Metacognitive Training Class
We are currently offering a Metacognitive training (MCT) class as part of a new collaboration to provide education to our residents and others with psychosis in the larger community. Our clinical director, Liz Macaulay, and a private therapist in the community, Robert Claflin, are running this structured, 16-week class designed to help individuals experiencing psychosis become more aware of the thinking patterns involved in their illness. MCT was developed by Steffen Moritz at the University Medical Centre Hamburg-Eppendorf in Germany, and is based upon current cognitive neuropsychiatric research. The main purpose of metacognitive training is to help people change the thinking patterns that cause delusions, thereby avoiding relapse into illness or reducing the impact of delusions.
The metacognitive training class is a group-based program that teaches participants about common thinking patterns to which they may be prone. The program also suggests ways to counter these potentially problematic thought patterns. Erroneous or distorted thinking patterns may—on their own or in combination with other factors—help establish delusions. Processing emotionally charged information through distorted thinking styles may trigger delusional thoughts.
Common thinking distortions include: making strong judgments based on little evidence, blaming other people rather than circumstances, being unable to let go of strongly held positions, and being overconfident that inaccurate memories are in fact accurate.
The MCT program aims to raise clients’ awareness of these distortions and to prompt them to critically reflect on, complement and change their current problem-solving tools. The classes are entertaining and designed to capture participants’ attention. Although the exercises are fun, they also challenge problematic thinking patterns. Though MCT is an interactive program, participants are not pressured to be involved. They are asked to participate at their own comfort level.
Early research from Dr. Moritz’s program suggests that MCT produces a reduction in the severity of delusions, and it was rated as more fun and more useful in daily life than an alternative cognitive program administered to a control group.
For more information on metacognitive training, please visit:
Illness Management and Recovery Group
Illness Management and Recovery (IMR) is a curriculum-based group led by our clinical director and a peer support specialist from the larger community. This group consists of a series of weekly sessions designed to help participants develop personal strategies for coping with mental illness and moving forward in their lives. The following subjects are covered in structured educational handouts: practical facts about mental illness, the stress vulnerability model of illness, building and using social support, recovery strategies, reducing relapses, using medication effectively, coping with problems and symptoms, and getting your needs met in the mental health system. In addition to these evidence-based modules, we routinely adjust the curriculum to include a wide variety of issues suggested by group participants. Recent additional topics have included: understanding the purpose of anxiety, the experience of being a client in therapy, cognitive conceptualization of symptoms, negotiating negative symptoms of psychosis, and living with delusional thoughts. We routinely utilize written materials to prompt group discussion. These may include personal accounts of individuals living with mental illness, new published research findings, and relevant current events.
Stress Management Group
Stress Management Group focuses on the development of varied techniques to combat daily persistent stress, as well as to manage the more overwhelming stessors which may have historically triggered a relapse of symptoms. This group emphasizes the practice of relaxation strategies, including but not limited to focused breathing, basic meditation, guided imagery, progressive muscle relaxation, in addition to individualized practices that promote relaxation. This group also employs applicable mindfulness and distress tolerance skills in order to most effectively manage stress. Much of this group is devoted to in-the-moment practice of stress management and stress relief skills, with the benefit of peer and facilitator support.
Modified DBT Skills Group
Based on the curriculum of Marsha Linehan’s Dialectical Behavior Therapy, Averte’s Modified DBT Group serves as an introduction to this treatment modality. The group meets weekly and is facilitated by DBT-trained licensed therapist and clinical support staff. This group follows each module of DBT, including core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, introducing the various skills and allowing for in-group practice in an effort to foster the development of these skills. Members of the group will also be provided individualized skills coaching practice with clinical staff as indicated.
Life Skills Group
Averte’s Life Skills Group is focused on providing education, problem-solving skills, and focused support over a wide variety of areas. This group encourages conversation and learning around activities of daily living, self-awareness, connection with others, independent living skills, and general self-care. Members are encouraged to request topics of need or interest, in order to best target each individual’s past barriers to success.
Integrated Treatment for Co-Occurring Disorders
Integrated Treatment for Co-occurring Disorders is an evidence-based practice that was developed to address previous limitations in services. Individuals with both a mental health and a substance use disorder have historically received fragmented treatment in either a substance abuse program or a mental health program, and there was little recognition of the connection between the two illnesses and the need for coordinated care.
The Integrated Treatment for Co-occurring Disorders program at Averte is based upon the work of Drs. Kim Mueser, Douglas Noordsy, Robert Drake and Lindy Fox out of Dartmouth Medical School and the New Hampshire-Dartmouth Psychiatric Research Center. We emphasize the importance of addressing the connection between substance abuse and mental health disorders, and of providing support in understanding the associated interaction of symptoms. We recognize that individuals go through different stages on their way to recovery. Stage-wise treatment provides individuals with services specific to their stage of treatment.
In the initial engagement stage, the therapist works to establish a trusting relationship with the individual. During this stage, the individual may not be ready for treatment, and often does not believe that he or she has a problem. In response to this, our treatment providers work to
Integrated Treatment for Co-occurring Disorders is an evidence-based practice emphasizing the intimate connection between substance use and symptoms of mental illness as central components of treatment. We recognize that individuals go through different stages during the process of recovery, and it is important to provide treatment with an understanding of these shifts in awareness and acceptance. This clinical program can be offered in individual or group settings.
