Cognitive and Social Treatment

Question 1

What is the mechanism behind contingency management and what is its theory of origin. i.e., the theory it is based on

Answer 1

Provide incentives to change target behaviors

Based off of operant conditioning

Question 2

What is the clinical effectiveness of contingency management?

Answer 2

Effective in short-term esp. for cocaine and opiates

Long-term unknown

(Can be expensive)

Question 3

How does aversion therapy work and what theories is it based on?

Answer 3

Pair pleasant drug stimulus with unpleasant stimulus
e.g., chemical/shock aversion

Classical and Operant Conditioning

Question 4

What is the clinical effectiveness of Aversion therapy?

Answer 4

Unknown, but keep in mind that this is also a very expensive test due to intense constant monitoring that is required

Question 5

What’s the idea with Cue Exposure Therapy (CET) and what theories guide this plan?

Answer 5

Attenuate responses to drug cues (Extinction)

Classical Conditioning and Extinction

Question 6

What is the clinical effectiveness behind CET?

Answer 6

Limited evidence for effectiveness
Extinction does not generalize to real world

Virtual Reality may make this a strong option in the future

Question 7

The previous three treatment plans discussed (Contingency management, aversion therapy, and cue exposure therapy) are all behavioral treatment types. What are examples (2) of Cognitive treatment types?

Answer 7

Cognitive Behavioral Therapy (Cog comes first) and Mindfulness-Based Therapy

Question 8

How do we do Cognitive Behavioral Therapy? What theories guide this?

Answer 8

Target Cognitions
Target Emotions
Target Behaviors

Cognitive Therapy for Depression

Question 9

What is the clinical value of Cognitive Behavioral Therapy?

Answer 9

Effective for Substance Abuse

Groups as effective as individuals

Question 10

How does Mindfulness-Based Therapy work and what is the theory behind it?

Answer 10

Attention retraining
Increased awareness
Detached perspective

Buddhist thinking

Question 11

With Mindfulness-Based Therapy, how is it clinically

Answer 11

Promising, but more data needed

Question 12

Motivational Interviewing (MI), a motivational treatment type (stretch there, I know) works in what way, and what theory is it based on?

Answer 12

Identification, Examination, and Resolution of ambivalence about changing behavior

Based on Ambivalence in problem drinkers and Stage Theories

Question 13

What’s the clinical significance of Motivational Interviewing?

Answer 13

Effective for Substance Abuse
Comparable to CBT

Great for those with short attention spans because these only last 1-4 sessions.

Question 14

What’s the point of Support Groups and why do we think these are a good idea?

Answer 14

Benefit from being supported
Benefit from supporting others
Benefit from leaning from others

Based on:
Social Network theory
Social Support literature

Question 15

How clinically effective are support groups?

Answer 15

Effective, particularly when combined with other EBT

Question 16

What’s the idea behind 12 step programs? What theories guide them?

Answer 16

Spiritual connection?
Personal responsibility?
Social support

Based on:
Belief in a higher power
Belief in power of atonement

Question 17

How effective are 12 step programs

Answer 17

Compares favorably to CBT

Question 18

These last two treatment options, social groups and 12 step programs, are what type of treatment?

Answer 18

Social treatments

Question 19

What is operant conditioning and who started it?

Answer 19

Operant Conditioning is defined as a form of learning in which an individual’s behavior is modified by its consequences. The term operant conditioning was coined by B.F. Skinner in 1937

Question 20

Reinforcement vs punishment

Answer 20

– Reinforcement is a consequence that causes a behavior to occur with greater frequency
– Punishment is a consequence that causes a behavior to occur with less frequency

Question 21

What is “Extinction” in operant conditioning?

Answer 21

– Extinction is caused by the lack of any consequence following a behavior. When a behavior is inconsequential (i.e., producing neither favorable nor unfavorable consequences) it will occur less frequently. When a previously reinforced behavior is no longer reinforced with either positive or negative reinforcement, it leads to a decline in that behavior

Question 22

This man was the first person to apply operant conditioning via contingency management to humans

Answer 22

Miller (1975)

Question 23

What are the two main targets of Contingency Management?

Answer 23

– Behavioral Targets – the behavior to be modified
– Reinforcing Consequences – reward provided when the desired behavior occurs and withheld when the desired behavior does not occur

Question 24

There are four principles that a clinician engages in to implement CM:

Answer 24

– Clinician arranges for regular drug testing to ensure the targeted substance is detected
– Clinician provides agreed upon tangible reinforcers when abstinence is demonstrated.
– Clinician withholds the designated incentives from the patient when substance use is detected
– Clinician assists the patient in establishing alternate and healthier activities

Question 25

Aversion therapy is based off of what famous conditioning type made by whom?

Answer 25

• Aversion therapy is a behavioral treatment that is based on principles in animal learning theory, particularly classical conditioning
• Classical Conditioning (I.P. Pavlov, 1927)

Question 26

Definition of classical conditioning

Answer 26

• When a stimulus that normally elicits a response (positive or negative) is repeatedly paired with a neutral stimulus, the neutral stimulus will begin to produce the response without the presence of the original stimulus

• For addictions, use of substance is paired with medication that causes nausea and vomiting
- Eventually the substance produces nausea without the addition of the medication

Question 27

What is Faradic Aversion?

