PLAGIARISM FREE "A" WORK SUMMARY TECHNIQUES

Chapter 10 Change Techniques

"Lowering and Raising Emotional Arousal

The fourth therapeutic factor in the REPLAN system is “L” for lowering and raising

emotional arousal. The purpose of this set of change techniques is to reduce the

impact of negative emotions and increase positive emotions. This goal is

accomplished in three different ways:

Reduce negative emotions: Helpers are called upon to help clients reduce

overpowering feelings of depression, anger, stress, and fear, primarily through

methods of stress reduction and cognitive techniques.

Facilitate expression of strong emotions that are being ignored: At other times,

helpers arouse emotions to act as catalysts for change: for example, helping

clients get in touch with repressed anger or sadness and allowing them to

recognize the powerful nature of unresolved feelings.

Activate positive emotions: Helpers also facilitate positive emotions such as joy,

gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love,

trust/faith, compassion, gratitude, and forgiveness (Fredrickson, 2009; Vaillant,

2013). Positive emotions also tend to weaken negative ones.

In this section, we will address each of these methods for raising or lowering

emotional arousal and identify some key techniques that helpers use in each

circumstance.

Reducing Negative Emotions

The three most common negative emotions that clients seek help for are

depression/guilt, anxiety, and anger. Earlier in this chapter, you learned the

countering technique, which is used to help clients reduce self-criticism. Reducing

negative thinking also tends to reduce depressive feelings, and cognitive therapy

has been the primary method for treating depression, by psychological means,

since the early 1990s.

Although depression, anxiety, and anger are treated differently, we only have

room here to talk about one of these troubling emotional states, so we have

chosen to present techniques for coping with anxiety. Anxiety is a very common

complaint, and there are several basic anxiety-reducing techniques that can be

learned and applied rapidly. In this section, we present two methods, relaxation

training via muscle relaxation, and meditation, which are both effective and low-

risk.

Reducing Anxiety and Stress

Although a little anxiety may actually enhance performance at times, it can easily

run out of control, causing distress and interfering with relationships and job

performance. Modern life, with more crowding, more work pressure, and more

choices, has led to greater stress levels for just about everyone. The emotional

arousal associated with anxiety or fear may have been useful in more primitive

times because the “fight or flight” syndrome chemically sparked physical

readiness to deal with potential harm, putting the amygdala in overdrive (Siegel,

2012). What once may have increased the chances for survival now threatens our

health because the physiological by-products of stress cannot be easily dissipated

in a sedentary lifestyle. Today’s helper is frequently called upon to help clients

learn to reduce the causes of stress by helping them acquire time management

skills; develop habits for self-care, including exercise and good nutrition; and gain

a healthier outlook on life. In addition, helpers assist clients in lowering stress by

reducing emotional arousal through quieting techniques. Helpers also need to

sustain their own mental health by utilizing stress-reducing resources such as

hatha yoga, meditation, being in nature, using religion and spirituality, and good

nutrition and exercise (see Corey, Muratori, Austin, & Austin, 2018)."

"The most fundamental and time-honored method for helping clients reduce

arousal is relaxation. Relaxation training brings about relief from symptoms of

anxiety and lets clients experience the positive sensations associated with

lowered muscle tension (Pagnini, Manzoni, Castelnuovo, & Molinari, 2013). This

technique is explained in detail here because it is part of most stress reduction

programs and forms the basis of systematic desensitization and biofeedback.

Relaxation Training

Edmund Jacobson’s progressive relaxation technique (1938) was, for many years,

the favored method for teaching clients deep muscle relaxation. Muscle relaxation

had been found to reduce anxiety in clients with phobias by pairing relaxation

with exposure to fearful stimuli, a process called systematic desensitization.

Jacobson’s method, if faithfully followed, enables the client to identify and relax

every major muscle group in the body. The traditional training process may

actually take several months in weekly sessions, but abbreviated versions have

been used successfully (Gatchel & Baum, 1983; Harris, 2003). Following is a simple

and even briefer format developed by Witmer (1985), which can be learned in

three or four sessions, each lasting about 20 minutes. Every session is identical

and provides a complete tensing and then relaxing of all the major muscle groups

(see Table 10.4). Please note that for most problems, relaxation alone is probably

not as effective as a treatment program that also incorporates mental or cognitive

control of anxious thoughts such as thought stopping or countering (Donegan &

Dugas, 2012; Hinton, Hofmann, Rivera, Otto, & Pollack, 2011; Stevens et al., 2007).

