Addiction Flashcards

Question

Covert Sensitisation

Answer 1

Aim: The idea of the therapy is that the pleasurable association with the addictive substance/behaviour has to be broken down and replaced with an unpleasant association in a vitro experience. How it works for nicotine addiction: Client is encouraged to relax. Therapist then reads from a script asking the client to imagine an aversive situation. For example, the client may imagine himself or herself smoking a cigarette followed by the most unpleasant consequences e.g. the experience of vomiting, or imagine themselves smoking a cigarette covered in faeces. The more vivid the imaginary scene is the better the treatment works. Therefore, the therapist will go into graphic detail about certain elements of the scene (smells, sounds, physical movements). Towards the end of the session, the client imagines turning their back on the addiction and experience the resulting feelings of relief. The participant should then associate the addiction with the unpleasant scenario, rather than pleasure, reducing their addiction.

Answer 2

McConaghy et al (1983) carried out research to support the effectiveness of behavioural interventions at reducing gambling addiction. They compared electric shock aversion therapy with covert sensitisation in treating gambling addiction. It was found that in a one year follow up; those who had received covert sensitisation were significantly more likely to have reduced their gambling activities. Therefore, suggesting covert sensitisation is more effective behavioural intervention for treating gambling addiction compared to aversion therapy. Moreover, some may question how ethical aversion therapy is as a method of reducing addiction. It is thought that aversion therapy such as rapid smoking, electric shock therapy and Antabuse could cause physical and/or psychological harm such as making the person physically sick or giving them electric shocks. For this reason, covert sensitisation may be more appropriate as the therapy is carried out in a vitro (imaginary) experience, potentially reducing any physical or psychological harm, suggesting covert sensitisation may be more appropriate than aversion therapy at reducing addiction. However, aversion therapy could be considered as ethical, this is because addiction to drugs and gambling is itself potentially dangerous to physical and psychological health where as aversion therapy is less dangerous. Individuals would be fully informed of what the therapy entails and they could give consent, moreover in electric shock aversion therapy individuals’ chose the intensity of the shocks so that they may be painful but they are not life threatening.

Answer 3

Aim: To identify and challenge cognitive distortions that are causing an addiction as a way of coping and replace with more adaptive ways of thinking via cognitive restructuring. COGNITIVE: 1. The first stage is functional analysis - A therapist will ask the client to identify the high-risk situations/triggers to their addiction e.g. walking past a betting shop, and ask them to report what they are thinking before, during and after the addiction. The relationship between the client-therapist is critical, it should be warm and responsive, but not cosy. This is because the therapist must challenge the client’s biased cognitions and not merely accept them. 2. Cognitive restructuring: After analysis, cognitive restructuring (disputing) is used to change irrational/maladaptive thoughts to rational/adaptive ones. For example, if a person had an addiction to gambling, they may have irrational beliefs that they win more than they lose (selective recall), this could be challenged via empirical disputing for example, the therapist could ask ‘where is the evidence that you win more than you lose?’ BEHAVIOURAL: 3. Social Skills: Moreover, the addicted person will be taught social skills, for example an individual will learn how to refuse the addictive behaviour (gambling) or substance without embarrassment and fuss in social situations. This is done by the therapist teaching the patient how to act within a social situation, for example making eye contact and being firm in the refusal to gamble, in a safe and secure environment (role play). Moreover, the client would be taught avoidance strategies, where the client would learn to avoid situations that are likely to produce addictive behaviours (high risk situations identified in functional analysis) i.e. driving a different way home to avoid driving past a betting shop. 4. Homework: The patient practices these social skills within the real world on their own and reports back to their therapist until they feel confident within social situations, where their addictive behaviour/substance is available. This leads to relapse prevention.

Answer 4

Research to support the effectiveness of CBT in reducing gambling addiction was conducted by Perty et al (2006). They randomly allocated gamblers to a control group who received Gamblers Anonymous (GA) meetings or a treatment condition who received GA meetings and an eight-session CBT programme. It was found that the patients in the treatment condition were gambling significantly less than the control group of patients. Therefore, demonstrating the effectiveness of CBT in reducing addictions such as gambling by challenging distortions we can help reduce gambling. However, a limitation of CBT in reducing addiction is that for some it may not be as effective as it require motivation from the patient. This is because the patient has to commit to a number of CBT sessions over months; they would have to challenge their irrational thoughts that are causing their addiction and would also be set homework to complete outside of the sessions such as avoidance strategies. This is unlike drug therapy where a patient just has to take a tablet or wear a nicotine patch/have nicotine gum to reduce their addiction. Therefore, CBT may be seen as a less appropriate treatment for reducing addiction than others such as drug therapy as patients may drop out of treatment and therefore relapse. A strength of CBT as a way of reducing addiction is that it avoids chemical dependence. This is because the patients are taught the skills to identify and challenges their own cognitive distortions which are causing their addiction e.g. feeling they cannot cope without the substance/behaviour and so are taking control of their own addiction. This is unlike drug therapy where the patient is dependent on the drugs to control their addiction by regulating their levels of nicotine/dopamine. Therefore, it could be argues that CBT is a more appropriate way to reduce addiction as patients do not become dependent on a drug.

