Trainer Notes
Module 4:
Brief Behavioral Therapy Based onClassical Conditioning
TIP 34 Reference
Chapter4:BriefCognitive-BehavioralTherapy(pp.51-55)
Training Emphasis
1.KeyConceptsofBriefBehaviorTherapybasedonClassical
Conditioning
2.ModelsUsedforBriefBehaviorTherapybased onClassical
Conditioning
3.ResearchonBriefBehaviorTherapy basedonClassicalConditioning
4.TypesofSettingsandClientsAppropriateforBriefBehaviorTherapybasedonClassicalConditioning
5.ApplicationsofBriefBehaviorTherapybased onClassical
Conditioning in Substance Abuse Treatment
6.DurationofBriefBehaviorTherapy basedonClassicalConditioning
7.EvaluationofEffectivenessofBriefBehaviorTherapybasedon
Classical Conditioning
8.StrategiesUsedforBriefBehaviorTherapybasedonClassical
Conditioning
9.Participant StrategyIntegration
Learning Objectives
1.Participantswillbeabletoidentifytwokeyconceptsabout brief behaviortherapy basedonclassicalconditioning.
2.Participantswill beabletoidentifytwomodels used forbrief behaviortherapy basedonclassicalconditioning.
3.Participantswill beabletoidentifytworesearchfindingsabout brief behavior therapy basedonclassicalconditioning.
4.Participantswillbeabletoidentifytwosettingsorclientsappropriate forusingbriefbehaviortherapy basedonclassicalconditioning.
5.Participants will beabletoidentifytwoapplicationsofbrief
behaviortherapy based onclassicalconditioning with substanceabusers.
6.Participantswillidentifyonenewbriefbehaviortherapybasedon classicalconditioning strategytointegrateintotheirpractice.
7.Participantswill identifyatleast one qualityassuranceand improvementprocedureforthenewbriefbehaviortherapy based on classicalconditioningstrategy.
Agenda
1.Welcome(2Minutes)
2.BriefBehavioralTherapyBasedonClassicalConditioningSummary
GridOverviewandDiscussion(20 Minutes)
3.StrategyIdentification Exercise(10Minutes)
4.StrategyIntegration Mind-MapExercise(10Minutes)
5.AssignmentsandClosing(3Minutes)
Training Equipment and Supplies
1.Whiteboardanderasablemarkers–OR–newsprintpad,markers,andeasel
2. LCD projector–OR–overhead transparencyprojector
3.PowerPointslideCD–OR–overheadtransparencies
4.Moveableseating
5.Nametags(optional,reusableordisposable)
6.Attendancerecord
7.Pens andcoloredpencilsorcrayons
8.Continuingeducation certificates(optional)
Definition of Terms
Classical Conditioning:Occurswhenaneutral stimulus(suchasatone oralight)comestoelicita response as aresult ofbeingpairedwithanunconditionedstimulus(anevent that elicitsaresponsewithoutanypriorlearninghistory,such assalivating)orwithaconditionedstimulus,thusbecoming conditionedreflexes or“cues.”
Counterconditioning:Amethod that uses classical conditioningprinciplestomakebehaviorspreviouslyassociatedwithpositiveoutcomesless appealingbymorecloselyassociatingthem withnegative consequences.Repeatedlypairingthosecuesthatformerlyelicitedaparticularbehaviorwithnegative rather thanpositiveoutcomes,thecueslose theirabilitytoelicittheoriginalpositiveresponse. Instead,theyelicitanegative outcome.Thisisalso calledanaversiveor
Participant Materials
TimeClock
Counter-conditioningtreatment approach.
CueExposure:Thisprincipleofclassicalconditioning holdsthat ifabehavioroccursrepeatedlyacrosstimebutisnotreinforced,thestrengthofthecueforthebehaviorandthebehavioritself willdiminish,andthebehaviorwilleventuallyvanish. Usingcueexposure,aclientispresentedwithphysical,environmental,social, oremotionalcuesassociatedwith pastsubstance abuse(e.g.,accompanying him/herintoanoften-frequentedbar).Theclientthenispreventedfromdrinkingortakingdrugs. Over timethis process leadstodecreasedreactivitytothe originalcues.
Covert Sensitization: Atechniqueused incounterconditioningtherapythatpairsnegative consequenceswithsubstance-relatedcuesthroughvisualimagery.