The central goal during the initial stages of treatment is the establishment of a trusting relationship. It is typical that the individual may not be ready for treatment, and often does not believe that he or she has a problem. In response to this, our treatment providers work to strengthen the therapeutic relationship and establish greater levels of trust.
As treatment progresses, we encourage clients to think about their substance use, mental illness, and the impacts that both have on life goals. Work begins to identify the discrepancy between the individual’s behaviors and their own progress in a variety of areas related to quality of life and personal goals for the future (for example, relationships, employment, education, and reduction of symptoms).
As the individual begins to see substance use as a barrier to future goals, therapeutic work focuses on providing support in achieving desired changes in behavior. This typically includes reducing or stopping substance use, increasing coping skills, and maintaining a focus on active steps towards personal goals. Ultimately, the therapist and individual work together to create a relapse prevention plan reflective of one’s accomplishments and goals.
Treating co-occurring disorders in this stage-wise fashion can help residents achieve recovery, however change is not an easy process. Some individuals with co-occurring disorders move through the stages of treatment consecutively, while many others go back and forth between stages before achieving stable remission from substance use. Our practitioners are trained to treat both substance use disorders and mental illness, and work closely with residents as they move through the stages of change. Co-occurring disorders services are provided in both individual and group therapy settings on a weekly basis.
For more information about Integrated Treatment for Co-occurring Disorders, visit the Substance Abuse and Mental Health Services Administration website (SAMHSA.gov).
REAL: Relationships Effectively Added to our Lives
Current literature reflects the need for therapeutic interventions targeting the development of effective relationship skills in order for individuals with mental illness to foster healthy relationships. REAL integrates appropriate techniques of cognitive behavior therapy (CBT) and social skills training (SST) to address social isolation, symptom management, self-confidence, and effective social and emotional interactions, creating the building blocks for relationship development. This group provides a safe space for individuals to explore past and current barriers to creating and maintaining relationships, while utilizing in-the-moment opportunities to practice developing social skills.
Developed by Mary Ellen Copeland, the Wellness Recovery Action Plan (WRAP) is an evidence-based intervention focused on the development of prevention measures to promote ongoing recovery. A WRAP includes several components, which are self-designed and supported by the treatment team, including a wellness toolbox, daily maintenance plan, specific outlines of triggers and early-warning signs, and crisis- and post crisis-planning. At Averte, the WRAP group utilizes its time together to create well-defined, comprehensive WRAPs for each participant, in anticipation of future independent living and the goal of sustaining recovery. Group members work together with the group facilitator to identify effective tools and strategies necessary to manage future challenges. For more information, please utilize the following link: http://mentalhealthrecovery.com/wrap-is/
Social Skills Building Group
This weekly activity engages its participants in community activities, with the goal of developing appropriate social skills and increasing interpersonal opportunities. Members are provided practical situations in which to try out new skills, while encouraged and supported by trained staff. In addition, this group provides enjoyment and humor, while introducing members to new pleasurable activities that can increase overall treatment adherence and quality of life.
Vocational Support Group
Averte clinical programming includes vocational support designed after Supported Employment, an evidenced-based practice devised specifically to support individuals with serious mental illness toward their vocational goals. The key tenet of Supported Employment is that every individual is capable of working in the community, with the right employment environment and the appropriate supports in place during each step of the vocational planning process.
Vocational support programming is delivered in group and individual formats. The Vocational Support Group meets weekly, led by the Clinical Program Coordinator, and focuses on developing skills to manage symptoms in the workplace, overcoming barriers to employment while identifying strengths and interests, and providing support to peers in each step of the vocational process. Individual vocational services are provided as needed to address specific action steps of an individual’s vocational plan.
Initially requested by Averte participants, Interaction Group is the program’s process-oriented group, which is held weekly and is focused on experiential opportunities that challenge participants to interact in more meaningful ways. These activities and discussions are designed to promote further growth and development, within a safe and supported environment. The focus of the group remains on the interactional patterns within the group dynamic, affording members opportunities to learn more about their role within various relationships.
In an effort to best support the development of a key symptom management and relapse prevention skill, Averte holds a weekly group designed to continue the practice of mindfulness activities in a variety of formats. Some activities include mindful interaction, guided imagery, and meditation. Members are encouraged to utilize experiences from group sessions to build their independent mindfulness practice.
Living Recovery Group
Living Recovery is a therapy group meeting weekly to provide an opportunity for clients to engage in discussion and education about the process of recovery from mental illness. Topics are varied and often result from participants’ interests. Discussions are the basis for this group, though all topics are supported by supplemental written material. We use a variety of sources to initiate discussion such as personal accounts, current events, research articles, and other educational resources. Recent topics have included:
- Exploration of different types of treatment
- Experiences of the therapeutic relationship with providers
- Engagement with family members through the recovery process
- Negotiating friendships and intimate relationships
- The concept of free will in the context of symptoms
- Effects of involuntary treatment
- The role of insight in the process of recovery
All are welcome to attend this group, and participation may range from quiet attentiveness to active discussion of the topics. Group members often discuss ways to promote exploration of these concepts in the larger Averte community, and put effort into thinking about ways to extend this learning to others. This is a group that is highly tailored to group members’ interests and strives to provide an opportunity for open discussion of the process of recovery.