group cbt for diverse addic5ve behaviors · please do not copy or distribute without permission of...

Liese-GroupCBTforDiverseAddic5ons 3/23/2017

PleasedonotcopyordistributewithoutpermissionofBruceS.Liese,PhD 1

GroupCBTforDiverseAddic5veBehaviors

BruceS.Liese,Ph.D.,A.B.P.P.UniversityofKansas

SandiaResortandCasino

March23,2017



SixCoreComponents(Griffiths,2005)

1)  Salience–Importanceinaperson’slife.Dominatesthoughts,feelings,behaviors.Salienceincreaseswithabs5nence

2)  Moodmodifica5on–Afunc5onoftheaddic5vebehavioristoinduceadesiredstate(e.g.,relieffromboredom,anxiety,depression;provisionofincreasedenergy)

3)  Tolerance–Increasingamountsneededtpachievesameeffect

SixCoreComponents(Griffiths,2005)

4)  Withdrawalsymptoms–Unpleasantfeelingsandphysicaleffectswhenac5vityisstoppedorreduced

5)  Conflict–Interpersonalrela5onshipsaredamaged

6)  Relapse–Repeatedslipsandreturntoaddic5vebehavior



DevelopmentalCBTModelofAddic5veBehaviors

GroupCBTBruceS.Liese,PhD,ABPPUniversityofKansas

Urges or cravingsto engage in

addictivebehaviors

Internal/externaltriggers (high-risk

or stimulussituations)

Activation of(learned)

addiction-relatedthoughts, beliefs

Opportunity toabstain bymeans of

control-relatedthoughts/beliefs

Permission toengage addictive

behavior,strategic planning

Lapse/relapse

CBT Model applied toaddictive behaviors




Strong urgesand cravings todrink and use

drugs

At a party wherefriends are

drinking andgetting high.

"Time to party!I'd love to get

drunk andstoned."

"No!""I'm supposed

to be clean andsober."

"No big deal.""I'll drink justone beer."

"I can quit againtomorrow."

Drinks one beer,then several

more. Eventuallysmokes a joint.

Addiction-related thoughts, beliefs activatedReinforcement of addictive behaviors as

compensatory strategies

Permission given to engage in addictivebehavior; strategic planning

Opportunity to abstain.Control thoughts activated.

CBT Model applied todrinking and drug use


Urge or cravingto smoke or

binge eat. Feelslike hunger.

At work.Feeling boredand restless.

"I really want acigarette or

something toeat."

"I quit smokingand starteddieting thismorning."

"I'll go crazy if Idon't smoke acigarette or eat

something."

Eats threeslices of pizza,then smokes a

cigarette.

Addiction-related thoughts, beliefs activated

Opportunity to abstainPermission to engage in addictive behavior;strategic planning

Reinforcement of addictive behaviors ascompensatory strategies

CBT Model applied tobinge eating and smoking




Urge or cravingto gamble or

shop

At home aloneon a Saturdaynight, feeling

lonely.

"I've got to getout of here. I'llgo shopping orto the casino."

"I can't affordto gamble or

shop."

"I'll limit myspending and

only bring $20 incash with me."

Go to casino orstore, spendhundreds of

dollars

Addiction-related thoughts, beliefs activatedReinforcement of addictive behaviors as

compensatory strategies

Permission to engage in addictive behavior;strategic planning

Opportunity to abstain

CBT Model applied togambling and shopping


Transtheore5calStagesofChangeModel

(Prochaska,DiClemente,&Norcross)

•  Precontempla5on•  Contempla5on•  Prepara5on•  Ac5on•  Maintenance




1.  Ins5lla5onofhope2.  Universality3.  Impar5nginforma5on

4.  Altruism

5.  Correc5verecapitula5onoffamilyoforiginissues

GroupPsychotherapyTherapeu(cFactors

(Yalom&Leszcz,2005)


6.  Developingsocialskills7.  Imita5vebehavior

8.  Interpersonallearning9.  Groupcohesiveness10. Catharsis11. Existen5alfactors

GroupPsychotherapyTherapeu(cFactors

(Yalom&Leszcz,2005)




Inclusioncriteria:•  Opennesstopsychotherapy•  Desiretoshareandreceivefeedbackinagroupsegng

•  Willingnesstotakeresponsibilityforaddic5vebehavior&otherproblems

•  Atleastcontempla5ngchange

•  Willingnesstofollowgrouprules

ScreeningCBTAGMembers


Exclusioncriteria:•  Believesthatheorshehasbeencoercedintogroupahendance

•  Deniesanyaddic5vebehaviors•  Severepsychopathology(e.g.,hallucina5ons,delusions,sociopathy)

•  Poten5alforhos5leorthreateningbehavior

ScreeningCBTAGMembers




•  Addic5vebehaviorgoalsvaryforeachperson(abs5nence,harmreduc5on,etc.)

