Module 3: Cognitive Behavioral Therapy principles Flashcards

Question

Naltrexone is also effective for

Answer 1

treating pathological gambling :0

Answer 2

inhibitory effect on glutamatergic system -> reduces craving for alcohol after abstinence

Answer 3

prescribing medication that has the same chemical properties as the drug to which that person is addicted -> withdrawal symptoms and craving are prevented (e.g., methadone and buprenorphine/naloxone (Suboxone).)

Answer 4

changing the pattern of problematic substance use (reducing or quitting) * includes protocolled treatment + a workbook * CBT and motivational interviewing MI: a way of doing treatment --> A basis for all therapy

Answer 5

* CBT 1: individual - 5 meetings * CBT 2: individual - 13 meetings * CBT 3: group - 6 meetings * CBT 4: group - 12 meetings

Answer 6

1) Discussing homework - Registration (of substance/alcohol use) assignment (every week) (e.g., when you have a craving, when using, when usually use but now don't) - Homework related to the theme of the previous meeting 2) introducing new theme 3) giving new homework - Registration assignment - Homework related to new theme

Answer 7

· Problematic use of alcohol and drugs · Smoking · Gambling · Sex addiction Any other addiction

Answer 8

· Self-control · Coping skills · Social skills --> behavioral based interventions (emphasis on behavioral, not cognitive therapy)

Answer 9

Any CBT treatment needs this important step of registration because we want them to fill things in as they happen -> helpful in future assignments in therapy * The act of writing down and showing to councellor can be shameful for some so they stop using Usually in first sessions there is confusion between thought, feeling and bodily sensation * You don't correct them but you explain your pov If they didn't use, what did they do instead * What reactions did people around you have to that

Answer 10

1) First of all: increase motivation for change by means of motivational interviewing · a technique that is used to elicit motivation in the client to change a specific negative behavior 2) Make a cost/benefit balance · Disadvantages of use · Benefits of decreasing/stopping use · Short-term · Long-term purpose: to provoke 'change language' · I want to change, I want to stop, etc.

Answer 11

outcome: * amount of change language spoken * Change in the ratio of change language / maintenance language relapse: * When abstinence is imposed * When clients identify the pros of using and cons of change

Answer 12

Writing a goal down makes it explicit and when they want to use, there is a cognitive dissonance -> this is why goal setting is important characteristics of goals * Important and feasible for the client * Negotiation between client and counselor * Abstinence or controlled use * Advice: 4 - 6 weeks of abstinence --> because after 4-6 weeks effects of substance are gone, to see if comorbid disorders are still there -->Many symptoms of withdrawals look like symptoms of comorbid disorders --> we have to rule them out * Goals are formulated SMART (specific, measurable, attainable, realistic, timely

Answer 13

Alcohol: * no alcohol at all / no more than 1 glass * minimally 2 substance-free days per week Drugs: * abstinence

Answer 14

a contract made between the counsellor and client. Agreement on: * how much they want to reduce and for how long do they want to maintain it for * goal needs to be small in the beginning to induce a feeling of accomplishment and motivation

Answer 15

* stimulus control: avoid places, situations or people that pose a risk for SU * stimulus-response prevention: in high risk situations, try and alternative behavior * response consequences: agreeing w/ the client that if the goal if achieved/not achieved the coming week, they will receive a reward/punishment --> same principle as in contingency management

Answer 16

an alternative behavior to turn to that can make them still feel good at the end of the day. Something that gives them hope that not all is lost

Answer 17

Revealing triggers of behavior * FA: the common thread of the treatment * One FA per substance * Determining function of use * Identify risk situations (Sd) * Choosing interventions on the basis of FA * Invite support person --> Closed ones usually know very well about patterns of use and triggers --> E.g., the warm feets patient = alternatively every time that he had warm feet as response to craving and wanted to take off shoe --> alternative behavior: go for a walk

Answer 18

specific context (Sd) -> dyfunctional behavior (R) -> 1) cogn. repr. of pos. consequences (Sr-representation) 2) factual neg. consequences

Answer 19

* external situation --> with who? --> where? --> when? * internal situation --> thoughts --> physical sensation? --> emotions? * behavior --> what substance? --> how much? --> how long? * consequences --> long term --> short term

Answer 20

communicating about the possibility of relapse and emergency measures that can be done * Complicated topic for clients! Clients do not want to talk about relapse * Comparison: safety instructions when you fly --> What they can do when things go wrong when they are doing fine, not when they are relapsing Flight safety instructions given when you are safe not when in turbulence

Answer 21

a negative emotional and cognitive response to relapsing after a period of abstinence -> person may feel guilt, shame, self-doubt which can in turn increase further risk of relapse + hinder recovery process --> clients think that the first moment of relapse means that everything is lost countering: reduce guilt, shame etc, see lapses as part of the process (a lapse is a learning moment), and plan emergency measures to prevent a full relapse.

