Transcript CD Group Training

Cognitive Behavioral Therapy
CBT
Julie Gutowski CASAC LMHC
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.
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
ABC’s of Cognitive Distortions
• A- activating event
• B- beliefs about the activating event
• C- consequence of beliefs
Critical Components of CBT
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Functional Analysis-
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Skills Training- Skills training will be used to help the client unlearn old habits associated with
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.
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.
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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.
Important Aspects of CBT
• Foster motivation for abstinence- An important technique used to enhance
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the client’s 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.
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
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
Increase Consumer Confidence in
Ability to Recover
– Facilitate hope by consistently acknowledging
consumer strengths
– Verbal praise for any attempt despite outcome
– Create time for consumer’s to share accomplishments
– Reframe relapse
– Demonstrate hope
Information Giving
– Involve consumers in sharing the information
– Stop periodically for clarification and questions
– Pay attention to client’s cues
– Reinforce how the information is important to them
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
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
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
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