Lee, Ross & Cash - CBTs for substance abuse Flashcards
What are, briefly, the major historical developments of CBT?
- 1950s as its root; shift to scientific method, from which behavioural therapy began to form
- 1960s Beck & Ellis; two brances that looked beyond behavioural therapy & look into personal interpretation (cognitive psych + social learning theory)
- 1990s mindfulness-based therapies (DBT, MBRP, ACT)
Under the umbrella term CBT, what underlying assumptions do all these therapies share?
Our thoughts, behaviours and emotional reactions are learned + path to well-being is through managing thoughts/beliefs and to some extent behaviour
Note how this translates to how addiction is viewed (this does not equate the discount of predisposing factors)
How is therapeutic allience seen in CBT?
As necessary, but not a sufficient, condition for change
Compared to anaesthetics
How is therapeutic allience built in CBT? (3, kind of)
- Collaboration and active participation of clients (seen as essential)
- Good, effective treatment experience (as negative attitudes predict poor allience)
- Alleviating problems, counselling skills, flexible/adaptable style. collaborative approach & seeking feedback from client
What is the primary tool to support self-reflection in CBT?
Guided discovery, based on Socratic questioning; method of asking questions to promote thinking and reflection (required collaboration and curiousity)
There is a client-centred approach in there; therapist acts as a guide, not an expert
Key difference between guided discovery and Socratic questioning?
Socratic questioning had an end goal in mind (usually), guided discovery does not
What is meant by the scientist-practioner approach (within CBT)?
That the practitioner applies the scientific method to understanding and addressing client issues (+ undertaking/utilising research about outcomes)
What does “collaborative empiricism” mean?
Constantly evolving (cogntive behavioural, here) case formulation that poses hypotheses that are then collaboratively tested
What does the structure of CBT, generally, look like in practice?
Let’s call it semi-structured; there is overarching structure (e.g., 20-20-20 rule,) in the sense that certain things are to be discussed (agenda setting, topic focus, review of the week, recap/review, etc. & decided by therapist/theory), but there is flexibility & it is tailored to the client
Why is “homework” or skill practice seen as particularly essential in CBT?
Evidence shows a moderate (small?) effect size of homework compliance on treatment outcome (similar to that of therapeutic allience) + CBT places a large focus on self-management (“client as their own therapist”)
effect size = 0.26 idk if that is moderate or small, take your pick
In the context of SUDs, which intervention was one of the first developed and what does it entail? (2)
CBT approach, btw
Relapse prevention:
- Develop skills to identify and prepare for high-risk situations that lead to relapse (main goal)
- Most effective in maintaining abstinence post-treatment (compared to CBT therapies)
they don’t really tell you anything else
Cogntive Therapy (not to be confused with CBT) entails what in the context of SUDs? (2)
- Focus on “proximinal situational factors” (cognitive, emotional, etc.) that are immediate triggers for substance use
- and “distal background factors” (personal history, personality traits, etc.) that provide a context or vulnerabilities for substance use (may act as maintaining factors)
Not dissimilar to relapse prevention, honestly idk what the exact difference is
Four main components of Coping Skills Therapy?
Four main components:
- Relapse prevention training
- Social/communication skills
- Coping with urges/craving (training)
- Mood management
Apparently effective (although, just one study as evidence in the paper)
no more info than this
Cue exposure could be combined with this? I think- at least probably regarding the relapse prevention training
Cue Exposure Therapy effectiveness for SUDs?
Has not shown the same effectiveness in SUDs compared to other mental disorders (e.g., PTSD)
Mindfulness-based relapse prevention entails what + effectiveness in SUDs?
Mindfulness-based meditation practices + relapse prevention
- Seemingly effective, compared to sole relapse prevention, cognitive therapy & two others (lazy)
Hofmann’s “critique” on mindfulness-based practices?
- That it does not require a separate classification (from CBTs)
- Outcomes seemingly about equivalent (unsurprisingly)
What are, briefly explained, some variations in CBTs for SUDs?
- Brief CBTs (self-explanatory, useful for moderate-high risk &/or people not ready for intensive treatment)
- Low-intensity CBTs (mostly for the practitioners, SBIRT, psych-edu groups, digital modules, stuff like that- useful for increased reach/access, flexibility and responsiveness)
- Digital CBTs (vary a lot, but speaks for itself + effectiveness is difficult to establish)
Prevalence rates of addiction and comorbidity with other mental health issues, 1+ traumatic event & functional cognitive impairment?
In this paper, that is
Respectively, up to 80% (x2) and 50-80%
Why are CBTs for SUDs especially suited for people with comorbid disorders?
Because of the structured nature (research supports this)
What does the General Cognitive Behavioural (therapy) Model (GCBM) look like?
Early experiences > beliefs > (triggers) thoughts >< behaviours <> feelings (thus the latter three are circular)
- interjected by “triggers” as beliefs can be triggered by a variety of things (e.g., people) which then bring forth thoughts, which are connected to the latter two
Which part of the GCBM is relapse prevention most concerned with?
Triggers (which can be things like feelings, thoughts, etc.)
don’t let the republicans hear you say that word
How do CBTs, generally, touch on the facets in the GCBM?
briefly
- Triggers = identification (+ what follows) and management
- Thoughts & beliefs = Analyzing, challenging & accepting
- Feelings = Identification, exploration and management
- Behaviour = Identification and management
truly revolutionary
What is meant by analyzing, challenging and accepting thoughts & beliefs, in the context of the GCBM?
- Analyzing = identification, consider usefulness
- Challenging = Interventions/strategies to tackle (what I assume are problematic thoughts/beliefs) + development of more helpful ones
- Accepting = kumbaya + cognitive diffusion (basically, ACT)
What is the “abstinence violation effect”?
The thoughts/beliefs that occur with a lapse (single violation after abstinence) and finding themselves moving towards a relapse (e.g., “I fucked up anyways, so what gives”)
