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Cognitive Behavioral Therapy and Mindfulness in Addiction Treatment Tony Pacione, LCSW, CSADC
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In Early Recovery, Cover Your… ,[object Object],[object Object],[object Object],ccountability tructure upport Pacione and Buino, 2009
Accountability… ,[object Object],[object Object],[object Object],[object Object]
Structure…  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Support … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cognition ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cognitive Schema:  A Beck, 1993 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cognitive Schema ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cognitive Schema ,[object Object],[object Object],[object Object],[object Object],[object Object],Core Beliefs (Self Efficacy)
Cognitive Schema:  Core Beliefs ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Complete Cognitive Schema Relevant Childhood and Developmental data: Core Beliefs: Conditional assumptions (if/then): Compensatory Strategy: Situation: Automatic Thoughts: Emotions: Behavior:
Cognitive Restructuring ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(DPW3 = GTH)
Thought Record  (Steps 1-2)  42 y/o female alcoholic Situation/Event Automatic Thought Related Feeling Rating Mood and  Desire/Craving (1-10) I  fought with my husband over missing our son's basketball game to attend an AA meeting. “ He is not supporting my recovery." Anger  Frustration Misunderstood 6 My husband invites me to  his holiday work party; I  remember last year’s party when I had leave because I was so intoxicated. “ I am an embarrassment to  my husband and a bad  wife. Guilt Depression 8 My sister is hosting the holiday dinner this year and asks me to make a run to the liquor store to buy the supplies for the event. “ She is insensitive and Putting me in a bad position for a relapse.” Anger Hurt 6 I tell me boss I’ve  been struggling with my recovery and he really wants to help me get sober. “ I am a bad employee for  letting my drinking affect my  work.” Frustration Guilt 8 I’m celebrating my son’s birthday,  and realize I’ve missed many of his achievements and milestones  because of my drinking “ I am a bad mother for letting him down for so long.” Guilt Depression 10
Common Cognitive Distortions (Step 3) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Burns, D. 1999
Thought Record - Cognitive Distortions (Steps 3)  42 y/o female alcoholic Overgeneralization and catastrophizing Emotional reasoning and dichotomous thinking Catastrophizing Emotional reasoning and dichotomous thinking Emotional reasoning and dichotomous thinking “ He is not supporting my recovery.”   “ I am an embarrassment to my  husband and a bad wife.” “ She is insensitive and putting me in  a bad position for a relapse.” “ I am a bad employee for letting my drinking affect my  work.” “ I am a bad mother for letting him down for so long.”
 
Challenging Automatic Thoughts (Steps 4-5)   Using I.C.E. to cool off ‘Hot’ thoughts ,[object Object],[object Object],[object Object],A. Pacione, 2003
I.C.E. (Steps 4-5) I dentify and rate the thought:  “I’ve missed so many of my son’s achievements because of drinking.  I I am a bad mother.”  truthfulness rating = 90% (of the time) C hallenge the thought: I didn’t attend a single one of his basketball games last season, when all the other mothers were there. I realized I had a problem and sought treatment; If I am sober I can be there for him from now on. He did poorly in math class because I wasn’t there to help him with his homework. I have made sure he always had a roof over his head and food on his plate. I couldn’t chaperone his class field trip because I didn’t want anyone to see me with the shakes. I’ve always made sure to tell him he is loved and that he is an extraordinary person. EVIDENCE FOR EVIDENCE AGAINST
I.C.E. cont. (Step 4-5) ,[object Object],[object Object]
Practice Time! ,[object Object]
Cognitive Grid (Step 6) ,[object Object],[object Object],[object Object],[object Object]
Cognitive Grid continued ,[object Object],[object Object],[object Object],[object Object]
Challenging Core Beliefs (‘acting as if’ - Step 7) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Practice Time! ,[object Object]
Mindfulness =  Becoming More Aware More Often  ,[object Object],Segal, et al. 2002
Mindfulness in recovery ,[object Object],[object Object],[object Object],[object Object],[object Object]
CBT + Mindfulness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(DPW3= GTH)
Principles of Mindfulness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kabat-Zinn, 1990
1. Non-judging ,[object Object],[object Object],[object Object]
2. Patience ,[object Object],[object Object],[object Object]
3. Fresh Mind ,[object Object],[object Object],[object Object],[object Object]
4. Trust ,[object Object],[object Object],[object Object],[object Object],[object Object]
5. Non-striving ,[object Object],[object Object],[object Object]
6. Acceptance ,[object Object],[object Object],[object Object],[object Object],[object Object]
7. Letting Go ,[object Object],[object Object],[object Object],[object Object]
Practice Time! ,[object Object]
CBT and Mindfulness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(DPW3 = GTH)
Bibliography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Cognitive Behavioral Therapy and Mindfulness

