DCBT -Designing Cognitive Behavioral Thinking: the workshop for medical externs

A year before the pandemic, I had the opportunity to work on a project which had tremendous positive output. My colleague and I designed and facilitated the DCBT workshop for externs at the Medical Education Center, Songkhla Hospital in southern Thailand.

DCBT-Designing Cognitive Behavioral Thinking is the integration of Design Thinking (DT) and Cognitive Behavioral Therapy (CBT).

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It was created by my co-worker and me. She is a child psychiatrist and an expert in CBT, and I am a veteran in Design Thinking. I have been using Design Thinking in many professional projects as well as “training the trainers” in Design Thinking for more than 10 years. At the time of the project, I was a CBT student in a Diploma program at Chulalongkorn University, Faculty of Medicine.

Design Thinking and CBT have much in common.

While each has its own uniqueness and characteristics and is used for different purposes. Design Thinking is a mindset, methodology, tools, and skills to solve complex problems and create innovation.

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CBT is a psychological treatment for patients with mental health problems such as depression, anxiety, PTSD and panic disorder. Both are empathy-driven, collaborative, and action-oriented, and focus on building essential skills for those who use them.

We hybridized the two to make psychological intervention accessible to a wider group of people. We found that Design Thinking helps deliver CBT skills faster.

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For this workshop, Songkhla Hospital wanted their externs to develop skills in understanding patients deep enough to identify their needs and concerns. Thus, these soon-to-be doctors could solve problems for their patients in a more holistic way, not just physical or biological aspects.

In the workshop, we focused on participants familiar with Cognitive model and Case formulation from CBT, and using processes and tools from Design Thinking to create intervention.

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Cognitive model, Case formulation VS. Empathy map and Persona

CBT’s Cognitive model and Case formulation have the same underlying idea as Empathy map and Persona of Design Thinking. However, to understand people’s needs and sufferings at such a deep level so as to treat them, requires solid psychological knowledge, thorough investigation, and empathy. Therefore, CBT’s techniques and tools here are more useful. On the other hand, Design Thinking is more helpful when it comes to idea-generation, trials and errors for quick feedback–known as rapid prototyping. So DCBT brings the best of both practices to work.

During this 2-day workshop, the externs would engage in each medical ward with patients they were responsible for. Then they identified their patients’ needs and formed ideas for intervention. I remember some of the interventions particularly impressed me, they are listed below.

Many of the patients in the orthopedic ward during that time were admitted because of traffic accidents. They often had not been wearing helmets since they thought it would be acceptable when they were driving for short distances. This team of externs accordingly suggested the idea of the talking helmet. The helmet would not allow an engine to start unless the driver was wearing it. If the driver goes way too fast, the helmet would shout and talk non-stop. As a learning designer I would say the helmet matches Skinner’s Operant Conditioning principle.

Lonely alert was another intervention. It was designed for the elderly with limited mobility in a close-knit community. They are often left alone in their houses because their grown-up children have to work during the day. When they feel sad or lonely, the system will alert others in the community to walk to their houses and talk to them. Again, this was based on the concept of Behavior Activation theory of Peter Lewinsohn.

Anxious middle-aged mothers were a target group the externs in the maternity ward designed for. The externs set up a chat-group for these mothers to share thoughts, feelings, and ideas, with other volunteer mothers and maternity ward staff who have more experience. This is based on Albert Bandura’s Self-Efficacy and Social learning theory.

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What we found fascinating was that during the workshop, we did not teach any psychological theory, mental health diagnostics, structure of CBT, or any protocols. We just showed them the Cognitive model and then encouraged them to use it to understand their own thoughts, feelings, behaviors, and body sensation as well as those of others.

We had them practice using it and actively engage in brainstorming and idea-generation exercise. We shared with them some design tools to use for collaborative work and rapid prototyping techniques, so that they could design something meaningful for the group of patients.

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This workshop was also one event that reminded me of why I chose to study CBT. As a designer, I need more concrete knowledge in human psychology to understand the user’s needs at a deeper level. As a lecturer and consultant, often my students and clients have unproductive thoughts and feelings that hinder their potential and development. I just wanted to help them not only on a career or academic side but also in overcoming obstacles.

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CBT is generally for helping people with mental health disorders. I thought if I could understand people who were suffering so much that they develop a mental health disorder (moderate to high intensity) and be able to help them change their thoughts, feelings, and behaviors, I would certainly be able to help students and clients who did not have a mental health disorder, but just negative thoughts and feelings (low-intensity).

Unexpectedly, I happened to like working as a therapist, so I have kept doing it part-time and volunteering as a CBT therapist after graduation from the program for 4 years already.

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“Empathize and understand like a CBT therapist, ideate, design and create like a designer, and feel the joy of discovery and co-creation” is our DCBT concept.

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DCBT workshop was a success because the externs developed the skills stated above. When they graduate and become doctors, these externs would be working in Thailand’s southernmost provinces, Pattani, Yala, Narathiwat, where the accessibility to healthcare and other facilities are limited. We hope the skills that they have acquired will be beneficial for people in the area as well as for themselves, and if we are right, we shall feel we have accomplished something with value.

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DCBT is co-created by Prowpannarai Mallikamarl and Sirirat Ularntinon, M.D.

If you want us to facilitate DCBT workshop, reach us at contact@artipania.com or visit our website www.artipania.com

This workshop was in our presentation at the World Congress of Behavioral and Cognitive Therapies Berlin 2019