THE HATTER CENTRAL®
THE APPROACH
COGNITIVE BEHAVIOURAL PSYCHOTHERAPY
CBT is based on several core principles, mainly that:
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Our psychological problems are primarily based, in part, on faulty or unhelpful ways of thinking.
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Psychological problems are based, also in part, on learned patterns of unhelpful behaviour.
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When people are suffering from psychological problems, they can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
CBT is an intensive, short-term (six to 20 sessions), problem-oriented approach. It was designed to be quick, practical and goal-oriented and to provide people with long-term skills to keep them healthy. Childhood experiences and events, while not the focus of cbt, may also be reviewed. This review can help people to understand and address emotional upset that emerged early in life, and to learn how these experiences may influence current responses to events. Most often, people think of their distress as emerging directly from events and situations in their lives
However, what you feel in response to a situation is determined not only by the situation, but also by the way you perceive the situation or make meaning of it. This way of seeing your emotional reaction as determined by what you think about a situation is a basic assumption of the cognitive-behavioural approach.
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VIRTUAL REALITY PSYCHOTHERAPY
VRT effectiveness is founded on the evidence-based principles that:
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VR interventions have been piloted in various healthcare settings, and is notable in treating chronic pain, improving balance in patients post-stroke, managing symptoms of depression, anxiety, fear phobias, trauma, problem behaviours and others.
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The use of a VRT implementation framework contributed to systematic data collection and analysis, which can increase the credibility of the findings.
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With the rise in technological advancement in healthcare and therapy settings, VRT implementation will see an increase in efficacy in addressing the above mentioned symptoms and problems.
Psychotherapy Approaches
My coaching plans are specifically designed to address the underlying function of a behaviour/s that commonly afflicts children, youths and young adults during a mental crisis. The goal is to deescalate and redirect behaviourial processes through cognitive based-methodologies.
Cognitive Behavioral Therapy (CBT) CBT is a structured, time-limited, problem-focused and goal oriented form of psychotherapy. The core notion affirms human emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, never by events themselves. Consequently changing one’s thinking leads to an emotional and behavioral change.
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A standard Dialectical Behavior Therapy (DBT) program that usually has five components, each serving a specific function:
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A DBT skills training group is facilitated by a skills therapist in a group format similar to a class. Tasks are provided for people to practice between sessions. The purpose is to help people introduce effective and practical skills into their lives, which they can use when they are distressed. These skills are meant to replace other unhealthy and negative behaviours. The class usually meets once per week for 2.5 hours. It takes 24 weeks to get through the full skills curriculum, which is often repeated to create a one-year program. In the class, four skills are taught:
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mindfulness: the practice of being in the present and acknowledging thoughts, feelings and behaviours as they happen, without trying to control them
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distress tolerance: the process of learning how to cope during a crisis, especially when it is impossible to change, and accepting a situation as it is, rather than how it should be
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interpersonal effectiveness: the ability to ask for what a person needs and to say no when necessary, while still maintaining self-respect and relationships with others
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emotion regulation: the ability to manage emotions so that they do not control thoughts and behaviours.
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Individual psychotherapy focuses on enhancing motivation and helping people apply the skills to specific challenges and events in their lives. These sessions provide opportunities for the person and the therapist to come together and discuss their individual goals. Sessions are usually held on a weekly basis for 60 to 90 minutes.
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In-the-moment coaching uses telephone coaching and other real-life (“in vivo”) coaching to provide in-the-moment support. The therapist will coach a person through a stressful event and encourage them to use their DBT skills. The goal is to ensure that skills are generalized and applied to a person's day-to-day life.
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Case management strategies empower the person to take control of their lives and care. The therapist applies the learned strategies to teach the person how to be autonomous and how to be their own case manager.
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The DBT consultation team is focused on supporting the people who provide DBT, including therapists, skills therapists, case managers and others.