•  Improveemo5onregula5on

•  Improvesocial/interpersonalskills

•  Improvecopingskills

•  Controlofundesiredhabits•  Increasedpsychologicalmindedness

•  Supportfromgroup

Goals of Therapy


•  90-minutesessions(moreifnecessary)

•  5-8memberswithpsychopathology,comorbidity,andassociatedproblems

•  Open,rollingenrollment

•  Compa5blewithotherapproaches(e.g.,12-stepprograms,individualtherapy)

•  Goalsmaybevariable(e.g.,harmreduc5on,improvedrela5onships,employment,etc.)

Group Structure




•  Facilitatorintroduc5ons(includingrules,basicfeaturesofgroup)

•  Memberintroduc5ons–addic5vebehavior,statusofaddic5vebehavior,goals,otherproblems

•  Cogni5ve&behavioralstrategies-basedonneedsofgroupmembers

•  Homework–reviewoldandassignnew

•  Closure

Group Structure


•  Facilitatornameandper5nentinforma5on

•  Reasonforfacilita5nggroup•  Setexpecta5onsregardingstructureandcontentofgroup

•  Provideexamples

•  Explainbasicrules

Facilitator Introductions




•  Strictconfiden5ality

•  Nocliqueforma5onoroutsidemee5ngs

•  Noadvice

•  Personalize(vs.philosophize):“I”statementsratherthan“You”or“People…”

•  Respectothers

•  Maintainwillingnesstogrow

•  Nodefensiveness

Basic Rules


•  Membername

•  Addic5vebehavior(s)

•  Statusofaddic5vebehavior(s)

•  Goal(s)

•  Otherissues

MemberIntroduc5ons




MemberIntroduc5onsName Primary

problemStatusofprimaryproblem

Goal(s) Otherissues

Joe Alcohol Controlleddrinking “Don’tgetdrunkagain”

Unemployed

Mary Marijuana Abs5nent “Abs5nence” Anxiety

Sarah Bingeea5ng Dailybingeea5ng “Healthyea5ng” Medicalproblems

Ben Gambling Abs5nent “Onlyonspecialoccasions”

Bipolarillness

Ann Smokes1.5pack/daycigarehes

Liveswithboyfriendwhosmokes.

“I’mjustnotreadytoquit.”

“Mychildrenhatemyboyfriend!”

Bill

Cocaine

“Outofcontrol”Recentlyvisitedcrackhouse.

“Stopmyself-destruc5vebehavior”

Wifedivorcinghim.


•  Socializegroupmemberstoaddic5onmodels•  Copingvs.compensatorystrategies•  Emo5onregula5onskillstraining•  Frustra5ontolerance•  Interpersonalskillstraining,includingcommunica5onskillswithrole-playing

•  Relapsepreven5onskillstraining•  Mo5va5onalinterviewing

Cogni5ve&BehavioralStrategies




•  Techniquesarestructuredmethods,strategiesforhelpingpeople.

•  Theseinclude:guideddiscovery,mo5va5onalinterviewing,reflec5ng,interpre5ng,confron5ng,self-monitoring,journaling,exposurewithresponsepreven5on,mindfulness,breathing,medita5on,asser5veness,the“as-if”technique,downwardarrow,advantages-disadvantages,communica5onskillstraining,etc.

SpecificTechniques

ProblemGrid

CBTforAddic>veBehaviorsBruceS.Liese,PhD,ABPPPleasedonotcopyordistributewithoutpermissionofauthor



ConceptMapping

Joe

Heavy alcoholuse

Cigarettesmoking

Maritalproblems

Depression

Anger,aggression

(raises voice,slams doors).

"I don't havea drinkingproblem"

"I drink torelax"

Drinksuntil

passed out

Impatient,restless

"My lifesucks."

Wife hateswhen hedrinks orsmokes

Tension,frustration,irritability

"I wish mywife wouldget off my

back!"

CBTforAddic>veBehaviorsBruceS.Liese,PhD,ABPPPleasedonotcopyordistributewithoutpermissionofauthor


DailyThoughtRecord(DTR)

DateandTime

Situa5onEmo5on(0-100)

Automa5cthoughts(0-100%)

Alterna5vethoughts(0-100%)

NewEmo5on(0-100)




Advantages-DisadvantagesAnalysis

Engageinaddic5vebehavior

Donotengageinaddic5vebehavior

Advantages

Disadvantages


•  CBTwouldn’tbeCBTwithouthomework

•  Assignmentsdeterminedcollabora5vely

•  Groupmemberslikelytoprovideideasforhomework

•  Mayberelatedtoaddic5vebehaviorbutoseninvolvesgeneralcopingskills

•  Maybecogni5ve,behavioral,rela5onal

•  Reviewofhomeworkisessen5al

Homework

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