Module6:
BriefCognitiveTherapy
TIP34 Reference
Chapter6:BriefCognitive-BehavioralTherapy(pp.61-68)
TIP 34Book
Trainer Notes
TrainingEmphasis
1. Key Concepts of Brief Cognitive Therapy
2. Models Used for Brief Cognitive Therapy
3. Research on Brief Cognitive Therapy
4. Types of Settings and Clients Appropriate for Brief Cognitive Therapy
5. Applications of Brief Cognitive Therapy in Substance Abuse Treatment
6. Duration of Brief Cognitive Therapy
7. Evaluation of Effectiveness of Brief Cognitive Therapy
8. Strategies Used for Brief Cognitive Therapy
9. Participant Strategy Integration
LearningObjectives
1.Participantswillbeabletoidentifytwokeyconceptsabout briefcognitive
therapy.
2.Participantswillbeabletoidentifytwomodelsused forbrief cognitive
therapy.
3.Participantswillbeabletoidentifytwo researchfindingsaboutbriefcognitivetherapy.
4.Participantswillbeabletoidentifytwosettingsorclientsappropriate forusing briefcognitivetherapy.
5.Participantswillbeabletoidentifytwoapplicationsofbriefcognitivetherapywithsubstance abusers.
6.Participantswillidentifyonenewbriefcognitivetherapystrategyto integrateintotheirpractice.
7.Participantswillidentify at least onequalityassuranceandimprovementprocedureforthenewbriefcognitivetherapystrategy.
Agenda
1.Welcome(2Minutes)
2.BriefCognitiveTherapySummaryGridOverviewandDiscussion
(20Minutes)
3.StrategyIdentificationExercise(10Minutes)
4.StrategyIntegrationMind-MapExercise(10Minutes)
5.AssignmentsandClosing(3Minutes)
TrainingEquipmentandSupplies
1.Whiteboardanderasablemarkers–OR–newsprintpad,markers,andeasel
2.LCDprojector–OR–overhead transparencyprojector
3.PowerPointslideCD–OR–overheadtransparencies
4.Moveableseating
5.Nametags(optional,reusableordisposable)
6.Attendancerecord
7.Pens andcoloredpencilsorcrayons
8.Continuingeducation certificates(optional)
DefinitionofTerms
CognitiveRestructuring:The general term applied to the process of changing the client’s thought patterns. Using this process, the therapist identifies distorted “addictive” thoughts in the client and encourages him/her to search for more rational ways of seeing the same event. Theclientdevelops and practices these alternative ways of thinking overthe course of cognitive restructuring
SocraticMethod:TheconversationalmethodusedbytheGreekphilosopherSocrateswhereintwoormorepeopleassist oneanotherinfindingtheanswerstodifficultquestions.This discussion method facilitates the client’s quest for insight and understanding by requiring him/her to answer questions on his/her own, to ponder the validity of what others have said or written, and to give reasonable support for his/her own opinion. It is considered the basis of the scientific method.
ParticipantMaterials
TimeClock
ParticipantMaterials
(OneforEachParticipant)
1.Module6Handouts
a.Module 6 Packet Cover
b. Brief Cognitive Therapy Summary Grid
c.StrategyIdentificationExercise
d.StrategyIntegration Mind-MapExercise
2.Homework:Handouts for next TIP 34 Training Module
Module6-Section1
WelcomeIntroduction
Time:2Minutes
TrainerNotes
Thissectioncanbedidacticorinvolvelowgroupinteraction.
Trainerandparticipantintroductionsare not necessary as these were doneinModule1.
TrainerScript
WelcomeTopicIntroduction
Welcometothe TIP 34trainingonbriefinterventionsandbrieftherapies. Ourtopicforthistrainingis“BriefCognitiveTherapy.”
Thisapproachplacesprimaryemphasisoncognition,andthe modificationofnegativeorself-defeatingthoughtprocessesor perceptionsthatseemtoperpetuatethesymptomsofemotional disorders.
Wewillexploreavarietyof aspectsaboutbriefcognitivetherapythatarehighlighted ontheBriefCognitiveTherapySummaryGridinyourhandoutpacket.
Wewill also use theStrategyIdentificationExerciseandtheStrategy IntegrationMind-Mapto identify a new brief family therapy strategy that you may want to integrate into your personal practice.
