:DoestheStage3needtoberepeatedorjustA1:Ifthepatienthassevereemotiondisorder,severalhotspots,thetheneedtobemorepatient.Q2:Whatifthepatientdidtheunforgivablemistake?A2:Howdoyoudefinethe“unforgivable”?Q2:Thepatienthasthemajor/directresponsiblefortheevent.A2:These3stagesDIDN’Tfitthat.PositiveImagery:CreatingnewwaysofFormulatingtheOldWaysof在座的都是成功的。經過很多努力和鞭策取得現(xiàn)在的成績。尤其是medicalWillyoudothistoyourkid/goodfriend?PATIENCEISMOREHELPFULTHANBECASE:theMiscarriageShecamebackayearlater.Depressed.Hermotherhadacaner.Hersisteraskedhermothertoleavemosthermoneytoherinherwill.TheOldWaysvs.TheNewBuildingandStrengtheningtheNewWaysofNeedsandeWhatkindofsupport(people, wouldhelptobuildandstrengthensuccessfullycultivated,whatNewWaysofwillitmaketoyourlife?HowwillImageyoutreatyourselfwithmorekindnessand