Participant Materials
(OneforEachParticipant)
1.Module4Handouts
a.Module4Packet Cover
b.BriefBehavioralTherapyBasedonClassical
Conditioning Summary Grid
c. StrategyIdentification Exercise
d.StrategyIntegration Mind-MapExercise
2.Homework:HandoutsfornextTIP 34 Training Module
Module 4 - Section 1
Welcome & Introduction
Time: 2 Minutes
Trainer Notes
Thissectioncanbedidacticorinvolvelowgroupinteraction.
Trainerandparticipant introductionsarenotnecessary as these weredoneinModule1.
Trainer Script
Welcome & Topic Introduction
WelcometotheTIP 34 trainingonBriefInterventionsandBriefTherapies. Ourtopicforthistrainingis“BriefBehavioral Therapy BasedonClassical Conditioning.”Behavioralapproachesassume substance abuse disordersaredeveloped andmaintainedthroughthegeneral
principlesoflearningandreinforcement.Thistypeofbehavioral therapy is basedontheprinciples ofPavlovianclassicalconditioning.
Wewillexploreavarietyof aspects aboutbriefinterventions whichare
highlightedontheBriefBehavioralTherapyBasedonClassicalConditioningSummary Gridinyourhandout packet.
WewillalsousetheStrategyIdentificationExerciseandtheStrategyIntegrationMind-Maptoidentifyanewstrategythatyouwanttointegrateintoyourpersonalpractice.
Module 4 - Section 2
TimeClock
TrainerNotes
Brief Behavioral Therapy Based onClassical
Conditioning Summary Grid
Time: 20 Minutes
Trainer Notes
Thissectionisacombination ofdidacticpresentationandlargegroup discussion.Itcaninvolvelowtohighgroupinteraction.
Thetrainer should notread each itemfromtheSummaryGrid.Summarizingeach sectionofthegrid,and addingadditional information available inthetrainer script orthroughpersonalclinical experience,willmakethetrainingmoreinteresting.
Integratinggroupdiscussionswitheach sectionwill enhancethe effectivenessofthetraining.Groupdiscussionsallowparticipantstolearnfromoneanotherandfromthetrainer.
Thetrainer alwaysfacilitatesthegroupdiscussionandinteraction.The trainer’sroleistoprovideexpertiseandguidance,andnottoprescribetheuse ofanyonemodelforbriefinterventions.Thetrainermaintainsfocusofdiscussionsonthetopic,andisalsotheleaderandtimekeeperforthegroup.
Thefocusofthediscussionsisthefeasibilityofusingthese approacheswithintheguidelinesandservicesoftheagency.
Thetrainer caninitiatediscussionwithopen questions:
●Doesanyoneinthegrouphaveexpertiseinusingbriefbehavioraltherapyapproaches?
●Whattypes ofbriefbehavioraltherapystrategiesarewithinthe establishedguidelinesforouragency?
●Whattypes ofbriefbehavioraltherapystrategiesarecurrentlyused inouragency?
●Whatother types ofbriefbehavioraltherapycouldbeused inour agency?
●Whatresourcesforbriefbehavioral therapyexist outsideouragency?
TIP 34 Reference
Chapter4:BriefCognitive-BehavioralTherapy(pp.51-55)
TIP34 Book
Participant Workbook
Participant Workbook
■BriefBehavioralTherapyBased OnClassicalConditioning
Summary Grid
Trainer Script
Key Concepts
Pavlovianclassicalconditioning isthefundamentalbuildingblockof learning.Pavlovianconditioning isfundamentallyinvolvedinourmotivationtobehaveincertainwaysandtorespondemotionallytoparticular events.
JustasPavlov’sdogwasconditionedtosalivatewhenatone wassounded,overtime,substanceusersdevelopconditionalresponsestoavarietyofsituationsorthings related todrug use.
Classicalconditioning issaid tooccurwhen(1)aneutral stimulus(suchasatone oralight)comesto(2)elicitaresponse(suchassalivating)asaresultof(3)beingpairedwithanunconditionedstimulus(aneventthat elicitsaresponsewithoutanypriorlearninghistory—such as food)orwithaconditionedstimulus(aneventthatelicitsapredictable response becauseofitspreviouspairingwith a reflex—such as drug paraphernalia),thusbecoming(4)conditioned reflexesor“cues.”