Answer 5

TPB argues behaviour change is due to intention, but this is affected by three things. ATTITUDES - If any individual has more negative attitudes towards their addiction than positive then they are less likely to intend to do to the addictive behaviour e.g. gamble, less likely to actually gamble and therefore more likely to change their addictive behaviour. (behaviour change by making people aware of risks of addictive behaviour) SUBJECTIVE NORMS – if an addicted person believes that the people who matter most to them disapprove of the addictive behaviour then this would make them less likely to intend to engage in the addictive behaviour and therefore less likely to actually gamble/smoke and more likely to change their addictive behaviour. (behaviour change by national campaigns to educate people on addictive behaviour) CONTROL – how much control a person feels they have over their own behaviour and ability to change influences their intention. This is based on: * Internal factors e.g. how determined they are * External factors e.g. support and time * Past experience e.g. if they have successfully given up before (behaviour change by improving social skills- just say no-, positive self talk) This is the most important part of the model as without the control person is still vulnerable to addiction.

Answer 6

Research to support the theory of planned behaviour comes from Haggar et al (2011). They asked 486 ppts to complete questionnaires about their alcohol-related behaviours at the start of the research and then one and three months later. They found that personal attitudes and subjective norms correlated significantly with the intention to limit drinking to match guidelines. Perceived control predicted actual unit consumption. increasing its validity in explaining behaviour change in addiction. This supports the TPB as the three components interact to effect an individual’s intention to stop. However, a problem with much of the research into TPB is that they rely on questionnaires which are prone to social desirability. Individual’s may lie about their intentions towards their addiction in order to present themselves in the best possible light. For example, they may say they intend to drink within guidelines to avoid being judged. Therefore, this reduces the validity of the research supporting TPB of behaviour change. A strength of TPB is that it has led to practical applications. This is because the principles of TPB can be used to predict who therapy is most likely to be successful for example, if person missing one of the components e.g. attitudes they will not have intention to change and so will not be offered therapy. This will help the NHS prioritise their limited resources on individuals with high intention to change and reducing waiting times for therapy. Therefore, TPB is an important area of applied psychology.

Answer 7

It is a cyclic model that takes a positive approach to addiction, where it explains where a person is in terms of behaviour change and which intervention to use. Relapse is not failure but just a part of the process, simply return to early stage six stages: 1. Pre-contemplation: Individual does not consider themselves as having a problem. This could be due to denial or demotivation. Focuses on helping the addict to consider the need for change. 2. Contemplation: Individual is now thinking about changing their behaviour Drug treatment at this stage would not be helpful. Ways of helping the individual understand the pros of overcoming the addiction outweighs the costs. 3. Preparation: They decide to change within the next month but maybe not exactly what they will do to change. The most useful form of intervention is support in constructing a plan e.g. making a GP appointment 4. Action: This is when the plan is put into action. Developing coping strategies and maintain their change of behaviour. 5. Maintenance: The individual has maintained some change of behaviour for more than six months. Applying the coping strategies to them to prevent relapse 6. Termination: Abstinence become automatic. They are confident in their ability to resist the behaviour. No intervention is required. 16: name 2/3 stages - explain-intervention -contemplation, maintenance + 1

Answer 8

However, Prochaska's six-stage model of behaviour change has been criticised as some argue that the stages of change are not well differentiated. Pa Kraft et al (1999) argue that the six-stages can be reduced to just two useful stages, pre contemplation plus the others grouped together, as the person is thinking about change in all of these later stages but not in the first. This has important implications as each stage in Prochaska's model is matched with a specific intervention. Therefore, this could limit Prochaska's usefulness as a model of behaviour change and for treatment recommendations. However, Prochaska's six-stage model of behaviour change can be praised because it takes a positive view of of relapse. The six stage model does not view relapse as a failure, but as an inevitable part of the dynamic, un-linear process of behaviour change. Although, relapse is more than a 'slip' the model takes it seriously and does not underestimate its potential to knock an addict off the course of recovery. This means the six stage model of behaviour change is more acceptable as a result of its positive outlook on relapse. Finally, much of the research in to Prochaska's six-stage model is based on self-report methods (questionnaire and interviews) which could lead to social desirability. Prochaska based this model on nicotine addicts and the changes in their thinking when giving up, they could have lied about how logical their thought processes were when giving up to present themselves in the best possible light. Therefore, this reduces the internal validity of the research into Prochaska's six-stage model of behaviour change.