HLTH 237 wk 12 - prevention and treatment options II

psychotherapy

• broad term encompassing a range of talk therapies

• focus of modern psychotherapy:

  • aloneness of modern life

  • absence of purpose or meaning in our lives

  • difficulty knowing who you are, how to behave, and what our obligations are

• addiction as a response to a stress or trauma

  • internal conflicts

  • drugs maintain and protect existing sense of self

  • problems arise by continued and escalating use

• treatment focuses on personality change through personal insights

  • major life events

  • experiences in developmental stages

  • trauma

• also focused on

  • identifying underlying psychic problems

  • redirecting defence mechanisms

  • strengthening sense of self

  • engaging in self-criticism

  • establishing positive interpersonal relationships

modern variants of psychotherapy

• strengths-based approach

• brief solutions-based therapy

• feminist approach

• narrative therapy

six principles of strengths-based therapy

1. service users with addiction can recover, reclaim, and transform their lives

2. the focus is on individual strengths, not deficits

3. the community is viewed as an oasis of resources

4. the individual is the director of the helping process

5. the worker-service user relationship is primary and essential

6. the primary setting for work is community, not a residential facility

brief solutions-based therapy: pathways for constructing solutions

• Goal frame: what is your goal in coming here

• wishes and complaints frame: what would you like to change about this?

• exceptions frame: when isn’t the problem happening?

• hypothetical frame: when the problem is solved, what will you be doing differently?

feminist approach

• shifts perspective from individual focus to inherent structures in society

• values:

  • personal is political

  • choice

  • equalization of power

• approaches:

  • consciousness raising

  • social and gender-role analysis

  • equalization of power

  • resocialization

  • social activism

narrative therapy

• counsellor is collaborator

• exploration of past experiences from different perspectives

  • meaning people make of their lives

  • language used in creating meaning

  • power relations person is involved with

• uncovering new perspectives on self

  • self as a survivor or fighter and not a victim

  • strengthening positive narratives

behavioural approaches overview

• drug use is caused by maladaptive decision making

• drug use produces immediate positive outcomes

• ongoing or extensive drug use produces long term negative consequences

• drug use behaviours can be unlearned

• focusing on drug use behaviours and circumstances in which drug use behaviours occur

operant methods

• behaviours leading to drug use are punished

• behaviours substituting for drug use are positively reinforced

• two techniques:

  • contingency management: changing environment to ensure rewards and punishments occur

  • behavioural contracting: explicitly defining behaviours and consequences, often in a written document

skills training

• drug dependence occurs because of deficiencies in skills needed to:

  • achieve personal goals

  • solve interpersonal problems

• types of skills:

  • problem solving skills

  • social skills

  • interpersonal skills

  • vocational skills

  • stress management

cognitive behavioural therapy

• focuses on:

  • how do people learn behaviours?

  • how do people think about and interpret life events?

• emotions and behaviours are influenced by thoughts

• drug use is an attempt to deal with negative thoughts and emotions

• people are taught to counter negative automatic thoughts that influence emotions and behaviour

mindfulness

• rooted in Buddhist spiritual practice

• meditation: attentive and non judgemental monitoring of moment by moment cognition, emotion, sensation, and perception

• goal is to help people stay in the present, without focusing on past regrets or future anxieties that can trigger substance use

• leads to:

  • better cognitive control

  • better emotional regulation

  • less stress

dialectical behavioural therapy

• useful for people with intense emotional regulation issues

• combines cognitive behavioural therapy and mindfulness

• therapist works with client to bring about:

  • acceptance of personal situation

  • positive changes to interpersonal relationships

  • tolerance and surviving crises with healthy coping strategies

community reinforcement approach

• starts with functional analysis: detailed analysis of individual’s substance use patterns, triggers, and consequences

• results inform targeted intervention

• focus on positive reinforcement

• involves skill development: communication, problem solving, and assertive refusal of substances

• family and close friends are involved with treatment

aversion therapy

• least favoured form of behavioural therapy

• substance use is paired with unpleasant stimulus, creating negative association

• examples:

  • induced nausea

  • apnea: injection that produced paralysis up to a minute

  • electric shock

  • covert sensitization

transtheoretical model

• when changing behaviour, people go through various stages:

  • precontemplation: no intention to change

  • contemplation: aware a problem exists

  • preparation: intends to take action

  • action: makes change

  • maintenance: continues behaviour

  • termination: behaviour is permanent with no temptation and complete self-efficacy

• different interventions are useful depending on the behaviour and a person’s stage

motivational interviewing

• collaborative conversation for strengthening person’s motivation and commitment to change

• questions interviewer poses to interviewee:

  • disadvantages of status quo

    • what difficulties have you experienced because of your substance abuse?

  • advantages of change

    • what are the positive things that could occur if you stopped drinking alcohol?

  • optimism for change

    • what strengths do you have that could help you stop using drugs?