Cognitive Behavioral Therapy CBT

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Cognitive Behavioral TherapyCBT

• Julie Gutowski CASAC LMHC

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Cognitive Behavior Therapy (CBT)

• Based on the idea that how we think (cognition),
  how we feel (emotion), and how we act (behavior)
  all interact together
• CBT aims to help the client to become aware of
  thought distortions which are causing
  psychological distress, and of behavioral
  patterns which are reinforcing it and to correct
  them.

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Basic Principles of CBT

• Learned Behavior- CBT is based on social learning
  theory. It is assumed that an important factor in
  how individuals begin to use and abuse substances
  is that they learn to do so. The several ways
  individuals may learn to use drugs include
  modeling, operant conditioning and classical
  conditioning.
• Modeling- People learn new skills by watching
  others and then trying it themselves.
• Classical Conditioning- Pavlov demonstrated that
  over time, repeated pairings of one stimulus with
  another could elicit a reliable response. Over
  time, substance use/abuse can become paired with
  money, paraphernalia, particular places,
  particular people, times of day or week, feeling
  states, etc. Eventually, exposure to those cues
  alone is sufficient to elicit very intense
  cravings or urges that are often followed by
  substance use

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ABCs of Cognitive Distortions

• A- activating event
• B- beliefs about the activating event
• C- consequence of beliefs

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Critical Components of CBT

• Functional Analysis- Functional Analysis can be
  used to address relapse. For each relapse, the
  client will complete a functional analysis with
  the help of the counselor. The client will need
  to discuss the relapse, paying particular
  attention to his/her thoughts, feelings and
  circumstances before and after the substance use.
  It can also be used to analyze thoughts and
  internal/external reinforcers that are
  maintaining behavioral patterns.
• Skills Training- Skills training will be used to
  help the client unlearn old habits associated
  with substance use and learn or relearn healthier
  skills and habits. By the time the level of
  substance use is severe enough to warrant
  treatment, the client is likely to be using
  substances as their single means of coping with a
  wide range of interpersonal and intrapersonal
  problems.
• Reframing- After cognitive distortions have been
  identified, the therapist will often work with
  the client in challenging the negative thoughts
  on the basis of evidence from the client's
  experience by reframing it, meaning to
  re-interpret it in a more realistic light. This
  helps the client to develop more rational beliefs
  and healthy coping strategies.

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Important Aspects of CBT

• Foster motivation for abstinence- An important
  technique used to enhance the clients motivation
  to stop using substances is to do a decisional
  analysis which clarifies what the individual
  stands to lose or gain by continued use.
• Teaching coping skills- This is the core of CBT,
  to help clients recognize the high risk
  situations in which they are most likely to use
  substances and to develop other, more effective
  means of coping with them
• Change reinforcement contingencies- By the time
  treatment is sought, many clients spend most of
  their time acquiring, using, and recovering from
  substance use to the exclusion of other
  experiences and rewards. In CBT, the focus is on
  identifying and reducing habits associated with a
  drug use lifestyle by substituting more enduring,
  positive activities and rewards.
• Foster management of painful affects- Skills
  training also focuses on techniques to recognize
  and cope with cravings and urges to use
  substances this is an excellent model for
  helping clients learn to tolerate other strong
  affects such as depression and anger.
• Improve interpersonal functioning and enhance
  social supports- CBT includes training in a
  number of important interpersonal skills and
  strategies to help clients expand their sober
  support network and build enduring, drug free
  relationships.

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Interventions That are NOT Part of CBT

• Extensive self disclosure by counselor
• Use of a confrontational style or a confrontation
  of denial approach
• Extensive exploration of interpersonal aspects of
  substance abuse
• Extensive discussion or interpretation of
  underlying conflicts or motives
• Provision of direct reinforcement for abstinence

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Critical CBT Skills for Clinicians

• Increase Consumer Confidence in Ability to
  Recover
• Information Giving
• Weighing Costs/Benefits of Behaviors
• Identifying Rewards and Supports for Recovery
• Managing Role Plays and Experiential Exercises
• Skill Rehearsal/ Homework

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Increase Consumer Confidence in Ability to
Recover

• Facilitate hope by consistently acknowledging
  consumer strengths
• Verbal praise for any attempt despite outcome
• Create time for consumers to share
  accomplishments
• Reframe relapse
• Demonstrate hope

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Information Giving

• Involve consumers in sharing the information
• Stop periodically for clarification and questions
• Pay attention to clients cues
• Reinforce how the information is important to
  them

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Weighing Costs/ Benefits of Behavior

• Acknowledge that all behaviors have benefits as
  well as consequences
• Have a nonjudgmental attitude while consumers
  discuss the benefits of use
• Acknowledge that all behaviors meet needs
• Identify alternative behaviors to meet those
  needs
• Highlight the reduction in consequences due to
  substitute behaviors
• Comfortable with behavioral rehearsal

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Identifying Rewards/ Supports for Recovery

• Engage consumer in positive self talk and beliefs
• Identify needs to facilitate change
• Assist consumer in identifying sober
  resources/supports

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Managing Role Plays Experiential Exercises

• Know and understand the role play
• Modeling the value of role playing
• Explain purpose of role play
• Monitor group for verbal and non verbal cues
  regarding role play
• Knowing when to stop the role play if needed
• Process any emotions evoked by the role play

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Skill Rehearsal and Homework

• Create a culture where homework is expected
• Discuss importance of skill rehearsal
• At the beginning of each session, check in about
  homework from previous session