Answer 22

1. Ask the patient to formulate a detailed emergency plan to prevent that a lapse becomes a relapse… E.g., emptying the bottle down the drain -> "are you able to?, have you been able to do this before?" 2. Ask about… a) Behavior (e.g., doing a useful but laborious chore following a lapse) b) Helpful thoughts c) Help> who? d) Medication

Answer 23

self-control: prevent use emergency measures: interrupt use during a (re)lapse

Answer 24

* Seek distraction - do something to take your mind of the urge * Seek social support * Mind surfing - Positive consequences of not using - Negative consequences of using * Alternative thoughts: - patients often think that craving can only be reduced by using. These thoughts are dysfunctional. An alternative, helpful thought is “it’s a disagreeable feeling, but I can tolerate it” or “the craving will subside eventually”. * Urge surfing: powerful intervention · Psycho-education + exercise helps clients to recognize, experience and accept craving as a normal response to conditioned stimuli, that will subside by itself. · Rather than giving into the urge, you ride it out, like a surfer riding a wave. After a short time, the urge will pass on it’s own. - Craving is a momentary phenomenon and when you can overcome that its effects subside away · This technique can be used to deal with craving, in SUD and behavioral addictions (but also emotional reactions such as ‘blowing up’ when angry)

Answer 25

1. Acknowledge you have it 2. notice your thoughts and feelings w/ out trying to change or suppress them 3. remind yourself - its ok to have them, they're natural - its a feeling, not a must - some discomfort is okay, don't have to change it - it is temporary

Answer 26

* I need something to feel better --> what will you do when there is no access to the drug? critical note on changing thoughts: * play no major causal role / SU is a habit behavior * clients mention it as a post-hoc rationalization in order to reduce cognitive dissonance * challenging thoughts does not have an added value

Answer 27

* Important: this is not an exposure exercise * It’s based on the same principle as Stimulus Response prevention (e.g., if a person offers me alcohol, I will ask for a fruit juice) * This also increases self-efficacy (a person's belief in their ability to succeed in a particular situation) * Practice with the client in role play --> Short & overwhelm them -> have to give an immediate trained response * Using attributes that are reminiscent of use * Watch out for avoidance (by both client and therapist)!

Answer 28

How: * react quickly * be clear, don't hesitate * make eye contact What you say: * first "no" * suggest alternative * when pressured, ask the other one to stop * change topic of conversation, avoid discussion * don't apologize or give vague answers

Answer 29

* 12-steps group therapy based on alcoholics anonymous AA * abstinence orientated, comprehensive multiprofessional approach to the treatment of addictions --> expouses recovery but not cure, for those who adhere to it --> it is intensive offering group therapy with fellows, lecturers, and counselling

Answer 30

Combination of acceptance, mindfulness and value-based therapeutic processes * guides people to accept urges and symptoms associated with SU, fosters psychological flexibility, and uses value-based interventions to reduce those urges and the symptoms

Answer 31

* focus on addiction behavior * give insight on the process of addiction through PE * Reshape (part of) the clients lifestyle * different names for comparable interventions

Answer 32

* focus on behavior and triggers * focus on learning new coping strategies * has long been first choice of treatment for SUD

Answer 33

* focus on psychological flexibility * focus on broader than just the addictive behavior * combines CBT with mindfulness * ACT is a relatively new treatment, especially in addiction care

Answer 34

* focus on (re)connecting with self and others * based on self-help groups * inegrates the physical, emotional and spiritual processes of addiction * has a worldwide network for a lifelong aftercae * oldest way of treatment * most common way of treatment in the USA and UK (probably rest of world as well)

Answer 35

1) contingency management (desired behavior is 'reinforced' or rewarded) - e.g., paying people to not take drugs, in actuality this is hard to implement 2) motivational interviewing * a technique that is used to elicit motivation in the client to change a specific negative behavior

Answer 36

It is an umbrella that encompasses a large group of therapies that have in common a focus on cognitions and behavior as both the cause of and the means to resolve, emotional and behavioral dysregulation

Answer 37

a focus on cognitions (thoughts, beliefs, schemas and metacognition)

Answer 38

Aaron Beck: cognitive therapy Albert Ellis: rational emotive behavior therapy --> early cognitive behavioral therapy models grew from behavior therapy and introduced the concept cognition into the behavioral models