With substance abuse,therepeatedpairingsbetween theemotional, environmental,andsubjectivecuesassociatedwiththeuse of substancescombined withtheactual physiologicalandphenomenological effectsproduced byspecificsubstancesleadstothedevelopmentofaclassically conditionedresponse.
Cuesrelated tosubstanceuse canbecome“triggers” orhigh-risk situationsthat canleadtosubstanceuse/relapse.Whenthesubstanceabuserisinthepresenceof such cues, aclassically conditionedwithdrawalstate orcravingiselicited.
Withthistypeofbehavioraltherapy,thetreatmentgoals ofreduction
orabstinencecanbeachieved byfocusingontheclassicallyconditionedcraving responsesthat maintain thesubstance use.
Brief Behavioral Therapy Models
TIP 34addressesthreedifferentmodelsthatareused for briefbehavioraltherapybased onclassicalconditioning.
Thesemodelsare:
1.CueExposureandExtinction.
2.Aversive/CounterconditioningProcedures.
3.Covert Sensitization.
Cue Exposure and Extinction
Evenafterrelativelylongperiods ofabstinence,asubstanceabuserwillexperiencestrong physiologicalreactionsandcravingswhenplaced insituationsthathaveenvironmental, social,oremotionalcuesassociatedwithpast substance abuse. Inclassicalconditioning,thisiscalledcueexposure.
Theextinction ofacuecanoccurifabehavioroccursrepeatedlyacrosstimebutisnotreinforced.Whenthis happens,thestrength of the cue for the behavior and the behavior itself will diminish, thus extinguishing the behavior.
Aversive/Counterconditioning ProceduresAversive/Counterconditioningproceduresareusedtomakebehaviors thathadbeenassociatedwithpositiveoutcomes(suchassubstanceuse) lessappealingbyassociatingthem morecloselywithnegativeconsequences.
Typically, theseproceduresusechemicallyinduced aversion orelectricshockasnegativeconsequencestobepaired withthesubstance-related cues.
Theyaremosteffectivewhenused asacomponentofamore comprehensivetreatmentprogramrather thanasanindependent, free-standingtreatment.
Covert Sensitization
Covertsensitizationisahighlyeffectiveandportable treatment component.
It usesvisualimagerytocreateanaversiveresponsetocues associatedwithsubstance use.
Unlikechemical orelectric aversiontherapies,covertsensitizationcanbeusedatanytimeandinanysettingasaself-controlstrategy.
Research
TIP 34 is basedonresearchstudiesfromthe1960s to the 1990s.
Substantialresearchevidence supportstheeffectivenessofbehavioral approaches,andbehavioraltheories have led to interventionsthathavebeenindividuallyproventobeeffectiveintreating substance abuse.
Someresearchoutcomesonbehavioraltherapybased on classical conditioning include:
1.Clientsnolongerreported either subjectivehighsorphysiological withdrawal.
2.Clientsnolongerexperiencedcravingwhenpresentedwiththe drug-related cues.
3.Clientswereless likelytodropoutoftreatment.
4.Clientshadmoredrug-free weeks.
5.Bothalcoholandcocainedependentuserswhoreceived chemical aversionproceduresaspartoftheirtreatmentexperiencedpositiveoutcomes.
Types of Settings and Clients
Briefbehavioraltherapycanbeused withclients before, during,andaftersubstanceabusetreatmentinindividual,group,andfamilysettings.
It hasmostoftenbeen usedinthealcohol treatment.
It hasalsobeenapplied tomarijuanaandcocaine treatment.
Ifaclienthascertainexpectationsoftherapythat makeitdifficultforhim/hertocommittothegoalsandproceduresofbrieftherapyortoaparticulartherapeuticapproach,otherapproachesshouldbeconsidered orareferralmade.
Applicationsin Substance Abuse Treatment
Thisbriefbehavioraltherapyissoundlygroundedinestablishedpsychological theory, andhas strong empiricalandscientificevidencetosupportits effectiveness.This canbebothreassuringandmotivatinginformation foraclient.
Itisflexibleinmeeting specificclientneeds,andisoftenreadilyacceptedbyclients because ofthehighleveloftheirinvolvementin treatmentplanningandgoalselection.
