1. SOWK6190/SOWK6127 Cognitive Behavioural Therapy and Cognitive Behavioural Intervention Week 9 – Imagery and Homework Dr. Paul Wong, D.Psyc.(Clinical)

2. Imagery

3. Numerous clinical observations suggest that an individual visualizing an imagined scene reacts as though it were actually occurring; “Induced" images can have a profound effect on behavior. The usefulness of guided imagery techniques have been shown to be effective in helping individuals learn or modify behaviors such as: –learning to relax; –changing or controlling their negative emotions in response to a particular situation –eliminating or reducing undesirable behaviors (smoking, obesity) –increasing effective pain management coping with difficult situations (a difficult boss) –learning new and desirable behaviors (assertiveness) –becoming more motivated (doing homework between therapy sessions)

4. Guided imagery techniques have been applied to— and found to be effective or show promise with—a variety of populations, including individuals with: –phobias –mild to moderate depression –generalized anxiety disorders –Post-traumatic stress disorder –Obsessive-compulsive disorder –sexual difficulties –chronic fatigue syndrome –children's behavioral disorders –stuttering –acute and chronic pain (and other physical disorders)

5. Identifying images 1.Elicit a spontaneous image a patient has had; or 2.Induce an image (“Could you picture it now?”)

6. Educating clients about imagery Some clients do not report images to therapists because: –Their images are too graphic and distressing; and –Reluctant to re-experience the distress or fear the therapist will view them as disturbed. Normalizing and teaching the client about images help to reduce her anxiety and make it more likely that she/he will be able to identify the images.

7. Responding to spontaneous images 1.Following images to completion; 2.Jumping ahead in time; 3.Coping in the image; 4.Changing the image; 5.Reality-testing the image; 6.Repeating the image; and 7.Substituting, stopping, and distracting oneself from images.

8. Inducing imagery as a therapeutic tool 1.Rehearsal of coping techniques; 2.Distancing; and 3.Reduction of perceived threat.

9. Homework

10. Ongoing homework assignments 1.Behavioral activation; 2.Monitoring automatic thought; 3.Biblotherapy; 4.Reviewing the past therapy session; and preparing for the next therapy session. If not sure, please check pp.251-253.

11. Increasing the likelihood of successful homework Tailoring homework to the individual; Providing a rationale; Setting homework collaboratively; Making homework a no-lose proposition Starting homework in the session; and Remembering to do homework;