Answer 39

psychology shifts from psychoanalytic roots into a science-based discipline --> a branch called behavior therapy began to form driven by scientific enquiry

Answer 40

Aaron Beck and Albert Ellis start to look beyond behavioral principles (role of interpretation of events, ideas from cognitive psychology & social learning theory) --> what people refer to traditional CBT is usually some version of one of these two styles

Answer 41

mindfulness-based therapies such as dialectical behavior therapy (DBT), mindfulness-based relapse prevention (MBRP) and acceptance and commitment therapy are developed (ACT)

Answer 42

they are based on well-researched theoretical models: share an underlying assumption that our thoughts, behaviors and emotional reactions are *learned* and the path to wellbeing is through managing thoughts and beliefs and to some extent behavior

Answer 43

researched group of therapies in the world and have become a core competency for people in the alcohol and other drug workforce

Answer 44

genetic, biological and temperamental factors are risk factors, not determinants --> instead, alcohol and other drug use dependance are learned behaviors emerging over time, which can be 'unlearned' , they operate within a context of a range of environmental influences (family, friends, availability and sociodemographic circumstances) --> cognitions & emotional responses are also considered to be learned

Answer 45

CBT's do not rely on therapeutic alliance to create change - e.g., TA is an anaesthetic in surgery, it is definitely needed and aids the surgery but alone it is not sufficient for the surgery to go smoothly

Answer 46

* collaboration and active participation (essential and important) * a good effective treatment experience * CBT's are goal oriented and problem resolution focused --> addressing client's immediate goals through developing problem solving skills is the initial focus --> this naturally creates therapeutic alliance * alleviatin client's problems * good counselling skills * a flexible adaptive style * seeking feedback from client

Answer 47

CBT's emphasize the present, at least initially -> CBT is of little use if the day-to-day issues of drug use are not addressed - e.g., there is little benefit in addressing childhood trauma that may have contributed to the development of a drug problem

Answer 48

CBT's focus on developing skills in the client to enable them to be their own therapist in a sense -> e.g., skills in reflection & self-management with an emphasis on usage outside the clinic, hence skill practice sometimes is referred to as 'homework' (very important to practice between sessions)

Answer 49

Guided discovery is the primary tool of to support self-reflection. comes from socratic questioning: asking questions to promote thinking --> difference is that Socrates had an end in mind whilst guided discovery doesn't necessarily see it as necessary --> it assumes that the client has the answer to their problems, or at least the means to find answers (therapist is a guide)

Answer 50

Practitioner applies scientific method to understanding and addressing client issues -> constantly evolving cogntive behavioral case formulation with hypotheses that are tested collaboratively (collaborative empiricism)

Answer 51

continually review science to maintain best practice and contribute to sceince through research because the scientist-practitioner approach necessitates undertaking and utilizing research about outcomes, (which is why CBT's are most researched)

Answer 52

relatively brief (no more than 12-16 sessions usually) even briefer ones exists: delivery between 1 and 6 sessiosn

Answer 53

structured session plan into 3 or 4 interconencted sessions - tailored to client needs to it is structured but also flexible

Answer 54

20 mins for review of the week, homework tassk and issues during week 20 mins for discussion and practice of a skill or topic linked to an issue from initial assessment or something that has arisen - in actuality this usually takes more than 20 minutes and is often the longest part 20 mins for recapping the session, agreeing on homework tasks and planning for the next week

Answer 55

1. setting agenda and recap of previous session 2. dealing with specific agenda items (focus of session) 3. planning for next session 4. session review setting an agenda: structure is outlined and agreed upon with the client at the beginning of each session - important because clients do not have well-developed skills in structuring their own lives and this can be a model to assist them to learn these skills

Answer 56

client needs are incorporated regularly and practitioners still need to use their clinical judgement & skills to determine: * what happens within the structure * when structure needs to adapt to immediate circumstances

Answer 57

both help client learn how to apply it and to focus the session in order to ensure critical therapeutic work is done - e.g., cannot just be chit chatting

Answer 58

moderate effect sizes (d=0,45) - largest treatment effects found for cannabis, cocaine, opioids and polusubstance dependece - effective and long lasting when compared with general counselling - effective in both individual and group formats

Answer 59

Main goal is to develop skills to identifying and preparing for high-risk situations that lead to the relapse to prolematic alcohol aor other drug guse

Answer 60

* self-efficacy, * outcome expectancies, * craving motivation, * coping, * emotional states * interpersonal factors * lifestyle factors