TimeClock
TrainerNotes
ParticipantWorkbook
Module6-Section2
BriefCognitive TherapySummaryGrid
Time:20 Minutes
TrainerNotes
Thissectionisacombination ofdidacticpresentationandlargegroup discussion.Itcaninvolvelowtohighgroupinteraction.
Thetrainer should notread eachitemfromtheSummary Grid.Summarizingeach sectionofthegrid,aswellasaddingadditional information availableinthetrainer script orthroughpersonalclinical experience,will makethetrainingmoreinteresting.
Integratinggroupdiscussionswitheach sectionwillenhancethe effectivenessofthetraining.Groupdiscussionsallowparticipantstolearnfromoneanotheraswellasfromthetrainer.
Thetrainer alwaysfacilitatesthegroupdiscussionandinteraction.The trainer’srole istoprovideexpertiseandguidance,andnottoprescribetheuseofanyonemodelforbrieftherapy.Thetrainer maintains focusofdiscussionsonthetopicandisalsotheleaderand timekeeperforthegroup.
Thefocustopicofthediscussionsisthefeasibilityofusing theseapproacheswithintheguidelinesandservicesoftheagency.
Thetrainer caninitiatediscussionwithopenquestions:
■Does anyoneinthegrouphaveexpertiseinusingbriefcognitive
therapystrategies?
■Whattypes ofbriefcognitivetherapystrategies are withinthe establishedguidelinesforouragency?
■Whattypesofbriefcognitivetherapystrategies are currently used inouragency?
■Whatothertypes ofbriefcognitivetherapycouldbeusedinour agency?
■Whatresourcesforbriefcognitivetherapyexistoutsideofour agency?
TIP 34 Reference
Chapter 6: Brief Cognitive Therapy (pp.61-68)
ParticipantWorkbook
■ BriefCognitiveTherapySummaryGrid
TrainerScript
Key Concepts
Cognitive therapy assumes that most psychological problems derive from faulty thinking processes. Dysfunctional behavior, including substance abuse, is determined in large part by these faulty cognitions. According to this theory, changing the way a client thinks can change the way he feels and behaves.
Cognitive therapy contains three bidirectional components: (A)antecedents, (B) behavior, and (C) cognitions (beliefs, attitudes, thoughts).
Antecedents are activating situations or life events (something happens or is about to happen—situations about which the individual has strong feelings).
Behavior is the individual’s observable actions and emotional reactions that result from his/her beliefs and emotions (how someone thinks or feels and the behavior resulting from those thoughts).
Cognitions represent the individual’s opinions, thoughts, or attitudes that serve to filter and distort the perception of the antecedents.
Cognitive theory views antecedent events, cognitions, and behavior as interactive and dynamic. These cognitive factors serve as a template through which events are filtered and appraised.
The cognitive therapist pays careful attention to the meaning the client assigns to significant events, and how that meaning is related to subsequent feelings and unwanted behavior.
Common content and themes in the thinking process of people with substance abuse disorders include:
1.Deniesthatalcoholordrugsareaproblem
2. Viewsalcoholordrugsasthebestandonly waytosolveemotional problems
3.Experienceslowfrustrationtolerance
4.Experiencesself-defined needs forhighlevelsofstimulation, gratification,andexcitement
5.Experiencesdiscomfort/anxietythatcausesallnegative emotionstobe avoided
6.Views change as being too difficult, thus causing feelings of hopelessness, helplessness, and worthlessness
7.Experiencesself-blame,guilt,andshameforbeinganaddict.
Cognitivetherapyprimarily addresses current, specificproblemsin
theclient’slife,ratherthanglobalthemesorlong-standing
problems.It is also structuredandgoal oriented.
Theclient’sattentiontocurrent problemsisintendedtopromotethe development of a plan of actionthat can reverse dysfunctional thought processes, emotions, and behavior—such as avoidance of problems or feelings of helplessness.
Clientsareenlistedasco-investigatorsorscientistswhostudytheirownthoughtpatternsandassociatedconsequences.
Generally, the cognitive therapist takes a more active role than in other types of therapy, depending on the stage of treatment, the severity of the substance abuse, and the degree of the client’s cognitive capability.
