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Use of a low frustration tolerance exercise for trainee therapists in a SP/SR framework

Published online by Cambridge University Press:  22 February 2022

James Collard Open the ORCID record for James Collard [Opens in a new window]  and
Michael Clarke
James Collard*
Affiliation:
Cairnmillar Institute, Hawthorn East VIC 3123, Australia
Michael Clarke
Affiliation:
Cairnmillar Institute, Hawthorn East VIC 3123, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Application of a self-practice self-reflection (SP/SR) framework to clinical training programmes for those learning cognitive behavioural therapy (CBT) have demonstrated positive outcomes. These programmes have typically resulted in reports of enhanced learning, improved clinical skills, heightened empathy, improved interpersonal skills, increased self-awareness, and self-development for those undertaking such training. However, the utility of specific activities within this framework for enhancing trainees’ learning still requires exploration. This study sought to explore the use of a low frustration tolerance (LFT) exercise to enhance trainee’s learning around issues relating to frustration and discomfort tolerance. It also further explored the possible application of SP/SR as a form of competency-based assessment. The study was based on 41 student trainees that engaged in a self-directed LFT exercise. Written reflections on these exercises were then thematically analysed. From a competency basis, the exercise provided an approach for observing the trainee’s competency with formulation skills, intervention planning, and self-reflective capacity. Participants reported both personal and professional development outcomes from the exercise. These included a ‘deepened’ understanding of cognitive behavioural principles related to their experiences, both in terms of principles relating to maintenance of dysfunction and to creating change. Increased self-awareness and learning outcomes relating to the development of interpersonal skills were also commonly reported by trainees.

Key learning aims

  1. (1) To understand the usefulness of a behavioural experiment [a low frustration tolerance (LFT) exercise] for training within a SP/SR framework.

  2. (2) To examine the potential for using SP/SR as a form of competency-based training.

  3. (3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.

Keywords

behavioural experimentcognitive behavioural therapy trainingexperiential learninglow frustration toleranceself-practice self-reflection
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e10
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi.org/10.1016/j.jbtep.2018.08.004 CrossRefGoogle ScholarPubMed
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. New York, USA: Guilford Press.Google Scholar

