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Addiction & Compulsive 1 > L3: CBT for Addiction > Flashcards

L3: CBT for Addiction Flashcards

1
Q

What are the 3 evidence based treatments for addiction?

A
  • CBT
  • Motivational Interviewing
  • Contingency management
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2
Q

What’s the difference between self control measures and emergency measures?

A

self control: prevent use
emergency: interrupting use during a relapse
can be difficult topic for clients (cus its like safety instructions when you fly)

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3
Q

Define acceptance & commitment therapy

A

guiding people to accept the urges and symptoms associated with substance abuse and use psychological flexibility and valuebased interventions to reduce those urges and the symptoms

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4
Q

Define the minnesota model

A

12- step facilitation throughgroup therapy, based on the Alcoholics Anonymous

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5
Q

Define contingency management

A

desired behaviour is “reinforced” or rewarded

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6
Q

What is the aim of CBT?

A

changing the pattern of problematic substance use (reducing or quitting)

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7
Q

What is CBT?

A

umbrella term for therapies that focus on “cognitions” (thoughts, beliefs, schemas etc) & behaviour as the central driver of and solution to healthy emotion regulation
- has protocolled treatment + workbook
- has aspects of Motivational interviewing

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8
Q

What are the 3 learning principles that play a role in the dev of substance use?

A
  • Social learning: observing and imitating
  • Operant (i.e., instrumental) Conditioning: Substance use is rewarded
  • Classical (i.e., Pavlovian) conditioning: substance use is maintained Pavlovian
    associations
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9
Q

What are the self control measures (to prevent use)?

A
  • stimulus control (avoidance)
  • stimulus response prevention (alternative behaviour)
  • response consequences (reward, negative consequences)
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10
Q

What are the assumptions behind Cognitive Behavioural Therapies?

A
  • thoughts, behaviours, and emotions are learned
  • substance use is automized behaviour
  • using is rewarding, disadvantages are usually not experienced until later
  • set well considered goals
  • make inventory of risk situations
  • strengthen skills to deal with risk situations
  • therapeutic alliance is a necessary but not sufficient for change
  • focus on the here and now
  • the client as their own therapist & importance of homework
  • guided discovery as a self-reflection tool
  • scientists-practiioner approach & collaborative empiricism
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11
Q

What is the length & structure of CBT?

A

length: relatively brief (12-16 sessions)
structure: plan broken into 3-4 interconnected sections, adapted to clients needs (so still a bit flexible). within session: 1. discuss homework 2. introduce new theme 3. give new homework

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12
Q

What are the major phases in CBT?

A
  • taxation
  • interventions
  • relapse prevention
  • conclusions
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13
Q

What are the pros of CBT?

A
  • widely applicable
  • adaptable to the wishes & circumstances of clients
  • reasonable empiricable evidence for it effectiveness
  • helps address multiple issues at once, which is good cus addiciton is very co-morbid
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14
Q

What are the 6 elements in the general cognitive behavioural model?

A

early experiences, beliefs, triggers, thoughts, feelings, and behaviours

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15
Q

How can the 6 elements in the cognitive behavioural model be addressed?

A

triggers:
- identify triggers & associated thoughts/feelings/behaviours
- manage triggers to prevent relapse
thoughts & beliefs:
- analyzing, challenging, accepting them
feelings:
- emotion regulation, distress tolerance, mindfulness
- dialectical behaviour therapy
behaviour:
- interventions targeting substance use & associated behaviours
- coping skills therapy
- relapse prevention

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16
Q

What are the 9 main treatment components of CBT for addiction?

A

(register substance use &craving)
- prepare for change (motivation)
- goal setting (SMART)
- self-control measures
- functional analysis
- emergency measures
- dealing w craving
- change thoughts
- refusal of offered substances
- evaluation & choose extra topics for leftover sessions

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17
Q

how can you deal with craving?

A
  • seek distraction
  • surfing the urge
  • identify alternative thoughts
  • mindsurfing
  • seek social support
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18
Q

How can you change thoughts (in CBT)?