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Dialectical Behaviour Therapy (DBT)
Acceptance and Commitment Therapy (ACT)
ACT rests on the fundamental premise that pain, grief, disappointment, illness, and anxiety are inevitable features of human life, with the therapeutic goal of helping individuals productively adapt to these types of challenges by developing greater psychological flexibility rather than engaging in counterproductive attempts to eliminate or suppress undesirable experiences. This is achieved through committed pursuit of valued life areas and directions, even in the face of the natural desire to escape or avoid painful and troubling experiences, emotions, and thoughts.
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Mindfulness-Based Cognitive Therapy (MBCT) + Transcendental Meditation (TM)
Mindfulness is defined as nonevaluative present-moment awareness, and is used within MBCT to help individuals disengage from their ruminative thoughts and to promote detachment and decentering from depression-related thoughts and feelings.
The TM technique is a simple psychophysiological procedure practiced for a minimum of 20 minutes twice a day. My approach is to incorporate breathing, peace and relaxation techniques to help clients regulate and focus primarily on manifesting affirmative lifestyle and behavioural changes; but no particular changes in beliefs are required.
Solution-Focused Brief Therapy (SFBT)
Solution-focused brief therapy (SFBT), also known as solution-focused therapy, is a method of psychotherapy that uses a goal-directed approach to find solutions to problems. This form of therapy is future-focused and prioritizes the discovery of current resources and strengths that the patient has, instead of fixating on the past or the problem. Unlike most talk therapy, SFBT is solely focused on the present and the preferred future — not the past. This type of therapy doesn’t focus on the why of a problem or underlying significance. Instead, it approaches each problem through small solutions that can be acted upon in the present day.
Benefits of Solution-Focused Brief Therapy
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It’s a short-term therapy, which makes it time and cost-effective
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The aim of SFBT is to find solutions as soon as possible. Due to this, average sessions can last up to 10 weeks, but can even be as short as one, singular session. Regular talk therapy is more long-term and can last for months or even years.
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It’s built on empathy and open-mindedness
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SFBT interventionists/coaches are trained to approach each case non-judgmentally. When the client shows growth or makes progress — no matter how small — they are praised for their resilience and encouraged to keep going.
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It’s client-led rather than therapist-led
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SFBT empowers clients to make their own goals, rather than relying on the therapist to lead the way. This therapy approach allows clients to identify their own problem-solving skills to improve their self-esteem and forward-thinking.
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It’s future-oriented
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Traditional psychotherapy often revolves around past life events and problems to uncover deeper significance. SFBT aims to motivate clients to focus on the present to achieve future goals. This approach is built around optimism and positivity psychology. It identifies steps that can be taken today to improve the client’s day tomorrow (or next week).
Interpersonal Psychotherapy (IPT)
Interpersonal Psychotherapy (IPT) is a diagnosis-targeted, time-limited, present-focused treatments that encourage the patient to regain control of mood and functioning. IPT is based on the so-called common factors of psychotherapy: a treatment alliance in which the therapist empathically engages the patient, helps the patient to feel understood, arouses affect, presents a clear rationale and treatment ritual, and yields success experiences. On this foundation IPT builds two major principles:
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Depression is a medical illness, rather than the patient's fault or personal defect; moreover, it is a treatable condition. This definition has the effect of defining the problem and excusing the patient from symptomatic self-blame.
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Mood and life situation are related. Building on interpersonal theory and psychosocial research on depression, IPT makes a practical link between the patient's mood and disturbing life events that either trigger or follow from the onset of the mood disorder.
