Positive Thinking. Rationale. Content Objectives. Counterconditioning, Reinforcement Management

Transcription

1 From Group Treatment for Substance Abuse, Second Edition. By Mary Marden Velasquez, Cathy Crouch, Nanette Stephens, and Carlo C. DiClemente Copyright 2016 The Guilford Press. A/M Session 11 Positive Thinking Change Process Objectives: Stimulus Control, Counterconditioning, Reinforcement Management Rationale Today s session combines the change processes of stimulus control, counterconditioning, and reinforcement management to teach clients how to manage and redirect maladaptive thoughts that could lead to substance use. Clients can use stimulus control to stop or redirect a triggering thought process before acting on it. By replacing the unhealthy thought process with positive, healthy, substance- free thoughts and actions, clients will be utilizing counterconditioning. Finally, the positive outcomes of avoiding substance use will reinforce clients efforts to manage potentially unhealthy thoughts in the future. Content Objectives Clients identify how thoughts can tempt one to use substances and engage in other unhealthy behaviors. Clients learn techniques they can use to manage thoughts. 242

2 A/M Session 11: Positive Thinking 243 Materials Required Whiteboard or flipchart and markers Copies of the following for distribution to each group member: Examples of Maladaptive Thoughts handout (A/M-11.1) Challenging and Changing Maladaptive Thoughts handout (A/M-11.2) Tools for Managing My Thoughts handout (A/M-11.3) ( Practice Managing Maladaptive Thoughts handout [A/M 11.4] can also be copied for use, if desired.) Pens or pencils Session Summary The facilitator helps the group brainstorm and discuss examples of unhealthy thoughts (i.e., thoughts that can lead to substance use, negative feelings, other unhealthy actions), sometimes labeled stinking thinking in AA. Group members think of the last time they used alcohol or drugs and remember thoughts that may have contributed to or precipitated that use. Then, they remember times in the past when they successfully managed unhealthy thoughts. The facilitator helps the group think about ways to manage and redirect thoughts, and provides tools to assist in this process. Implementation Many clients do not recognize the role that thoughts/cognitions play in their lives. They are generally unaware that a thought, often triggered by an event, can act as a stimulus that evokes emotions, which in turn can influence their decisions and behaviors. Many times clients can learn to avoid a particular triggering event. At other times, however, even if they may not be able to identify a particular event as being a trigger, they can learn to recognize the thoughts that a trigger has elicited. Some of these thoughts may represent attempts to rationalize substance use (e.g., just one drink won t hurt or drinking helps my problems go away ), while others may relate more to a misinterpretation of a situation or experience (e.g., I didn t get the job I wanted must mean I m really stupid ). By helping clients recognize either of these kinds of unhealthy, maladaptive thoughts as they occur, and giving them the tools to manage these thoughts, counselors will facilitate use of the change processes of stimulus control, counterconditioning, and reinforcement management. Throughout the session, encourage discussion with open questions and reinforce clients constructive ideas with reflections.

3 244 MAKING CHANGES IN SUBSTANCE USE Steps 1 and 2: Open the Session and Introduce the Topic Begin the session by explaining that thoughts play a key role in the decisions that people make. Point out that people constantly have thoughts but sometimes do not notice them because they are fleeting, not fully formed or totally conscious. By learning how to identify thoughts that can lead to substance use or other self- defeating behaviors, members will be better able to successfully manage them. These kinds of thoughts are often called maladaptive because they lead to poor choices that are unhealthy or cause problems in our lives. One way to view behavior change is to see it as a series of decisions, one after another, every day. Specifically, at some point during a thought process, people make a decision either to act on their thoughts, let them go, or replace them with different thoughts. Recognizing some of the ways that thoughts can lead to substance use is the first step in learning how to change unhealthy thoughts before making the decision to act. Step 3: Notice and Redirect Maladaptive Thoughts Explain to clients that the way we think influences how we feel and behave. It is important to pay attention to the way we perceive situations. Sometimes we take a negative, rather than positive, perspective. Negative thinking patterns can be self- defeating and can create feelings of low self- esteem, depression, and/or anger, which in turn can lead to substance use and other unhealthy behaviors. As clients learn to recognize their negative thoughts and moods, they will become able to see them as signals to change the negative thinking rather than to give up and use substances. Monti and colleagues (2002) suggest guidelines that clients can use in changing negative thoughts: Catch yourself thinking negatively. Learn what ways of negative thinking you have developed over the years and begin to notice them as they are occurring. Sometimes your moods can be a sign that negative thinking is occurring. For example, Bill noticed that he suddenly seemed to feel really sad and pessimistic. He wondered where those feelings came from and then realized that he had been thinking about how many missed opportunities he had had in his life. Stop the negative thoughts. Distract yourself; challenge and/or replace the maladaptive thought with ones that are either neutral or positive. In the example above, Bill said to himself, Wait a minute... I did miss a chance for a promotion, but I learned a lot that I can use going forward. To his surprise, he began to feel a little more positive and hopeful.