Still, relaxation training has been consistently shown to work as a treatment for

various kinds of anxiety and can easily be included as an adjunct to other quieting

strategies.

The Technique of Deep Muscle Relaxation.

Step 1: Preparation. Ask the client to find the most comfortable position with eyes

closed. This position may be sitting or lying down, but in either case, there should

be support for the head. The legs and arms should not be crossed. The procedure

is best practiced without the distractions of noise or glaring lights. Instruct the

client to speak as little as possible and to avoid moving except as necessary to

achieve a more comfortable position. The client may be instructed to raise one

finger to indicate when an instruction has been understood or completed.

Step 2: Tighten and Relax. Ask the client to progressively tighten and then relax

each muscle. There are a variety of ways to move the body to tense each area.

Experiment and allow the client to try out different ways that feel best to tense

that area but do not hurt. Encourage the client to hold each tensed muscle about

6–7 seconds until the experience of tightness is fully felt. If the posture is held too

long, cramps and spasms may result. While a muscle group is tensed, ask the

client to focus attention on that area, simultaneously relaxing other parts of the

body and holding the breath. After tensing the muscle group, the client is asked to

relax and breathe diaphragmatically to let go of all muscle tension. It may take

some time to learn how these muscle groups are properly tensed."

"Step 3: Relax Fully and Breathe. Following the tensing of a muscle group, instruct

the client to exhale and relax fully and completely. This relaxation is to be

accompanied by slow, deep, diaphragmatic breathing and should last 20 seconds

or so. The tension and relaxation of the same muscle group is then repeated

before moving on. Diaphragmatic breathing consists of inhaling and exhaling

below the ribs rather than in the upper chest. It is the relaxed breathing

demonstrated by sleeping babies and practiced by singers. Help clients learn

diaphragmatic breathing by placing one hand on the chest and the other on the

diaphragm/stomach area. Diaphragmatic breathing occurs when the stomach

hand goes up and down, but the chest hand remains relatively immobile.

Step 4: The Body Scan. The most important phase of the lesson is the body review,

or body scan. This phase is critical because the client is learning to self-monitor. In

this step, the client is asked to return to specific, discrete areas of tension during

the relaxation procedure and relax them. This process allows the helper to

individualize the relaxation so that clients can spend time on the areas that they

tend to tighten. Tell clients that a body scan can be used on their own, at any time

during the day, to check bodily tension.

Step 5: Assign Practice. The first administration of the relaxation technique should

be recorded for the client, or a standardized commercially available version of the

technique should be provided. Ask the client to practice the relaxation technique

twice daily, usually once upon rising and once in bed before falling asleep. Have

the client note which of the six areas of the body show the greatest sources of

tension during the day, and ask the client to report this information at the next

session.

Meditation for Lowering Emotional Arousal and Increasing Positive Emotions

Meditation may be one of the most effective means for decreasing anxiety, panic,

and persistent anger and depression (Burns et al., 2011; Kabat-Zinn et al., 1992;

Lane, Seskevich, & Pieper, 2007; Young, 2012). Moreover, meditation is not merely

a method for reducing tension; it actually produces positive states of happiness,

alertness, improved concentration, fearlessness, optimism, joy, and feelings of

well-being (Chandler, Holden, & Kolander, 1992; Fredrickson, Cohn, Coffey, Pek, &

Finkel, 2008; Singh, 2003; Smith, Compton, & Beryl, 1995). Meditation has been

used to treat and prevent substance abuse (Dakwar & Levin, 2009; Gelderloos,

Walton, Orme-Johnson, & Alexander, 1991; Shafii, 1974, 1975; Young et al., 2011;

Zgierska et al., 2009). Along with prayer, meditation is a key tool in the 12 steps of

Alcoholics Anonymous. Meditation is utilized in about 60% of addiction treatment

programs (Priester et al., 2009).