Itempowers aclienttomakehis/her own behaviorchange.
Duration of Therapy
Insome programs,durationoftherapyisdeterminedmutuallybytheclientandtherapist.Briefbehavioraltherapymaybethe best option iftheclientobjectstolongertermtreatmentorifexpense is an issue.
Theduration ofbrieftherapiesisreportedtobeanywherefrom1- 40 sessions, withthetypicaltherapylastingbetween 6 - 20sessions.
Themajorityofclients intherapy(regardlessofthemodality)remainin treatmentforbetween 6- 22 sessions;90%endtreatmentbeforecompleting 20 visits.
Evaluation of Effectiveness
Effectivenessevaluationsdonothavetobetime-consumingor complicated.Theycanbeconductedinperson,byphone, throughthe Internet, orbymail.
Theeffectivenessofbriefbehavioraltherapycanbeevaluatedby:
1.Client participation
2.Treatment admissions
3.Discharge againstmedical advice rates
4.Clientsatisfactionsurveys
5.Follow-upphone calls
6.Counselor-rating questionsaddedtotheclinicalchart
Module 4 - Section 3
TimeClock
TrainerNotes
Strategy Identification Exercise
Time: 10 Minutes
Trainer Notes
■Turn offallnoisyaudio/visualequipmentduringsmallgroup discussions.
■Beawareofanyexternalandinternaldistractionsfromthesmallgroupdiscussions.
Thetrainerpreparesparticipantsforthestrategyintegrationprocess.Thepurposeofthisprocessistoencourageparticipantstodevelop newtherapeuticskillsfor workingwiththeirclients.
Thetrainerinvitesparticipantstothinkaboutaparticular clientthatwouldlikelybenefitfromabrieftherapy.
TheparticipantsreviewthehandoutfortheStrategyIdentificationExercise.Thishandoutpresentslists ofstrategiesofthemodule topic,usuallyorganizedaccording tothebasic conceptualmodels presentedintheSummaryGrid.
The trainerdirectstheparticipantstoplaceacheck(√)nexttostrategies s/he has used successfullyinhis/herpractice,andtoplace astar (*)nextto new strategies s/hewantstoincludeinhis/herclinicalpractice.
WhiletheparticipantsworkoncompletingtheStrategy IdentificationExercise,thetrainerisavailabletorespondtoquestionsandmoves abouttheroomtohelpparticipants.
Thetrainerfacilitatesawhole-groupdiscussionabout thisexercise,askingparticipantstosharewhichstrategiestheyhavesuccessfullyused withagencyclients.Participantscanlateruse a staff memberwithsuccessfulexperiencestohelpthem integrateanewstrategy intheirownpractice.
Participant Workbook
■BriefBehavioralTherapyBased onClassicalConditioningStrategy
IdentificationExercise
ParticipantWorkbook
GroupExercise
Trainer Script
Strategy Identification Exercise
Thepurposeofthistrainingistointegratenewskillsforbrieftherapyintoourprofessionalpractice.
You will begin this processbyidentifyingonenewstrategythat you believe willbehelpfulforoneofyourcurrent clients.
PleasereviewtheStrategyIdentificationExerciseforBriefBehavioral
TherapyBased onClassicalConditioninghandout.
Thishandoutpresentslists ofbrieftherapystrategies.For thismodule, thestrategiesarenotorganizedaccordingtothemodels presentedin theSummaryGrid,butaccordingto processesrelated tobrieftherapy.
Thehandoutdirects youtoplace acheck(√)nexttostrategiesthatyouhaveused successfullyinyourpractice,andtoplaceastar(*)nextto newstrategiesthat youwouldliketoincludeinyourclinicalpractice.
Aftercompleting thisportionoftheexercise,selectonenewstrategy(fromthestrategieswithastar) touse withacurrent client.
Thisexercisegivesusanopportunitytosharesuccessfulexperienceswe have had with thesebrieftherapystrategies.
Pleasepayclose attentiontotheexpertiseofourstaff thatisrevealedinthisexercise.Youmaywanttorecruitthemtohelpyouwithyournewstrategy.
Who would liketoshareyoursuccessfulbrieftherapyexperienceswithus?
