Cognitive Behavioral Therapy

Figure 4-2
Basic Assumptions of Behavioral Theories of Substance Abuse and Its Treatment

Human behavior is largely learned, rather than determined by genetic factors.
The same learning processes that create problem behaviors can be used to change them.
Behavior is largely determined by contextual and environmental factors.
Covert behavior such as thoughts and feelings is subject to change through the application of learning principals.
Actually engaging in new behavior in the contexts in which they are to be performed is a critical part of behavior change.
Each client is unique and must be assessed as an individual in a particular context.
The cornerstone of adequate treatment is a thorough behavioral assessment.

Source: Rotgers, 1996.

Figure 4-3
Advantages of Behavioral Theories in Treating Substance Abuse Disorders

Flexible in meeting specific client needs
Readily accepted by clients due to high level of client involvement in treatment planning and goal selection
Soundly grounded in established psychological theory
Derived from scientific knowledge and applied to treatment practice
Structured in its guidelines for assessing treatment progress
Empowering clients to make their own behavior change
Effective, according to strong empirical and scientific evidence

Source: Rotgers, 1996.

Figure 4-4
Functional Analysis

A functional analysis probes the situations surrounding the client's substance abuse. Specifically, it examines the relationships among stimuli that trigger use and the consequences that follow. This type of analysis provides important clues regarding the meaning of the behavior to the client, as well as possible motivators and barriers to change. In behavioral therapy, this is the first step in providing the client with tools to manage or avoid situations that trigger substance use. Functional analysis yields a roadmap of a client's interpersonal, intrapersonal, and environmental catalysts and reactions to substance use, thereby identifying likely precursors to substance use. (For more information on this topic, see the section below under the heading "Cognitive-Behavioral Therapy.")

Figure 4-5
Teaching Stress Management

The client learns methods that will help her reduce stress, including relaxation techniques, systematic desensitization, planning in advance for a potentially stressful event, and cognitive strategies. These techniques can help in resisting the temptation to abuse substances in otherwise stressful situations. While it does not seem that all clients with substance abuse disorders face increased stress (Cappell, 1987), for those who do, stress management techniques (such as those described by Stockwell, 1995) can prove useful.

Figure 4-6
Programmed Therapy and Writing Therapy

These techniques lend themselves to brief therapy because they reduce the role of the therapist and increase the amount of work required from the client. Phillips and Weiner developed these techniques as stand-alone approaches to treatment (Phillips and Weiner, 1966). However, they can also be used as adjuncts to other forms of treatment and may be incorporated into the homework assignments that many therapists already are using. In programmed therapy, the client interacts with written or computerized instructions and tests that work to teach the client new behaviors, much in the way students might learn a subject from a textbook. Writing therapy involves having the client come in at a designated time each week to write for 1 hour in a notebook which the therapist then reads and responds to in writing. No one but the therapist and the client should have access to the notebook. Writing therapy is a technique that may be particularly useful for clients who have difficulty talking about their thoughts and feelings.

Figure 4-8
Fifteen Common Cognitive Errors

Filtering--taking negative details and magnifying them, while filtering out all positive aspects of a situation
Polarized thinking--thinking of things as black or white, good or bad, perfect or failures, with no middle ground
Overgeneralization--jumping to a general conclusion based on a single incident or piece of evidence; expecting something bad to happen over and over again if one bad thing occurs
Mind reading--thinking that you know, without any external proof, what people are feeling and why they act the way they do; believing yourself able to discern how people are feeling about you
Catastrophizing--expecting disaster; hearing about a problem and then automatically considering the possible negative consequences (e.g., "What if tragedy strikes?" "What if it happens to me?")
Personalization--thinking that everything people do or say is some kind of reaction to you; comparing yourself to others, trying to determine who's smarter or better looking
Control fallacies--feeling externally controlled as helpless or a victim of fate or feeling internally controlled, responsible for the pain and happiness of everyone around
Fallacy of fairness--feeling resentful because you think you know what is fair, even though other people do not agree
Blaming--holding other people responsible for your pain or blaming yourself for every problem
Shoulds--having a list of ironclad rules about how you and other people "should" act; becoming angry at people who break the rules and feeling guilty if you violate the rules
Emotional reasoning--believing that what you feel must be true, automatically (e.g., if you feel stupid and boring, then you must be stupid and boring)
Fallacy of change--expecting that other people will change to suit you if you pressure them enough; having to change people because your hopes for happiness seem to depend on them
Global labeling--generalizing one or two qualities into a negative global judgment
Being right--proving that your opinions and actions are correct on a continual basis; thinking that being wrong is unthinkable; going to any lengths to prove that you are correct
Heaven's reward fallacy--expecting all sacrifice and self-denial to pay off, as if there were someone keeping score, and feeling disappointed and even bitter when the reward does not come

Source: Beck, 1976.