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Behavioural Interventions 1 - Coggle Diagram
Behavioural Interventions 1
Behavioural
Interventions
behavioural interventions in a therapeutic setting are interactions between clients and a treatment practitioner.
normally takes place in a medical office or hospital setting within an outpatient or inpatient treatment centre.
can occur in groups or in a one-to-one arrangement.
the practitioner may be a qualified clinician, such as a doctor, psychiatrist, or clinical psychologist, or more commonly, a trained counsellor or a peer who is further along in recovery.
behavioural interventions are an acquired complex skill and differ substantially between practitioners and treatment sites.
empirically, its been proven that behavioural interventions improve the drug abstinence in the client, but there remains a question as to what component of the interaction is crucial
only a minority of drug abusers enter treatment, majority quit themselves without it
Project MATCH
eight-year clinical trial of alcohol treatments conducted in the US, across multiple inpatient and outpatient treatment facilities.
alcohol dependent patients randomly allocated to one of three behavioural treatments:
twelve-step facilitation therapy
cognitive-behavioural coping skills therapy
motivational enhancement therapy.
each treatment was delivered over a 12-week period by trained therapists
standardised delivery of the interventions provided across inpatient and outpatient facilities
cognitive behavioural therapy (CBT)
therapists teach clients interpersonal and self-management skills
to develop these skills, clients must identify high-risk situations that may increase the likelihood of renewed drinking.
high-risk situations can be external or internal
clients must develop skills to cope with high-risk situations
manual contains material for 22 sessions (client receives 12 sessions; 8 core, 4 elective)
CBT core topics
introduction to coping skills training
coping with cravings and urges to drink
: triggers and avoidance, urge surfing, craving plan and record
managing thoughts about alcohol and drinking
: awareness of states of mind that elicit relapse.
problem solving:
examine triggers and establish coping skills. role play crisis events and actions to deal with them.
drink refusal skills:
role play scenarios where therapist models effective ways to handle high-risk situations
planning for emergencies and coping with a lapse:
discussion of relapse crisis and plans of action to cope.
seemingly irrelevant decisions:
attention to decision making process to interrupt chain of decisions to relapse.
termination
: summary, emergency plan, further treatment options.
CBT electives
starting conversations, nonverbal communication, introduction to assertiveness, receiving criticism
awareness of anger, anger management, awareness of negative thinking, managing negative thinking
increasing pleasant activities, managing negative moods and depression, enhancing social support networks, job-seeking skills
couples/family involvement 1, couples/family involvement 2.
motivational enhancement therapy
designed to produce rapid, internally motivated change. employs motivational strategies to mobilise the client's own resources.
consists of an initial extensive assessment. treatment occurs over 4 sessions spread across 12 weeks.
structured feedback from initial assessment and building client motivation to initiate or continue change
continued motivation enhancement, working toward consolidating commitment to change
3+4. therapist continues to monitor and encourage progress.
rationale
few differences in outcomes between longer, more intensive alcohol treatment programs and shorter, less intensive alternative approaches.
one interpretation of there being few differences in outcomes is that all alcohol treatments are equally ineffective, but a larger review of the literature doesn't support this
significant differences amongst alcohol treatment approaches are found in nearly half of clinical trials, and relatively brief treatments have been shown in numerous studies to be more effective than no treatment.
treatments contain a common core of ingredients that evoke change and additional components of more extensive approaches may be unnecessary in many cases.
six elements believed to be active to induce change (FRAMES).
FEEDBACK
of personal risk or impairment
emphasis on personal
RESPONSIBILITY
for change
clear
ADVICE
to change
a
MENU
of alternative change options
therapist
EMPATHY
facilitation of client
SELF-EFFICACY
or optimism
prochaska & diclemente (1986): 6 stages of change:
precontemplation:
people who are not considering change
contemplation:
beginning to consider both that they have a problem and the feasibility/costs of changing that behaviour.
determination:
the decision is made to take action
action:
begin to modify the problem behaviour
maintenance:
after successfully negotiating the action stage, individuals move to maintenance (sustained change)
relapse:
maintenance fails and the individual begins another cycle
MET phase 1
building motivation for change:
focuses on developing clients' motivation to make a change by:
eliciting self-motivational statements:
facilitates client taking themselves into change.
listening with empathy:
therapist listens to what the client is saying, then reflects i t back to the client. acknowledgement of the client's feeling.
affirming the client:
therapist affirms, compliments and reinforces the client.
handling resistance:
how the therapist responds to resistant behaviours is one of the defining characteristics of MET.
resistance: talking over the therapist, cutting them off, aruging, challenging.
never meet resistance head-on.
some reactions can exacerbate resistance
deflect resistance- simple reflection.
reframing:
a strategy whereby therapists invite clients to examine their perceptions in a new light or a recognised form. new meaning is given to what has been said or problematic thoughts.
