HC.1.4 Flashcards
(22 cards)
What is CBT for substance abuse and Gambling disorder?
- The aim is to change the pattern of problematic substance use
- it often involves also motivational interviewing
- CBT = it helps people to identify and change unhelpful thoughts, emotions and behaviours.
— it focuses on breaking the cycle of:
—– Negative thoughts
—– Distressing emotions
—– Maladaptive behaviours
— Key techniques:
—– Cognitive restructuring: challenging and changing distorted thoughts
—– Exposure
—– Skills training: coping strategies, social skills, problem-solving skills
—– Relapse prevention: learning to handle triggers and high-risk situations
In addiction:
- Recognizing and avoiding triggers
- managing cravings
- coping with negative emotions without using substances
- preventing relapse by changing thoughts and behaviours that lead to drug use
- the interventions aim at improving:
— Self-control
— Coping skills
— Social skills
Which 4 CBT forms are there?
- individual - 5 meetings
- for people that only need a little push. The disorder isn’t that severe. Not at Jellinek - Individual - 13 meetings
- group - 6 meetings
- Not at Jellinek
- The same as CBT 1 but in a group - group - 12 meetings
How does a CBT session look like?
- Discussing Homework
- the homework is related to the theme of the previous meeting - Introducing new theme
- Explain why this theme is important and helpful - Giving new homework
Name the components of CBT for addiction
- Prepare for change (motivate)
- Goal setting (SMART)
- Self-control measures
- Emergency measures
- Functional analyses
- Dealing with craving
- Changing thoughts
- Refusal of offered resources
How to register substance use and craving?
- You do this everyday. and preferable when the emotions/ thoughts/ feelings happen
- It is to help therapists and clients to track patterns related to addiction.
- It’s a self-monitoring worksheet
- It increases awareness of triggers and behaviours
- You describe which day it is and what time
- Then you describe the situation (where/ who/ what)
- Then you describe your thoughts/ feelings/ bodily sensations
- Then you describe your behaviours (what did you do, which substance, how much, how long etc.)
- Then you describe the consequences (what happened after the use
How it is used in therapy:
- Increases self-awareness of habit loops and cravings
- Guides discussions in therapy to build coping strategies
- Forms the basis of relapse prevention
Intervention 1: preparing for change: explain
> Enhancing the client’s motivation to change their behaviour
- Main strategy: motivational interviewing (MI)
– MI is a client-centered technique aimed at increasing intrinsic motivation to change a problematic behavior (e.g., substance use).
– The therapist elicits the client’s own reasons for change, rather than imposing them.
- Then make a cross-benefit analyses:
— Clients are encouraged to reflect on the pros and cons of substance use and change, both:
—- Short-Term (ST): e.g., immediate pleasure vs. short-term discomfort from quitting
—- Long-Term (LT): e.g., health deterioration vs. long-term wellness and stability
- You want to provoke change language:
— Change language includes verbal expressions of desire, ability, reasons, or commitment to change.
— Encouraging this kind of talk is linked to greater treatment success
- Positive Predictors of Treatment Outcome:
- The more “change language” a client uses, the more likely they are to succeed
- A shift in language from maintaining current behavior to change-focused language is crucial - Predictors of Relapse:
- Imposed abstinence (e.g., without client’s choice or motivation) can increase relapse risk
- When clients articulate only the benefits of using and downsides of stopping, they are more likely to relapse—this reflects ambivalence or resistance to change.
Intervention 2: setting goals: explain
How:
- Collaborative approach: the goals are set through negotiation between the client and the counselor, ensuring client autonomy
- Clients can aim for abstinence or controlled use depending on their situation and readiness.
- Generally, a period of 4–6 weeks of abstinence is advised to allow proper assessment and behavior change.
- Goals must be meaningful and achievable for the client.
- Goals should be formulated as SMART goals:
1. Specific: clear and well-defined
2. Measurable: include quantifable criteria so progress can be tracked
3. Attainable: realistic and achievable based on the client’s current resources and situation
4. Realistic: Personally meaningful and aligned with the client’s broader values and objectives
5. Timely: a clear time-frame or deadline to create urgency and motivation
Name some risk-free guidelines for alcohol and drugs
Alcohol:
- The Dutch Health Council recommends no more than 1 glass per day
- min: 2 substance-free days per week
Drugs:
- Complete abstinence is recommended due to higher risk
Intervention 3: Self-control measures: explain
These strategies help clients regulate their behavior by changing their interaction with triggers, responses, and consequences.