TimeClock
Trainer Notes
Participant Workbook
Module 4 – Section 4
Strategy Identification Mind-MapExercise
Time: 10 Minutes
Trainer Notes
■Turn offallnoisyaudio/visual equipmentduringsmallgroup discussions.
■Beawareofanyexternalandinternaldistractionsfromthesmallgroupdiscussions.
Participantsworkindividuallytocompletethisexercise.
WhiletheparticipantsareworkingontheStrategyIntegrationMind-Map,thetrainerisavailabletorespondtoquestionsandmoves abouttheroomtohelpparticipants.
Theuseofcoloredpencils orcrayonswiththisexercisehelpstoenhancean atmosphere ofcreativityforbrainstorming.Brainstormingisfordevelopingideas, not forevaluating them. Thetrainerencouragesparticipantstohelponeanotherwithanonjudgmentalattitude.
Whenmostoftheparticipantshavecompletedthemind-map,thetrainermayinvitevolunteerstosharetheirstrategy andplanwiththerest ofthegroup.Maintainingthegroupruleregardingrespectisveryimportantinthisdiscussionsoasnottodiscourageaparticipant fromexecutinghis/herplan.
Participant Workbook
■StrategyIntegration Mind-Map
Trainer Script
Strategy Integration Mind-Map
You will developaplanofactionforutilizingyournewstrategy andevaluatingitseffectiveness. TheStrategyIntegrationMind-MapExercise is used for this purpose. Thisisinyourhandoutpacket.
ThepurposeoftheStrategyIntegrationMind-Mapistodevelopaplanabouthowyouwill integratetheselectednewbriefbehavioraltherapy skillintoyourclinicalpractice.
Youshouldselecttheideasthat arethebestandmost appropriateforyourclient.Donotputthenameofyourclientonthisform.However,youmaywanttoincludethisstrategyinyourclient’streatmentplan.
GroupExercise
TimeClock
Trainer Notes
Mind-Mapping Directions
Thisexerciseisamind-map.Mind-mappingallows youtoconceptualize theintegrationofanewstrategy ononepage,andinamannerthatismoreeasilyrememberedthan otherformsofwriting,such asoutlinesorlists.
Itusesbrainstormingtoencouragethegenerationofnewideas,andallowsyoutoorganizeyourthinkingbyfittingideastogetherintoaconceptual“map.”
Youcanwriteordrawyourideas.Youcanhavefunandbecreativewhileyoudevelopyourideas.Theuseofcolorscanhelptoseparatedifferentpartsofyourmap. Bypersonalizingthemapwithsymbols anddesigns,youcandevelopastrategythat will bemoreeasilyrememberedandused withyourclient.
Allideasonthemind-maparerelatedtothethemeinthecenter.Theideasareconnectedtothecentral themeortooneanotherwithlinesorarrowstoindicatetheirrelationship.Keyideasforthestrategymind- maparesuggestedontheborderoftheexercise form.
Writeyourselectednewstrategyinthecenterofthemind-map,andthen–usingpens,coloredpencils,orcrayons–place relatedideasin boxes,circles, lists, ordrawingsthatradiatefromthecenter.
Wouldanyonevolunteer tobrieflyshareyourstrategy andmind-mapwiththerest ofthegroup?
Module 4 - Section 5
Assignments and Closing
Time: 3 Minutes
Trainer Notes
Thetrainer givesabriefpreviewofnexttrainingtopic.
Thetrainer distributesthehandoutpacket forthenexttrainingsession, andencouragestheparticipantstoread theSummary GridandStrategyIdentificationExercisebeforethetraining.
Thetrainer discusses date,time,andplace ofnexttrainingsession.
Thetrainer givesTIP 34 readingreferencesforthistraining.
Participant Workbook
■Handout Packet forNextTIP34 Training
ParticipantWorkbook
Trainer Script
Reading and Homework
Thankyouforparticipating inthisTIP 34 TrainingProgram.
Ournexttrainingmodule willexplore [Training Topic]. PleasereadtheSummary GridandcompletetheStrategy IdentificationExercisebefore thetraining.
The TIP 34referencesforthistrainingare [relevant
TIP 34 pagesorchapter].
Thistrainingmoduleisscheduledfor [date,time,and place].
Participant
Workbook
Module 4:
Brief Behavioral Therapy Basedon
Classical Conditioning
Brief Behavioral Therapy Based on Classical Conditioning Summary Grid
Key Concepts
■Thisapproachisbased ontheprinciplesofPavlovianclassicalconditioning.