A
  • thoughts actually play no role as trigger of substance use! its habit behaviour
  • we interpret certain bodily sensations as craving and then use substance
  • challenging thoughts doesnt have an added value
  • what can you do: formulate a helpful thought, like a pep talk! (ex: what would you say to a friend in the same situation?) & list dangerous thoughts
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19
Q

How can you decline/refuse offered substances?

A

not as exposure exercise! as role play with client
how
- react quickly
- be clear, dont hesitate
- make eye contact
- first say no
- suggest an alternative
- when pressured: ask other to stop
- change topic of convo, avoid discussion
- dont apologize or give vague answers

20
Q

What is mindsurfing?

A

identifying the positive consequences of not using, negative consequences of using

21
Q

How do you prepare for change (motivation)?

A
  • increase SELF motivation through MI
  • make cost/benefit balance (pros of abstinence, cons of use, short term & long termà
    = to provoke “change language)”
22
Q

How do you set treatment goals (SMART goals)?

A

must be
- collaborative
- abstinence or controlled use
- advice: 4-6w of absitencne
Specific Measurable Achievable Realistic Timely

23
Q

What are the 4 key cognitive behavioural therapies for addiction?

A
  • Relapse Prevention
  • Cognitive Therapy
  • Coping Skills Therapy
  • Mindfulness-Based Cognitive Behavioural Approaches
24
Q

How does CBT Relapse Prevention appoach work?

A

develop skills to identify & prepare for situations & risk factors that lead to relapse

25
Q

How does CBT Cognitive therapy approach work for addiction?

A

focus on “proximal, situational factors” like psych, emotional, behavioural variables that are triggers for drug use, and “distal background factors” like personal history, long standing cognitive, behavioural & personality variables that may act as vulnerabilities or maintaining factors for the use

26
Q

What are the 4 main components of CBT Coping Skills therapy for addiction?

A
  • relapse prevention training
  • social & communication skills training
  • training in coping w urges and cravings
  • mood management
    may also use cue exposure therapy to extinguish alcohol related cues
27
Q

How do CBT Mindfulness based cognitive behavioural approaches work for addiction?

A

purposeful attention to present & opennes to accept things as they are
- can be combined with relapse prevention

28
Q

What are variations on CBT for addiction?

A
  • BRIEF CBT: for ppl not ready to do intense treatment, for moderate to high risk users
  • LOW INTENSITY CBT: usually means less intensive for the practitioner. can be delivered by non-specialists & use range of remote & self directed tools. help increase accessibliity, flexibility, cost-effectiveness…Etc
  • DIGITAL CBT: created cause many barriers to in person treatment (long waiting lists, no anonymous, less accessibility) but might still have some methodological issues
29
Q

what are CBT interventions aimed at improving?

A
  • self control
  • coping skills
  • social skills
  • cognitions (cognitive therapy)
  • motivation (MI)
30
Q

What is a functional analysis & how do you formulate one based on a case?

A

helps clients gain insight into own behaviour
- one FA per substance
- determine function of use
- Sd: risk situations
- choosing interventions on basis of FA
- invite support person

31
Q

Define motivational interviewing

A

a collaborative, goal-oriented conversation style with special attention to change language. designed to enhance personal motivation & commitment to a particular goal by eliciting and exploring a person’s reasons for change in an atmosphere of acceptance and compassion

32
Q

How does motivational interviewing work?

A
  • patient asked emphatically about the suffering, motives for / against change, their values​​/norms/objectives, discrepancy between the situation now and the desired one
  • attempts to improve the patient’s sense of competence (‘self-efficacy’) by identifying main obstacles, by exploring past successes, and by letting them reflect on possible strategies.
  • empathetic conversation style combined with directivity to investigate patient’s ambivalence w regard to substance use and to encourage change
  • therapist guides patient towards change
  • eliciting “change” talk (i want to quit) & reducing “sustain” talk (i have to drink cause x) through open questions
  • last phase: create plan of change
33
Q

What are the 4 specific things to focus on in MI?

