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419 -13 Useful Brief Interventions
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC

CEUs are available at

~ Review the benefits of brief interventions
~ Identify the goals of brief interventions
~ Explore 13 brief interventions that can be used with most clients
~ Reduce no-show
~ Increase treatment engagement
~ Increase compliance
~ Increase self-efficacy
~ Reduce aggression and isolation
~ Provide an interim for clients on waiting lists
Goals of Brief Interventions
~ Goals should be…
~ Specific
~ Measurable
~ Achievable in 8-10 weeks
~ Relevant
~ Time Limited
~ Purpose:
~ Reduce the likelihood of damage/additional problems from the current issue. (i.e. family, work, health, self-esteem, guilt, anger)
~ Provide rapid measurable change to increase hope and motivation

Target Symptoms
~ General Symptoms
~ Depression/anxiety (mood)
~ Muscle tension
~ Sleep disturbances
~ Concentration
~ Irritability
~ Fatigue
~ Lethargy/psychomotor retardation
~ Hopelessness/helplessness (efficacy)
~ Meta Issues
~ Relationship issues
~ Unhealthy habits (smoking, emotional eating etc.)

~ Modern populations are increasingly overfed yet malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated
Assessment for Brief Interventions
~ Identify what the resolution of the problem looks like.
~ Define a starting point to create one measurable change in the client’s behavior
~ Explore the array of causes of the behavior
~ Physical (sleep, nutrition, relaxation, medicine, health, pain, hormones, addiction…)
~ Affect (anxiety, depression, grief)
~ Cognitions (Cognitive distortions)
~ Environment and Employment
~ Social Relationships (quality, boundaries, communication)

Assessment cont…
~ Explore Current Strengths/Mitigating Factors
~ Support systems
~ Client strengths
~ Situational advantages (mitigating factors)
~ Previous treatment (What has and has not worked)
1. Backward Chaining
~ Identify triggers and mitigating factors by backward chaining.
~ Ask the client to describe a situation that triggered the problem
~ John came home late and I got angry
~ I had a bad day and came home and drank a bottle of wine
~ It was valentine’s day and I wasn’t in a relationship so I got depressed
~ I didn’t sleep well and everything seemed to make me feel overwhelmed
~ Ask the client to think of a similar situation that did not trigger the problem
~ John came home late but he called and let me know.
~ I had a bad day and decided to go out to dinner with friends from work to commiserate
~ It was valentine’s day and I wasn’t in a relationship so I went out with friends and we celebrated un-valentine’s day together
~ I didn’t sleep well, so I kept my office door closed and reminded myself that I can only do what I can do
2. Forward Chaining
~ Add in triggers for behaviors you want to start doing
~ Push notifications
~ Visual cues
~ Change buddy
~ Rewards
~ Add in obstacles to behaviors you wish to stop
~ Make it more difficult to start
~ Journal
~ Inaccessibility
~ Temporal distance
~ Aversion

3. Positive Reflection
~ Positive Affect Journaling for 20 minutes per day improves depression and anxiety , enhanced resilience, reduced medical visits
~ Alternatives for those who hate journaling
~ Tell someone about the positive things in your day for ~10-20 minutes
~ Mentally reflect on all the positive things in your day and life for ~10-20 minutes
~ Draw a picture about something incredibly awesome in your life
4. Sleep
~ Benefits: Enhances cognition, enhances immunity, reduces depression and reduces anger, anxiety, and fatigue
~ Only quality sleep within normal limits (7-9 hours) is helpful
~ Incorporation into treatment
~ Review sleep hygiene
~ Develop a sleep routine
~ Keep a log of symptom severity and sleep
5. Sunlight and Circadian Rhythms
~ The body uses sunlight to set circadian rhythms and make vitamin D
~ Vitamin D deficiency is implicated in seasonal affective disorder, behavioral withdrawal
~ Sunlight exposure related positively to job satisfaction and organizational commitment, and negatively to depressed mood and anxiety
~ Bright light therapy has been found effective for addressing eating disorders, depression, fatigue, sleep disruption
~ Incorporation
~ Sunlight exposure first thing in the morning and throughout the day
~ Light boxes
~ Full-spectrum lights (100watt or more) within 1 meter
6. Oxygenation
~ Oxygen is needed for serotonin and ATP-synthesis
~ Relaxing Deep Breathing has been shown to attenuate pain perception, tension, anger, anxiety and depression and improve sleep
~ Incorporation
~ Breathing breaks
~ Exercise improves mood, cognition and sleep
~ Even in healthy adults without clinical depression, exercise has improved depressive symptoms.
~ Exercise may modulate dopaminergic and glutamatergic neurotransmission as well as serotonin, noradrenaline, and GABA systems, which are all related to depression, anxiety, and sleep
6. Oxygenation
~ Laughter
~ Alters dopamine and serotonin activity, decreases cortisol levels and increases endorphin release
~ Impacts depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose
~ Significantly decreased adults' depression, anxiety, and improved their sleep quality
~ Integrating laughter into the treatment plan– 10-15 minutes per day prior to stressful situations, and at the end of the day to “reset” the system.
~ Laughter distracts from distress and “breaks the loop”
~ Laughter increases good chemicals
~ Laughter increases oxygenation