There are several forms of meditation, but we will talk about two: mantra

meditation and mindfulness. Mantra meditation has a long history in Western and

Eastern thought. A mantra is a word or phrase repeated slowly and at intervals,

mentally, not aloud but with the “tongue of thought” (Singh, 2003). For those who

are spiritually inclined, any name of God can be used. Others have found it

effective to repeat a word such as one or peace (Benson, 1984). If you are

interested in learning more about mantra meditation, read Rajinder Singh’s book

Inner and Outer Peace through Meditation (2003). It contains complete and

simple instructions for nondenominational spiritual meditation and exercises for

getting started. A recent study of this technique finds that it is an effective way for

counselor trainees to reduce stress (Gutierrez, Conley, & Young, 2016). For those

who are not attracted to a spiritually oriented meditation, Patricia Carrington’s

The Book of Meditation (1998) and Meditation for Dummies (Bodian, 2016) are

good resources.

Mindfulness is a form of Theravadin Buddhist meditation that has found its way

into a number of new therapies without its religious accoutrements. These include

mindfulness-based stress reduction (Kabat-Zinn et al., 1992), mindfulness-based

cognitive therapy (Segal, Williams, & Teasdale, 2002), dialectical behavior therapy

(Linehan, 1993), and acceptance and commitment therapy (Hayes, Luoma, Bond,

Masuda, & Lillis, 2006). Mindfulness is not merely an activity conducted in a

meditation sitting; it is also a way of life. It involves paying strict attention to what

is happening in the present moment without judging. Mindfulness as a

therapeutic tool contrasts with traditional cognitive therapy because mindfulness

does not challenge or replace negative thoughts. It substitutes “present

awareness” for negative thinking. As a negative thought enters, it is noted without

judgment and allowed to pass through the mind. Mindfulness practitioners think

that arguing with thoughts tends to strengthen them, whereas allowing them to

flow through consciousness unchallenged reduces their potency.

Whether one uses mantra or mindfulness-based meditation, a noticeable benefit

is a reduction in the constant chattering of the mind and the mental images that

produce anxiety. For example, have you ever tried to sleep and found plans for the

next day going around in your head? Meditation is a means of putting such

thoughts to rest for a while. Unlike relaxation techniques, meditation has the

effect of producing mental quietude, not just physical rest. Like relaxation,

meditation must be practiced on a regular basis for at least 15 minutes per day for

several weeks before real benefits can be realized (Benson, 1984). After that, at

least 30 minutes per day should be devoted to meditating. Regularity is crucial,

and longer meditations are considered to be more beneficial than several short

meditations. Like any skill or technique you learn, a teacher is essential (Singh,

2003). Refer clients to a class if you are not qualified to teach them or you do not

practice meditation yourself.

Raising Emotional Arousal and Facilitating Expression

Be aware that emotionally stimulating techniques can be traumatic and

potentially harmful to clients. Arousing techniques, in their simplest and most

benign form, include encouraging clients to talk about troubling experiences and

feelings rather than avoiding them. At the extreme, helpers may evoke powerful

emotions that make the client feel out of control. Because some arousing

techniques can produce harmful reactions, we will discuss moderately arousing

methods that encourage clients to focus on their emotions but do not pressure

them to do so. The more confrontational and cathartic methods require very

advanced skills to be used only by experienced practitioners within strict ethical

guidelines and in conjunction with close supervision (Young & Bemak, 1996). They

are mentioned here because, sooner or later, every helper will see these methods

on films or at conference workshops.

Besides the risks associated with arousing and expressive techniques, there is

what Goleman (2006) calls a ventilation fallacy. Because expressing anger feels so

good immediately, we are seduced into thinking that we have dispelled it. In fact,

the opposite may be true (see Tavris, 1989). Expressing anger tends to arouse a

person more, increasing the likelihood of feeling anger later, whereas managing or

reducing anger may be more effective in preventing outbursts (LeCroy, 1988).

Techniques that Stimulate Emotional Arousal and Expression

The term catharsis is the most commonly used term in the context of arousal and

expression, but it has become a catchall that actually encompasses two separate

activities: (1) stimulating emotional arousal of the client and (2) encouraging

emotional expression by the client (Young & Bemak, 1996). Arousing techniques

put the client in touch with deeply held emotions. Expressive techniques, on the

other hand, allow the client to communicate these emotions to the helper.

