Cognitive Behavioral Therapy CBT

1. Cognitive Behavioral TherapyCBT Julie Gutowski CASAC LMHC

2. 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.

3. 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

4. ABC’s of Cognitive Distortions • A- activating event • B- beliefs about the activating event • C- consequence of beliefs

5. 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.

6. Important Aspects of CBT • Foster motivation for abstinence- An important technique used to enhance 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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