Rational Emotive Behavioural Therapy (REBT)
REBT holds that it is not events that directly cause emotions and behaviors. Rather, it is one’s beliefs about the events that lead to emotional and behavioral reactivity. REBT places this central idea or philosophy into an ABC framework where the event is represented by the letter A (activating event or adversity), the beliefs are allocated the letter B, and finally emotions and behaviors are represented by C (consequences). In REBT rational beliefs are defined as beliefs that are flexible, non-extreme, and logical (i.e., consistent with reality), and in contrast, irrational beliefs are rigid, extreme, and illogical (i.e., inconsistent with reality). Specifically, there are four types of rational and irrational beliefs:
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HFT, and self/other acceptance). In sport, preference beliefs could reflect a belief that “I want to be successful but that does not mean I have to be.” An anti-awfulizing belief could be that “if I do not succeed it would be bad, but not awful.” An example of HFT is “failure is difficult, but not unbearable.” A self-acceptance belief could be “when I fail, it is bad, but does not mean that I am a complete failure,” whereas other-acceptance could reflect a belief that “when coaches treat me poorly it is bad, but does not prove they are bad people.” Irrational beliefs comprise a primary belief (demandingness) and three secondary beliefs (awfulizing, low frustration tolerance;
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LFT, and self/other depreciation). In sport, demandingness beliefs could reflect a belief that “I want to be successful and therefore I must.” An awfulizing belief could be that “if I do not succeed it will be awful” An example of LFT is “it is unbearable to fail.” A self-depreciation belief could be “when I fail, it means that I am a complete failure,” whereas other-depreciation could reflect a belief that “when coaches treat me poorly, it proves they are bad people.”
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(HNEs) associated with adaptive behaviors stem from rational beliefs, whilst unhealthy negative emotions (UNEs) associated with maladaptive behaviors stem from irrational beliefs.
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APPLIED BEHAVIOURIAL ANALYSIS
Applied Behavioural analysis or ABA therapy applies our understanding of how behaviour works to real situations. The goal is to increase behaviors that are helpful and decrease behaviours that are harmful or affect learning.
ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.
“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior).
Using a functional approach, the aim is to properly observe, record and implement Individualized Program Plans and goals using cognitive behavioural models based on applied behavioural principles. Our sessions consists of interactions, which encumbers: assigned brain labs, liaising with primary care giver, therapists and approved IPP by a Board Certified Behavior Analyst (BCBA).
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Applied Behavioural Principles
Discrete Trial Training (DTT)
Discrete trial training is a fundamental and highly effective technique used in ABA therapy to aid in the learning process of individuals with autism. It involves breaking down skills into smaller components, thus facilitating individual learning of these skill subsets.
Discrete trial training consists of the repetition of a single cycle of instruction until the child masters the skill. It involves five key steps:
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Initial instruction: For example, instructing the child to touch their head.
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Prompting: Providing assistance to help the child respond correctly, such as the teacher pointing to the child’s head.
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Child’s response: The child’s action, like touching their head.
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Motivational consequence: This step involves offering words of recognition and a small reward, such as a sticker, to reinforce positive behavior. Positive Reinforcement is a fundamental aspect of discrete trial training and ABA therapy.
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Pause for rehearsal: Teachers usually wait 1 to 5 seconds before starting the subsequent trial. However, the pace and duration of the pause should be consistent to maintain the child’s attention.
Discrete trial training has been one of the most extensively studied and effective methods for instructing children with autism in various physical and verbal imitation skills. These skills may include activities like clapping, writing letters, or pronouncing letter sounds, for example.
Discrete trial training is effective in teaching various skills:
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Language skills: Receptive actions to instructions, such as “Show me your plate,” “Stand up,” and “Touch the number three,” can be elicited through discrete trials.
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Expressive language response: Discrete trial formats can teach expressive language responses, such as identifying body parts, colors, and objects.
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More complex skills: Discrete trial methods can also teach more advanced skills, such as dressing, using the telephone, and establishing routines.
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Antecedent, Behaviour, Consequence (ABC)
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Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.
The following three steps – the “A-B-Cs” – help us teach and understand behavior:
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An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
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A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
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A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.
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Looking at A-B-Cs helps us understand:
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Why a behavior may be happening
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How different consequences could affect whether the behavior is likely to happen again
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Positive Behaviour Supports (PBS)
Positive Reinforcement
Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.First, the interventionist / coach identifies a goal behaviour. Each time the person uses the behavior or skill successfully, they get a reward.
The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more. Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.