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Section 8
Cognitive-Behavioral Therapy for Stress

Question 8 | Test | Table of Contents | Anger Management
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

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On the last track we discussed Four Stress Reduction Techniques. These were scanning Your Body for Stress, Breathing Away Stress, Progressive Muscle Relaxation and Meditation.
On this track, we will discuss Four Cognitive Behavior Therapy Steps to Solving Stress Problems. These include Identifying Problems that Cause Stress, Clarifying Your Goals, Alternative Strategies and Analyzing the Consequences.

#1 Identifying Problems that Cause Stress
First, let’s discuss identifying problems that cause stress. When Vera from track 6 good experienced the failure of one of her coping strategies, she experienced a growing sense of helplessness. Are you currently treating an anger management client whose spouse, like Vera, feels helpless? 

Vera’s increased anxiety and despair made her search for a successful solution with her husband, Alexander’s anger, even more difficult. Therefore, I found it useful to suggest to her to examine her life, category by category, and make a checklist to pinpoint where to concentrate her attention regarding stress in different areas of her life. Eight areas of life Vera explored were

  1. Health problems.  For Vera, these involved eating (digestion, weight, poor diet), sleeping (insomnia) and feeling chronically tired or run down.
  2. Financial problems.  Vera stated, "I  don’t have money for necessities or recreation, and our debts keep increasing."
  3. Work-related.  Alexander was a handy man and often underemployed.  His sudden bursts of anger could make him impossible to work with.  In the past, work conditions, boring work, trouble with a boss or co-worker and desire for a career change had contributed to the stress in Vera and Alexander’s life together.
  4. Living situations.  For Alexander and Vera, they lived in a bad neighborhood, home could be far from work, the house was often messy, things often broke down and they had hassles with the landlord.
  5. Interpersonal relationships.  Vera felt lonely, vulnerable and shy, and Alexander felt unable to get along with people.  Alexander also or felt a lack of affection from Vera in the way he expected it.
  6. Recreational.  Vera often expressed that she felt neither Alexander nor herself had enough fun.  They didn’t have enough free time and wanted a vacation.
  7. Family troubles.  Alexander and Vera often argued.  Vera would get worried and Alexander would become irritated by her concern.  Vera felt trapped in an unhappy family situation and Alexander, deep down, was insecure about losing Vera.  Vera felt an inability to be open and honest with Alexander for fear of his anger.
  8. Psychological problems.  Vera felt nervous and depressed and worried excessively.  Alexander had problems with authority, felt blockaded from attaining his goals, and therefore suffered from lack of motivation.

#2 Clarifying Your Goals
Second, let’s discuss the CBT technique of clarifying your client goals. Alexander had difficulty seeing what Vera did for him.  I asked him to try this exercise. 

I stated to Alexander, "As you are aware, describing the problem and your usual response in minute detail will allow you to reassess your goals.
a. First
, define who is involved, what happens, where it happens, when it happens, how it happens and why it happens. 
b. Next, examine your response by describing where you do it, when you do it, how you do it, how you feel, why you do it and what you want." 

Alexander came to the conclusion, "In reality, the problem isn’t my wife, Vera, the real problem is my response to her actions. When I only focus on her shortcomings, I undermine both my own happiness and Vera’s happiness in our relationship."
#3 Alternative Strategies
Third, in addition to identifying problems that cause stress and clarifying your goals, let’s look at alternative strategies.  I explained to Alexander that there are four basic rules to brainstorming for alternative strategies. 

I stated, "These are:

  1. Being uncritical.  Write down whatever idea comes to your head without consideration of whether its good or bad.
  2. Being wild and crazy.  The more "far out" your idea is, the better.  Following this rule can help you out of a mental rut and allow you to break free of old, limited views of the problem.
  3. Being prolific.  The more ideas you can generate, the better your chances of finding some really good solutions.
  4. Being creative.  Go back over your list and see how you can combine and improve the ideas you have thought of.  Brainstorming at this point should focus on general strategies.  The nuts and bolts will come later."

Do you have a client who could benefit from developing alternative strategies for stress-problem-solving?  Would he or she benefit from listening to this track? good

#4 Analyzing the Consequences
Fourth, let’s discuss analyzing the consequences.

I stated to Alexander, "After defining a goal and developing strategies for achieving it, the next step is to identify the best approaches and consider their consequences. Rule out any obviously bad ideas, and whenever possible, combine strategies.Write down the pros and cons for each plan of action. Think of how these pros and cons will affect what you feel, need or want. What impact would it have on other people? How would it affect their reaction to you? Explore short-term and long-term consequences." 

Would playing this track be beneficial for your Alexander?

On this track, we discussed four CBT steps to solving stress problems. These stress reduction steps were identifying problems that cause stress, clarifying your goals, alternative strategies, and analyzing the consequences.

On the next track, we will discuss Six Aversive Chains.  These include verbal behaviors, nonverbal sounds, voice quality, gestures using hands and arms, facial expressions and body movements.

- Mann, S. (2004). ‘People-work’: Emotion management, stress and coping. British Journal of Guidance & Counselling, 32(2), 205-221. doi:10.1080/0369880410001692247
- Stimpson, A., Kroese, B. S., Macmahon, P., Rose, N., Townson, J., Felce, D., . . . Willner, P. (2012). The Experiences of Staff Taking on the Role of Lay Therapist in a Group-Based Cognitive Behavioural Therapy Anger Management Intervention for People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities, 26(1), 63-70. doi:10.1111/jar.12006

A Guide to Managing Stress in Crisis Response Professions

- U.S. Department of Health and Human Services. (2005). A Guide to Managing Stress in Crisis Response Professions. DHHS Pub. No. SMA 4113. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 1-40.

Peer-Reviewed Journal Article References:
Fredette, C., El-Baalbaki, G., Palardy, V., Rizkallah, E., & Guay, S. (2016). Social support and cognitive–behavioral therapy for posttraumatic stress disorder: A systematic review.Traumatology, 22(2), 131–144.

Gutner, C. A., Gallagher, M. W., Baker, A. S., Sloan, D. M., & Resick, P. A. (2016). Time course of treatment dropout in cognitive–behavioral therapies for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 115–121.

Pukay-Martin, N. D., Torbit, L., Landy, M. S. H., Macdonald, A., & Monson, C. M. (2017). Present- and trauma-focused cognitive–behavioral conjoint therapy for posttraumatic stress disorder: A case study. Couple and Family Psychology: Research and Practice, 6(2), 61–78.

What are four ways to solve stress problems? To select and enter your answer go to Test.

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