Cognitive Behavioural Therapy for Problem Drinking by Spada, Marcantonio -- Read -- Imperial Library of Trantor

Index

Contents Figures and tables

Figures Tables

About the author Acknowledgements Preface

AIMS, SCOPE AND CONCEPTUAL FRAMEWORK WHO IS THIS BOOK WRITTEN FOR? HOW TO USE THIS BOOK

CHAPTER 1 The cognitive-behavioural therapy approach to problem drinking

INTRODUCTION BASIC PROCESSES AND THERAPEUTIC INTERVENTIONS

Classical conditioning

Aversion conditioning Stimulus control Cue exposure and response prevention

Operant conditioning Modelling Cognitive mediation The development and maintenance of problem drinking

EMPRICAL RESEARCH ON THEORY AND THERAPEUTIC INTERVENTIONS CONCEPTUAL FRAMEWORKS

The relapse prevention model The coping skills training model The cognitive model Proposed conceptual framework

CHAPTER 2 Preparing for change

ASSESSMENT

Introduction Screening

Self-report data

Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 1992) CAGE (Mayfield, McLeod, & Hall, 1974) TWEAK (Russell et al., 1994)

Objective data

Determination of severity

Alcohol Dependence Scale (ADS; Skinner & Allen, 1982) Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar; Sullivan et al., 1989)

Determination of impact

Drinking behaviour

Quantity Frequency Scale (QFS; Cahalan, Cisin, & Crossley, 1969) Timeline Follow Back Interview (Sobell et al., 1996) Self-Monitoring or Record Keeping (Sobell & Sobell, 1993)

Mental health state Interpersonal stressors Neuropsychological impact

Determination of motivation and risk of relapse

Motivation

Stages of Change and Therapy Eagerness Scale (SOCRATES; Miller & Tonigan, 1996) Alcohol Expectancy Questionnaire (AEQ; Brown et al., 1980)

Evaluating the risk of relapse

Reasons for Drinking Questionnaire (RDQ Zywiak et al., 1996) Coping Behaviors Inventory (CBI; Litman et al., 1983)

Corroboration of data Selection of assessment components Structured interviews

ENHANCING MOTIVATION FOR CHANGE

Introduction Therapeutic interventions Stages of change

The pre-contemplation stage The contemplation stage The preparation/determination stage The action stage The maintenance stage Cyclicality Motivational interviewing skills

Empathic listening Responding to resistance Developing discrepancy Supporting self-efficacy

Motivational interviewing strategies

Exploration of the good and less good aspects of alcohol use Exploration of concerns about alcohol use Initial decision-making

Cognitive strategies

Completing a drinking decisional balance sheet Reiterating problems and goals Tackling concerns about change Examining specific change concerns

CASE FORMULATION

Introduction Defining problems Exploring problems

Functional analysis Integrated developmental profiling

The problem formulation

KEY ISSUES IN THERAPY

Introduction Structure of therapy sessions

Part 1 of the therapy session Part 2 of the therapy session Part 3 of the therapy session

Therapy goals Measurement Compliance with therapy The therapeutic relationship

CHAPTER 3 Implementing change

DEALING WITH STIMULUS CONDITIONS

Introduction Identifying stimulus conditions

People Places Time Recording stimulus conditions

Dealing with stimulus conditions

Developing a generic coping plan

Out-of-therapy session practice

TACKLING CRAVING

Introduction Craving as a phenomenon

The environment Memories of the drinking life Emotions

Modifying uncontrollability beliefs Developing and enhancing strategies for managing craving

Relaxation Positive self-statements Distraction Image replacement Review the benefits of not drinking and the costs of drinking Decisional delay Developing a flashcard

Cue exposure and response prevention Out-of-therapy session practice

FOCUSING ON SKILLS

Introduction

Refusing drinks

Managing voice and eye contact Changing subject of conversation and suggesting an alternative Asking for a change in behaviour Avoiding excuses and vague answers Rehearsing

