Mobile mind mapping: using mobile technology to enhance rational emotive behavior therapy.
Cognitive therapy (Methods)
Cognitive therapy (Technology application)
|Author:||Warren, Jeffrey M.|
|Publication:||Name: Journal of Mental Health Counseling Publisher: American Mental Health Counselors Association Audience: Professional Format: Magazine/Journal Subject: Health; Psychology and mental health Copyright: COPYRIGHT 2012 American Mental Health Counselors Association ISSN: 1040-2861|
|Issue:||Date: Jan, 2012 Source Volume: 34 Source Issue: 1|
|Topic:||Canadian Subject Form: Cognitive-behavioural therapy; Cognitive-behavioural therapy Computer Subject: Technology application; Smart phone|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Email, chat rooms, and websites are often used in counseling. Now,
smartphones and their applications can also be used. Mobile mind mapping
tools can support counseling frameworks, such as rational emotive
behavior therapy (REBT). The integration of counseling and technology
has great potential for helping clients to lead healthier and more
productive lives. This article describes REBT and outlines four ways to
use mobile mind maps in REBT. It also offers tips on how to use mobile
mind mapping to enhance the counseling process. The article concludes
with a briefcase study demonstrating how mobile mind maps can be
integrated into counseling.
Now more than ever, counselors are using web-based portfolios (Barnes, Clark, & Thull, 2003); distance learning tools (Berry, Srebalus, Cromer, & Takacs, 2003); computer-based supervision (Watson, 2003); and computer-based career counseling programs (Kuo & Srebalus, 2003). They are serving clients via e-mail, chat rooms, and social media such as Second Life. The number of Internet-based counseling services is surging (Alleman, 2002; Haberstroh, 2009; Mallen, Vogel, & Rochlen, 2005).
Besides being a medium through which to provide counseling, technology can also complement counseling theory and practice. For example, Stuhlmiller and Tolchard (2009) identified several cognitive behavior therapy (CBT) computer-based programs (Beating the Blues, Fear Fighter, and MoodGYM) for treating clients suffering from anxiety and depression. These programs not only enhance the counseling process, they are affordable and accessible. Counselors in schools also use the Internet, e-mail, and text messages to enhance the process and relay information to students and parents (Landry, 2008).
A study by McDoniel, Wolskee, and Shen (2009) found counseling that used a hand-held, self-monitoring apparatus and internet communication was effective in treating obese adults. Lawler et al. (2010) found telephone counseling using motivational interviewing and social cognitive theory decreased unhealthy behaviors of clients with chronic conditions.
Rational-emotive behavior therapy (REBT; Ellis, 1962) seems to be especially adaptable to incorporating technology. For example, Ross (2006) developed an on-line version of the REBT self-help form (Dryden & Walker, 1992) that allows clients to independently complete the form with guidance from pop-up directions and definitions. Clients can then print the results and process them with the counselor later.
Warren (2009) created an interactive website that allows child and adolescent clients to immerse themselves in the REBT philosophy through a group of animals called the rational instincts that are presented in adverse situations. Clients respond to questions related to the scenarios by typing in the text boxes provided, with the responses submitted directly to the counselor. The website also contains songs that encourage rational living.
Warren (2010) suggested that Second Life[R], developed by a private Internet company, Linden Research, Inc. (n.d.), could be used with REBT. Counselors can use Second Life[R] in treating anxiety or addressing issues such as low frustration tolerance and self-worth (Warren, 2010). For example, counselors might encourage clients struggling with social anxiety to communicate with others through Second Life[R]. Clients can use their Second Life[R] avatar to desensitize themselves to interaction with others (Warren, 2010).
The use of technology in counseling will evolve with further technological advances. Laptops and nethooks are smaller yet have increased memory and functionality. Tablet computers and smartphones make accessing Internet applications easier. Smartphones allow users to remain connected throughout the day. Counselors should continually search for technological ways to enhance counseling, especially hand-held devices such as smartphones.
The following overview of REBT provides a framework for application of portable mind mapping, which is also summarized. Four uses for mobile mind maps in REBT are discussed, with implementation tips for counselors. A brief case study then demonstrates how mobile mind maps can be used in REBT. Finally, the article challenges readers to explore other smartphone applications.
RATIONAL EMOTIVE BEHAVIOR THERAPY
REBT evolved in the mid-1950s because Albert Ellis was dissatisfied with other forms of therapy. He based REBT on the premise that people are disturbed not by things but by how they see them. Ellis (1962, 1975, 1991, 2003) posited that confronted with adverse events (A), people tend to think irrationally, though they do not have to. Thoughts or beliefs (B) about (A) ultimately lead to consequences (C), which may be helpful or unhelpful (Ellis & MacLaren, 2005). This ABC model is the main impetus for REBT.
