The Skills System Instructor's Guide

iUniverse, Inc.

Contents

Preface........................................................................................ixAcknowledgments................................................................................xvChapter 1: Introducing The Skills System.......................................................1Chapter 2: Learning The Skills System..........................................................11Chapter 3: Skills Coaching.....................................................................35Chapter 4: Understanding Learning Challenges And Intellectual Disabilities.....................41Chapter 5: Structuring Skills System Instruction...............................................55Chapter 6: Foundational Teaching Strategies....................................................62Chapter 7: E-Spiral Teaching Strategies........................................................69Chapter 8: Skills System Twelve-Week Cycle Curriculum..........................................81References.....................................................................................151Appendix A.....................................................................................157Appendix B.....................................................................................289Appendix C.....................................................................................293Appendix D.....................................................................................297Glossary.......................................................................................305

Chapter One

Bernice Johnson Reagon, an African-American scholar and songwriter, wrote "Life's challenges are not supposed to paralyze you—they're supposed to help you discover who you are" (Lewis, 2009). Fully experiencing life's challenges and remaining present within the current moment can be excruciatingly difficult. Painful emotions and overwhelming thoughts may bombard the individual, blurring self-reflection and the course ahead. The person may not choose to be paralyzed; it is what happens when certain events occur and he or she lacks effective coping skills.

While emotions may blind the individual and pose difficulties, they may also be the very vehicle of self-discovery and fulfillment. Emotions are key components of many important and joyful aspects of the human experience. Having the capacity to benefit from emotions, rather than being paralyzed by them, offers the individual the opportunity to mobilize individuality while actively learning valuable life lessons and evolving to reach personal potential. As the individual learns how to regulate emotions, thoughts, and actions, he is not only not paralyzed, but he is able to face life, relationships, and himself with courage, grace, and strength.

Developing effective emotion-regulation skills is an important step toward managing life's complexities, versus becoming paralyzed by them. Knowing how to increase positive effect and reduce negative feelings can help the person improve his or her quality of life. This regulatory capacity allows the person to balance both rational and emotional aspects of situations to reach his or her personal goals. Regulating emotions does not mean erasing them; it means proactively and reactively making adjustments in behavior that help the individual maintain balance. This ability to balance helps the individual remain actively engaged in the process of self-discovery even when experiencing significant life challenges.

The Skills System

The Skills System is a set of nine skills and three system rules that helps the individual cope with life's challenges. The emotion-regulation skills curriculum was developed to help the person organize her internal and external experiences in ways that decrease discomfort and problematic behaviors, while increasing positive affect and goals directed actions. This simple framework guides the person through the process of becoming aware of the current moment, directing attention, and activating behaviors that are in service of personal goals. The person learns to follow steps that mobilize inner wisdom in each unique situation. As the skills and the guidelines are integrated into the context of the person's life, the demonstration of effective coping behaviors within challenging situations increases. Each situation provides the person with an opportunity for self-discovery and for active participation in events. The individual is no longer paralyzed; he or she is a Skills Master.

User-friendly for individuals with learning challenges.

Learning new, more adaptive patterns of behavior is a challenging task for anyone. This is especially difficult when the individual must manage complicating factors such as mental health issues, intellectual impairment, physical problems, or other difficult life circumstances. These life challenges may increase stress and impact the individual's ability to learn new information.

The Skills System and the curriculum contained in this guide are designed to help individuals who experience learning challenges. For example, an individual who is diagnosed with an intellectual disability or mental illness may have difficulty focusing attention, remembering information, and utilizing concepts within complex situations. The Skills System itself and the teaching strategies contained in the Instructor's Guide are constructed to maximize learning, integration, and ultimately generalization of the skills into life's contexts. Even an individual who cannot read or write can learn and use the Skills System.

Compatible with dialectical behavior therapy (DBT).

The Skills System was developed as an accessible alternative for individuals with cognitive impairment who were participating in DBT therapy (Linehan, 1993). DBT therapy has two main components: individual therapy and skills-training group. The skills curriculum (Linehan, 1993b) is broken down into four modules. The individual learns skills in the areas of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. The clients learn adaptive coping skills in group and discuss implementation of the strategies within life contexts during individual therapy.

The standard DBT skills (Linehan, 1993b) were not specifically designed for individuals with intellectual disabilities in that the terms are complicated and there is no framework for utilizing the skills. Although the format of the standard skills is challenging, the general concepts are vastly helpful for this population. Merely modifying the teaching of the standard curriculum is not sufficient to capture the essence of DBT in a way that promotes generalization of the principles and skills by this population. The Skills System utilizes DBT principles, while the language and format are adapted to address the needs of individuals who experience significant learning challenges. The Skills System may be conceptualized as pre-DBT skills; the remedial structure of the Skills System model offers the individual basic self-regulation capacities, upon which the standard skills can be added.

