Group CBT for Diverse Addic5ve Behaviors

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Warren Higgins
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1 Liese - for Diverse Addic5ons 3/23/2017 for Diverse Addic5ve Behaviors Bruce S. Liese, Ph.D., A.B.P.P. Sandia Resort and Casino March 23, 2017 permission of Bruce S. Liese, PhD 1

2 Liese - for Diverse Addic5ons 3/23/2017 Six Core Components (Griffiths, 2005) 1) Salience Importance in a person s life. Dominates thoughts, feelings, behaviors. Salience increases with abs5nence 2) Mood modifica5on A func5on of the addic5ve behavior is to induce a desired state (e.g., relief from boredom, anxiety, depression; provision of increased energy) 3) Tolerance Increasing amounts needed tp achieve same effect Six Core Components (Griffiths, 2005) 4) Withdrawal symptoms Unpleasant feelings and physical effects when ac5vity is stopped or reduced 5) Conflict Interpersonal rela5onships are damaged 6) Relapse Repeated slips and return to addic5ve behavior permission of Bruce S. Liese, PhD 2

3 Liese - for Diverse Addic5ons 3/23/2017 Developmental CBT Model of Addic5ve Behaviors Lapse/relapse Internal/external triggers (high-risk or stimulus situations) Activation of (learned) addiction-related thoughts, beliefs CBT Model applied to addictive behaviors Permission to engage addictive behavior, strategic planning Opportunity to abstain by means of control-related thoughts/beliefs Urges or cravings to engage in addictive behaviors permission of Bruce S. Liese, PhD 3

4 Liese - for Diverse Addic5ons 3/23/2017 Reinforcement of addictive behaviors as compensatory strategies At a party where friends are drinking and getting high. Addiction-related thoughts, beliefs activated Drinks one beer, then several more. Eventually smokes a joint. "Time to party! I'd love to get drunk and stoned." CBT Model applied to drinking and drug use "No big deal." "I'll drink just one beer." "I can quit again tomorrow." Strong urges and cravings to drink and use drugs Permission given to engage in addictive behavior; strategic planning "No!" "I'm supposed to be clean and sober." Opportunity to abstain. Control thoughts activated. Reinforcement of addictive behaviors as compensatory strategies At work. Feeling bored and restless. Addiction-related thoughts, beliefs activated Eats three slices of pizza, then smokes a cigarette. "I really want a cigarette or something to eat." CBT Model applied to binge eating and smoking "I'll go crazy if I don't smoke a cigarette or eat something." Permission to engage in addictive behavior; strategic planning "I quit smoking and started dieting this morning." Opportunity to abstain Urge or craving to smoke or binge eat. Feels like hunger. permission of Bruce S. Liese, PhD 4

5 Liese - for Diverse Addic5ons 3/23/2017 Reinforcement of addictive behaviors as compensatory strategies Go to casino or store, spend hundreds of dollars At home alone on a Saturday night, feeling lonely. Addiction-related thoughts, beliefs activated "I've got to get out of here. I'll go shopping or to the casino." CBT Model applied to gambling and shopping "I'll limit my spending and only bring $20 in cash with me." Urge or craving to gamble or shop Permission to engage in addictive behavior; strategic planning "I can't afford to gamble or shop." Opportunity to abstain Transtheore5cal Stages of Change Model (Prochaska, DiClemente, & Norcross) Precontempla5on Contempla5on Prepara5on Ac5on Maintenance permission of Bruce S. Liese, PhD 5

6 Liese - for Diverse Addic5ons 3/23/ Ins5lla5on of hope 2. Universality 3. Impar5ng informa5on 4. Altruism Group Psychotherapy Therapeu(c Factors (Yalom & Leszcz, 2005) 5. Correc5ve recapitula5on of family of origin issues 6. Developing social skills 7. Imita5ve behavior 8. Interpersonal learning 9. Group cohesiveness 10. Catharsis Group Psychotherapy Therapeu(c Factors (Yalom & Leszcz, 2005) 11. Existen5al factors permission of Bruce S. Liese, PhD 6

7 Liese - for Diverse Addic5ons 3/23/2017 Screening CBTAG Members Inclusion criteria: Openness to psychotherapy Desire to share and receive feedback in a group segng Willingness to take responsibility for addic5ve behavior & other problems At least contempla5ng change Willingness to follow group rules Screening CBTAG Members Exclusion criteria: Believes that he or she has been coerced into group ahendance Denies any addic5ve behaviors Severe psychopathology (e.g., hallucina5ons, delusions, sociopathy) Poten5al for hos5le or threatening behavior permission of Bruce S. Liese, PhD 7

