Brief interventions cbt-addictions
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Cognitive Behavioral Therapy (CBT) for addictions.
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Brief interventions cbt-addictions
- 1. Brief Interventions Cognitive-BehavioralTherapy for Addictions
- 2. Brief Interventions What are the characteristics? How short is brief? Why are brief interventions important?
- 3. What treatments work for addictions? Motivational Interviewing? CouplesTherapy? CBT? 12 Steps?
- 4. Cognitive-BehavioralTherapy What is it? LearningTheory Functional Assessment Clinical Model (ABC) Techniques
- 5. Cognitive-BehavioralTherapies BehavioralTherapies CognitiveTherapy (CT) Rational Emotive BehaviorTherapy (REBT) Problem Solving Dialectical BehaviorTherapy (DBT) Acceptance and CommitmentTherapy (ACT) Functional Analytic Psychotherapy (FAP)
- 6. Addiction What is it? What are the causes? Does any of this inform treatment?
- 7. CBT: Behaviorist Model Antecedent Behavior Consequence
- 8. CBT – what are the strategies CBT attempts to change behaviors by modifying: Antecedents/Cues Beliefs, Emotions, Stressors Processes Acceptance/Willingness/HFT/DistressTolerance Consequences Reinf/Punishers / Modeling
- 9. CBT: Cognitive Cognitive Model A = Activating Events B = Beliefs C = Consequences
- 10. Focus today on ?: Cognitive Chaining (ABC Assessment) Hedonic Calculus Shame Secondary Disturbance
- 11. REBT: General & Specific Strategies General REBT Regulate emotions Tolerate frustration (distress) Pursue goals REBT for Addictions Motivation Cravings & Urges Modulating Emotion Hedonic Calculus
- 12. REBT: Irrational Beliefs? What beliefs maintain addictive behaviors? Urges are unbearable, I can’t tolerate them, I can’t have them and function They won’t go away, they last until I use My internal experience directs my behavior One more (one more time) won’t hurt that bad I’ll just start tomorrow I already blew it, so I might as well [What the hell? or F- it!] F-Them I’ve tried everything, nothing will work I don’t deserve to be happy or healthy I can’t make it, so why try I can’t take feeling [ Fill in the Blank] It shouldn’t be this hard Using will make me feel better, and I have to feel better
- 13. IB’s Demandingness = Unconditional demand LFT/Discomfort Anxiety Awfulizing GEW = Absolute value for self or other (across all judges, across all time)
- 14. AddictionTreatment Efficacy Alcoholism (40-70%) Opiate Dependence (50-80%) Cocaine Dependence (50-60%) Nicotine Dependence (20-40%)
- 15. What are the Chains for addiction? Let’s imagine a few: A1 = [Fill in the blank] B1 = [Fill in the blank] C1 = [Fill in the blank]
- 16. REBT Secondary Disturbance A1 Lose job I’m such a loser, he is a jerk! Shame, Anger A1 Shame, Anger LFT Depression Drinks A3 Depression @ Depression Doesn’t matter, no efficacy Hopelessness Drinks
- 17. REBT Secondary Coping A1 Lose job RB + Rule Discomfort Anxiety; Ego Anxiety A1 Discomfort Anxiety; Ego Anxiety HFT; Consequential Thinking/Hedoni c Calculus Hope (positive valenced uncertainty); less ego anxiety, less “feeling” out of control, more self-efficacy A3 Hope (positive valenced uncertainty); less ego anxiety, less “feeling” out of control, more self-efficacy This isn’t easy, but I can take it, and I can do it. Now what to do? [Planning] Resume, call contacts, etc. No drinking
- 18. Cost-benefit Analysis What are the benefits of using? What are the costs of using? What are the benefits of being sober? What are the costs of being sober?
- 19. Goal Setting Values Driven Values clarification SMART Specific - very Measurable – Operationalize it Achievable – Outcome, not value, there is an end Realistic – it is likely that you (under these circumstances) can Timed –Time frame
- 20. Coping with Urges Monitor urges Keep a log Antecedents (Day/time, location, situation, pre-state) Intensity of urge Duration Associated thoughts Behavior (what did I do) Consequence or Outcome Impact on Goal Reflections What can be learned from a log?