  • 1. Cognitive Behavioral Therapy and Mindfulness in Addiction Treatment Tony Pacione, LCSW, CSADC
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  • 12. The Complete Cognitive Schema Relevant Childhood and Developmental data: Core Beliefs: Conditional assumptions (if/then): Compensatory Strategy: Situation: Automatic Thoughts: Emotions: Behavior:
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  • 14. Thought Record (Steps 1-2) 42 y/o female alcoholic Situation/Event Automatic Thought Related Feeling Rating Mood and Desire/Craving (1-10) I fought with my husband over missing our son's basketball game to attend an AA meeting. “ He is not supporting my recovery." Anger Frustration Misunderstood 6 My husband invites me to his holiday work party; I remember last year’s party when I had leave because I was so intoxicated. “ I am an embarrassment to my husband and a bad wife. Guilt Depression 8 My sister is hosting the holiday dinner this year and asks me to make a run to the liquor store to buy the supplies for the event. “ She is insensitive and Putting me in a bad position for a relapse.” Anger Hurt 6 I tell me boss I’ve been struggling with my recovery and he really wants to help me get sober. “ I am a bad employee for letting my drinking affect my work.” Frustration Guilt 8 I’m celebrating my son’s birthday, and realize I’ve missed many of his achievements and milestones because of my drinking “ I am a bad mother for letting him down for so long.” Guilt Depression 10
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  • 16. Thought Record - Cognitive Distortions (Steps 3) 42 y/o female alcoholic Overgeneralization and catastrophizing Emotional reasoning and dichotomous thinking Catastrophizing Emotional reasoning and dichotomous thinking Emotional reasoning and dichotomous thinking “ He is not supporting my recovery.” “ I am an embarrassment to my husband and a bad wife.” “ She is insensitive and putting me in a bad position for a relapse.” “ I am a bad employee for letting my drinking affect my work.” “ I am a bad mother for letting him down for so long.”
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  • 19. I.C.E. (Steps 4-5) I dentify and rate the thought: “I’ve missed so many of my son’s achievements because of drinking. I I am a bad mother.” truthfulness rating = 90% (of the time) C hallenge the thought: I didn’t attend a single one of his basketball games last season, when all the other mothers were there. I realized I had a problem and sought treatment; If I am sober I can be there for him from now on. He did poorly in math class because I wasn’t there to help him with his homework. I have made sure he always had a roof over his head and food on his plate. I couldn’t chaperone his class field trip because I didn’t want anyone to see me with the shakes. I’ve always made sure to tell him he is loved and that he is an extraordinary person. EVIDENCE FOR EVIDENCE AGAINST
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Notes de l'éditeur

  1. Accountability – what you are responsible for bringing to recovery
  2. Structure – what tools are available to help you accomplish CBT goals in recovery
  3. Support – who is available to assist you in putting together your strengths + the tools to help you on the path for recovery
  4. All or nothing thinking : If your performance falls short of perfection, you see yourself as a total failure Overgeneralization : You see a single negative event as a never-ending pattern of defeat Mental filters : you may dwell on a single negative event; until it distorts your view of things as they really are. You are apt to disqualify the positives in your experience because they “don’t count” Jumping to conclusions : You may generate negative interpretations of events before all the facts are in ‘ Catastrophizing’ : You may exaggerate the importance of negative events; or conversely, minimize the importance of positive events Emotional reasoning: You believe your bad feeling about events are an accurate reflection on how events really are—“I feel like a loser, so I must be” Personalization: You erroneously believe that you are the primary cause of negative events, you may not have responsibility for
  5. Perhaps you have struggled with the thought that “this class won’t work; I tried to change my stress level but it seems only to get worse.” If you take hold of thoughts like this, or most other troubling thoughts, too often they can lead to disastrous consequences. You can very quickly and efficiently convince yourself that this thought (and others like it) must be true—“I think therefore I am!” If I tried and failed before, I ‘know’ it won’t work, then why bother to seek help at all. Thoughts and feelings can lead to judgments, which lead to actions, and actions lead to consequences.