BriefCognitiveTherapyModels
TIP 34includestwomodelsusedinbriefcognitivetherapydeveloped byAaronBeckandAlbertEllis:
1.CognitiveTherapy
2.RationalEmotiveTherapy
CognitiveTherapy
Beckfoundthat psychological difficultieswereduetoautomaticthoughts, dysfunctionalassumptions,andnegative self-statements.Heidentified15common cognitiveerrorsfoundinthethinkingprocessesofindividualswithemotionalandbehavioralproblems,includingsubstance abuse.
These thoughts are presumably automatic,overlearned, rigid, inflexible, overgeneralized, illogical, dichotomous, and not based on fact. They also tend to reflect reliance on substances as a means of coping with boredom and negative emotions, a negative view of theself as a person who has a substance abuse problem, and a tendency to facilitate continued substance use.
Negativethoughtsandirrationalbeliefsthathavebeenfoundtobe associatedwithsubstanceabusedisordersinclude:
1.Problemavoidance
2.Dwellingonnegative events
3.Holdinganegative outlookontheworldandonone’sfuture
4.Avoidance of responsibility
KeyconceptsofBeck’sCognitiveTherapyinclude:
1.Placingmoreimportanceontheclient’sowndiscoveryoffaultyand unproductivethinking
2.Usingasupportive Socraticmethodtoenlist theclientincarefully examiningtheaccuracyofhis/herbeliefs
3.Usingcognitiverestructuringtochangedistortedormaladaptive thoughtsandtherelatedbehavioraldysfunction
Cognitiverestructuringisthegeneraltermappliedtotheprocessof changingtheclient’sthought patterns.Usingthisprocess,thetherapistidentifies distorted“addictive”thoughtsintheclientandencourageshimorhertosearchformorerationalwaysofseeingthesame event. Theclientdevelopsandpracticesthesealternativewaysofthinkingoverthecourseofcognitiverestructuring.
TheSocratic Methodis basedontheconversationalmethod used bytheGreekphilosopherSocrateswhereintwoormorepeopleassistoneanotherinfindingtheanswerstodifficultquestions.Itis considered to be thebasisofthemodernscientificmethod.Thisdiscussion methodfacilitatestheclient’squestforinsightandunderstandingbyrequiringhimorhertoanswerquestionsonhis/her own, to ponder the validity of what others have said or written, and to give reasonable support for his/her own opinion.
Rational-EmotiveTherapy
While Ellis and Beck have similar views about the role that cognitions play in the development and maintenance of substance abuse disorders, their theories differ in considering how the therapist should treat irrational or maladaptive cognitions.
Rational-Emotive Therapy (RET), developed by Albert Ellis, is often more challenging and confrontational with the client.
Ellis believes that the client should simply be told that irrational beliefs exist and what they are, rather than using a Socratic method.
The RET therapist informs the client of common irrational beliefs so that the client can be educated to approach his problems rationally.
Research
TIP 34 is based on research studies from the 1960s to the 1990s.
Substantial research evidence supports the effectiveness of brief cognitive therapy.
Cognitive theories have led to interventions that have been individually proven to be effective in treating substance abuse.
There has not been much research to study the relative effectiveness of longer cognitive therapy.
Seventy (70) different rational-emotive therapy studies found increased effects correlated with longer treatment times.
TypesofSettingsandClients
Briefcognitivetherapyisaflexible,individualizedapproachthat canbe adaptedtoawiderangeofclients,settings(bothinpatientandoutpatient),andformats, includinggroups.
Itisashort-term approachsuitedtotheresourcecapabilitiesofmany deliverysystems.
Itcanbeusedepisodically withclientswholeaveandthenreturnto treatment,duringaftercare,orincontinuingcarefollowingamoreintensivetreatmentepisode.
ApplicationsinSubstanceAbuseTreatment
Briefcognitivetherapycanbeusedtoalterdistortedorunproductivewaysofthinkingaboutdailylifeeventsthatleadtonegative emotionalstates thatpromotesubstance use.
Briefcognitivetherapyaltersthisprocessbytargetingandmodifyingtheclient’sthoughts.
This approach can help clients explore alternative behaviors and attitudes that do not involve the use of substances.