Answer 61

Abstinence, so if abstinence is the goal, relapse prevention may be the best choice -> although other CBT's have lower dropout rates (but also lower abstinence rates)

Answer 62

Cognitive therapy of SU first developed by Aaron Beck on the general cognitive therapy model CBT usually a pure or modified form of cognitive therapy OR a pure or modified version of relapse prevention

Answer 63

'proximal situational factors' such as cognitive, behavioral, emotional and physiological variables as immediate triggers for alcohol and other drug use 'distal background factors' * personal history * long-standing cognitive and behavioral variables * personality traits --> provide a context or set of vulnerabilities for SU + can also act as maintaining factors

Answer 64

1- relapse prevention training 2- social and communication skills training 3- training in coping with urges and cravings 4- mood management project MATCH, use a modified version of Coping skills therapy as the cognitive beharioval arm of the study - **equally as effective and motivational enhancement and 12-step facilitation**

Answer 65

from Buddhist practice of 'mindfulness' = purposeful attention to the present and an openness to accept things as they are examples: a) MBRP mindfulness-based relapse prevention integrates traditional relapse prevention w/ mindfulness based meditation practices - significant improvements on withdrawal and craving symptoms

Answer 66

only a few well-conducted empirical studies from which to draw conclusions --> outcomes from both traditional CBT's and mindfulness-based therapies are equally equivalent

Answer 67

moderate to high-risk use and with people who are dependent but not ready to engage in intensive treatment - effective for alcohol & other drugs also for severely dependent ppl - also effective for drug related problems like insomnia

Answer 68

* goal setting * planning to quit * dealing with lapses and relapses * refusal skills * managing withdrawal skills * cognitive skills * coping skills

Answer 69

* social learning * cognitive behavioral therapy principles * coping skills * relapse prevention

Answer 70

methamphetamine, so for them a briefer intervention may be more desirable

Answer 71

intensity is in terms of practitioner or service use, not the experienced intensity for clients. - delivered face to face - by non-specialists in the field ( e.g., medical practitioners delivering screening) - psychoeducational groups - self-directed technologies (books, papers, internet)

Answer 72

increase 'reach', access, flexibility and responsiveness, patient choice and cost-effectiveness of Evidence based intervention

Answer 73

they are brief, structured and easily manualized

Answer 74

* accessibility of services * availability * considerations of anonymity and autonomy * recognizing problematic alcohol and other drug use behaviors * shame

Answer 75

mitigate some barriers to traditional CBT's - e.g., easier access, reaching a larger proportion of people who would benefit from alcohol & other drug use treatment (90%) - stigma and privacy concerns mitigated as anonymity in accessing and detachment from clinician interaction promising, similar results compared to face-to-face therapy

Answer 76

* methodological inconsistency issues w existing literature * based on CBT foundations but a lot of variation exists (clinician involvement, frequency, format)

Answer 77

1. self-efficacy, outcome expectancies, craving motivation, coping, emotional statea and interpersonal factors & lifestyle factors 2. variations in the terminology used to describe these interventions in the literature 3. the degree to which any given intervention is faithfully translating cogni- tive behavioural therapy to a digital application varies current state of the evidence sup- ports a prudent approach be taken to their wide- spread adoption as stand-alone methods of treatment.

Answer 78

80% in alcohol + other drugs treatments have a comorbid mental health issue 50-80% have some level of functional cognitive impairment CBT's are suited for alcohol and other drug treatment populations with comorbid disorders - highly structured --> those w/ cognitive impairment able to benefit

Answer 79

flexible: accomodates newer cognitive behavioral therapies + allows clinicians to develop a clear formulation of a problem and flexibly implement a variety of strategies and techniques

Answer 80

1. early experience - CBT recognizes it to be important in the development of fundamental beliefs (family, social, community, environmental and personal experiences early in life 2. beliefs & schemas - triggered by day to day stimuli 3. triggers 4. cycle of thoughts 5. cycle of feelings 6. cycel of behaviors these are all important and influence each other

Answer 81

by identifying and understanding triggers or high risk situations we maximise the selction of appropriate interventions - useful first step is managing triggers - this also develops a sense of control e.g., relapse prevention focuses on triggers

Answer 82

1. analyzing - identifying thoughts & beliefs + their connection to feelings and behavior + considering their helpfulness or unhelpfulness 2. challenging - challenging the thoughts that are analyzed (e.g., asking for evidence for the beliefs) + developing alternative thoughts and beliefs 3. accepting - noticing and accepting thoughts & beliefs without judgement

Answer 83

if feelings have been identifed as an area requiring intervention, a number of strategies can be utilised * understanding emotions * identifying the relationship between emotions and alcohol and other drug use (including emotions as a trigger for and a consequence of alcohol and other drug use), * emotion regulation * distress tolerance (including mood and urge surfing) * mindfulness.

