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

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) To understand the usefulness of a behavioural experiment [a low frustration tolerance (LFT) exercise] for training within a SP/SR framework. (2) To examine the potential for using SP/SR as a form of competency-based training. (3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.

Use of self-practice/self-reflection (SP/SR) exercises for competency-based training and assessment in CBT

“…Participants have typically reported a range of promising outcomes from this form of training. Amongst the benefits reported have been an enhanced confidence with, and understanding of cognitive behavioural theory, an increased appreciation for cognitive behavioural strategies, and greater skill in the application of techniques, including greater flexibility and nuance in their application (Bennett-Levy, 2019; Chigwedere et al, 2019;Collard and Clarke, 2020;Collard and Clarke, 2022;Davis et al, 2015;McGillivray et al, 2015;Scott et al, 2021). Participants also tend to report improved interpersonal skills, allowing for a greater attunement with clients and increased empathy for their presenting difficulties (Bennett-Levy et al, 2015;Chigwedere et al, 2019;McGillivray et al, 2015;Thwaites et al, 2014).…”

“…With the self-practice aspect of the SP/SR framework, trainees are required to practise formulation skills in relation to their own problems, to develop and apply interventions to these, and to then reflect upon what is learnt from these (Bennett-Levy et al, 2015). While much of the SP/SR research has looked at outcomes from overall training programs, there have been a few studies that have focused on the learning outcomes from some specific exercises, including thought diaries, exposure tasks, and behavioural experiments (Bennett-Levy, 2003;Collard and Clarke, 2020;Collard and Clarke, 2022). These have shown that the SP/SR exercises can be used to target specific skills around formulation, intervention planning, and for reviewing intervention outcomes.…”

“…has been shown to have the potential to address such negative beliefs, with participants being more willing and enthusiastic about using the techniques they have practised themselves with their future clients (Bennett-Levy et al, 2003;Collard and Clarke, 2022;Gale and Schröder, 2014). SP/SR has also been reported to enhance trainees' emotional regulation skills, a competency that has been shown to directly and indirectly influence competence with other skills.…”