1. Stimulus control:
- What: The client avoids external triggers—people, places, or situations—that increase the risk of substance use.
- Goal: Reduce exposure to cues that could lead to craving or relapse
- Example: Avoiding bars, parties, or certain friends associated with previous drug/alcohol use.
- Stimulus-Response Prevention:
- What: In high-risk situations, the client chooses an alternative behavior instead of engaging in substance use
- Goal: Break the automatic link between the cue (stimulus) and the unwanted behavior (response)
- Example: Going for a walk, calling a support person, or using relaxation techniques instead of drinking when stressed - Response Consequences:
- What: agreeing with the client that if the goal is achieved/not achieved the coming week, they will receive a reward/punishment.
- Example: If the client avoids using for a week, they reward themselves with a treat; if they relapse, they lose a privilege
- Note: Positive consequences are tied to contingency management, a behavioral strategy that uses reinforcement to increase desirable behaviors.
Intervention 4: Functional analysis: explain
What:
- The main goal is to understand the function of substance use—why someone uses in that specific context (e.g., to relax, escape, feel pleasure).
- It involves identifying risk situations (Sd), or triggers that cue the substance use.
- Based on this analysis, tailored interventions are selected.
- One FA per substance: If a client uses multiple substances, separate analyses help pinpoint the function of each
- Involving a support person helps reinforce treatment goals and provide accountability.
Functional Analysis in CBT helps uncover the why behind substance use. It guides interventions by:
- Identifying triggers and motivations.
- Breaking down internal and external contributing factors.
- Highlighting the discrepancy between immediate rewards and long-term consequences.
By understanding these patterns, clients can develop healthier coping mechanisms and replace maladaptive habits with goal-directed behavior.
Describe the classical functional analysis
- Describe the specific context or situation
- Describe the dysfunctional behaviour (using the substance)
- Describe the positive reinforcement the person expects (relaxation)
- Describe also the factual negative consequences (hangover, guilt etc.)
Describe the detailed functional analysis
- Describe the external situation (with who, where, when) and the internal situation (thoughts, physical sensations, emotions)
- Describe the behaviour (what, how much, how long)
- Describe the short-term and long-term consequences
Intervention 5: Relapse and emergency measures: explain
This part of therapy helps clients deal with setbacks in a constructive and non-judgmental way.
- Relapse is a complex and sensitive topic: Clients may feel confused, ashamed, or guilty.
- The “abstinence violation effect” (Marlatt et al., 1985): After a lapse, clients often experience intense guilt and shame, which can lead to a full relapse if not managed.
- CBT strategy: View a lapse as a learning opportunity, not failure. Help clients prepare by developing emergency coping plans in advance.
CREAT AN EMERGENCY PLAN
- Clients are encouraged to formulate a plan for what to do immediately after a lapse to prevent it from escalating into a full relapse.
- Ask about:
— Behavior: What can they do right after a lapse (e.g., a helpful task)?
— Helpful thoughts: What can they say to themselves to stay motivated?
— Help: Who can they call or talk to?
— Medication: Are there any prescribed tools they should use?
Explain the difference between emergency measures and self-control
- Self-control measures are proactive and aim to prevent substance use before it starts.
- Emergency measures are reactive and aim to interrupt substance use after a lapse or during an active moment of risk.
- Both are essential, but serve different purposes in maintaining recovery.
Intervention 6: Dealing with craving: explain
Coping strategies for carvings:
1. Seek distraction: Engage in activities that shift attention away from the craving.
2. Seek social support: Talk to or spend time with supportive friends or family.
3. Mind surfing:
- Reflect on the positive consequences of not using.
- Consider the negative consequences of using.
4. Alternative thoughts: Replace dysfunctional thoughts like “I must use” with adaptive ones like “This is unpleasant, but I can manage it.”
Other technique:
Urge surfing:
- A mindfulness-based technique where clients are taught to:
— Recognize that cravings are natural and temporary.
— “Ride the wave” rather than acting on the urge.
— Avoid suppression, instead allowing the craving to pass on its own.
- Helps with substance use disorders (SUD) and emotional regulation (e.g., anger).
Identifying Dysfunctional thoughts
- Common irrational beliefs during cravings include:
— “I need something to feel better”
— “I worked hard, I deserve a treat”
— “Everything is lost now that I relapsed”
- These thoughts increase vulnerability to use and must be challenged.
Formulating helpful thoughts
- To change thinking patterns, therapists might ask:
— “What would you think if the drug wasn’t present?”