■Classicalconditioning occurswhenaneutral stimulus(suchasatone oralight)elicitsa response(suchassalivating)asaresult ofbeingpaired withanunconditionedstimulus(anevent that elicitsaresponse withoutanypriorlearninghistory--such as food)orwithaconditionedstimulus(aneventthat elicitsapredictableresponsebecauseof its previous pairingwithareflex--such as drugparaphernalia),thus becoming (4)conditionedreflexes or“cues.”
■Repeatedpairingsbetween theemotional,environmental,andsubjectivecuesassociatedwiththeuse ofsubstancesandtheactual physiologicalandphenomenologicaleffectsproduced byspecificsubstancesleadstothedevelopmentofaclassically conditioned response.
■Cuesrelated tosubstanceusecanbecome“triggers” orhigh-risksituationsthat can lead to substance use and relapse.
■Subsequently,whenthesubstanceabuserisinthepresenceofsuch cues,aclassically conditioned withdrawalstate orcravingiselicited.
■Goalofreduction orabstinencecanbeachieved byfocusing ontheclassically conditionedcraving responses that are assessedas maintaining thesubstance abuse.
Models
■CueExposure: Evenafterrelativelylongperiods ofabstinencefromsubstances, beingplacedin situationsthathavephysical–environmental,social,oremotionalcuesassociatedwith past substance abuse willelicitstrong physiologicalarousalreactionsandreportsofstrong sensations of craving.
■Extinction: Ifabehavioroccursrepeatedlyacrosstimebutisnotreinforced,thestrengthofboththecue for the behaviorandthebehavioritself willdiminishandthebehaviorwill extinguish.
■Aversive/CounterconditioningProcedures:
1.Usedtomakebehaviorsthathadbeenassociatedwithpositiveoutcomes(suchassubstance use) lessappealingbyassociatingthemmorecloselywithnegative consequences.
2. Typically, use chemicallyinduced aversion orelectricshockasnegativeconsequencestobe pairedwiththesubstance-relatedcues.
3.Best viewedasacomponentofamorecomprehensivetreatmentprogramrather than as anindependent,free-standingtreatment.
■CovertSensitization:
1.Highlyeffectiveandportable treatmentcomponent.
2.Uses visualimagerytocreateanaversiveresponsetocuesassociatedwithsubstance use.
3.Unlikechemical orelectric aversiontherapies,canbeused atanytimeandinanysetting as self-controlstrategy.
Research
■Substantialresearchevidence supportstheeffectivenessofbehavioralapproaches.
■Behavioraltheorieshaveledtointerventionsthathavebeen individuallyproventobeeffectivein treatingsubstance abuse.
■Some researchoutcomesonbehavioraltherapy basedonclassicalconditioning:
1.Clientsnolongerreported eithersubjectivehighsorphysiologicalwithdrawal
2.Clientsnolongerexperiencedcravingwhenpresentedwiththedrug-related cues
3.Clientswereless likelytodropoutoftreatment
4.Clientshadmoredrug-freeweeks
5.Bothalcoholandcocainedependentusers who received chemical aversionproceduresaspartoftheirtreatmentexperiencedpositiveoutcomes
■Researchweakness:Some criticsarguethat behavioralapproacheshavebeendevelopedundercontrolledconditionsandthat in“real”therapythere aremanymorevariablesatworkthancanbemeasuredincontrolledexperiments.
Types of Settings and Clients
■Canbeusedwithclientsbefore,during,andaftersubstanceabusetreatmentinindividual, group,andfamilysettings
■Havemostoftenbeenused inthetreatmentofalcoholdependence
■Havealso beenapplied tothetreatmentofmarijuanaandcocaine use
Applications in Substance Abuse Treatment
■Soundlygroundedinestablishedpsychological theory
■Strongempiricalandscientificevidence tosupport itseffectiveness
■Flexibleinmeeting specificclient needs
■Readilyacceptedbyclientsduetohighlevelofclientinvolvementintreatmentplanningandgoalselection
■Structuredinits guidelines for assessingtreatmentprogress
■Empowerstheirownbehaviorchange
Duration of Therapy
■Insomeprograms,duration oftherapyisdeterminedmutuallybytheclientandtherapist;brieftherapymaybethe best optioniftheclientobjectstolongertermtreatmentorifexpenseisanissue.
