1	Recovery Coach Training Part 6: PROBLEM SOLVING BARRIERS WITH CBT TECHNIQUES
2	Topics Covered Situations that indicate need for CBT Barriers to recovery Identifying reinforcing behaviors Tracking behaviors and thoughts Rewriting the event Identifying cognitive distortions Behavioral techniques
3	Situations that indicate the need for CBT Repeated relapses that occur without warning and without the person asking for help Urges to use alcohol and drugs that appear to be random or spontaneous Panic attacks or restlessness (particularly at night)
4	Situations that indicate the need for CBT Feeling trapped, overwhelmed or immobile Unable to ask for help and unable to resolve ongoing problems Hidden benefits of alcohol and other drugs (i.e., beware of individuals who report that there is nothing good about alcohol or other drugs)
5	Situations that indicate the need for CBT Self-destructive behaviors, such as self-mutilation, angry outbursts, or bulimia Returning to old friends or significant others who can undermine the client’s recovery
6	Barriers to Recovery- PTSD Ask clients about any symptoms of PTSD (example of the brief PTSD scale) Ongoing exposure to traumatic experiences will undermine recovery Untreated PTSD will undermine recovery Individuals can learn to manage symptoms of PTSD without having to treat the source of the trauma Individuals in early recovery benefit more from a CBT model of treatment, such as Seeking Safety, rather than therapies that treat the source of the trauma (e.g., exposure therapy) Help individuals identify and differentiate triggers (i.e., flags) of PTSD from triggers to drinking and drugging
7	Barriers to Recovery- Lack of Social Support Ask clients about social support, such as Count the number of important social supports in their life who support their recovery Count the number of important social supports in their life who support their ongoing drinking and drugging (or undermine their recovery through abuse) If individuals have more people supporting their drinking and drugging, recovery will be difficult to achieve under any situation Most individuals need a ratio of 2 to 1 or better of recovery supports to drugging supports to have a chance at recovery
8	Barriers to Recovery-Nutrition Look for eating and drinking (non-alcoholic drinks) patterns that can undermine recovery Ask clients what they eat for breakfast, lunch and dinner Ask clients to document the amount of junk food and soda (or power drinks) they consume each day Look for patterns of crashes (e.g., mood swings), anxiety and restlessness at night (e.g., excessive consumption of caffeinated drinks or sugar products), low energy (e.g., not eating breakfast), and weight gain (e.g., binge eating) Cigarette smoking is also a trigger to alcohol and drug usage and has been found to be a consistent indicator for relapse (i.e., heavy smokers are more likely to have relapse compared to those who can reduce or eliminate smoking)
9	Identifying Reinforcers Identify the underlying reinforcer within a “seemingly” destructive behavior All individuals will initiate behaviors that lead to immediate reinforcers, even though some of these behaviors may lead to delayed punishment (this is why millions of Americans overeat or overspend with credit cards)
10	Identifying Reinforcers When talking about destructive behaviors, try to identify the reinforcer that still exists (at least in the individual’s mind) A women who returns to an abusive partner probably needs to eliminate loneliness (reinforcer is companionship), receive kindness (she remembers that he has also said and done nice things in the past), wants sex with a familiar person, or she is responding to his verbal statements that could lead to positive things (the man has reported that he will be a better father, boyfriend, or that he will abstain with her) Binging and purging or self-mutilation can relieve obsessive thoughts or undesirable feelings (e.g., guilt & shame) Selecting an alternative drug that can be “controlled” is a way for a person to replace the uncontrollable drug while still enjoying the pleasures of a mind altering drug (find out what is still pleasurable about the mind altering drug) Overeating can be a replacement drug Bad friends are still better than no friends Old friends are easier to engage than developing new friends
11	Tracking behaviors and thoughts Understating patterns of behavior is an effective first step at altering behavior of finding replacements for behaviors Worry or mood log Anger log Passive log – logging situations where the client wanted to be assertive Track eating patterns or energy levels Look at daily patterns of urges to use alcohol and other drugs
12	Re-writing the Event Re-writing an event using the logs Writing a new script Keeping a script for future events Identify a list of behaviors that can replace the target behavior (i.e., select a list of relaxation techniques that can target one or two hours of worrying each day)
13	Identifying cognitive distortion Use the list of cognitive distortions Log your thinking patterns Challenging cognitive distortions challenging the probability of the event providing an alternative interpretation steps to understating a perception
14	Behavioral Techniques Role playing Try to avoid accepting a person’s report that they understand how to perform the activity Always ask the client to demonstrate the activity (role play is an excellent group activity) A role play can be completed in less than 3 minutes, provide feedback, discuss alternatives, replay the role play (most individuals can improve their behavior within 2 or 3 rounds of role play)
15	Behavioral Techniques Modeling The counselor, recovery coach, or another client can start the role play by modeling the behavior Demonstrate the techniques in the field (this is a benefit of a community-based addiction treatment program, like case management or recovery coaching)
16	Behavioral Techniques Instituting small wins (i.e., baby steps) Breaking down complex behaviors into smaller and easier steps An effective behavioral technique is to get people winning early, by creating opportunities for achieving simple steps
17	Behavioral Techniques Ways to disrupt the all-or-nothing pattern through behavioral changes AON thought – I need to quit smoking all cigarettes BP – I will monitor my cigarette intake for two weeks BP-2 I will identify periods in the day when I can avoid cigarettes and other periods where I rely on cigarettes BP – 3 I will select one period in the day where it would be easier to avoid smoking and eliminate one or two cigarettes from that time span BP – 4 I will select a behavior to replace the smoking for that one hour (drink coffee, chew gum, eat snacks)
18	Behavioral Techniques Ways to disrupt the all-or-nothing pattern through behavioral changes AON thought – I have to clean my entire house BP – I will pick the easiest room to clean first
19	Behavioral Techniques Ways to disrupt the all-or-nothing pattern through behavioral changes AON thought – I need to exercise 3 days a week BP – I will pick one day and walk around the block
20	Behavioral Techniques Ways to disrupt the all-or-nothing pattern through behavioral changes AON thought – I have to stop overeating my meals BP – I will eat half my meal, wait 15 minutes, and eat the other half if I’m still hungry