Mindfulness-­‐based

 Sobriety    
PSYCHOLOGICAL  TREATMENT  FOR    
SUBSTANCE  USE  DISORDERS  
SPRING  2015  
 Acceptance  and  Commitment  
Therapy  (ACT)  

*  Accepting  one’s  experience  and  situation  

*  Committing  to  value-­‐informed  living  
 Awareness  

*  Mindful  practice  
*  Self-­‐reflection  
 Psychological  Rigidity:  
6  core  processes  

*  Experiential  avoidance  
*  Inflexible  attention  
*  Attachment  to  a  conceptualized  self  
*  Cognitive  fusion  
*  Disruption  of  chosen  values  
*  Inaction  or  impulsivity  
 Main  Goal  of  ACT:    
Psychological  Flexibility  

*  Acceptance  
*  Mindfulness:  flexible  attention  to  the  present  
moment  
*  Self  as  context  
*  Defusion  
*  Chosen  values  
*  Committed  action  
 Motivational  Interviewing  

*  Evolved  from  the  Humansitic-­‐Existential  tradition  and  

Carl  Rogers  Person-­‐Centered  therapy  
*  A  way  of  being  with  the  client  
*  Engages  client  in  their  current  stage  of  change  
*  Helps  to  process  ambivalence  
 What Is Motivational
Interviewing?  
“…a collaborative, person-centered
form of guiding to elicit and
strengthen motivation for change.”  

URL:  Motivationalinterview.org  
 Components of MI Spirit  

*  Collaboration: Working in partnership (vs.

Confrontation)
*  Evocation: Draw out ideas and solutions (rather
than imposing Ideas)
*  Autonomy: Decision-making left up to the client
(vs. Authority)
*  Compassion: Therapist’s consistent actions to
support the client  
 Characteristics of Motivational
Interviewing  

*  Guiding, more than directing

*  Dancing, rather than wrestling
*  Listening, as much as telling
*  Collaborative conversation
*  Evokes from a person what he/she already has
*  Honoring autonomy

Source: Rollnick, Miller & Butler (2008). Motivational Interviewing in Health Care.  
 
Motivational Interviewing: General
Principles

*  Express empathy.
*  Support self-efficacy.
*  Roll with resistance.
*  Develop discrepancy.
 What  is  Resistance?  
*  4 types of behavior:
*  Arguing
*  Denying
*  Ignoring
*  Interrupting
*  Represents movement away from change.
*  Interpersonal process
*  May mean the therapist is ahead of the person in the change
process.
*  Signal for the therapist to change approach.
Motivational Interviewing: Skills
and Strategies  
*  Open-­‐Ended  Questions  
*  Affirmations  
*  Reflections  
*  Summaries  
 Reflective  Listening  
*  Allows individual to feel heard.
*  Allows therapist to confirm perceptions.
*  Simple declarative statement:
”It wasn’t your idea to come to see me today.”
”You feel pretty discouraged right now.”
”You have mixed feelings about your drug use.”  
 
 Examples  of  Reflective  Listening  
*  “It  sounds  like  .  .  .”  
*  “It  seems  as  if  .  .  .”  
*  “What  I  hear  you  saying  .  .  .”  
*  “I  get  a  sense  that  .  .  .”  
*  “It  feels  as  though  .  .  .”  
*  “Help  me  to  understand.    On  the  one  hand  you  .  .  .    and  on  the  
other  hand  .  .  .”  
 
 Change  Talk  

*  Statements  by  the  client  indicating  

commitment  to  change:  
*  Desire  (I  want  to  change)  
*  Ability  (I  can  change)  
*  Reason  (It’s  important  to  change)  
*  Need  (I  should  change)  
*  Commitment  (I  will  make  changes)  
*  Activation  (I  am  ready,  prepared,  willing  to  change)  
*  Taking  Steps  (I  am  taking  specific  action  to  change)  
 Strategies  To  Elicit    
Change  Talk    
1.  Ask  Evocative  Questions    
2.  Explore  Decisional  Balance  
3.  Good  Things/Not-­‐So-­‐Good  Things    
4.  Ask  for  Elaboration/Examples  
5.  Look  Back    
6.  Look  Forward  
7.  Query  Extremes  
8.  Use  Change  Rulers  
9.  Explore  Goals  and  Values  
10.  Come  Alongside  

 
 Relapse  Prevention  Therapy  

*  Clinical  approach  to  address  factors  that  contribute  to  

relapse  
*  Uses  a  taxonomy  of  high-­‐risk  situations,  including  
lifestyle  imbalance  
 High-­‐risk  situations  

*  Marlatt:  “any  experience,  emotion,  setting,  thought  

or  context  that  presents  an  increased  risk  for  a  
person  to  engage  in  some  transgressive  behavior.”  
*  Interpersonal  determinants  
*  Interpersonal-­‐Environmental  determinants  
Relapse  Prevention  Strategies  

*  Lifestyle  changes  
*  Avoidance  of  risk  situations  
*  Skill  building  
*  Urge  surfing  
*  Lapse  management  
 Mindfulness-­‐Based  Sobriety  

*  Experience  in  situation:  the  individual’s  personal  

experience  in  the  situation  where  challenges  occurred  
or  are  anticipated  (p.28-­‐30)