References

Beck, A. T. (2019). A 60-year evolution of cognitive theory and therapy. Perspectives on Psychological Science, 14, 16–20. https://doi.org/10.1177/1745691618804187 CrossRefGoogle ScholarPubMed
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Beck, J. S. (2020). Cognitive Behavior Therapy: Basics and Beyond (3rd edn). New York, USA: Guilford Press. https://doi.org/10.1017/CBO9781107415324.004 Google Scholar
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31, 261–277. https://doi.org/10.1017/S1352465803003035 CrossRefGoogle Scholar
Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi.org/10.1016/j.jbtep.2018.08.004 CrossRefGoogle ScholarPubMed
Bennett-Levy, J., & Lee, N. K. (2014). Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42, 48–64. https://doi.org/10.1017/S1352465812000781 CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Reflective Practice in Psychotherapy and Counselling (pp. 115–135). https://doi.org/10.13140/2.1.1111.9040 CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. New York, USA: Guilford Press.Google Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29, 203–220.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa CrossRefGoogle Scholar
Chapman, A. L., Dixon-Gordon, K. L., & Walters, K. N. (2011). Experiential avoidance and emotion regulation in borderline personality disorder. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 29, 35–52. https://doi.org/10.1007/s10942-011-0124-6 CrossRefGoogle Scholar
Chigwedere, C., Thwaites, R., Fitzmaurice, B., & Donohoe, G. (2019). Self-practice/self-reflection as an alternative to personal training-therapy in cognitive behavioural therapy training: a qualitative analysis. Clinical Psychology & Psychotherapy, 26, 74–83. https://doi.org/doi:10.1002/cpp.2331 CrossRefGoogle ScholarPubMed
Clark, D. A. (2013). Collaborative empiricism: a cognitive response to exposure reluctance and low distress tolerance. Cognitive and Behavioral Practice, 20, 445–454. https://doi.org/https://doi.org/10.1016/j.cbpra.2012.06.001 CrossRefGoogle Scholar
Collard, J., & Clarke, M. (2020). Experiential learning for trainee therapists through a shame attack exercise. Cognitive Behaviour Therapist (November). https://doi.org/10.1017/S1754470X20000549 CrossRefGoogle Scholar
Craske, M. G., Treanor, M., Conway, C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006 CrossRefGoogle Scholar
David, D., Lynn, S. J., & Montgomery, G. H. (eds) (2018). Evidence-based psychotherapy: the state of the science and practice. Evidence-Based Psychotherapy: The State of the Science and Practice. Wiley-Blackwell.CrossRefGoogle Scholar
Davis, M. L., Thwaites, R., Freeston, M. H., & Bennett-Levy, J. (2015). A measurable impact of a self-practice/self-reflection programme on the therapeutic skills of experienced cognitive-behavioural therapists. Clinical Psychology & Psychotherapy, 22, 176–184. https://doi.org/doi:10.1002/cpp.1884 CrossRefGoogle ScholarPubMed
Ellis, A. (1994a). Post-traumatic stress disorder (PTSD): a rational emotive behavioral theory. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 12, 3–25. https://doi.org/10.1007/BF02354487 CrossRefGoogle Scholar
Ellis, A. (1994b). Reason and Emotion in Psychotherapy. Secaucus, NJ: Carol Publishing Group.Google Scholar
Fassbinder, E., Schweiger, U., Martius, D., Wilde, O. B., & Arntz, A. (2016). Emotion regulation in schema therapy and dialectical behavior therapy. Frontiers in Psychology, 7. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2016-48153-001&site=ehost-live CrossRefGoogle Scholar
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5, 80–92. https://doi.org/10.1177/160940690600500107 CrossRefGoogle Scholar
Freeston, M. H., Thwaites, R., & Bennett-Levy, J. (2019). “Courses for horses”: designing, adapting and implementing self practice/self-reflection programmes. Cognitive Behaviour Therapist (May). https://doi.org/10.1017/S1754470X19000138 CrossRefGoogle Scholar
Gale, C., & Schröder, T. (2014). Experiences of self-practice/self-reflection in cognitive behavioural therapy: a meta-synthesis of qualitative studies. Psychology and Psychotherapy: Theory, Research and Practice, 87, 373–392. https://doi.org/doi:10.1111/papt.12026 CrossRefGoogle ScholarPubMed
Haarhoff, B., Gibson, K., & Flett, R. (2011). Improving the quality of cognitive behaviour therapy case conceptualization: the role of self-practice/self-reflection. Behavioural and Cognitive Psychotherapy, 39, 323–339. https://doi.org/10.1017/S1352465810000871 CrossRefGoogle ScholarPubMed
Harrington, N. (2005a). Dimensions of frustration intolerance and their relationship to self-control problems. Journal of Rational - Emotive and Cognitive - Behavior Therapy, 23, 1–20. https://doi.org/10.1007/s10942-005-0001-2 CrossRefGoogle Scholar
Harrington, N. (2005b). It’s too difficult! Frustration intolerance beliefs and procrastination. Personality and Individual Differences, 39, 873–883. https://doi.org/10.1016/j.paid.2004.12.018 CrossRefGoogle Scholar
Harrington, N. (2005c). The frustration discomfort scale: development and psychometric properties. Clinical Psychology and Psychotherapy, 12, 374–387. https://doi.org/10.1002/cpp.465 CrossRefGoogle Scholar
Harrington, N. (2006). Frustration intolerance beliefs: their relationship with depression, anxiety, and anger, in a clinical population. Cognitive Therapy and Research, 30, 699–709. https://doi.org/10.1007/s10608-006-9061-6 CrossRefGoogle Scholar
