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They work with patients to identify patterns of thinking and behavior that contribute
to addiction and help them develop new skills and coping mechanisms to manage
cravings and triggers. They often work in conjunction with other healthcare
professionals, such as psychiatrists and addiction counsellors, to provide
comprehensive care to individuals struggling with drug addiction.
Cognitive behavioral therapy (CBT) is one of the most common and best studied
forms of psychotherapy. It is a combination of two therapeutic approaches, known as
cognitive therapy and behavioral therapy.The methods of treatment are applied
depending on the illness or problem to be treated. The basic principle behind therapy
is however always the same: What we think, how we feel and how we behave are
all closely connected – and all of these factors have a decisive influence on our
well-being.
The term cognitive comes from the Latin "cognoscere", meaning "to recognize." The
point of cognitive therapy is to form a clear idea of your own thoughts, attitudes and
expectations. The goal is to reveal and change false and distressing beliefs, because it
is often not only the things and situations themselves that cause problems, but the
importance that we attach to them too.
For example, a dangerous thought pattern might be when somebody immediately
draws negative conclusions from an occurrence, generalizes them and applies them to
similar situations. In psychology, this generalized way of thinking is called “over-
generalizing.” Another distressing error in reasoning is “catastrophizing”: If
something disturbing happens, people immediately draw exaggerated conclusions
about the scope of the supposed disaster ahead.
Such thought patterns can sometimes develop into self-fulfilling prophecies and make
life difficult for the people affected. Cognitive therapy helps people learn to replace
these thought patterns with more realistic and less harmful thoughts. It also helps
people to think more clearly and to control their own thoughts better.
Additionally,cognitive behavioral therapy has a high level of empirical support for the
treatment of substance use disorders, helping people with these disorders improve
self-control, avoid triggers, and develop coping mechanisms for daily stressors.
This is one reason why studying psychology as an addiction counsellor is very
important.
There are four distinct principles that guide the practice of MI. The therapist
employing MI will hold true to these principles throughout treatment.
The first principle is to express empathy. Empathy involves seeing the world through
the client's eyes, thinking about things as the client thinks about them, feeling things
as the client feels them, sharing in the client's experiences. This approach provides
the basis for clients to be heard and understood, and in turn, clients are more likely to
honestly share their experiences in depth. The process of expressing empathy relies
on the client’s experiencing the counselor as able to see the world as they (the client)
sees it.
The third principle is to roll with resistance. This occurs when the client experiences
a conflict between their view of the “problem” or the “solution” and that of the
clinician or when the client experiences their freedom or autonomy being impinged
upon. These experiences are often based in the client’s ambivalence about change.
In MI, counselors avoid eliciting resistance by not confronting the client and when
resistance occurs, they work to de-escalate and avoid a negative interaction, instead
"rolling with it." Actions and statements that demonstrate resistance remain
unchallenged especially early in the counseling relationship.
By rolling with resistance, it disrupts any “struggle” that may occur and the session
does not resemble an argument or the client’s playing "devil's advocate" or “yes, but”
to the counselor's suggestions. The MI value on having the client define the problem
and develop their own solutions leaves little for the client to resist.
A frequently used metaphor is “dancing” rather than “wrestling” with the client. In
exploring client concerns, counselors invite clients to examine new points of view,
and are careful not to impose their own ways of thinking. A key concept is that
counselor’s avoid the “righting reflex”, a tendency born from concern, to ensure that
the client understands and agrees with the need to change and to solve the problem for
the client.
The last principle is to develop discrepancy. Motivation for change occurs when
people perceive a mismatch between “where they are and where they want to be”, and
a counselor practicing Motivational Interviewing works to develop this by helping
clients examine the discrepancies between their current circumstances/behavior and
their values and future goals.
When clients recognize that their current behaviors place them in conflict with their
values or interfere with accomplishment of self-identified goals, they are more likely
to experience increased motivation to make important life changes. It is important
that the counselor using MI does not use strategies to develop discrepancy at the
expense of the other principles, yet gradually help clients to become aware of how
current behaviors may lead them away from, rather than toward, their important goals.
Dialectical behavior therapy (DBT) is effective for patients who struggle to regulate
emotions and have thoughts of self-harm or suicide. The therapy emphasizes an
acceptance of uncomfortable thoughts, feelings or behaviors to allow patients to
overcome them. DBT has been proved to treat several disorders that co-occur with
addiction, including:Mood disorders, Personality disorders, Eating disorders, Self-
destructive behavior
DBT involves relaxation techniques, such as yoga, that help the patient become more
aware of thoughts and emotions. They learn skills such as controlled breathing and
muscle relaxation to tolerate self-destructive thoughts or urges. The goal is to
decrease the frequency and severity of self-harming behavior and encourage healthy
change.
Wilderness therapy is another form of therapy that supports why psychology is key in
addiction counselling. It combines nature and survival experiences with rehabilitative
therapy techniques that address substance use disorders, mental health problems and
behavioral issues. The therapy places individuals into an unfamiliar outdoor
environment to focus on self-improvement and overcoming problem behaviors with
coping skills. The overall goal is to foster personal and social responsibility while
encouraging emotional growth.
The majority of wilderness therapy programs assess the client’s specific needs and
develop an appropriate treatment plan to address any behavioral health issues. Clients
live in the wilderness and develop life skills by overcoming activities that are
physically and mentally demanding.
Wilderness therapy programs are for individuals and families who are experiencing a
crisis related to substance abuse, mental health disorders or both. The average client is
12 to 17 years old, but many young adults benefit from these programs as well.
According to an article by researchers with the University of Idaho and the Outdoor
Behavior Healthcare Research Cooperative, good candidates for wilderness therapy
include those with substance use disorders, attention-deficit disorder, depression or
behavioral problems.
What are the most common types of therapy used during alcohol or drug rehab?
(n.d.). [Video]. Drug Rehab. https://www.drugrehab.com/treatment/types-of-therapy/
Russell, K., Hendee, J. & Phillips-Miller, D. (1999, November 29). How Wilderness
Therapy Works: An Examination of the Wilderness Therapy Process to Treat
Adolescents with Behavioral Problems and Addictions. Retrieved
fromhttps://obhcouncil.com/wp-content/uploads/2012/02/article2.pdf