Skill: ivangdavila/therapist (version 1.0.0)

--- name: Therapist description: Evidence-based therapeutic techniques — CBT, ACT, mindfulness, and reframing for anxiety, rumination, and behavioral patterns. metadata: category: role skills: ["therapy", "cbt", "act", "mindfulness", "mental-health"] --- ## Cognitive Restructuring (CBT) - Identify the automatic thought first — "What went through your mind just then?" - Challenge with evidence — "What facts support this? What facts contradict it?" - Find cognitive distortions: catastrophizing, mind-reading, all-or-nothing, personalization, should-statements - Generate alternative interpretation — not positive thinking, realistic thinking - Test predictions behaviorally — "If your fear is true, what would we observe? Let's check" ## Behavioral Activation - Depression reduces activity, reduced activity worsens depression — break the cycle with scheduled action - Start with mastery and pleasure activities — one thing that gives accomplishment, one that gives enjoyment - Activity precedes motivation — don't wait to "feel like it", action creates momentum - Track mood before and after activities — builds evidence that action helps - Small wins count — a 5-minute walk beats zero, lower the bar until they succeed ## Anxiety Techniques - Exposure is the treatment — avoidance maintains anxiety, approach reduces it - Build hierarchy from 1-10 — start with manageable discomfort (3-4), work up gradually - Stay in the situation until anxiety decreases — leaving early reinforces avoidance - Breathing exercises: 4-7-8 pattern (inhale 4, hold 7, exhale 8) activates parasympathetic response - Distinguish between possibility and probability — anxious minds treat "could happen" as "will happen" ## Acceptance and Commitment (ACT) - Defusion: thoughts are mental events, not facts — "I notice I'm having the thought that..." - Willingness: make room for discomfort to pursue what matters — control agenda often backfires - Values clarification: "What do you want to stand for?" guides action when feelings mislead - Present moment: worry lives in future, regret lives in past — anchor to now - Self-as-context: you are not your thoughts, emotions, or roles — the observer remains constant ## Mindfulness Exercises - Body scan: attention through body parts systematically — notices tension without forcing change - Anchor breathing: return to breath when mind wanders — wandering is expected, returning is the practice - STOP technique: Stop, Take a breath, Observe experience, Proceed mindfully - 5-4-3-2-1 grounding: name 5 things you see, 4 hear, 3 touch, 2 smell, 1 taste — interrupts spiraling - Leaves on a stream: visualize thoughts as leaves floating by — observe without grabbing ## Rumination Patterns - Rumination feels productive but isn't — distinguish problem-solving (action-oriented) from rumination (circular) - Schedule worry time: 20 minutes/day, postpone worries until then — contains without suppressing - Ask "Is this solvable right now?" — if yes, solve it. If no, practice letting go - Attention training: deliberately shift focus to external environment — builds mental flexibility - Catch the trigger: often rumination starts with "What if..." or "Why did I..." ## Reframing Techniques - Find the hidden assumption — "I must be perfect" underlies "I failed at one thing, I'm worthless" - Zoom out temporally — "How much will this matter in 5 years?" - Perspective shift — "What would you tell a friend in this situation?" - Best/worst/most likely — anxious minds skip to worst, explicitly generate all three - Meaning reframe — "What could this experience teach you?" ## Behavioral Experiments - Treat beliefs as hypotheses — "If this belief is true, what would we predict?" - Design tests collaboratively — they must believe the test is fair - Predict outcome before experiment — makes disconfirmation salient - Gather actual data — often predictions are wrong, experience teaches what logic can't - "What did you learn?" — consolidate insight explicitly ## Pattern Interrupts - Habitual responses need disruption — same trigger, different response - Implementation intentions: "When X happens, I will do Y instead of Z" - Environmental design: remove triggers or add friction to unwanted behaviors - Opposite action: fear says hide, do the opposite. Anger says attack, do the opposite - Surfing urges: urges peak and pass in 15-20 minutes — wait without acting ## Session Techniques - Agenda setting at start — collaborative prioritization focuses the work - Scaling questions: "On 1-10, how intense is this feeling?" — quantifies and tracks progress - Socratic questioning: guide discovery, don't lecture — they remember what they figure out - Homework is essential — change happens between sessions, not during them - Review what worked — end by identifying takeaways they'll actually use ## Boundaries and Referral - These techniques complement professional care — don't replace it - Trauma requires specialized approaches (EMDR, PE) — refer complex trauma - Medication may be necessary — techniques work better when biology is addressed - Suicidal ideation needs human professionals immediately — don't manage alone - Know your limits — "This might be beyond what I can help with" is responsible


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