8 Liese - for Diverse Addic5ons 3/23/2017 Goals of Therapy Addic5ve behavior goals vary for each person (abs5nence, harm reduc5on, etc.) Improve emo5on regula5on Improve social/interpersonal skills Improve coping skills Control of undesired habits Increased psychological mindedness Support from group Group Structure 90-minute sessions (more if necessary) 5-8 members with psychopathology, comorbidity, and associated problems Open, rolling enrollment Compa5ble with other approaches (e.g., 12- step programs, individual therapy) Goals may be variable (e.g., harm reduc5on, improved rela5onships, employment, etc.) permission of Bruce S. Liese, PhD 8

9 Liese - for Diverse Addic5ons 3/23/2017 Facilitator introduc5ons (including rules, basic features of group) Member introduc5ons addic5ve behavior, status of addic5ve behavior, goals, other problems Cogni5ve & behavioral strategies - based on needs of group members Homework review old and assign new Closure Group Structure Facilitator Introductions Facilitator name and per5nent informa5on Reason for facilita5ng group Set expecta5ons regarding structure and content of group Provide examples Explain basic rules permission of Bruce S. Liese, PhD 9

10 Liese - for Diverse Addic5ons 3/23/2017 Strict confiden5ality No clique forma5on or outside mee5ngs No advice Personalize (vs. philosophize): I statements rather than You or People Respect others Maintain willingness to grow No defensiveness Basic Rules Member Introduc5ons Member name Addic5ve behavior(s) Status of addic5ve behavior(s) Goal(s) Other issues permission of Bruce S. Liese, PhD 10

11 Liese - for Diverse Addic5ons 3/23/2017 Member Introduc5ons Name Primary problem Status of primary problem Goal(s) Other issues Joe Alcohol Controlled drinking Don t get drunk again Unemployed Mary Marijuana Abs5nent Abs5nence Anxiety Sarah Binge ea5ng Daily binge ea5ng Healthy ea5ng Medical problems Ben Gambling Abs5nent Only on special occasions Ann Smokes 1.5 pack/day cigarehes Bill Cocaine Lives with boyfriend who smokes. Out of control Recently visited crack house. I m just not ready to quit. Stop my selfdestruc5ve behavior Bipolar illness My children hate my boyfriend! Wife divorcing him. Cogni5ve & Behavioral Strategies Socialize group members to addic5on models Coping vs. compensatory strategies Emo5on regula5on skills training Frustra5on tolerance Interpersonal skills training, including communica5on skills with role-playing Relapse preven5on skills training Mo5va5onal interviewing permission of Bruce S. Liese, PhD 11

12 Liese - for Diverse Addic5ons 3/23/2017 Specific Techniques Techniques are structured methods, strategies for helping people. These include: guided discovery, mo5va5onal interviewing, reflec5ng, interpre5ng, confron5ng, self-monitoring, journaling, exposure with response preven5on, mindfulness, breathing, medita5on, asser5veness, the as-if technique, downward arrow, advantages-disadvantages, communica5on skills training, etc. Problem Grid CBT for Addic>ve Behaviors Please do not copy or distribute without permission of author permission of Bruce S. Liese, PhD 12

13 Liese - for Diverse Addic5ons 3/23/2017 Concept Mapping Wife hates when he drinks or smokes Drinks until passed out "I don't have a drinking problem" Marital problems Cigarette smoking Heavy alcohol use "I drink to relax" "I wish my wife would get off my back!" Joe Anger, aggression (raises voice, slams doors). Depression Impatient, restless Tension, frustration, irritability "My life sucks." CBT for Addic>ve Behaviors Please do not copy or distribute without permission of author Daily Thought Record (DTR) Date and Time Situa5on Emo5on (0-100) Automa5c thoughts (0-100%) Alterna5ve thoughts (0-100%) New Emo5on (0-100) permission of Bruce S. Liese, PhD 13

14 Liese - for Diverse Addic5ons 3/23/2017 Advantages-Disadvantages Analysis Engage in addic5ve behavior Do not engage in addic5ve behavior Disadvantages Advantages Homework CBT wouldn t be CBT without homework Assignments determined collabora5vely Group members likely to provide ideas for homework May be related to addic5ve behavior but osen involves general coping skills May be cogni5ve, behavioral, rela5onal Review of homework is essen5al permission of Bruce S. Liese, PhD 14

MEETING PEOPLE WHERE THEY ARE

Advancing the Concept of Stages of Change & Treatment for Individuals with Co- Occurring Disorders MEETING PEOPLE WHERE THEY ARE Presented by Erwin Concepcion, Ph.D. LP 1 Objec,ves 1. Describe one primary