Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy Enduring Effects
and Mechanisms Bruce J. Rounsaville Yale
University

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Cognitive Behavioral Coping Skills

• Based on social learning theory
• Substance use is functionally related to other
  problems
• Emphasizes learning of coping skills
• Initiation and mastery of skills through
  practice, role playing, and extra-sessions tasks

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Functional Analysis

• Exploration of substance use
• in relationship to
• antecedents and consequences

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CBT for drug dependence

• Introduction to functional analysis
• Coping with craving
• Shoring up motivation
• Refusal skills and assertiveness
• Seemingly Irrelevant Decisions
• All purpose coping plan
• Problem solving
• Case management
• Termination

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Empirical support for CBT

• CBT may be more effective for more severe cocaine
  abusers
• Carroll et al., 1994, 1998 McKay et al 1997
  Maude-Griffin et al, 1998

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Empirical support for CBT

• CBTs effects appear to be durable up to one year
  after treatment ends
• CBT appears to be associated with continuing
  improvement in substance use

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Carroll et al., 1999
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Rawson et al., 2002 CM vs CBT in methadone
maintenance
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MTP Marijuana use through 15 months
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Does CBT work the way we think it works?

• Initial exploration of mechanisms of action of
  CBT
• Does CBT differentially increase coping skills?
• Are coping skills related to outcome?

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Cocaine Risk Response Test

• Role playing task based on Chaneys work,
  administered pre-and posttreatment
• Example You are at a party, where you didnt
  think cocaine would be available. However, you
  notice people going in and out of a back bedroom,
  and a friend invites you to join them. What do
  you do?

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Cocaine Risk Response Test

• Audiotaped responses to 10 high risk situations
  scored on 6 dimensions
• Latency
• Number of coping plans
• Quality of best plan
• Overall quality
• Specificity
• Type of coping response

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Psychometric properties

• Good interrater reliability (.74-.89)
• Good internal consistency (.79-.96)
• Significant pre-posttreatment increases in number
  of coping plans, quality of response, specificity
  of response

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Treatment and coping skills acquisition

• Significant treatment condition by time
  interactions suggest patients assigned to CBT,
  TSF, or Clinical Management show greater
  increases in coping skills associated with that
  treatment condition
• Higher posttreatment CBT skills associated with
  significantly less cocaine use during follow-up

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