Most cognitive behavioral therapies attempt to dispute a client's view of reality (Backx, 2003). However, REBT asserts that individuals are not disturbed by perceptions alone; imperative thoughts or irrational beliefs about the perceptions are what lead to emotional disturbance (Dryden & Branch, 2008). Irrational beliefs are defined as rigid, dogmatic inferences accompanied by exaggerated evaluations (Dryden, 2009; Ellis, 2003), such as "She should not treat me that way and it's terrible when she does." Irrational beliefs often contain words such as "should" or "must" and one of three evaluations (Ellis & MacLaren, 2005): "I can't stand it," "It's terrible," or "I'm worthless." Irrational beliefs often lead to such unhelpful negative emotions as anger, depression, or anxiety (Dryden, 2009; Ellis, 2003). People experiencing these emotions tend to respond in counter-productive ways. For instance, someone experiencing anger may punch a hole in the wall, or anxiety may lead to avoiding a task.
REBT strives to help clients think rationally. Rational beliefs are considered to be flexible and preferential (Dryden, 2009; Ellis, 2003). Language like "I'd prefer," "I wish," or "I'd like to" suggests rational beliefs, which lead to healthy negative emotions, such as concern or bother (Ellis & MacLaren, 2005). When these emotions are experienced rather than anxiety or anger, helpful behaviors are more likely. For example, the thought, "I wish she wouldn't treat me this way, but I can handle it," would likely lead to bother rather than anger. The behavioral response might be to talk calmly.
The REBT framework provides numerous behavioral, emotive, and cognitive techniques to promote a preferential philosophy of life. Examples of behavioral techniques are in vivo desensitization, operant conditioning, and relaxation training (Ellis & MacLaren, 2005). Rational emotive imagery, shame-attacking exercises, and humor are popular emotive techniques (Ellis & Wilde, 2002). Cognitive techniques are largely challenges to faulty thinking. Rational coping statements, stopping and monitoring thoughts and feelings, or the self-help form (Dryden & Walker, 1992) are valuable in creating cognitive awareness and disputing irrational beliefs (Ellis & MacLaren, 2005).
The cognitive techniques would seem to lend themselves most readily to Internet and phone applications. Where counseling and technology intersect, clients will be equipped to "be their own therapist"--an REBT mantra.
MOBILE MIND MAPPING
Although mind maps have been used for centuries, Dr. Allan Collins is often considered to be the father of modern mind mapping (Nada, Kholief, Tawfik, & Metwally, 2009), which evolved from his work with Quillian on semantic networks. In attempting to organize semantic concepts, Collins and Quillian (1969) created pictorial representations, tree-like structures, which evolved into the modern mind map. Mind maps use words, lines, and symbols to organize and graphically represent information (Mind Mapping, 2010). Nada et al. (2009) referred to mind mapping as a visual learning technique that enhances thinking. Individuals can use mind maps to solve problems and record or recall information. Research on mind map users has found enhancements in motivation (Holland, Holland, & Davies, 2004); critical thinking (Michelini, 2006); and memory (Evreklia, Balim, & Inela, 2009; Toi, 2009).
Mind maps can be drawn on paper or with a computer. Recent advances in communication technology have also made mind mapping accessible via mobile devices like smartphones, which offer advanced features, such as Internet access and an operating system for using applications. SimpleMind, Mindberry, and Thinking Space are three popular mind-mapping applications (Strohmeyer, 2011). Although not endorsing a particular application this article uses Thinking Space to demonstrate how to develop mind maps during REBT.
Thinking Space was developed by C. Chilton of Kinesthetic Ltd. (personal communication, June 13, 2011) for smartphones based on the Android operating system (Kinesthetic Ltd., 2011). Once it is downloaded, users can typically begin mind-mapping immediately and easily, adding nodes and sub-nodes of information as needed. The style, size, and text-color of the nodes can be modified. Users can add notes for each node, and icons and hyperlinks can be embedded. Users can create relationships between nodes by drawing arrows between them. Nodes can also be rearranged as the mind map develops. With slight variations these features are typical of most mobile mind-mapping applications.
Mind-mapping applications like Thinking Space can be used to organize ideas, collect data, and assist in recall of valuable information. Because they are accessible, portable, and easy to use, counselors can use them to assist clients, as the case study shows.
MOBILE MIND MAPPING IN REBT
A major goal of REBT is to encourage clients to become their own therapists (Dryden, 2005). Clients can use mobile mind mapping to implement the ABC model during or immediately after adverse situations, but they can also use it daily for storing and readily accessing a database of rational thoughts. It can also be used to record how clients experience adverse events. Together counselors and clients can use it to identify cognitive themes across adverse events.