Applications of the Skills System

Who can benefit from learning the Skills System? Many people have experiences or physiology that complicates the learning and demonstration of effective emotion-regulation behaviors. Each person has unique clusters of strengths and deficits, abilities and disabilities. Any individual, intellectually disabled or otherwise, may be prone to overwhelming emotions, unclear thinking, or unproductive action. All people have the capacity to make impulsive decisions that hinder the accomplishment of personal goals. Even individuals who practice adaptive coping behaviors experience overwhelming circumstances that can stress such capacities. The Skills System materials are user-friendly concepts that are accessible to learners of all abilities.

The utilization of the Skills System is expanding. Although the Skills System was originally designed for adults with significant cognitive impairment who were participating in DBT, the model is often used within the context of other forms of individual therapy or with individuals not receiving these services. Similarly, although the curriculum was designed for adults, adolescent and children's programs have adopted the model. In addition, the curriculum is being used by a broad spectrum of individuals, from those with severe learning challenges to those with no learning challenges whatsoever. The Skills System concepts and teaching strategies are constructed to facilitate learning and implementation; the ease of learning benefits all.

The Skills System model has been used in many different therapeutic settings. For example, the Skills System has been implemented in residential programs for emotionally disturbed children, as well as within outpatient community mental health settings. Residential programs serving emotionally disturbed adolescents have also utilized the Skills System. In addition, residential programs supporting intellectually disabled adolescents and adults have integrated the model into their programs. Although no empirical data is yet available in these settings, informal reports support the usage of the Skills System with diverse populations.

Overview of the Skills System

There are nine skills in the Skills System; these nine skills form the Skills List. There are also three System Tools that guide utilization of the skills. An individual who tends to become overwhelmed by emotion, has difficulty focusing on thoughts that are in service of personal goals, and/or reacts impulsively to urges benefits from learning step-by-step progressions to manage these factors. A person with these issues may have difficulty transitioning successfully from one strategy to the next in traditional coping-skills education that provides individual elements without offering a system to guide implementation. The unified structure assists the person in remembering strategies and moving fluidly through a multistep coping transaction while experiencing intense emotional-, cognitive-, and behavioral-regulation problems. As the individual learns the skills and the system, he or she integrates the capacity to successfully experience a full range of human emotions, practice self-determination, and acquire the means to navigate toward goals even in challenging circumstances.

The first three skills in the Skills System comprise a core progression that serves as the foundation for skills use. This sequence begins when an individual experiences a change in emotion; he or she begins by getting a Clear Picture (Skill 1). Six steps lead the person to become aware of information within the current moment. This is crucial, because often individuals with self-regulation problems focus attention on the past or future, rather than the present. Not only does focusing on the current moment give the person accurate information to use in making decisions, but it also reduces strong emotional responses.

Once the person gets a Clear Picture, he or she switches to focusing on On-Track Thinking (Skill 2). In On-Track Thinking, the individual moves through a simple four-step sequence that leads him or her through the process of mapping out an effective coping plan. This cognitive framework serves to shape the individual's thinking patterns to promote emotion regulation and goal-directed behaviors. As the person learns the adaptive cognitive structure in group, practices it within his life context, and experiences positive reinforcement, the functional thinking patterns become increasingly sophisticated and automatic over time.

On-Track Thinking requires the individual to make a Skills Plan. This component links the remaining skills together in a chain. Three simple rules (System Tools) determine which skills will be helpful and how many to use within the context of the present moment. Depending on the individual's self-reported level of emotional arousal (using the Feelings Rating Scale), he or she knows whether using more interactive skills (Skills 6-9) are options (using the Categories of Skills). The person learns that at high levels of emotional (and cognitive) arousal, it is necessary to choose more solitary skills (Skills 1-5) that function to reduce the sensations of uncomfortable feelings, to divert attention from problematic urges to effective actions, to minimize risks, and to improve focus. At all levels of escalation, the individual makes a plan to choose a sufficient number of skills (using the Recipe for Skills), targeting specifically the most effective skills according to the demands of the situation.

Next, the individual takes an On-Track Action (Skill 3). On-Track Actions are the behaviors the individual mobilizes to move in the direction of his goal. Therefore, the person gets a Clear Picture, does On-Track Thinking, and executes a series of On-Track Actions. If the individual is over a level 3 emotion, she may engage in a Safety Plan (Skills 4) or New-Me Activities (Skills 5). If under a level 3, the person can also use the Calm-Only skills, which are Problem Solving (Skill 6), Expressing Myself (Skill 7), Getting It Right (Skill 8), and Relationship Care (Skill 9). Once a cluster of skills has been completed, the individual returns to do Clear Picture again to become aware of the new situation that has evolved.

