Cognitive and Behavioural Therapies: How can we apply them in the field of homelessness 27th October

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Cognitive and Behavioural Therapies How can we
apply them in the field of homelessness?27th
October, 2006

• Nick Maguire
• University of Southampton

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Overview

• Psychological therapies
• Formulation
• Interventions What do we do?
• Case study

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The Cognitive and Behavioural Therapies

• Cognitive Behavioural Therapy
• Thoughts mediate feelings and behaviours
• Formulate how behaviours maintain attitudes
  towards self and world
• Dialectical Behavioural Therapy
• Many problems linked to attempts to cope with
  emotional arousal
• Teach skills, e.g. emotion regulation,
  interpersonal skills

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Formulation

• A map of how the problem started and why it
  isnt going away
• Description of the factors which
• Predispose
• Precipitate
• Perpetuate
• Can be general (population, model of a disorder),
  or specific (individual)

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Possible pathway to homelessness
Abusive childhood
Negative view of self, world and others
Survival, coping strategies
Negative ruminations
Difficult emotions
Substance misuse
Antisocial behaviours
CBT
Repeated tenancy breakdown
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Interventions Facilitating change

• Engendering hope
• Skills coaching
• Motivation to change
• Motivational interviewing techniques
• Psychological squirm
• Pros and cons
• Alcohol and substance abuse
• Harm reduction strategies
• Beliefs about use
• Seemingly irrelevant decisions
• Engagement with specialist services
• Detox psychiatric

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Facilitating change

• Tolerating difficult emotions (distress
  tolerance)
• Recognise and label emotions
• Coping techniques (rehearse beforehand)
• Mindfulness techniques (observe thoughts,
  physical feelings)
• Interpersonal skills
• Difference between assertive, aggressive and
  passive-aggressive
• Useful assertiveness skills
• Problems saying no
• Stuck record technique
• Problem solving skills
• Thinking through problems, generating solutions
  without resorting to aggression
• PTSD work
• Repeated exposure to difficult memories without
  escape / avoidance

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Case study 1

• Man, 36, history of violence, constant heavy
  drinking
• Half to one bottle of vodka
• Ten cans strong lager
• Three prison terms for assault
• Repeated eviction from hostels because of
  violence and threats of violence

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History

• Father very controlling
• Unfavourably compared to older brother
• Rebelled to be different
• Found sister comatose after suicide attempt aged
  11
• Family culture of heavy drinking
• First partner left him, took son to Ireland
  without telling him
• Second partner left him because of drinking

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Diagrammatic formulation
Alcohol abuse
Reduce arousal
Rumination about unfairness of previous
experience
Self-harm, previous cultural beliefs
Violence to others
Consequences, negative reaction to authority
Prison Tenancy breakdown
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Intervention

• 1. Alcohol abuse
• Refused to totally give up alcohol
• Most violence associated with spirit drinking
  reduced this
• 2. Violence
• Addressed his perceptions of others intentions
• Looked at pros and cons of dealing with situation
  in particular ways guilt
• Considered readiness to change behaviours,
  considering previous culture
• Developed other ways of reducing emotional
  arousal
• Distract with friends, TV
• Sit with arousal, wait for it so subside
• 3. Ruminations
• Mindfulness, Distraction

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Outcome
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Questions?