Harrington, N. (2007). Frustration intolerance as a multidimensional concept. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 25, 191–211. https://doi.org/10.1007/s10942-006-0051-0 CrossRefGoogle Scholar
Harrington, N. (2011). Frustration intolerance: therapy issues and strategies. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 29, 4–16. https://doi.org/10.1007/s10942-011-0126-4 CrossRefGoogle Scholar
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychological Bulletin, 136, 576–600. https://doi.org/10.1037/a0019712 CrossRefGoogle ScholarPubMed
McGillivray, J., Gurtman, C., Boganin, C., & Sheen, J. (2015). Self-practice and self-reflection in training of psychological interventions and therapist skills development: a qualitative meta-synthesis review. Australian Psychologist, 50, 434–444. https://doi.org/10.1111/ap.12158 CrossRefGoogle Scholar
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33, 511–525. https://doi.org/10.1016/j.psc.2010.04.012.Cognitive-Behavioral CrossRefGoogle ScholarPubMed
Meindl, P., Yu, A., Galla, B. M., Quirk, A., Haeck, C., Goyer, J. P., … & Duckworth, A. L. (2019). A brief behavioral measure of frustration tolerance predicts academic achievement immediately and two years later. Emotion, 19, 1081–1092. https://doi.org/10.1037/emo0000492 CrossRefGoogle ScholarPubMed
Motivational Interviewing Network of Trainers (2014). Motivational Interviewing Training: New Trainers Manual. Retrieved from: https://motivationalinterviewing.org/motivational-interviewing-training Google Scholar
Orlinsky, D. E., Schofield, M. J., Schroder, T., & Kazantzis, N. (2011). Utilization of personal therapy by psychotherapists: a practice-friendly review and a new study. Journal of Clinical Psychology, 67, 828–842. https://doi.org/10.1002/jclp.20821 CrossRefGoogle ScholarPubMed
Padesky, C. A. (1996). Developing cognitive therapist competency: teaching and supervision models. Frontiers of Cognitive Therapy. New York, USA: Guilford Press.Google Scholar
Pittig, A., Treanor, M., LeBeau, R. T., & Craske, M. G. (2018). The role of associative fear and avoidance learning in anxiety disorders: gaps and directions for future research. Neuroscience and Biobehavioral Reviews, 88, 117–140. https://doi.org/10.1016/j.neubiorev.2018.03.015 CrossRefGoogle ScholarPubMed
Rodman, S. A., Daughters, S. B., & Lejuez, C. W. (2009). Distress tolerance and rational-emotive behavior therapy: a new role for behavioral analogue tasks. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 27, 97–120. https://doi.org/10.1007/s10942-009-0090-4 CrossRefGoogle Scholar
Scott, J., Yap, K., Bunch, K., Haarhoff, B., Perry, H., & Bennett-Levy, J. (2021). Should personal practice be part of cognitive behaviour therapy training? Results from two self-practice/self-reflection cohort control pilot studies. Clinical Psychology and Psychotherapy, 28, 150–158. https://doi.org/10.1002/cpp.2497 CrossRefGoogle ScholarPubMed
Spendelow, J. S., & Butler, L. J. (2016). Reported positive and negative outcomes associated with a self-practice/self-reflection cognitive-behavioural therapy exercise for CBT trainees. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 26, 602–611. https://doi.org/10.1080/10503307.2015.1058983 CrossRefGoogle ScholarPubMed
Suso-Ribera, C., Jornet-Gibert, M., Ribera Canudas, M. V., McCracken, L. M., Maydeu-Olivares, A., & Gallardo-Pujol, D. (2016). There’s more than catastrophizing in chronic pain: low frustration tolerance and self-downing also predict mental health in chronic pain patients. Journal of Clinical Psychology in Medical Settings, 23, 192–206. https://doi.org/10.1007/s10880-016-9454-y CrossRefGoogle ScholarPubMed
Thwaites, R., Bennett-Levy, J., Cairns, L., Lowrie, R., Robinson, A., Haarhoff, B., … & Perry, H. (2017). Self-practice/self-reflection (SP/SR) as a training strategy to enhance therapeutic empathy in low intensity CBT practitioners. New Zealand Journal of Psychology, 46, 63–70.Google Scholar
Thwaites, R., Bennett-Levy, J., Davis, M., & Chaddock, A. (2014). Using self-practice and self- reflection (SP/SR) to enhance CBT competence and meta-competence. In Whittington, A. & Grey, N. (eds), How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (pp. 241–254). Wiley-Blackwell.Google Scholar
Thwaites, R., Cairns, L., Bennett-Levy, J., Johnston, L., Lowrie, R., Robinson, A., … & Perry, H. (2015). Developing metacompetence in low intensity cognitive-behavioural therapy (CBT) interventions: evaluating a self-practice/self-reflection programme for experienced low intensity CBT practitioners. Australian Psychologist, 50, 311–321. Retrieved from http://10.0.4.87/ap.12151 CrossRefGoogle Scholar
von Treuer, K. M., & Reynolds, N. (2017). A competency model of psychology practice: articulating complex skills and practices. Frontiers in Education, 2, 1–7. https://doi.org/10.3389/feduc.2017.00054 CrossRefGoogle Scholar
Waltman, S. H., Frankel, S. A., & Williston, M. A. (2016). Improving clinician self-awareness and increasing accurate representation of clinical competencies. Practice Innovations, 1, 178–188. https://doi.org/10.1037/pri0000026 CrossRefGoogle Scholar
Waltz, J. L., Fruzzetti, A., & Linehan, M. (1998). The role of supervision in dialectical behavior therapy. The Clinical Supervisor, 17, 101–113.CrossRefGoogle Scholar
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