Title: Risk Factors for Deliberate SelfHarm among Female and Male College Students
1 Using Behavioral Activation to Treat Bipolar
Disorder Carl W. Lejuez, PhD Center for
Addictions, Personality, and Emotion
Research University of Maryland
2Treatment Model
Positive and Rewarding Behavior
Positive Feelings (Happiness, Fulfillment, Sense
of Accomplishment)
3Form 1 Daily Monitoring FormCircle the day
insert the date M Tu W Th F
Sa Su Date_______________
4Planned Relaxation Rationale and Techniques
- Stress and tension can be overwhelming and lead
to a desire to use substances - Review and Practice in Session
- Behavioral relaxation postures
- Deep breathing exercises
- Homework Practice Relaxation at least 5 minutes
per day
5Life Areas Assessment
- Family Relationships
- Social Relationships
- Intimate Relationships
- Education/Training
- Employment/ Career
- Hobbies/ Recreation
- Volunteer Work/ Charity/ Activism
- Physical/Health Issues
- Spirituality
- Psychological/ Emotional Issues
6Identifying Activities
- Select Activities that will help you towards your
goals in each life area and list them on the
Selected Activities Form - Refer to Activity Checklist for ideas
- Example 1
- Goal Take my medication every day
- Activity 1 Make sure my pills are in my purse
before I leave for work - Activity 2 Set alarm on my phone to go off when
I need to take my pills - Example 2
- Goal Sleep 8 hours a night
- Activity Practice planned relaxation when it is
time to go to sleep
7Creation of Activity Hierarchy
- APPROXIMATELY 15 ACTIVITIES ARE SELECTED
- RANK-ORDERED ON LEVEL OF DIFFICULTY
- GOALS IN TERMS OF FREQUENCY DURATION
- PATIENT MOVES THROUGH THE HIERARCHY 1. BEGINS
WITH EASIER ACTIVITIES (GAIN MOMENTUM) - 2. WEEKLY GOALS INCREASED UNTIL FINAL GOAL IS
ACHIEVED - 3. MORE DIFFICULT BEHAVIORS PROGRESSIVELY ADDED
AS - EASIER GOALS ARE MASTERED
(I.E., 3 CONSECUTIVE WEEKS)
8Activity Plan
9Sample Activity Hierarchy
- LEVEL ONE LEVEL TWO
- A. Go to work A. Make dinner
- B. Wake up before 1 P.M. B. Attend Church
- C. Play with the dog C. Clean bedroom
- LEVEL THREE LEVEL FOUR
- A. Exercise at gym A. Visit a friend
- B. Wake up before 11 A.M. B. Write letter to a
friend - C. Go to sleep before 2 A.M. C. Knit or
crochet - LEVEL FIVE
- A. Return to School
- B. Attend karate class
- C. Volunteer
10Charting ProgressMaster Activity Log
- KEPT IN THE POSSESSION OF THE THERAPIST
- USED TO CHART WEEK-TO-WEEK PROGRESS
- INCLUDES CURRENT AND IDEAL GOALS
- BEGIN BY CHARTING 2-3 ACTIVITIES/WEEK
- MASTERY CLEARLY NOTED
- ADD NEW ACTIVITIES FOLLOWING MASTERY
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12Charting Progress Weekly Behavior Checkout
- PATIENT CHARTS DAILY PROGRESS ON BEHAVIOR
CHECKOUT - PATIENT CIRCLES Y FOR EACH ACTIVITY COMPLETED
OTHERWISE, N IS CIRCLED - G IS CIRCLED WHEN WEEKLY GOAL IS MET
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14Charting ProgressRewards and Graphs
- Assess activities completed on a weekly basis
- Assess depressive symptom severity via the BDI-II
- Patient and therapist mediated rewards through
monitoring of activities and depressive symptoms