Initially, the individual conceptualizes the Skills System as a series of linear events; when a sequence of skills is finished, he or she returns to doing Clear Picture, On-Track Thinking, OnTrack Action, and so on, repeating the process in each subsequent situation. As the individual integrates the Skills System, he or she is more able to utilize Clear Picture and On-Track Thinking throughout the coping process in a dynamic, transacting pattern to adjust On-Track Actions. Even individuals with significant cognitive impairment gradually improve the ability to make subtle adjustments; this flexibility can enhance the person's success in reaching goals and in maintaining on-track relationships. The Skills System is a structured, yet malleable framework that can help an individual reduce reliance on avoidant behaviors, bear increased responsibilities, and fully engage in the human experience.

The Skills List

The following section includes brief descriptions of each of the skills and System Tools. This is intended as an initial exposure to the information. These concepts are presented in greater detail in Chapter 2. This introduction will serve as a skeleton upon which more information will be layered in the following chapters.

1. Getting started with a Clear Picture.

The first skill in the Skills System is Clear Picture; the metaphor of a television represents having a clear versus a fuzzy vision of a situation. Clear Picture guides the individual through steps that bring focused attention to six aspects of the person's present experience to gain clarity. The first of the Clear Picture Do's prompts the individual to focus on her breath. Next, the person shifts attention to notice what is happening around her. Once the individual has awareness of the environment, attention is then shifted to doing a Body Check; bringing attention to the body begins a series of self-reflections that help orient the person to the realities of her internal experience. The person then labels and rates her emotions and notices thoughts and urges.

There are two important facets of this skill: (1) gaining accurate information about these important internal and external experiences and (2) effectively shifting attention. Some individuals who experience cognitive deficits and/or self-regulation problems have difficulty shifting attention in ways that manage her level of arousal. The Clear Picture skill trains the person to see facts versus fantasies and to focus on making decisions that are in her best interest.

2. Using On-Track Thinking.

Once the individual has a Clear Picture of her internal and external circumstances in the moment, the person strategically transfers attention to Skill 2, which is On-Track Thinking. The name "On-Track" uses the metaphor of a train to represent the concept of the individual moving incrementally toward a destination or goal. Thus, the image of "Off-Track" communicates circumstances that are not in service of the goal.

On-Track Thinking offers the person a series of four tasks to complete to create an effective thinking process. This sequence, (1) Stop, Step back, and Think about what I want; (2) Check the Urge; (3) Turn It to Thumbs-Up; and (4) Make a Skills Plan, provides an adaptive cognitive structuring template for the individual to follow in each situation. These simple steps lead the person to pause before reacting to impulses, reflect on desired outcomes, check the utility of the urge, create useful alternatives, and create a plan to reach the goal.

3. Taking an On-Track Action.

Once the participant gets a Clear Picture and does On-Track Thinking, he uses Skill 3, which is On-Track Action. The reuse of the word "On-Track" is designed to reinforce the concept that the person transitions from On-Track Thinking to On-Track Action. It is challenging for any person to alter problematic patterns of behavior; On-Track Actions mobilize new, adaptive actions that are directly related to personal goals. It is useful to have On-Track Thoughts, but without On-Track Actions, the individual may revert to problematic behaviors.

There are five different elements of the On-Track Action skill. First, this skill includes any action that the individual takes in the direction of her goal. An action is considered on-track if the person has taken time to be self-aware within the present moment (Clear Picture) and has made an effective decision (On-Track Thinking). The remaining functions of On-Track Actions include Switching Tracks, making an On-Track Action Plan, Accepting the Situation, and/or Letting It Pass and Moving On. Each of these concepts give the individual tools to proactively or reactively manage Off-Track Urges.

4. Managing risky situations with Safety Plans.

During the process of getting a Clear Picture and doing On-Track Thinking, the person may identify possible risks that may impede her progress toward goals. In a situation such as this, the individual may take the On-Track Action to create and execute a Safety Plan. Safety Plans, the fourth skill in the Skills System, provide a framework that assists in evaluating the Level of Risk and in choosing the appropriate responses to manage the circumstances. It is important that the person be fully aware of risks, understand various options for managing the problems, and have the ability to implement actions that neither unnecessarily avoid situations nor recklessly engage in problematic ones.

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Excerpted from The Skills System Instructor's Guideby Julie F. Brown Copyright © 2011 by Julie F. Brown. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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