Cognitive and Behavioural Therapies: How can we apply them in the field of homelessness 27th October, 2006

1. Cognitive and Behavioural Therapies: How can we apply them in the field of homelessness?27th October, 2006 Nick Maguire University of Southampton

3. The ‘Cognitive and Behavioural Therapies’ Cognitive Behavioural Therapy Thoughts mediate feelings and behaviours Formulate how behaviours maintain attitudes towards self and world Dialectical Behavioural Therapy Many problems linked to attempts to cope with emotional arousal Teach skills, e.g. emotion regulation, interpersonal skills

4. Formulation A ‘map’ of how the problem started and why it isn’t going away Description of the factors which: Predispose Precipitate Perpetuate Can be general (population, model of a disorder), or specific (individual)

5. Possible pathway to homelessness

6. Interventions: Facilitating change Engendering hope Skills coaching Motivation to change Motivational interviewing techniques ‘Psychological squirm’ Pros and cons Alcohol and substance abuse Harm reduction strategies Beliefs about use ‘Seemingly irrelevant decisions’ Engagement with specialist services Detox; psychiatric

7. Facilitating change Tolerating difficult emotions (distress tolerance) Recognise and label emotions Coping techniques (rehearse beforehand) Mindfulness techniques (observe thoughts, physical feelings) Interpersonal skills Difference between assertive, aggressive and passive-aggressive Useful assertiveness skills Problems saying ‘no’ ‘Stuck record’ technique Problem solving skills Thinking through problems, generating solutions without resorting to aggression PTSD work Repeated exposure to difficult memories without escape / avoidance

8. Case study 1 Man, 36, history of violence, constant heavy drinking Half to one bottle of vodka Ten cans strong lager Three prison terms for assault Repeated eviction from hostels because of violence and threats of violence

9. History Father very controlling Unfavourably compared to older brother Rebelled to be ‘different’ Found sister comatose after suicide attempt aged 11 Family culture of heavy drinking First partner left him, took son to Ireland without telling him Second partner left him because of drinking

10. Diagrammatic formulation

11. Intervention 1. Alcohol abuse Refused to totally give up alcohol Most violence associated with spirit drinking – reduced this 2. Violence Addressed his perceptions of others’ intentions Looked at pros and cons of dealing with situation in particular ways – guilt Considered ‘readiness to change’ behaviours, considering previous culture Developed other ways of reducing emotional arousal Distract with friends, TV Sit with arousal, wait for it so subside 3. Ruminations Mindfulness, Distraction

12. Outcome

13. Questions?