It can help clients develop healthier ways of viewing their history of substance use/ abuse.
It can help clients explore the meaning of a recent “slip” or relapse so that it does not lead to more substance use/abuse.
Cognitiveinterventionscanbeintroducedatanypointthroughoutthe treatmentprocesstoexamineaclient’sinaccurateornon-productive thoughts that leadstotheriskofsubstance use/ abuse.
DurationofTherapy
Briefcognitivetherapyisdesignedtobeashort-term approachsuitedtotheresourcecapabilitiesofmanydeliverysystems.
Thetherapistmust usetheearly sessions todeterminethemost productive focusofthetherapygiventheshorttimeframe.
Briefcognitivetherapytypicallylastsfrom12-20 weeks, withtheclientandtherapistmeeting onceperweek.
Itcanbeconductedin less time—forinstance,onceperweekfor6-8sessions.
Periods withouttherapysessionsallowclients timetopractice thenewskillsofidentifyingandchallenging unproductive thinkingontheirown.
TimeClock
Trainer Notes
EvaluationofEffectiveness
Evaluationscanbeconductedinperson,byphone, ontheInternet,orbymail.
Theeffectivenessofbriefcognitivetherapycanbeevaluatedby:
1.Clientparticipation
2.Treatment admissions
3.Discharge againstmedical advice
4.Clientsatisfactionsurveys
5.Follow-upphone calls
6.Counselor-rating questionsaddedtotheclinicalchart
Module6-Section3
StrategyIdentificationExercise
Time:10 Minutes
TrainerNotes
■Turnoffallnoisyaudio/visualequipmentduring small groupdiscussions.
■ Beawareofanyexternalandinternaldistractionsfromthesmallgroupdiscussions.
The trainer prepares participants for the strategy integration process. The purpose of this process is to encourage participants to develop new therapeutic skills for working with their clients.
The trainer invites participants to think about a particular client who would likely benefit from brief cognitive therapy.
TheparticipantsreviewthehandoutfortheStrategyIdentificationExercise.Thishandoutpresentslists ofstrategiesofthemodule topic,usuallyorganizedaccording tothebasic conceptualmodelspresentedintheSummaryGrid.
The trainer directs the participants to place a check (√) next to strategies s/he has used successfully in his/her practice, and to place a star (*) next to new strategies s/he wants to include in his/her clinical practice.
WhiletheparticipantsworkoncompletingtheStrategy IdentificationExercise,thetrainerisavailable torespondtoquestionsandmoves about theroomtohelpparticipants.
Thetrainer facilitatesawhole-groupdiscussionabout thisexercise,askingparticipantstosharewhichstrategiestheyhavesuccessfullyused withagencyclients.Participantscanlateruse staff members with successfulexperiencestohelpthem integrate a new strategy into their own practice.
ParticipantWorkbook
GroupExercise
ParticipantWorkbook
■BriefCognitiveTherapyStrategyIdentificationExercise
TrainerScript
StrategyIdentificationExercise
Thepurposeofthistrainingistointegratenewskillsforbrieftherapyintoourprofessionalpractice.
You will begin this process by identifying one new strategy that you believe will be helpful for one of your current clients.
PleasereviewthehandoutforStrategyIdentificationExerciseforBrief
Cognitive Therapy.
These strategiesaredividedaccording totheCognitiveTherapyandRationalEmotiveTherapymodels,andincludesuggestedstrategiesfortheinitialandlatersessions.
Thehandoutdirectsyoutoplaceacheck(√)nexttostrategiesthat youhaveusedsuccessfullyinyourpractice,andtoplaceastar(*)nexttonewstrategiesthat youwouldliketoincludeinyourclinicalpractice.
After completing this portion of the exercise, you select one new strategy(from the strategies with a star) to use with a current client.
This exercise gives us an opportunity to share successful experiences we have had with these brief therapy strategies.
Please pay close attention to the expertise of our staff that is revealed in this exercise. You may want to recruit them to help you with yournew strategy.
Whowould liketoshareyoursuccessfulbrieftherapyexperienceswithus?
TimeClock
Trainer Notes
ParticipantWorkbook
Module6-Section4
StrategyIdentificationMind-MapExercise
Time:10 Minutes
TrainerNotes
■Turn off all noisy audio/visual equipment during small group discussions.
