Select Page

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

CEUs are available at allceus.com/counselortoolbox

Objectives
~ Review the benefits of brief interventions
~ Identify the goals of brief interventions
~ Explore 13 brief interventions that can be used with most clients
Benefits
~ 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 beā€¦
~ 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 clientā€™s behavior
~ Explore the array of causes of the behavior
~ Physical (sleep, nutrition, relaxation, medicine, health, pain, hormones, addictionā€¦)
~ Affect (anxiety, depression, grief)
~ Cognitions (Cognitive distortions)
~ Environment and Employment
~ Social Relationships (quality, boundaries, communication)

Assessment contā€¦
~ 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 valentineā€™s day and I wasnā€™t in a relationship so I got depressed
~ I didnā€™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 valentineā€™s day and I wasnā€™t in a relationship so I went out with friends and we celebrated un-valentineā€™s day together
~ I didnā€™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 planā€“ 10-15 minutes per day prior to stressful situations, and at the end of the day to ā€œresetā€ the system.
~ Laughter distracts from distress and ā€œbreaks the loopā€
~ 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 onesā€™ 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

Hardiness
~ Incorporating it
~ Have clients identify all the different aspects of self which are important
~ Health
~ Housing
~ Family
~ Friends
~ Finances
~ Job
~ Otherā€¦
~ 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 ā€œsafeā€), but it does not help me)
~ Resolve dissonance between helpful behaviors (exercise, sleep, nutrition)– (Itā€™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 oneā€™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 ā€“Change the situation, change your reaction, let it goā€¦
~ Incorporation
~ Mealtime/General mindfulnessā€”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 discomfortā€”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 ā€œstressā€ as well as pain perception
~ Incorporating it
~ Fitness trackers with ā€œstress feedbackā€
~ 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
Summary
~ 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