Before mobile mind mapping is recommended, clients should be clearly motivated to engage in the counseling process and work toward change. Also, a basic understanding of REBT is necessary. Therefore, it is recommended that the counselor present and discuss the ABC model before introducing these techniques. Clients need access to a smartphone and an interest in using it to complete REBT-related tasks. It should be emphasized that mobile techniques are recommended only to supplement the counseling process, not replace it. Clients who meet these requisites may find mobile mind mapping useful; however, as with any counseling strategy it is important to ensure that clients are prepared for a mobile mind mapping task and understand its intent.
Counselors often recommend that clients complete ABC exercises as homework during the course of REBT or after adverse events. These are opportunities for using mobile mind maps. For example, clients can begin ABC mind mapping exercises in Thinking Space by selecting "New MindMap" from the main screen. Then they are prompted to create a title node (A) for the MindMap or the adverse event they are analyzing. They can create additional nodes to represent emotional and behavioral consequences (C) and beliefs (B) as extensions of the title node (Figure 1). They can also add nodes to dispute irrational beliefs (D), create new rational alternatives (E), and identify healthier negative emotions (F).
[FIGURE 1 OMITTED]
Tip 1: Make mind mapping easy. Clients may benefit from a demonstration of how they can use mind mapping to complete ABC exercises. Counselors can also support clients as they attempt such exercises. For example, they can give clients generic outlines of questions, prompts, or the self-help form (Dryden & Walker, 1992) to refer to during work on ABC exercises.
Stop, Monitor, and Record
Counselors using the REBT framework with clients often rely on subjective experiences to drive the treatment process--a clear understanding of the client's reality helps counselors to provide the most appropriate treatment (Heppner, et al., 1994). However, sometimes counselors may assess the client's perceptions of adverse events, thoughts, and emotions inaccurately. They might recommend that clients use mobile mind mapping to self-report in vivo. Stop, monitor, and record (SMR) allows counselors to assess a client's thoughts and feelings throughout the day. They might also suggest SMR as a way to foster client awareness of irrational thoughts and feelings. This might be a prerequisite for clients challenging irrational thinking and completing ABC exercises.
From the main screen of Thinking Space, clients can be instructed to create separate mind maps, one titled "Thoughts" and one "Feelings." During or immediately after adverse situations, clients can record specific thoughts by accessing the "Thoughts" mind map and creating additional nodes (Figure 2), each containing a thought. They can then return to the main screen, access the "Feeling" mind map, and record the feelings associated with the situation (Figure 3). The information recorded can be presented to the counselor during the next scheduled counseling session, to both give the counselor a clear picture of the client's experiences in daily living and promote client self-awareness.
[FIGURE 2 OMITTED]
[FIGURE 3 OMITTED]
Tip 2: Provide emotional and cognitive education. In describing situations, clients often use thoughts and feelings interchangeably, saying, for example, "I felt like he should not have treated me that way." In REBT distinguishing thoughts and feelings is very important. Counselors can help clients to differentiate these constructs before recommending the SMR technique. However, for mind mapping, encourage clients to concentrate on recording thoughts and feelings without worrying about whether they are identifying them correctly.
REBT encourages clients to practice thinking in rational ways. Clients can build mind mapping databases of rational thoughts, and counselors can encourage them to refer to these databases throughout the day. When they review rational statements often, clients can formulate more preferential philosophies of life. The databases of rational thoughts can also be used to complete other mind-mapping tasks, such as ABC exercises.
In Thinking Space clients can create a new mind map from the main screen that is titled "Rational Thoughts" (Figure 4), starting with nodes that contain generic rational thoughts such as "I'd like to get my way but I don't have to" that clients can access and rehearse throughout the week. Additional rational thought nodes can be added at any time.
[FIGURE 4 OMITTED]
Tip 3: Demonstrate how to craft a rational thought. Clients new to REBT often find it difficult to construct rational thoughts. They need clear guidance. Demonstrate how they can create flexible statements that negate their original beliefs. For example, "I'd like to get my way, but I don't have to" is a general rational thought that dismisses a demand. In session counselors can help clients construct a rational thoughts mind map with examples that clients can refer to when adding personal rational thoughts to databases.