■ Beawareofanyexternalandinternaldistractionsfromthesmallgroupdiscussions.
Participantsworkindividuallytocompletethisexercise.
WhiletheparticipantsareworkingontheStrategyIntegrationMind-Map,thetrainer isavailable torespondtoquestionsandmovesabouttheroomtohelpparticipants.
The use of colored pencils or crayons with this exercise helps to enhance an atmosphere of creativity for brainstorming. Brainstorming is for developing ideas, not for evaluating them. The trainer encourages participants to help one another with a nonjudgmental attitude.
When most of the participants have completed the mind-map, the trainer may invite volunteers to share their strategy and plan with the rest of the group. Maintaining the group rule regarding respect is very important in this discussion so as not to discourage a participant from executing his/herplan.
ParticipantWorkbook
■StrategyIntegrationMind-Map
TrainerScript
StrategyIdentificationMind-MapExercise
You will develop a plan of action for utilizing your new strategy and evaluating its effectiveness.TheStrategyIntegrationMind-MapExerciseisused forthispurpose.Thisisinyourhandoutpacket.
ThepurposeoftheStrategyIntegrationMind-Mapisto develop a plan about how you will integrate the selected new brief behavioral therapy skill into your clinical practice.
You should select the ideas that are the best and most appropriate for your client. Do not put the name of your client on this form. However, you may want to include this strategy in your client’s treatment plan.
Mind-MappingDirections
Thisexerciseisamind-map. Mind-mappingallowsyoutoconceptualize theintegrationofanewstrategy ononepage,andinamannerthatismoreeasilyrememberedthan otherformsofwriting,such asoutlinesorlists.
Itusesbrainstormingtoencouragethegenerationofnewideas,andallowsyoutoorganizeyourthinkingbyfittingideastogetherintoaconceptual“map.”
You can write or draw your ideas. You can have fun and becreative while you develop your ideas. The use of colors can help to separate different parts of your map. By personalizing the map with symbols and designs, you can develop a strategy that will be more easily remembered and used with your client.
All ideas on the mind-map are related to the theme in the center. The ideas are connected to the central theme or to one another with lines or arrows to indicate their relationship. Key ideas for the strategy mind- map are suggested on the border of the exercise form.
Write your selected new strategy in the center of the mind-map, and then – using pens, colored pencils, or crayons – place related ideas in boxes, circles, lists, or drawings thatradiate from the center.
Whowouldliketoshareyoursuccessfulbrief cognitivetherapy experienceswithus?
GroupExercise
Time Clock
Trainer Notes
Module6-Section5
AssignmentsandClosing
Time:3Minutes
TrainerNotes
Thetrainer givesabriefpreviewofthenexttrainingtopic.
Thetrainer distributesthehandoutpacket forthenexttrainingsession,andencouragestheparticipantstoread theSummaryGridandStrategyIdentificationExercisebeforethetraining.
The trainer discusses date, time, and place of the next training session. The trainer gives TIP 34 reading references for this training.
ParticipantWorkbook
■Handout PacketforNextTIP34 Training
ParticipantWorkbook
Trainer Script
ReadingandHomework
Thank you for participating in this TIP 34 Training Program.
Our next training module will explore_____ [Training Topic].
PleasereadtheSummary GridandcompletetheStrategyIdentification
Exercisebeforethetraining.
The TIP 34 references for this training are______[relevantTIP 34 pages or chapter].
Thistrainingmoduleisscheduledfor [date, time,and place].
Participant
Workbook
Module 6:
Brief Cognitive Therapy
BriefCognitiveTherapySummaryGrid
KeyConcepts
■Thisapproachplacesprimaryemphasisoncognition,andthemodificationofnegative orself-defeatingautomaticthoughtprocessesorperceptionsthat seemtoperpetuatethesymptomsof emotionaldisorders.
■Cognitivetherapyassumesthat most psychological problemsderivefromfaultythinkingprocesses.
Dysfunctionalbehavior,includingsubstance abuse,isdeterminedinlargepartbythesefaulty cognitions.
■Cognitivetherapycontainsthreebidirectional components: (A) antecedents,(B)behavior,and
(C)cognitions (beliefs, attitudes,thoughts).
