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Cognitive Behavioral Therapy CBT

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Cognitive Behavioral Therapy CBT Julie Gutowski CASAC LMHC Cognitive Behavior Therapy (CBT) Based on the idea that how we think (cognition), how we feel (emotion ... – PowerPoint PPT presentation

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Title: 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
ABCs 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 clients 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 consumers 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 clients 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
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