Answer 27

• Faradic aversion (mild electric shock) appears safe for all patients

Question 28

What is a typical aversion medication combination used clinically (3 drugs)

Answer 28

− Emetic (emetine) administered with medications to increase autonomic arousal and to prevent alcohol absorption (pilocarpine) and hypotension (ephedrine)

Question 29

What happens in aversion therapy via vomiting just prior to the onset of nausea? What is the long term therapy schedule like?

Answer 29

− Just prior to onset of nausea/vomiting, the patient looks at, smells, and tastes (“swish and spit”) favorite alcoholic beverage, switches to “swish and swallow” after onset of vomiting

− 5 aversion therapy sessions during a 10-day inpatient hospital stay, booster sessions at 60 and 90 days after discharge

Question 30

Weekly homework and 12 - 15 sessions is central to which therapy?

Answer 30

Cognitive Behavioral Therapy (CBT)

Question 31

What three mechanisms exist behind Cognitive Behavioral Therapy?

Answer 31

– Challenge maladaptive cognitions
– Reduce negative emotional responses
– Target adaptive behaviors

Question 32

Is CBT cost effective?

Answer 32

• Cost studies have shown that CBT is cost effective (van Asselt et al., 2008)
− Treatment protocol is brief
− Provides tools to cope with co-morbid conditions (anxiety, depression, etc.)

Question 33

Discuss how Buddhism is related to mindfulness that we see in mindfulness-based therapies

Answer 33

• In Buddhism, mindfulness is the 1st of the Seven Factors of Enlightenment, and the 7th of the Noble Eightfold Path toward cessation of suffering and self-awakening
• Enlightenment (bodhi) is a state of being void of greed, hatred and delusion

• Mindfulness as an attentive awareness of the reality of things (especially of the present moment) is believed to be an antidote to delusion

Question 34

Two components of mindfullness in MBT

Answer 34

– The first component (of mindfulness) involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment (the Here and Now)
– The second component involves adopting a particular orientation (attitude) toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance

Question 35

MBRP (Mindfulness relapse prevention therapy) is based on what 4 principles?

Answer 35

o Develop awareness of personal triggers and habitual reactions, and learn ways to create a pause in this seemingly automatic process
o Change our relationship to discomfort, learning to recognize challenging emotional and physical experiences and responding to them in skillful ways
o Foster a nonjudgmental, compassionate approach toward ourselves and our experiences.
o Build a lifestyle that supports both mindfulness practice and recovery

Question 36

This type of Mindfulness based therapy is used often for those with borderline personality disorder

Answer 36

DBT (Dialectical Behavioral Therapy)
– The DBT dialectic pushes for immediate and permanent cessation of drug abuse (i.e., change), while recognizing that relapse does not mean that the patient or the therapy cannot achieve the desired result (i.e., acceptance)
– The therapist in the first DBT session asks the patient to commit to abstinence immediately. The commitment begins with an attainable goal—a day, a month, or just 5 minutes.

Question 37

In his work with Motivational interviewing, Miller argued that treatment would be more effective if counselors:

Answer 37

– De-emphasized labeling clients (e.g., alcoholics, treatment failures)
– Emphasized individual responsibility (i.e., the client decides himself to change) and self-efficacy

Question 38

What is cognitive dissonance? How does it relate to motivational interviewing?

Answer 38

o	Cognitive dissonance is a social psychology principle that postulates that the recognition of inconsistency within the individual necessitates a change (Festinger, 1975)
o	Miller (1983) argued that counselors could facilitate change by helping the client see discrepant behaviors

Question 39

Discuss Miller’s thoughts on empathy and how it relates to motivational interviewing

Answer 39

o Miller argued that therapeutic processes studied by Carl Rogers such as empathy and reflective listening could facilitate change
o The use of empathy and reflective listening allows the counselor to be a mirror for the client (there are several other techniques that come from Rogers that are listed in the techniques section)

Question 40

What is self-perception theory? How does it relate to motivational interviewing?

Answer 40

o	Bem (1972) posited that people develop their attitudes by observing their behavior and concluding what attitudes must have caused them
o	Miller argued that change could be facilitated by having the client elicit self-motivational statements 
o	For example:  The counselor asks the client questions to help he/she make a statement related to the (1) recognition of alcohol-related problems (cognition),  (2) concern regarding the problem (affect) and (3) recognition of a need to change drinking pattern (behavior)

Question 41

Two components of Maslow’s Hierarchy of Needs in 1943 that are the basis behind support groups

Answer 41

– Primary human need for connectedness and belonging

– Fundamental human need for self-esteem

Question 42

What are the drop out rates for 12 step groups?

Answer 42

25-50%

In 16 years, 42% of 12-step patients and 24% untreated patients are stable in remission

Question 43

What did Carroll in 1997 show about the effectiveness of single therapies?

Answer 43

– Combination of psychotherapy + drug therapy better than single therapy (Carroll, 1997)