■Thewayweactandfeelismost oftenaffectedbyourbeliefs, attitudes,perceptions,cognitiveschema,andattributions.Antecedent events,cognitions,andbehaviorareinteractiveanddynamic.
■Changingthewayaclientthinks canchangethewayhe/shefeels andbehaves.Oncethemaladaptivethoughtsarediscoveredinhabitual,automaticthinking,theycanbemodifiedbysubstitutingrational, realisticideasforthedistortedones.
■Characteristicthinkingofpeoplewith substance abuse disorders:
1.Automaticandunconscious
2.Rigidandinflexible
3.Overlearned andoftenpracticed
4.Dichotomousandall-or-none
5.Overgeneralizedandillogical
6.Non-empiricalandabsolute
■Commoncontentandthemesinthethinkingprocessofpeople withsubstance abuse disorders:
1.Deniesthat alcoholordrugsareaproblem
2.Viewsalcoholordrugsasthe best andonly waytosolveemotionalproblems
3.Experienceslowfrustrationtolerance
4.Experiencesself-defined needsforhighlevelsofstimulation,gratification,andexcitement
5. Experiences discomfort anxiety that causes all negative emotions to be avoided at all costs
6. Views change as being too difficult, thus causing feelings ofhopelessness, helplessness, and worthlessness
7.Experiencesself-blame,guilt,andshameforbeinganaddict
■Thecognitivetherapistpayscarefulattentiontothemeaningtheclient assignstosignificantevents, andhowthatmeaning isrelated tosubsequentfeelings andunwantedbehavior.
■Clients are enlisted as co-investigators or scientistswho study their own thought patterns and associated consequences.
■Devotedprimarily,although notexclusively,toaddressingspecificproblems or issuesintheclient’spresentlife,rather than globalthemesorlong-standing issues, it focusesonimmediateproblemsandisstructuredandgoaloriented.
■Cognitivetherapypromotesthedevelopmentofaplanofaction that can reversedysfunctional thoughtprocesses,emotions,andbehavior - such asavoidanceofproblemsorfeelingsof helplessness.
■Generally,thecognitivetherapisttakesamoreactiverolethan inothertypesoftherapy,dependingon thestageoftreatment,theseverity of the substance abuse, and the degree of the client’s cognitive capability.
Models
■CognitiveTherapy(Aaron Beck):
1.Assertsthat psychological difficultiesareduetoautomaticthoughts,dysfunctionalassumptions,andnegative self-statements.
2.Automaticthoughtsoftenprecedeemotionsbutoccurquiterapidlywithlittleawareness;
consequently,individualsdonotvaluethem highly.
3.Thecognitivetherapist,usingasupportiveSocraticmethod,enliststheclientincarefully examiningtheaccuracy ofhis/her beliefs.
4.Cognitiverestructuringisusedtochange distortedormaladaptivethoughtsandtherelated behavioraldysfunction.
5.Cognitivetherapyplacesmoreimportanceontheclient’sowndiscoveryoffaultyand unproductive thinking.
■Rational-EmotiveTherapy(AlbertEllis):
1.Rational-EmotiveTherapyisoftenmorechallenging and confrontationalwiththeclient.
2.Thetherapistinformstheclientofcommonirrationalbeliefs(believes that theclientshouldsimplybetoldthat these existandwhattheyare),rather than usingaSocratic method.
3.A clientcanbeeducatedtoapproachhisproblemsrationally.
Research
■Substantialresearchevidenceinsupportofitseffectiveness.
■Cognitivetheorieshaveledtointerventionsthathavebeenindividuallyproveneffectiveintreatingsubstanceabuse.
■Therehas notbeenmuchresearchtostudythe relative effectivenessoflongercognitivetherapy.
■Seventy(70)differentrational-emotivetherapystudiesfoundthatincreasedeffectscorrelatedwithlongertreatmenttimes.
■Moreresearchneedstobeconductedlookingattheeffect oftreatmentduration ontheefficacyof thesetherapies.
Types of Settings and Clients
■Cognitivetherapyisaflexible,individualizedapproach that canbeadaptedtoawiderangeofclients, settings(bothinpatientandoutpatient),andformats, includinggroups.