Answer 84

Intervening at the behavioural level can focus on the substance using behaviour itself or on behaviours strongly associated with the alco- hol and other drug use.

Answer 85

CBT's can accomodate cultural and other influences --> has been successful in a number of cultures

Answer 86

values: * conformity * certainty & discipline * persistence * strong work ethic * respect for authoritarian system there is a huge stigma around mental health issues and a tendency for somatization CBT's are structured and can be adapted to a more instructive than collaborative style --> it can therefore suit cultural contexts that need a directive style also reduces stigma by using a 'coaching' style of therapy as a nice bonus, the mindfulness aspect that stems from Buddhist ideas is likely to be well received

Answer 87

addictions involve powerful and often conflicting sources of reinforcement -> there are powerful motivational incentives for drug use

Answer 88

social reinforcement and modeling

Answer 89

negative reinforcement for continued use -> punished (withdrawal) for not using

Answer 90

we view addiction as a matter of choice

Answer 91

dominant models of addiction treatment -> belief that addicted individuals had a pathological personality characterized by high levels of immature defense mechanisms (e.g., denial) --> this made therapy approaches that were highly confrontational since it was thought that this is needed for overcoming the denial eventually this belief was discarded to make space for other approaches

Answer 92

just one clinical tool (it is not therapy) within an array of options - it is combined with other EBT methods - increases the efficacy of treatments - can be used in brief health care consultations

Answer 93

readiness for change as a **prerequisite** for treatment --> some patients would be left outside care if they were considered not ready for change "come back when you're ready"

Answer 94

people's readiness for change is malleable and is actually a part of the clinician's task to help increase it

Answer 95

a highly confrontational therapeutic approach - e.g., clients are ambivalent about substance use and clinician strongly voicing prochange arguments --> resistance or counterchange arguments from clients

Answer 96

to arrange the conversation so that the client themselves starts talking about change or motivations --> you are never the one that sets goals for them - when done right this has been effective in treatment outcomes + increases change talk

Answer 97

there is significant benefit from MI in addressing alcohol, tobacco, and other substance use problems (effect sizes small to medium) even when MI involved fewer sessions, there is no difference in treatment outcomes when compared with other Evidence based methods --> better to use MI than place people on waiting lists when combined with other active treatments MI enhances retention and adherence

Answer 98

* therapists are confounded with the sites in which they work * variations in MI skills and fidelity in practice also contribute to variability of findings

Answer 99

understand clients' own experience and perspective on their life situation by OARS skills * open questions * affirmations * reflective lists * summaries

Answer 100

Exploring what changes people are willing to consider and then developing agreed-upon goals this can be especially challenging if a client comes in for depression but their self report indicates a possible alcohol use disorder, you need to approach the topic carefully by asking permission - example on article

Answer 101

the point is to evoke the client's own reasons for change involves asking & being curious about what clients themselves perceive as possible reasons for change - open ended questions --> important step as otherwise the client doesn't have any personal motivation to change

Answer 102

* ask more about it * reflect the change talk, offer a complex reflection that makes a guess about what the person may mean * affirm it * summarize the change talk you've heard / 2 or 3 themes that favor change

Answer 103

Decisional balance is asking and exploring all pros and cons to change or to not change this is not advised in addiction as clients are ambivalent about their SU - there is no theoretical or empirical justification for systematically evoking and exploring all of the person's counterchange motivations if your goal is to encourage change - e.g., considering tgt with client reasons for why continuing substance use would be a pro

Answer 104

is planning is done prematurely it can manifest in resistance, unaccomplished homework assignments, low compliance, missing appointments and dropouts on the other hand there is insufficient planning. A good plan seeks to go further and always asks "what would be one good next step?", "when and how will the person do it?" --> people are more willing to go through with an action when they have a specific plan of action and state intentions to accomplish it

Answer 105

the idea that any diversion from a goal is thought of as a "relapse" - this is quite extreme and considering that other disorders do are not looked at this way, it would also make sense that we see relapses as part of the process instead - thinking in black-and-white terms can easily undermine perfectly good progress - --> planning therefore is a continuous process occurring over time sometimes motivation can also fluctuate indicating that returning to previous steps of evoking, focusing or engaging

Module 3: Cognitive Behavioral Therapy principles Flashcards

1. Module background (1-27), 2. lecture (28-60), 3. Lee & Cash (61-112), 4. Miller (113-132)