Reducing addiction: cognitive behaviour therapy

Question 1

cognitive behaviour therapy definition

Answer 1

method for treating mental disorders based on cognitive and behavioural techniques. from the cognitive viewpoint the thepay aims to deal with thinking, such as challenging negative thoughts. the therapy also includes behavioural techniques

Question 2

what does CBT aim to do

Answer 2

chang teh maladaptive ways of thinking and behaving associated with substance or behavioural addictions

Question 3

what are the 2 indispensable elements to CBT

Answer 3

-functional analysis
-skills training

Question 4

what is the first stage of CBT

Answer 4

functional analysis

Question 5

what is the second stage of CBT

Answer 5

skills training

Question 6

what is functional analysis

Answer 6

identifies the cognitive biases that underline addictions, replacing the cognitive biases with more adaptive ways of thinking (cognitive element)

Question 7

what is skills training in CBT

Answer 7

helps a client develop coping behaviours to avoid the high-risk situations that usually maintain addictions or trigger relapse (behavioural element)

Question 8

how do the client and therapist do functional analysis in CBT

Answer 8

-client and therapist identify high risk situations where they are more likely to gamble or use a substance
-therapist reflects on what client is thinking before, during and after such as situation. the quality of the client-therapist relationship is critical, it should be warm, collaborative and responsive but not cosy. this is because the therapist must challenge the clients biased cognitions and not merely accept them

Question 9

what is the cognitive restructuring element of functional analysis of CBT

Answer 9

aims to change addiction-related cognitive biases by addressing the clients faulty beliefs an example of these are randomness, control, gains and losses. these are then confronted and challenged by the therapist. this allows for an initial education element, in which the therapist might give the client information about the nature of chance

Question 10

how if functional analysis and ongoing process (cognitive restructuring)

Answer 10

in early phases of the therapy is heps a client identify the triggers for their addiction, a necessary starting point. but it is useful later as well, in helping a cline to work out the circumstances in which he or she is still having problems with coping, and what further skills training may be needed

Question 11

what aspect of cognitive behaviour therapy is functional analysis

Answer 11

cognitive

Question 12

what aspect of cognitive behaviour therapy is skills training

Answer 12

behavioural

Question 13

why do people with addiction often have CBT

Answer 13

have lots of problems but only know how to cope with them by addiction. CBT helps this be replaced with a more constructive strategy

Question 14

why is the fact CBT is a felxible therpay important for social skills training

Answer 14

therapist can call upon a wide range of techniques for social skill training, starting with the basics and moving onto more individually tailored methods such as social specific skills

Question 15

what are the specific skills taught in social skills training of CBT

Answer 15

-CBT is broad as focuses in the wider aspects of a client’s life that relate to addiction (an example is functional analysis may reveal that a client lacks specific skills to allow him or her to cope with situations that trigger alcohol use
-assertiveness training could be used to help a client confront interpersonal conflicts in a controlled and rational way instead of suing avoidance, manipulation and aggression
-anger management training can help some clients to cope with the situations that make them angry enough to resort to drinking

Question 16

why is important to learn social skills in the skills training of CBT

Answer 16

they can learn skills that help them cope with social situations such as if a recovering alcoholic finds themselves in a situation such as party or wedding where alcohol is available

Question 17

how is social skills training used in an an alcohol addiction

Answer 17

learn how to refuse alcohol with minimum fuss in ways that avoid embarrassment, for example by making appropriate eye contact and being firm in refusing an offer of a drink

Question 18

how does a therapist carry out skills training of CBT

Answer 18

-beings with an explanation of the reasoning being learning a new skill. perhaps a lack of skill was identifies in the functional analysis as the reason why the client relapsed during the week, the therapist then explains how the skill is performed, but crucially they model the behaviour which the clients imitates by role play
-therefore the skills element is highly directive with the constant tell and show by the therapist with the client initially imitating the therapists performance before eventually using the skill on their own high-risk situations

Question 19

limitation of cognitive behaviour therapy as a way of reducing addiction - short term only

Answer 19

-CBT may only be effective in the short term
-Cowlishaw et al (2012) conducted a meta-analysis of 11 studies comparing the CBT for gambling addiction with control conditions. the analysis showed that CBt had a medium to very large effects in reducing gambling related behaviour for periods of up to 3 months after treatment. But after 9-12 months there was no significant differences in the outcome between CBT and control groups. the studies may have even overestimated the benefits of CBT as they were of such poor quality –> therefore, the research picture for CBT is one of short term benefits but long term disappointment

Question 20

strength of cognitive behaviour therapy as a way of reducing addiction -counterpoint to short term only

Answer 20

some high quality research challenges that effects of CBT are only short term. Petry et al (2006) randomly allocated pathological gamblers to either a control group (gamblers anonymous meetings) or a treatment condition (GA meetings and an 8-session individual CBT programme) the treatment clients were gambling significantly less than the control participants 12 months later. the study has high internal validity because of the random allocation and there were no significant differences in the extent of their gambling at the start –> therefore, this one study (which was methodologically better) suggests CBT is effective in reducing gambling addiction beyond the short term

Question 21

limitation of cognitive behaviour therapy as a way of reducing addiction - high drop rate

Answer 21

-clients may drop out of CBT
-Cuijpers et al (2008) found dropout treatments for CBT can be 5x greater than for other therapies. This could be as CBT is a demanding therapy, or as clients usually seek CBT as a life crisis occurs which is caused by the addiction has driven them to therapy. once this resolve, or does not loom large in their life the clients often give up the therapy –> the high drop out rate is a major obstacle to success of CBT reducing addictions

Question 22

strength of cognitive behaviour therapy as a way of reducing addiction - relapse prevention

Answer 22

-CBT is useful at preventing relapse
-most people’s experience of addiction is one of relapse. CBT presents a very realistic view of recovery and incorporates likelihood of relapse into treatment. relapse if viewed as an opportunity for further cognitive restructuring and learning rather than failure. it is inevitable part of an addicted person’s life, but manageable as as long as their psychological functioning improves –> when clients stick with the terpay, CBT can help them to avoid relapse by maintaining a stable lifestyle

Question 23

evaluation of cognitive behaviour therapy as a way of reducing addiction - do we need the C in CBT

Answer 23

-CBT proposes that it is important to target both cognitions and behaviours to successfully treat addictions. In fact behavioural interventions may work partly because of their effect on changing cognitions. Changing cognitions may also -avoid the risk of symptom substitution.
On the other hand, CBT could treat addictions by focusing just on behaviour and drop the cognitive element. For example, covert sensitisation is a successful treatment that targets behaviour only.
–>Changing cognitions can also be counterproductive because it is the most demanding aspect of CBT.