7. Hardiness
~ Hardiness
~ Commitment: Tendency to involve oneself in activities in life and as having a genuine interest in and curiosity about the surrounding world (activities, things, other people) and to recognize ones’ self as multidimensional
~ Control: Tendency to believe and act as if one can influence the events
~ Challenge: Belief that change, rather than stability, is the normal mode of life and constitutes motivating opportunities
~ Improves: Cardiovascular health, anxiety, response to bullying, insomnia, reduces neuroticism, rumination and worry

~ Incorporating it
~ Have clients identify all the different aspects of self which are important
~ Health
~ Housing
~ Family
~ Friends
~ Finances
~ Job
~ Other…
~ When unpleasant things happen, encourage them to identify 5 things that are going well, how this event represents a growth opportunity and what aspects of the situation they can change.

8. Cognitive Restructuring
~ Cognitive Restructuring teaches people to identify and dispute maladaptive thoughts
~ Cognitive Restructuring can assist in increasing perceived efficacy, altering negative self-concept, enhancing pain tolerance, reducing hopelessness and helplessness associated with anxiety and depression
~ Incorporating into the treatment plan
~ Worksheets (CPT, ABC-Des)
~ Identifying 3 alternatives
~ Finding meaning
~ Note: Older adults with anxiety and depression are worse at learning and benefiting from CR with a brief intervention, partially due to having poorer cognitive flexibility
9. Cognitive Dissonance
~ Create dissonance between unwanted behaviors, thoughts and emotions to encourage purposeful change– (It may be pleasurable (or “safe”), but it does not help me)
~ Resolve dissonance between helpful behaviors (exercise, sleep, nutrition)– (It’s good for me, but it is awful)
~ Cognitive dissonance has been shown to be maximized by four factors:
~ Voluntary nature
~ Absence of an external justification
~ High public accountability
~ Dissonance-inducing behaviors required a high level of effort
~ Incorporation
~ Self-talk scripts
~ Make dissonant behaviors difficult
10. Mindfulness
~ Mindfulness meditation and cognitive therapy cultivates an awareness of one’s feelings, urges, thoughts and perceptions in the present moment, without judgement and relate constructively (purposefully) to those experiences to improve the next moment
~ Mindfulness meditation improves pain perception, anxiety and depression, emotion regulation, insomnia, binge eating
~ The key is not only being aware and accepting of the present moment, but also figuring out how to relate constructively to it –Change the situation, change your reaction, let it go…
~ Incorporation
~ Mealtime/General mindfulness—Awareness and early intervention
~ Problem focused mindfulness (pain, anxiety, habits)
11. Guided Imagery
~ Guided imagery improves mood, fatigue, and quality of life, pain perception, anxiety and depression
~ Incorporating it
~ Envision success
~ Take a mental vacation
~ Envision healing
~ Altered focus (physical discomfort—pain, cravings, urges)
12. Biofeedback–HRV
~ Heart rate increases are associated with increased stress and HPA-Axis activation
~ Prolonged HPA-Axis activation contributes to fatigue, insomnia, difficulty concentrating and problem solving, irritability, anxiety and depression
~ HRV-BF is effective at reducing symptoms of depression, anxiety and “stress” as well as pain perception
~ Incorporating it
~ Fitness trackers with “stress feedback”
~ Heart rate monitors/fitness trackers can be used at point of distress to alter focus and reduce HPA-Axis activation (fight or flight response)
~ Planned relaxation breaks
13. Distress Tolerance
~ Distress tolerance significantly mitigates depression, substance misuse, negative affect, stress, intolerance of uncertainty, and anxiety sensitivity
~ Distress tolerance is related to reductions in cortisol and HRV by altering how people perceive and relate to stressors.
~ Incorporation (SPAM-IT)
~ Sensations
~ Positive focus
~ Activities
~ Mental vacation
~ Thought stopping
~ Imagery
~ Brief therapy is a cost effective technique that can:
~ Help engage clients in the preparation phase
~ Enhance treatment compliance
~ Improve outcomes
~ Increases success and client self-efficacy
~ Reduce cost-per-patient expenses
~ Be used for a variety of issues to help clients accomplish SMART goals
~ Be implemented in group or individual settings