— “What would a non-user do or say?”
— “What would you say to a friend in your situation?”
- This encourages cognitive restructuring and development of coping cognitions.
Critical note on changing thoughts
- Thoughts may not be the root cause of use—it might be habit-driven.
- Clients often rationalize use after it happens, leading to cognitive dissonance.
- Changing thoughts might help, but isn’t always necessary or sufficient for change.
Intervention 7: Declining/refusing offered substances: explain
It is an essential skill for relapse prevention and self-efficacy in recovery from substance use.
- This is not about exposure therapy—the goal is not to gradually desensitize someone to substances.
- Instead, it is based on the principle of Stimulus-Response Prevention: breaking the automatic link between being offered a substance (stimulus) and accepting or using (response).
How it helps:
- Builds self-efficacy: Practicing refusal increases confidence in one’s ability to resist substances in real situations.
- Reduces relapse risk by preparing clients for high-risk social scenarios (e.g., parties, peer pressure).
- Teaches alternative responses (e.g., choosing a non-alcoholic drink, leaving the situation).
Methods:
- Role play practice: Therapists and clients rehearse common situations where substances might be offered.
— Say what the client needs to say or do en than do the roleplay, don’t talk too much about it
— It is short, you have to kinda overwhelm them to stick.
- Use of cues/reminders: Sometimes physical or visual reminders of previous use are included to simulate realistic scenarios—without encouraging avoidance, which could be counterproductive.
- Concrete refusal skills:
— React quickly and with clarity
— Make eye contact
— Say “No” firmly and clearly
— Offer an alternative (e.g., “No thanks, I’ll have a soda”)
— Set boundaries if pressured (“Please don’t ask me again”)
— Avoid vague answers or apologies—they weaken the message
— Change the subject if needed
Describe the Minnesota model
What:
- The Minnesota Model is a 12-step facilitation treatment rooted in the philosophy of Alcoholics Anonymous (AA). It’s an abstinence-based, multi-professional program designed to treat addiction through a structured and supportive group process.
Core features:
- Abstinence-Oriented: The ultimate goal is complete cessation of substance use.
- Group Therapy-Based: Treatment is delivered through peer-led group sessions.
- Professional Involvement: Includes therapists, counselors, and often medical professionals.
- Disease Model of Addiction: Views addiction as a chronic, progressive disease that can be managed but not cured.
- Emphasis on Self-Help: Encourages personal responsibility and growth through the 12 steps.
- Recovery, Not Cure: Focuses on sustained recovery through ongoing support.
The 12 steps:
1. Admit powerlessness.
- Acceptance of addiction and the chaos it brings. This step breaks denial.
2. Seek help.
- Embraces hope and the idea that recovery requires help beyond oneself—can be spiritual or simply external support.
3. Accept help.
- Encourages trust and surrender—not necessarily religious, but about letting go of control and accepting guidance
4. Self-awareness.
- Self-reflection to understand one’s behaviors, patterns, and flaws. Think of it as self-assessment.
5. Confession of wrongdoings.
- Confession and vulnerability—sharing your flaws to reduce shame and promote accountability.
6. Desire to change.
- Willingness to change and let go of harmful traits or habits
7. Ask for support in changing.
- Asking for help with change—humility and commitment to growth
8. Acknowledge past harm.
- Acknowledging the impact of addiction on others—owning responsibility.
9. Make amends.
- Taking constructive action to repair relationships and rebuild trust.
10. Daily self-reflection.
- Practicing ongoing self-awareness and taking responsibility in daily life.
11. Pursue spiritual development.
- Building spiritual awareness or mindfulness, strengthening inner guidance.
12. Help others in recovery.
- Helping others and integrating recovery principles into everyday life—giving back and staying grounded.
Treatment format:
- Intensive and Structured: Often inpatient or outpatient programs.
- Includes lectures, individual counseling, and peer support.
- Builds a strong recovery community to prevent relapse.
Describe acceptance and commitment therapy
A modern form of behavioral therapy that focuses on acceptance, mindfulness, and values-based living.
WHAT?
It helps individuals:
- Accept their internal experiences (e.g. cravings, emotions, thoughts) without fighting them.
- Commit to behavior that aligns with their personal values, even in the presence of discomfort or urges.
- Develop psychological flexibility—the core goal of ACT.
KEY CONCEPTS:
1. Acceptance
→ Willingly experiencing difficult thoughts/feelings without avoiding or suppressing them.
