Reducing addiction: Cognitive behaviour therapy Flashcards
What is the aim of cognitive behaviour therapy for addiction?
- two key elements
To change the maladaptive ways of thinking and behaving associated with substance or behavioural addictions
There are two indispensable elements to a CBT programme. First, a functional analysis identifies the cognitive biases that underlie addictions, replacing the cognitive biases with more adaptive ways of thinking (cognitive element)
Second, skills training helps a client to develop coping behaviours to avoid the high risk situations that usually maintain addictions or trigger relapse (behavioural element)
Cognitive biases?
These result in a person having a warped view of reality and causes a person to make faulty judgements and decisions. People tend to simplify things to a few rules of thumb and make bad decisions as a result
What are the four things involved in CBT?
Involves dialogue between therapist and patient
They agree areas to improve upon
The patient ‘reality tests’ better behaviours
They meet again and assess how it went
Explain functional analysis
- identifying and correcting cognitive distortions
The client and the therapist identify the situations in which he/she is likely to gamble/take drugs or drink alcohol.
They explore the thoughts and motivations before, during, and after the event in an attempt to help the patient to identify “faulty thinking,” cognitive distortions, or cognitive biases.
These are challenged by the therapist. Functional analysis is ongoing throughout the treatment to assess the success of the therapy and guide its future direction.
The quality of client therapist relationship is therefore critical. It should be warm, collaborative and responsive, but not cosy. This is because the therapist must challenge the client’s biased cognitions
Explain cognitive restructuring
The treatment helps the client in modifying their irrational beliefs and cognitive biases.
E.g In gambling they would educate them as to the nature of chance and odds
Explain skills training (behavioural)
- Replacing poor coping behaviours
People seeking treatment for addiction may have a huge range of problems but only one way of dealing with them - their addiction
CBT helps the client to replace this strategy with more constructive ones by developing new skills
Explain specific skills (behavioural)
- e.g to deal with anger
The aim is to enable the client to cope with situations that lead to drinking/gambling or drug use. The skills taught vary depending on the client’s needs.
They may include assertiveness training to help an alcoholic firmly but politely refuse a drink offered at a party.
- Anger management, often anger triggers drinking so need to learn to control the anger
Explain social skills (behavioural
- can help in social situations
Most clients can benefit from developing skills that help them to cope with social situations
e.g A recovering alcoholic will find themselves in situations where alcohol is available such as weddings/parties
Social skills training helps the client to refuse alcohol in order to avoid embarrassment (e.g making eye contact and being firm)
The therapist may model coping strategies for client and use role play to make the new behaviours habitual.
One strength of CBT to reduce addiction?
Useful in preventing relapse
EVALUATION: Useful in preventing relapse
CBT includes relapse prevention into treatment by providing a realistic picture of persistent addiction.
It is an opportunity for cognitive restructuring rather than a failure. An addict’s life will inevitably include relapses, but they can be controlled as long as their psychological health improves.
As a result, even when clients adhere to CBT, they may relapse by continuing to have stable lives.
What are two limitations of CBT to reduce addiction?
May only be effective in short term
Many clients drop out
EVALUATION: May only be effective in short term
According to Cowlishaw et al.’s meta-analysis of 11 research, cognitive behavioural therapy (CBT) can reduce gambling for up to three months with medium-to-large effects. However, there were no changes between the CBT and control groups after nine to twelve months.
Additionally, low-quality research may have overstated the benefits of CBT. As a result, the research on CBT shows that treatment has short-term benefits but long-term disappointments.
COUNTERPOINT TO COWLISHAW
However Petry et al in a well controlled study e.g random allocation, found that CBT treating gambling addicts less than controls after 12 months
Therefore, this one study (which was methodologically better) suggests that CBT is effective in reducing gambling addiction beyond the short term
EVALUATION: Many clients drop out
Because CBT is so demanding, Cuijepers et al. observe that the dropout rate from CBT can be up to five times higher than that of other therapies.
Furthermore, clients frequently attend CBT to address a crisis brought on by their addiction, but they discontinue treatment when the issue is resolved or becomes less significant.
One of the biggest challenges to CBT’s ability to successfully reduce addictions is its high dropout rate.
A strength of CBT is that, unlike other therapies…
, it provides skills to resist social pressure and deal with everyday situations without engaging in drugs or alcohol
