校园忧郁与自我伤害防治二级预防研习活动39课件.ppt

1、校园忧郁与自我伤害防治二级预防研习活动39Rational Emotive Behavioral Therapy(REBT)認知行為治療 強調思考、判斷、決定、分析與行動 假定：認知、情緒和行為有明顯的交互作用，有可逆性的交互作用存在 情緒來自於我們的信念、評價、解釋，以及對生活情境的反應 教育過程人性觀 人類生而兼具有理性、非理性思考 天生扭曲思考的傾向，以及學來的自我挫敗模式 自我談話 有朝向自我成長和自我實現的傾向各種模態之間的關係負向循環心理問題是如何被習得的？生命事件（life events）社會因素應對失策如何從心理紛擾恢復至心理健康？認知治療是以問題為取向、具有教育性的心理治療法

2、，其目標包括：改善或解決當事人的困難或問題協助當事人學習積極的應對之策幫助當事人修正思想謬誤和基模協助當事人變成自己的治療師EX：情緒方案如何有效的溝通情緒如何有效的溝通情緒 I I 辨別你的情緒 選擇如何溝通你的情緒評估自己目前的狀態選擇討論感受的適當時機選擇討論感受的適當地點如何有效的溝通情緒如何有效的溝通情緒 II II 擁有你的感受避免依賴卸責語言 監視你的自我對話 傾聽與回應他人的情緒第一步 溝通監視你對沮喪的事項和經驗的情緒反應第二步 辨識引起你不愉快反應的事物、情況或經驗，找出共同性第三步 進入你的自我對話注意非理性的信仰和謬誤第四步 使用自我對話推翻繆誤情緒的理情取徑（Albe

3、rt Ellis,1982）BACK繆誤繆誤產生影響（舉例）產生影響（舉例）完美主義壓力、自我不滿對別人羨慕與嫉妒不實際的自我概念應該做的事使他人產生防衛將自我與感受分開過度一般化將失敗認知為自我的一部份為他人負責認為自己對他人的感受有責任無助放棄、沮喪不可能改變毀滅性失敗的恐懼對未發生的事有極度負面的想像評估自我感受常見的謬誤評估自我感受常見的謬誤BACK 當你感受情緒化時會採用什麼樣的自我對話?你在下列情緒中你有什麼想法：知覺情緒自我對話例如：無助我怎麼也沒辦法改變這情況自我憐憫嫉妒不耐煩傷心The Therapeutic Process 引導當事人發現其非理性信念 讓當事人看清，緊抱著不

4、合邏輯的思考模式，如何讓自己的情緒困擾肆虐 幫助當事人修正思考和放棄非理性信念 鼓勵當事人發展出一套理性的生活哲學理情行為治療技術與程序 認知方法駁斥非理性的信念家庭作業改變一個人的語言幽默理情行為治療技術與程序情緒技術理性-情緒的想像角色扮演攻擊羞愧感練習力量與活力的使用行為技術個案概念化 詳細描述個案行為、感受、生理和認知的模態 以發展及過程的觀點進行瞭解 有無因素導致問題惡化？問題清單 訂定共同目標 問卷/測驗使用典型典型認知治療公式個案目前心理狀況？談判諮商日程表（SMART）檢討家庭作業特定諮商目標的達成新的家庭作業每次諮商時間50 mins/620次Beck 的認知治療 Aaron

5、 Becks Cognitive Therapy(CT)Insight-focused therapy（洞察式治療）Emphasizes Assumptions Peoples internal communication is accessible to introspection（自省）Clients beliefs have highly personal meanings These meanings can be discovered by the client rather than being taught or interpreted by the therapistTheor

6、y,Goals&Principles of CT Basic theory:To understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individuals reaction to the upsetting event or stream of thoughts Goals:To change the way clients think by using their automatic thoughts（自動化思

7、想）to reach the core schemata（核心基模）and begin to introduce the idea of schema restructuring（重建）Principles:Automatic thoughts:personalized notions that are triggered by particular stimuli that lead to emotional responsesCTs Cognitive DistortionsCTs Cognitive Distortions（認知扭曲）（認知扭曲）Arbitrary inferences（

8、獨斷的推論）Selective abstraction（選擇性摘要）Overgeneralization（過度類化）Magnification and minimization （誇大與貶抑）Personalization（個人化）Labeling and mislabeling（標籤化和錯誤標籤化）Polarized thinking（極端化的思考）Beck 的認知治療應用說明基模、訊息處理、思考內容與憂鬱刺激他們不跟我說話基模如果別人忽略你，就是不喜歡你。如果人們不喜歡我，那我就是沒有價值的人。訊息處理 他們是有意忽略我的推論他們不喜歡我情緒悲傷、憂鬱基模、訊息處理、思考內容與焦慮刺激參加

9、party設定模態 Party上困難重重，很多人很具威脅性基模如果我很怪，我將無法融入，大家也會認為我是怪人訊息處理 沒有人過來與我說話推論他們不喜歡我，視為我陌生人情緒焦慮CTs Cognitive Triad Pattern that triggers depression:1.Client holds negative view of themselves 2.Selective abstraction:Client has tendency to interpret experiences in a negative manner 3.Client has a gloomy visio

10、n and projections about the future方法和策略I 詢問（蘇格拉底式問答法）這種想法如何影響你的情緒？有什麼證據證明妳的想法是對的？還可以用其他方式來看待這件事嗎？這樣的思考方式會產生什麼效果？這種思考方式有什麼缺點？你如何遽下結論？這是你使用占心術的例子嗎？你會將與你沒什麼關係的事，看成是針對你個人而發的嗎？問題與討論心理治療本質上是否為一種再教育過程？治療者是否適合使用說服和高指導性的方法？用邏輯、勸告、提供資訊和解釋等方法有可能去除 錯誤信念嗎？改變一個人的想法就必然可以改變他的感覺和行為嗎？kSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E

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