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Combining Cognitive Behavioral Therapy and Motivational ...

Combining Cognitive Behavioral Therapy and Motivational InterviewingJim Carter, Behavioral HealthUCSD SOMLa Jolla, CAPresented At:CCCOE Spring Staff TrainingApril, 2011 CBT = Cognitive Behavioral TherapyMI = Motivational InterviewingAgendaCBT for substance useMI for substance useSimilarities and differencesRationale for combiningWays to combinePossible models for combiningCBT Model of DisordersPredisposing FactorsPrecipitating FactorsDysregulation in Function Behavioral System Cognitive System Affective System+Dysregulationin Substance Use ProblemsCognitive DysregulationAttention to positive and negative outcomesAttribution (internal vs.)

CBT = Cognitive Behavioral Therapy MI = Motivational Interviewing Agenda CBT for substance use MI for substance use Similarities and differences

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Transcription of Combining Cognitive Behavioral Therapy and Motivational ...

1 Combining Cognitive Behavioral Therapy and Motivational InterviewingJim Carter, Behavioral HealthUCSD SOMLa Jolla, CAPresented At:CCCOE Spring Staff TrainingApril, 2011 CBT = Cognitive Behavioral TherapyMI = Motivational InterviewingAgendaCBT for substance useMI for substance useSimilarities and differencesRationale for combiningWays to combinePossible models for combiningCBT Model of DisordersPredisposing FactorsPrecipitating FactorsDysregulation in Function Behavioral System Cognitive System Affective System+Dysregulationin Substance Use ProblemsCognitive DysregulationAttention to positive and negative outcomesAttribution (internal vs.)

2 External) Decision making (risk taking)Self-efficacyAttitudes, beliefs, schemasBehavioral DysregulationPositive and negative reinforcementConditioning (cue reactivity)Displaced reinforcementsCBT ProcessCase conceptualizationTime-limited and solution-focusedStructured and directiveIndividual and/or group formatSound therapeutic relationship is essentialEducative and skill-building processes Socratic method Role play, rehearsal, shaping Homework Examples of CBT Topics for Substance Use ProblemsTriggers and decision pointsCoping with urges and cravingsHandling social pressuresCatching and challenging distorted beliefsEmotional regulation ( , anger mgt.

3 Daily planning and routine (occupation)Re-establishing trust with social supportsCognitive Distortions Related to Criminal Thinking Self-justificatory thinking Misinterpretation of social cues Displacement of blame Deficient moral reasoningMinimizing impact of behaviorSchemas of dominance and entitlementBehaviors Related to Criminal Thinking Misperceive benign situations as threats ( , be predisposed to perceive harmless remarks as disrespectful or deliberately provocative) Demand instant gratification Confuse wants with needsAssume victim stance (avoidance)Reinforce beliefs within subculture(s)MI for Substance Use ProblemsNot driven by theory or model Focuses on building client motivation Client primarily responsible for changeProvider elicits, guides, and supportsNo specific assumptions regarding course of treatmentMI ProcessBrief - Individual meeting(s)

4 With clientSpirit of MI provider Collaborative Respects client s autonomy EvocativeClient-centered aspects ( reflective listening, open-ended questions)Provider guides client toward changeStrengthen commitment to action planPossible Topics in MIExploring client s point of view Emotional reactions Obstacles to changeEliciting client s reasons to decrease substance useEliciting client s strengths and resourcesEliciting client s strategies for changeEliciting commitment for specific change(s)Similarities Between CBT and MITalk therapies with manuals Share common elements of a therapeutic relationship Empathy CollaborationEmphasize client activity outside meetingsEmpirical support for efficacyRequire training for provider competenceDifferences Between CBT and MICBTMIB uilding skillsBuilding motivationEducativeEvocativeSolutions pre-selectedClient picks solutionsEmpirical support for group formatBriefer.

5 Strategies for client resistanceRationale for Combining StrategiesCBT Can provide structure for treatment Can be done in groups Not effective without client engagementMI Effective at engaging clients Relatively brief Fits with other models (not theory driven)Models for Combining CBT and MIMI as precursor to CBTMI at pre-determined pointsContextually driven integration of MI and CBTD angersResourcesSBH (2004) Combined Behavioral Intervention Manual: A Clinical Research Guide for Therapists Treating People with Alcohol Abuse and Dependence.

6 NIAAA: Exercise-Skill TrainingElicit importance of skillDescribe skillModel skillStudent practice of the skillFeedback and coachingTransfer of skill to real lifeParticipant Exercise Raising ConcernsRASA Model (COMBINE Manual) Reflect back plan ( you statement) Ask permission to share concern State concern ( I statement) Ask for responseParticipant Exercise -Giving AdviceWhen?Why?AATA Model Ask what already knows Ask permission Tell key information Ask for respons


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