■ It isdesignedtobeashort-termapproach suitedtotheresourcecapabilities of many delivery systems.
■ It can be used episodically with clients who leave and then return to treatment, during aftercare, or in continuing care following a more intensive treatment episode.
ApplicationsinSubstanceAbuseTreatment
■Whendistortedorunproductive waysofthinkingabout dailylifeeventsleadtonegativeemotional statesthatthenpromote substance use,cognitivetherapycanbeusedtoalterthesequencebytargeting andmodifyingtheclient’sthoughts.
■This approach can help clients explore alternative behaviors and attitudes that do not involve the use of substances.
■Itcanhelpclientsdevelophealthierwaysofviewingtheirhistoryofsubstance use/ abuse.
■Itcanhelpclients explorethemeaning ofarecent “slip”orrelapsesothatitdoes notleadtomore substanceuse/abuse.
■Cognitiveinterventionscanbeintroducedatanypointthroughoutthetreatmentprocesstoexaminea
client’sinaccurateorunproductive thinkingthat leadstotheriskofsubstance abuse.
DurationofTherapy
■Cognitivetherapyisdesignedtobeashort-term approachsuitedtotheresourcecapabilitiesof manydeliverysystems.
■Thetherapistmustusetheearly sessionstodeterminethemostproductivefocusofthetherapy,giventheshorttimeframe.
■Treatmenttimescanvary.
■Briefcognitivetherapytypically lastsfrom12-20 weeks, withtheclientandtherapistmeeting once perweek.
■Itcanbeconductedinless time—forinstance,onceperweekfor6-8sessions.
EvaluationofEffectiveness
■Evaluationscanbedone simplyandefficiently,withoutrequiringexcessivestaff timeandenergy,orintegratedintoroutine clientcontacts.
■Effectivenessevaluationscanbeconductedinperson,byphone,throughtheInternet, orbymail.
■Theeffectivenessofbrieftherapycanbeevaluatedby:
1.Clientparticipation
2.Treatmentadmissions
3.Dischargeagainstmedicaladvice
4.Clientsatisfactionsurveys
5.Follow-upphonecalls
6.Counselor-ratingquestionsaddedtotheclinicalchart
StrategyIdentificationExercise
BriefCognitiveTherapy
■Placeacheck(√)nexttostrategiesthatyouhaveusedsuccessfullyinyourclinicalpractice.
■Placeastar(*)nexttonewstrategiesthatyouwanttoinclude inyourclinicalpractice.
IdentifyCommonCognitiveErrors (Beck):
●Filtering
●Polarizedthinking
● Overgeneralization● Mindreading
●Catastrophizing
●Personalization
●Control fallacies
■Fallacy of fairness
●Blaming
●Shoulds
●Emotionalreasoning
●Fallacyofchange
●Globallabeling
●Beingright
∙
CognitiveRestructuring:
●Noticenegativeorself-defeatingautomaticthoughtprocessesorperceptionsandthenchangethem
●Challengingtheclient’sunderstandingofhim/herselfandthesituation
●Helptheclientbecomemoreobjectiveabouttheirthinking
●Helptheclientdistancefromcognitiveerrorsorfaultylogicbroughtaboutbyautomaticthinking
●Givehomeworkto testthetruthoftheclient’scognitions
Rational-EmotiveTherapy(Ellis):
●Educatetheclientaboutcommonirrationalbeliefs
IntheInitialSession:
●Educatetheclientabouthowtoapproach his/herproblemsrationally
●Educate theclientaboutthecognitivemodeloftherapyanddetermineifs/heissatisfiedwiththemodel
●Assessthe client’s view of his/her problems and their causes
●Emphasizethecollaborative aspectofthetherapyprocess
●Establishrapport bylisteningcarefullytotheclient,usingquestionsandreflectivelistening
●Askclienttodescribearecent event that hastriggeredsomerecent negativefeelings asawayof illustratingthecognitivetherapyprocess
StructureLater SessionsintoEightElements(Beck):
●Settingtheagenda
●Moodcheck
●Bridgefromlast session
●Discussionoftoday’sagenda
●Socratic questioning
●Capsulesummaries
●Homeworkassignments
●Feedbackinthetherapy sessions