Identification of Themes
In REBT counselors often look for life themes that might interfere with client well-being and functioning. Counselors and clients can work together to explore possible themes by analyzing the mind maps. Mind maps created during ABC exercises and SMR can be brought to sessions or e-mailed to the counselor. By analyzing their thought content, clients can identify core beliefs across various adverse situations. For example, core beliefs such as "I'm worthless" or "life is terrible" may appear throughout the mind maps. Over time, clients can witness changes in cognitive structuring and assess progress. These types of tangible discoveries can be quite therapeutic.
Tip 4: Encourage diligence. It is important for clients to understand the ultimate goal of REBT: to develop a rational philosophy of life. They will reap the benefits of REBT faster if they are diligent and invested in the process. Encourage clients to frequently use and save their mobile mind mapping efforts. Work closely with them to analyze isolated irrational thoughts and move toward broad rational philosophies of self, others, and life.
THE FURIOUS FRESHMAN: AN ILLUSTRATIVE CASE
Tonya, a college freshman, noticed that after a recent break-up she easily became angry. She entered counseling almost two months ago. Her counselor has used an integrative approach comprising REBT, solution-focused counseling, and a person-centered approach. Tonya is highly motivated and completes the homework assignments she negotiates with the counselor during sessions. They have established a solid therapeutic relationship. The counselor has learned that Tonya is tech-savvy and has a smartphone. She also has a basic understanding of the ABC model and has several times used the self-help form (Dryden & Walker, 1992) to address the anger she experiences.
During one session the counselor explored whether Tonya might be interested in using her smartphone to support her therapy. She was. The counselor recommended that Tonya choose a mobile mind mapping application and learn how it worked before the next counseling session. Tonya returned excited the following week with her downloaded application. She said she had viewed a tutorial and created a basic mind map a few days earlier.
Based on the current goals and direction of treatment, the counselor introduced Tonya to rational reviews: together they reviewed the differences between rational and irrational thoughts. The counselor gave a few examples of rational thoughts and prompted Tonya to create her own.
Tonya had previously commented that when she thinks she is being treated with disrespect, she becomes very angry. She identified the irrational belief that leads to anger as "People should treat me with respect and I can't stand it when they don't!" Using the mind mapping tool in the current session, she created a rational review to challenge this imperative cognition. She titled it "RESPECT IS NICE, not needed!" Among the rational statements she added to the database were (a) "Disrespect is bad, but it is far from terrible!" (b) "I don't like being disrespected, but I can handle it!" (c) "I would like to be treated with respect, but it is not required!" and (d) "Disrespect does not equal the end of the world!" The counselor encouraged Tonya to review these rational thoughts throughout each day (waiting in line, before class, during meals, on the bus, etc.).
At the next session Tonya said she had been reviewing the rational thoughts several times each day--so often, in fact, that she had memorized them. She also stated that she had created several other rational reviews. Most importantly, she said she had reduced the intensity of her anger toward those who show disrespect.
To assess the degree to which Tonya had internalized the rational thoughts she rehearsed, the counselor recommended SMR, asking Tonya to stop, monitor, and record her thoughts in a mind map several times each day. The next week Tonya brought in copies of the SMR mind maps. The counselor and Tonya analyzed these together to identify cognitive themes and realized that Tonya still struggled slightly when she perceived others as not treating her with respect: during the week, 9 out of 35 recorded thoughts had been irrational.
The counselor encouraged Tonya to continue the SMR exercise. Because she had done so well with mind mapping and had previously used the self-help form, the counselor also suggested that she begin ABC exercises. Tonya agreed to complete an ABC exercise for each irrational thought she recorded.
Over the next two weeks Tonya reported continued improvements in daily living. She thought SMR was heightening her awareness of thoughts and feelings, and the ABC exercises were giving her a structured way to challenge irrational beliefs. As the counseling relationship moved toward termination, the counselor encouraged Tonya to continue using mobile mind mapping to explore and challenge irrational thoughts. Because she participated consistently during each counseling session and was willing to complete the mind mapping tasks, Tonya was able to overcome the demands she placed on others and acquire a more preferential philosophy of life.
As technology becomes more accessible and mobile devices advance, counselors need to consider applications that might help clients to address social-emotional issues. Although research is needed about the most effective use of technology, mobile mind mapping appears to provide an accessible format for delivering established counseling practices. While this article presents mind maps as an adjunct to REBT, other counseling models or paradigms (solution-focused counseling, narrative therapy, gestalt, etc.) may also find mind maps useful. In time it is likely that new smartphone applications will further enhance the counseling process.
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Jeffrey M. Warren is affiliated with the University of North Carolina at Pembroke. Correspondence concerning this article should be addressed to Jeffrey M. Warren, UNC-Pernbroke School of Education, P.O. Box 1510, 1 University Place, Pembroke, North Carolina 28372. E-mail: firstname.lastname@example.org.
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