MET phase 2
strengthening commitment to change:
recognising change readiness:
knowing when to begin moving toward a commitment to action.
discussing a plan:
shift from focusing on reasons for change to negotiating a plan for change.
communicating free of choice:
emphasise the client's responsibility and freedom of choice.
change plan workout:
specifies the clients action plan.
session 3 and 4:
review progress, renew motivation and commitment.
twelve-step facilitation (TSF)
based on the principles of alcoholics anonymous and narcotics anonymous.
principles:
acknowledging that willpower alone cannot achieve sobriety, surrender to the group conscience must replace self-centeredness, and long-term recovery consists of a process of spiritual renewal.
therapist:
assessment, advocates abstinence, explains 12-step concepts and actively supports initial involvement and ongoing participation. also discusses specific readings from AA and NA with the client, aids the client in using AA/NA resources in crisis times and presents more advanced concepts such as "moral inventories".
AA 12 steps
admitted powerlessness over alcohol > lives had become unmanageable
came to believe that a power greater that themselves could restore them to sanity.
made a decision to turn our will and our lives over to the care of god.
made a searching and fearless moral inventory of ourselves.
admitted to god, ourselves, and to another human being the exact nature of wrongs
entirely ready to have god remove all defects of character
humbly asked god to remove shortcomings
make a list of all people harmed, become willing to make amends to them all
make direct amends to people wherever possible, except where it would cause harm to them
continued to take personal inventory, admit when wrong.
sough through prayer and meditation to improve conscious contact with god, praying for the power to carry out his will.
carry out this message to other alcoholics, continue to practice these principles
TSF objectives
acceptance
: of their alcoholism, cannot control their drinking, abstinence is the only option.
surrender:
accept loss of control and have faith that AA can help them.
cognition:
understand how drinking has affected thinking, denial, connection between alcohol abuse and negative consequences.
emotion:
understand how certain emotional states lead to drinking, how to deal with these emotions.
behaviour:
understand how alcoholism has affect their lives and habits, and getting active in AA.
social:
regular AA meetings/activities, sponsorship, re-evaluate relationships with "enablers"
spiritual
hope; belief and trust in a power greater than own willpower acknowledging the harm done to others.
TSF core topics
concepts are covered across 12 sections. 5 core topics (sections 1-4 and 10).
program introduction.
acceptance: step 1 of AA
surrender: steps 2 and 3 of AA.
getting active: introduce and discuss getting active in AA.
10: termination: helping the client evaluate the treatment and establish long term goals.
TSF elective topics
genogram:
reinforce concept of alcoholism as a disease that can be traced across generations
enabling:
behaviour of others that allow the client to continue drinking or avoid/minimise negative consequences related to drinking. acknowledge enabling and actively resist it.
people, places and things:
review and address some of the practicalities of staying sober. replace old with new sobriety-associated habits.
halt:
identify emotions which are most often associated with slips
moral inventories:
alcoholism is an illness of the spirit in the sense that alcoholics are driven by their disease to behave in ways that compromise their personal ethics and values.
sober living:
attention to the matter of changing habits in the interest of recovery.
Project MATCH
Results
babor (2008):
all groups reduced alcohol consumption relative to baseline by the end of treatment
no significant differences between treatments
TSF, CBT and MET showed the same relapse curves over time.
~20% of each group remained abstinent at 280 days post-treatment
because behavioural treatments with different qualities don't appear to produce different effects on abstinence, nor do they have markedly different therapeutic efficacy for different groups of subjects, it appears they are having a non-specific effect to produce their effect on abstinence.
simply by occupying addicts' time, you're engaging them with other activities and this provides the opportunities to break out of drug use routines.
general encouragement to abstain from drug use.