MNCAMH provides information on how to improve you practice through Clinical Tips documents. These tips will be released on a regular basis and can be downloaded via the links below.
Behavioral Tailoring for Medication Management and Beyond
Behavioral tailoring (BT) is a cognitive-behavioral, recovery-oriented set of strategies that helps individuals with mental illnesses, substance use disorders, and co-occurring disorders meet personal goals. These strategies include developing a routine and modifying one’s environment to promote and support a change in behavior. While this clinical tip focuses specifically on medication management, BT is also used to support changes in housekeeping, hygiene, substance use, exercise, and other behaviors.
Recovery Oriented Relapse Prevention Training
Relapses are often a part of the recovery process over the course of a person’s illness. Individuals with co-occurring mental illness and substance use disorders (COD) are at higher risk for relapse. Integrating relapse prevention training for individuals with COD requires consideration of their substance use, psychiatric symptoms, and the interplay between them. Planning for relapses and working to identify steps to address early warning signs and triggers for both substance use and mental health disorders can help reduce the risk of a relapse or need for inpatient care.
Beliefs, feelings and behaviors are interconnected. However, our beliefs are the driving force behind subsequent feelings and behaviors. Sometimes negative beliefs can generate distressing feelings which can lead to unhealthy behaviors. Many individuals with mental illness and/or substance use disorders struggle with negative beliefs and in turn, develop unhelpful coping strategies. Examples of these coping strategies include avoiding, isolating, and substance use. Originating from cognitive behavioral therapy, a behavioral experiment is a helpful tool designed to test the consequences of a current belief and help people develop more realistic beliefs. Through the process of a behavioral experiment, individuals evaluate current coping strategies and beliefs about their illness and/or substance use. This helps them recognize inconsistencies, discrepancies and collect evidence to develop a more realistic perspective. Additionally, individuals can often broaden their perspective and learn they have more control over their behavior than previously thought.
Recognizing Medical Crises: Diabetes
Approximately 29.1 million people or 9.3% of the U.S. population have diabetes. The risk for diabetes is increased among individuals who have serious mental illness (SMI). Individuals with bipolar disorder or diagnoses on the schizophrenia spectrum are 2 to 3 times more likely to develop diabetes than the general population. Depression also increases the risk for diabetes. The high prevalence of diabetes in the SMI population is a result of biological, lifestyle, and environmental factors. Biological factors may include physiological processes or pharmacological side effects. Contributing lifestyle and environmental factors may include little physical activity, poor diet, and lack of access to quality preventive care, screening, and exercise facilities, which can lead to obesity and increased risk for diabetes.
The use of minfulness in clinical practice is becoming more common as the benefits are recognized. Mindfulness training is especially helpful as a coping skill for stress and anxiety. It can be a wonderful way to begin and/or end a session. We also want to encourage clients to practice outside the session. It can be easier to use the skill during times of stress if they have practiced during more peaceful times. This clinical tip provides a sample session of how mindfulness can be taught to clients.
Home assignments are a key component in the recovery process, allowing individuals to develop confidence in their ability to utilize new skills effectively outside of treatment. Home assignments are integral to learning information and trying out skills in all recovery models. In manualized treatments such as Illness Management and Recovery (IMR) and Enhanced Illness Management and Recovery (E-IMR), there are specific steps to collaboratively develop and follow-up on home assignments.
Social Skills Training
Social skills training can be used in a variety of clinical settings and is a useful tool for clinicians to have in their toolbox. Social skills are listed as a component of 121 evidence based practices listed on SAMSHA’s registry of evidence based programs and practices. These practices are diverse and include a wide range of clinical issues such as: schizophrenia, autism, families, substance use, depression, and anxiety.