A
  1. Engaging: engage the client from the start by establishing trust & a relationship through good listening
  2. Focusing: establish goals WITH client. discuss what they want, work on changes they want, and do harm reduction. honor their autonomy.
  3. Evoking: elicit the clients own reasons for change, their own motivations (“change” talk). to do when you hear change talk: ask more, reflect, affirm, summarize.
  4. Planning: once enough motivation, make a (flexible) plan for how to get change.
34
Q

Why does Motivational Interviewing work better than confrontational methods?

A

Confrontation -> high levels of resistance to change & treatment. cus if ppl are ambivelent feelings about their use, then a counseler strongly voicing prochange arguments makes the client evoke the other side of the ambvilence: the counterchange arguments.
MI -> client makes the arguments for change by voicing their own motivations

35
Q

How does motivational interviewing contribute to addiciton treatment?

A

more effective than confrontational interventions
- as stand alone treatment its suitable for mild forms of substance abuse
- in more severe cases its a valuable addition to CBT

36
Q

Define the “abstinence-violation effect”

A

negative emotional and cognitive response to relapsing after a period of abstinence. A person may feel guilt, shame, and self-doubt, and this may increase the risk of further relapses and hinder the recovery process.

37
Q

What should be in an emergy plan?

A
  • how do you prevent a slip from turning into relapse?
  • emergency measures
  • helpful thoughts
  • help -> who?
  • medication
38
Q

What were Skinner’s main 2 ways of addressing substance abuse?

A
  • negative reinforcement of substance use: disulfiram for alcohol abuse: form of aversion therapy cus in combination w alcohol it produces a negative physical reaction
  • positive reinforcement of desired behaviour: contingency management (get direct, small rewards like lottery tickets for desired behaviour like abstinence or showing up to therapy)
39
Q

What are the main psychopharmacological interventions in substance use disorders & how they work (in terms of 4 different ways in which they can support CBT)

A
  • detoxification
  • aversive drugs
  • anti craving medication
  • preservation treatment
40
Q

How does detoxification work as a treatment for substance abuse and as a support to CBT?

A

patient stops using drugs
- in alcohol detox, meds used to reduce withdrawal symptoms (benzos) & to prevent seizures / deliruim
- in opiod addiction, abuse is gradually reduced after being administered & while being monitored. usually opiate first replaced w methadone or naloxone, after which this new drug can be reduced or an serve as basis for opioid maintenance therapy (preservation treatment).
- these replacement drugs can help patients get their lives back on track

41
Q

How do aversive drugs work as a treatment for substance abuse and as a support to CBT?

A

Disulfiram prevents alcohol in the body of breaking down, resulting in nausea, headache, dizziness, sweating and palpitations.
most effective when taken under supervision of a partner / doctor (to increase treatment compliance).

42
Q

How does anti craving medication work as a treatment for substance abuse and as a support to CBT?

A
  • naltrexone -> obstruction of opiod receptor -> reduced rewarding effect of alcohol + opiates -> reduced craving
  • can be initiated while patient is still drinking
  • relatively ineffective for chronic alcholoics
  • can work for gambling addiction
  • acamprosate -> inhibits affect on glutametergic system -> reduced craving for alcohol after abstiencne
  • nalmefen, similar to naltrexone, but fast acting and can even be taken preventatively on days when patients feels increased risk of relapse
43
Q

How does preservation treatment work as a treatment for substance abuse and as a support to CBT?

A
  • involves prescribing medicatino that has the same chemical properties as the drug to which person is addicted -> withdrawal symptoms & craving prevented
  • usually for more “chronic” addictions like opiod addiction
    most common meds used: methadone & naloxone
44
Q

What is cue exposure?

A

triggers offered in absence of the opportunity to consume the substance
idea behind it: pavlovian association weakened in this way
but research showed that its very hard to erase associations once they are formed
so now in cue exposure: the unwanted behaviour is replaced w a new desired behaviour, so that a new association is created that can compete w the old association

45
Q

What is surfing the urge?

A

Learning to experience and accept craving as a normal response to conditioned stimuli, that will subside by itself.
* Phase 1: The craving presents itself.
* Phase 2: The craving gets bigger and bigger as long as you don’t do anything about it and don’t give in to what you normally would
* Phase 3: And eventually the craving diminishes.

Addiction & Compulsive 1 (5 decks)

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