Receiving criticism about drinking

Avoiding counterattack Obtaining more information Agreeing and restating in a clearer manner Compromising

Assertiveness

Enhancing assertiveness Handling confrontation Common difficulties

Identifying apparently irrelevant decisions Problem-solving

Recognizing the problem Generating solutions Evaluating the advantages and disadvantages of the solutions Choosing a solution Planning to implement the solution Implementing the solution and evaluating performance Planning for future problems

Out-of-therapy session practice

MODIFYING BELIEFS

Introduction Identifying beliefs Examining and challenging beliefs

Examining beliefs Challenging beliefs

Practising the activation of adaptive beliefs Drinking postponement experiment Out-of-therapy session practice

MANAGING NEGATIVE EMOTION

Introduction Psycho-education Key strategies

Increasing pleasurable activities

Step 1— Reviewing existing sources of pleasure Step 2— Learning to monitor pleasurable activities Step 3— Developing a list of pleasurable activities Step 4— Developing a pleasurable activities schedule Step 5— Comparing activity diaries

Tackling boredom

Carrying out practical tasks Removing thought blocks Reframing the meaning of boredom

Restructuring cognitions Dealing with anger Interrupting recyclical thinking

Strategies Postponement of recyclical thinking exercise

Improving sleep Relaxation

Controlled breathing Progressive muscular relaxation (PMR) Brief relaxation Meditation

CHAPTER 4 Maintaining change

WORKING WITH SIGNIFICANT OTHERS

Introduction Responses to abstinence and drinking Decreasing cues for drinking Support for not drinking Relationship change Accessing and enhancing social support systems

CONTINGENCY MANAGEMENT

Introduction Principles of contingency management Difficulties with contingency management

CONTROLLED DRINKING

Introduction

ADDRESSING COMPLICATING PROBLEMS

Introduction Concomitant and co-morbid mental health problems

Anxiety disorders Mood disorders—dysthymia and major depression Mood disorders—bipolar disorder Suicide Personality disorders Psychotic disorders Intimate partner violence Homelessness

RELAPSE PREVENTION AND THE END OF THERAPY

Relapse prevention

Normalization and prevention of relapse Management of relapse Achieving a balanced lifestyle

End of therapy Areas covered Practitioner’s feedback Client’s feedback Longer-term objectives Planning for emergencies

CHAPTER 5 Practitioner training and clinical supervision

TRAINING CLINCIAL SUPERVISION

Feedback on the practitioner’s implementation of CBT Frequency of clinical supervision Common problems encountered in clinical supervision

CASE EXAMPLE

Biographic details Assessment Enhancing motivation for change Case formulation

Presenting problems as stated by the client

Problem 1: Increasingly out-of-control drinking Problem 2: Low mood

Therapy goals as stated by the client

Goal 1: Gain greater control of drinking Goal 2: Improve mood

Functional analysis of the presenting problems

Integrated developmental profiling Problem formulation Collaborative definition of therapy goals

Goal 1: Improvement in mood Goal 2: Reduction in drinking

Development of the therapeutic programme

Stage 1: Therapeutic interventions for low mood Stage 2: Therapeutic interventions for problem drinking Monitoring change Course of therapy Outcome of therapy

Appendices: Blank diaries and worksheets with instructions

Appendix A Drinking diary Appendix B Drinking decisional balance sheet Appendix C Problems and goals Appendix D Advantages of changing, concerns of changing and responses to concerns Appendix E Examining specific change concerns Appendix F Functional analysis Appendix G Activating event breakdown Appendix H Evidence for and against the uncontrollability of craving Appendix I Decision sheet on past slips Appendix J Decision sheet on upcoming events Appendix K Identifying permissive beliefs Appendix L Challenging permissive beliefs Appendix M Identifying positive beliefs Appendix N Challenging positive beliefs Appendix O Hierarchy of difficult situations Appendix P Drinking postponement experiment Appendix Q Activity diary Appendix R Controlled drinking skills Appendix S Controlled drinking programme Appendix T Plan for managing high-risk situations References Index

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