- 21. Urge Surging “Ride the Wave” “If you die, we’ll throw you a nice funeral, with flowers.” –Ellis This too, shall pass.
- 22. Organization:Time,Tasks, & Stuff (Management) Weekly Calendar Daily Preview Daily Review Weekly Revisions Task Management System Stuff (Clutter)
- 23. Stimulus Control Take different routes Moratorium on cues in the house (substance, or music, etc.) At least for some time, avoid people
- 24. Thought Stopping CLAP and say very loud “Stop!” Then do something else
- 25. Thoughts & Imagery Positive Visualize the life you want, the future you want See the people who appreciate/need/etc. you Review yourValues & Goals Negative Imagine the consequences in the future if you keep going Construct a punishing scene, i.e., vomit and alcohol, etc…
- 26. Crisis Cards Situation Coping Strategies Statements Behaviors Motivators (SalientValues & Goals)
- 27. Contact (In-vitro & In-vivo): Professional Guidance ** Not Brief Intervention Conjure up an urge + Coping Go to the avoided place/situation (some places are never going to be a good idea)
Editor's Notes
- Only goal for this: To get them to plug in examples into ABC1->ABC2 for IB and RB example Not technically B column is only beliefs, not worrying about that Now how to get there may be for another time: Behavioral Health Goal Setting & Values Clarification Hedonic Calculus (Cost-Benefit Analysis) Prime Realistic Expectations 3 P’s HALT RB + SIT (HFT for Discomfort Anxiety, Self-efficacy, SIT, USA) Problem Solving Relaxation Communication Relapse Prevention Mindfulness Exposure Behavioral Activation GEW = Absolute
- MBSR, MB Cognitive Therapy, etc.
- Beliefs – Core RB’s, Core IB’s, Schema Thoughts – Cognitive Distortions,
- Consequences = 1 – Thoughts 2 – Feelings 3 – Sensations 4 – Behaviors
- So really- we want to understand what comes before and after the behavior. Then we want to change the Antecedents (Consequential Thinking, Cues Problem solving or alternative coping, or has a covert punisher- ughh that beer will produce a hangover, and I’ll lose my wife) and the Behavior – Reinforcer Pattern by either getting a similar consequence with a different behavior, e.g., engage in relaxation (negatively reinforcing) or a different consequence for a similar behavior, e.g., system responds differently to drinking/drugging behavior or the individual provides his/her own different consequence SR, RR, SORC Rule Governed
- Consequences = 1 – Thoughts 2 – Feelings 3 – Sensations 4 – Behaviors
- May skip
- What are they? What are some common B’s (addiction?) Boils down to one process = experiential avoidance. Typically two domains 1) negative emotions [and thoughts] 2) cravings [and urges] But, there are other processes, e.g., sensation seeking **** what we aren’t thinking/believing that matters, e.g., there aren’t negative consequences (or they aren’t that bad), there are other ways to cope with this, tomorrow has as much value as today
- p.22 Bish Demand for Excitement Chain Sensation seeking personality (Type T) Sensation seeking mood/learning history Boredom or lack of stimulation Demand for excitement Expectation (cultural) that drinking/drugging lead to excitement [party] Relapse Chain (Marlatt – from p.23 Bish) High-risk Situation No coping response Decreased self-efficacy & Positive Outcome Expectancy Initial use of substance Abstinence violation: dissonance conflict and self-attribution (guilt and percieved loss of control) Increased probablility of relapse Beck Chain p.24 Activating Stimulus (Internal Cues, External Cues) Belifs Activated Automatic Thoughts Cravings / Urges Facilitating Beliefs (Permission) Focus on instrumental strategies (action) Continued Use Example of Beck Chain Feel sad -> “If I take a fix, I will feel better” -> “What the hell” -> Craving -> “I can do it this time without any harm” -> Look around to get the money -> Purchase and use Excitement now with costs > Going without it without the benefits – Original
- Hedonic Calculus Enlightened Hedonism – consider short, mid, long-term consequences
- ANSWER to What can be learned from a log? I can tolerate them They have a beginning, middle, and an end If I used there were consequences If I didn’t use every time, then the urges aren’t the only determining factor, what else could be?
- Draw it Highlight characteristics -experience (not fused with it) -temporary (ends) -unstable (different levels while it is there)