The nonjudgmental listening cycle (NLC) and especially reflection of feelings are

the primary methods that helpers use to allow clients to experience and express

their emotions as deeply as possible. More advanced methods for enhancing

emotional awareness and emotional expression are often used in Gestalt therapy

(Perls, 1977; Prochaska & Norcross, 2009), psychodrama (Moreno, 1958), and a

number of group approaches. Emotional arousal has been activated through

hypnosis and drugs (Wolberg, 1977), psychodramatic methods (Moreno, 1958),

guided imagery (Witmer & Young, 1985), free association in psychoanalysis, the

empty-chair technique (Polster & Polster, 1973), focusing (Gendlin, 1969, 1978),

flooding and implosive therapy (Stampfl & Levis, 1967), bioenergetics (Lowen,

1967), play therapy (Kottman & Meany-Walen, 2018), and many others. Research

has generally supported the use of emotional expression as a therapeutic change

technique (Rosner, Beutler, & Daldrup, 2000) even if many of the more radical

approaches have been discredited (Norcross et al., 2006).

Because these listed techniques are advanced and require thorough training and

supervision, we will focus on one specific method that most helpers can

incorporate immediately: journal writing. Using the “Stop and Reflect” section,

you can experiment with this method yourself."

"Creating Positive Emotions

Positive psychology is a term that was coined by Abraham Maslow in 1954.

Maslow and other humanistic psychologists were concerned about the

overemphasis on pathology and diagnosis. Since that time, focusing on strengths

has remained alive in the work of Carl Rogers and many others who have studied

“positive emotions, positive character traits, and enabling institutions” (Seligman,

Steen, Park, & Peterson, 2005, p. 410). More recently, positive psychologists,

counselors, social workers, and others have begun to accumulate a body of

research supporting the use of strength-based helping techniques, including

gratitude, meditation, forgiveness, utilizing personal strengths, humor, creativity,

optimism, humility, authenticity, and many others. One of the most important

voices in this movement is Barbara Fredrickson (2001), who has found that these

methods evoke positive emotions, and that is why they work. She found that

creating positive emotions both broadens the ability to see alternative solutions

and builds resistance to negative feelings. Her popular book, Positivity (2009), is

not about how to maintain a positive attitude but how to produce positive

emotions as a bulwark against the stresses of the world and our own negative

emotions.

Gratitude to Increase Positive Emotions

Gratitude is a feeling that results when one recognizes a benefit that is

unwarranted and unexpected. It involves feelings of wonder, thankfulness, and

appreciation (Emmons & McCullough, 2003). Gratitude may be directed toward

others or a higher power. Inducing gratitude has been found to be associated with

happiness, decreased depression, relationship satisfaction, improved sleep, and

better social functioning (Harvard Medical School 2019; Young & Hutchinson,

2012).

The timing of a gratitude intervention is important. Getting clients to focus on

gratitude following a major calamity is a mistake. Gratitude is something to build

into one’s life over the long term, not something to distract or cheer up someone

after a serious loss. Clients who are prescribed gratitude interventions should not

be instructed to ignore or gloss over problems, but they should also be aware of

good things that are happening in their lives. For example, we saw a client named

Portia who had been out of work for some time but recently found a job as a retail

manager in an upscale shop. Although the pay is low, she receives good benefits,

including health insurance and retirement. At her counseling visit, the client

discussed the fact that she finds her job boring. She resents having to put up with

rich clients she says do not respect her. She feels that her talents are not being

recognized by her boss. I was aware that Portia had said 2 months before that

having a job was crucial to her happiness and financial well-being. She was elated

when she signed on but is now unhappy with her work. We discussed alternatives

to her present situation and developed a plan to help her look for a new job. In

the meantime, Portia was asked to keep a gratitude journal about the good things

in her life in order to counteract some of the negative thoughts and feelings she

was experiencing. Those negative thoughts could impede her present job

functioning as well as her ability to find a new job.

Techniques for Increasing Gratitude.

The gratitude journal is the most popular method for practicing gratitude. A client

can be instructed to write daily or weekly record five things for which he or she is

grateful. These can be simple things such as “no lines at Walmart.” Sometimes,

clients seem to write the same things and do not pay attention after a few entries.

To counteract this, clients are instructed to use a different letter of the alphabet

each day and write five things to be grateful for that begin with that letter. In

addition, clients may need reminders to work on gratitude. These can be sticky

notes, automated text messages, or e-mails. Clients can set up reminders and

even journal on their smartphones using a number of available gratitude

applications such as Zest and Mojo. A more personal technique is the gratitude

visit. Clients are instructed to write and then deliver a letter to someone to whom

they feel grateful but whom they have never acknowledged."