2. Cognitive Defusion
→ Learning to distance from thoughts, rather than getting “hooked” by them (e.g., “I am not my thoughts”).
3. Present Moment Awareness (Mindfulness)
→ Staying connected to the here and now, rather than ruminating on the past or worrying about the future.
4. Self-as-Context
→ Viewing the self as more than just thoughts or emotions—like the calm observer behind mental experiences.
5. Values
→ Clarifying what truly matters to the person (e.g., relationships, health, honesty).
6. Committed Action
→ Taking concrete steps that align with one’s values, even in the face of challenges.
IN THE CONTEXT OF ADDICTION
- Urges to use are treated as natural, not dangerous, and don’t have to be acted on.
- Clients learn to observe cravings mindfully, without trying to suppress or escape them.
- They’re encouraged to live a meaningful life based on their values—not just escaping discomfort.
SUMMARY:
ACT isn’t about “fixing” thoughts or feelings—it’s about accepting them while still choosing actions that build a better life. For addiction, this means helping clients tolerate cravings and make value-based choices instead of acting on urges.
Describe the similarities between CBT, Minnesota model and Acceptance and Commitment therapy
- All focus on addiction behavior.
- Aim to increase insight into the addiction process (often through psychoeducation).
- Help reshape the client’s lifestyle, not just reduce substance use.
- Many interventions overlap in essence but may use different terminology.
Describe the differences between CBT, Minnesota model and Acceptance and Commitment therapy
🧠 CBT (Cognitive Behavioral Therapy)
- Focuses directly on behavior and triggers.
- Emphasizes learning new coping strategies.
- Uses techniques like functional analysis, craving management, relapse prevention.
- Long considered the standard treatment for Substance Use Disorders (SUDs).
- More structured and problem-focused.
🌱 ACT (Acceptance and Commitment Therapy)
- Focuses on psychological flexibility, not just behavior change.
- Encourages clients to accept cravings and distress rather than fight them.
- Goes beyond addiction—addresses broader life functioning.
- Combines CBT elements with mindfulness and value-based living.
- A newer approach in addiction care.
🙏 Minnesota Model
- Centers on (re)connecting with self and others, often spiritually.
- Based on 12-step programs and self-help groups like Alcoholics Anonymous.
- Integrates physical, emotional, and spiritual aspects of addiction.
- Offers lifelong aftercare through group therapy networks.
- The oldest and most widespread treatment model, especially popular in the USA and UK.
SUMMARY:
- CBT: Practical, structured, skills-focused.
- ACT: Mindful, accepting, values-driven.
- Minnesota Model: Community-based, spiritual, long-term support.
Name 2 other evidence-based treatment approaches
- Contingency Management:
- definition: A behavioral strategy that reinforces positive behavior (like staying clean or attending sessions) with tangible rewards.
- How it works: Clients might receive vouchers, prizes, or privileges when they:
— Test negative for drug use
— Attend appointments consistently
— Meet therapy goals
- Goal: Strengthen and encourage desired behavior through positive reinforcement, increasing the chances it will continue. - Motivational Interviewing:
- Definition: A client-centered conversational approach designed to enhance the client’s own motivation to change.
- Focus: Instead of confronting resistance, MI helps clients resolve ambivalence about their substance use by:
— Exploring their personal values and goals
— Eliciting “change talk” (statements that reflect desire, ability, or reasons to change)
- Goal: Guide the client to find intrinsic motivation for behavior change (rather than feeling forced or judged).
IN SUMMARY:
- Contingency Management reinforces external behavior change through rewards.
- Motivational Interviewing fosters internal motivation for change through supportive dialogue.
What is meant with the abstinence-violation effect?
The abstinence-violation effect (AVE) refers to the emotional and cognitive response a person experiences after relapsing (using a substance) following a period of abstinence.
WHAT HAPPENS:
- After a lapse (one-time use), the person may feel guilt, shame, failure, or self-blame.
- These negative feelings can lead to self-doubt (“I can’t do this”), which may undermine their motivation to continue trying.
- This can increase the likelihood of a full relapse, where the person returns to uncontrolled or regular substance use.
WHY IT MATTERS:
- Instead of seeing the lapse as a learning moment, the person sees it as proof of failure, creating a negative cycle. The AVE is therefore a key psychological barrier to long-term recovery.
THERAPEUTIC TIP:
Help clients understand that a lapse is not the same as a relapse, and encourage them to respond constructively rather than giving up completely. This is why CBT and relapse prevention plans often include emergency measures to break the AVE cycle.