■Theduration ofbrieftherapiesisreported tobeanywherefrom1-40sessions,withthe typicaltherapylastingbetween 6- 20sessions.
■Twenty sessionsisusuallythemaximumbecauseoflimitations placed bymanymanagedcare organizations.
■Thetherapiesdescribedhere mayinvolveaset number of sessions orasetrange(e.g.,from
6 - 10sessions),buttheyalwaysworkwithinatimelimitationthatiscleartoboththerapistand client.
■Themajorityofclients intherapy(regardlessofthemodality)remainintreatmentforbetween
6- 22sessions; 90 percentendtreatmentbefore completing20 visits.
■Byitsverydesign,mostbehavioraltherapyisbrief.
■Decisionsabout thelengthoftreatmentaremade onthebasisofclientassessments, rather than accordingtoaformulaortheoreticalassumptionabouthowlongtherapyshouldtake.
Evaluation of Effectiveness
■Regularassessment and measurementofprogressareintegraltoeffectivebehavioral therapy.
■Behavioraltherapyfocusesonidentifyingandchangingobservable,measurablebehaviors.
■Treatment islinkedtoalteringthebehavior,andsuccess is thechange,elimination, or enhancementofaparticularbehavior.
■Evaluations canbedone simplyandefficiently,withoutrequiringexcessivestaff timeandenergy,or integratedintoroutineclientcontacts.
■Effectivenessevaluationscanbeconductedinperson,byphone,throughtheInternet, orby mail.
■Theeffectivenessoftime-limitedbrieftherapycanbeevaluatedby:
1.Clientparticipation
2.Treatmentadmissions
3.Discharge againstmedical advice rates
4.Clientsatisfactionsurveys
5.Follow-upphone calls
6.Counselor-ratingquestionsaddedtotheclinicalchart
Strategy Identification Exercise Brief Behavioral
Therapy Based on Classical Conditioning
■ Place a check (√) next to strategies that you have used successfully in your clinical practice.
■ Place a star (*) next to new strategies that you want to include in your clinical practice.
Cue Exposure:
●Theextinctionprocess,overtime,leadstoadecreasedreactivitytoconditionedcues.
Extinction:
●Theclientispresentedwithcuesphysically/environmentally(suchasshowingpersonaldrug paraphernalia,goingintoawell-frequented bar),orvisually(suchasavideoofadrug-usingscenario, visualizationofsuchascenario).
●Theclientispreventedfromdrinkingortakingdrugsinpresenceofconditionedcues.
Aversive/Counterconditioning Procedures:
●Repeatedlypaircues thatpreviouslyelicitedaparticularbehaviorwithnegativeoutcomesratherthanpositiveoutcomes.
●Typicallyused withchemicallyinduced aversionorelectricshockasthenegativeconsequences pairedwiththesubstance-related cues.
Covert Sensitization:
●Clientvividlyimaginesasequenceofeventsbeginningwithhis/her favoritebar(typically accompaniedbyincreasedcraving).
●Clientthenproceedstoimagineenteringthebar,sittingdown,orderingadrink,andsoon (theinitialsense ofcravingshiftstomilddiscomfort).
●Clientvisualizesbeginningtotakeadrinkand tastes the alcohol.
●Clientimaginesbecoming violentlysickandvomiting.
During an Initial Session:
●Engagetheclientinacollaborativeprocess.
●Explorethereasonstheclientisseekingtreatmentatthisparticulartime.
●Exploretheextent towhichtheclient’smotivationfortreatmentisintrinsic,rather thaninfluencedbyexternalsources.
●Explorethe areas ofconcernthattheclientandsignificantothersmayhaveabout his/hersubstance abuse.
● Note the most salient problems identified by the client and intervene with these first.
● Assess the client’s readiness to change and then develop initial behavioral goals in collaboration with the client.
● Explore the situations in which he/she drinks or uses excessively, and the consequences he/she experiences, bothpositive and negative, as well as proximal and removed from the actual substance abuse.
● Begin to formulate a treatment plan.
During Later Sessions:
● Negotiatetreatment goals
● Consider the introduction of cue training
● Involve the client’s spouse or significant others