4 A/M Session 11: Positive Thinking 245 Step 4: Brainstorm and Discuss Examples of Maladaptive Thoughts Distribute the Examples of Maladaptive Thoughts handout (A/M-11.1). Engage clients in a discussion of different types of maladaptive thinking. Ask them for examples of self- defeating thoughts they might have heard or seen in others or themselves. Tell them that these types of thoughts can create negative emotions such as anger, frustration, or sadness that may lead to substance use. Note that other types of thoughts can create a direct path to deciding to drink or use other drugs. Give the example of walking home after a frustrating day at work. Ask clients what thoughts might come up that would lead a person to have a drink or use drugs and write them on a flipchart or whiteboard. Have clients remember the last time they used alcohol or other drugs and point out that even if they were not aware of it, they had a series of thoughts that led to that substance use. Ask them to recall what thoughts were going through their minds. Examples might be What s the use? I may as well have a drink, I ll show them! I can do whatever I want to, I can t deal with this! Forget it I m going to get high, I have to have this drink because... or I need this joint to... Write on a flipchart or whiteboard examples of the members responses. Point out that sometimes a thought in and of itself may not be tempting, but the combination of that thought with other triggers (such as certain emotions, pressure by friends, habit, or routine) can prove overwhelming. Ask what factors seem to push their thoughts from being just thoughts into action. Note that people can see the same situation in different ways, depending in part on how they think about it. For example, one person might see a neighborhood bar and think, A cold beer would sure be good right now... I ve had a lousy day, nothing will ever change... I think I ll have a drink, while another might think, There is that tempting situation again. I m not going to let it get the best of me. I want to be in charge of me. Step 5: Brainstorm and Discuss Ways to Manage Maladaptive Thoughts Tell members that the next step, after becoming aware of their maladaptive thoughts, is to begin to use strategies that can help them manage their thoughts, so their thoughts do not manage them. Ask the members to think for a minute about times when they were able to ignore or let go of a thought that could have resulted in substance use. How did they do this? How were they able to talk themselves out of doing something that might not have been in their best interest? Write their suggestions on the whiteboard/flipchart and facilitate a discussion. Explain that there are many ways to manage automatic, harmful thoughts, and point out how it is helpful to become aware of what works best for each of them. Review the following ways (which are also on Handout A/M-11.1) to redirect thoughts, writing them on the whiteboard/flipchart if you like or referring clients to their handout.

5 246 MAKING CHANGES IN SUBSTANCE USE Notice your thoughts. Stop and focus on what you have been thinking. Could these thoughts cause trouble? What expectations do you have about the alcohol or drug use? Are these really accurate, realistic expectations? If you were in a different mood, place, or time, would you be making the same decision? Speak out loud. Sometimes by actually verbalizing a thought, it is easier to recognize it as being maladaptive or irrational. Wait. Take a deep breath and tell yourself to wait 30 minutes before you decide to take action. Distract yourself. Do something else for a few minutes. Consider the consequences. Think about the unhelpful results of acting on the thought. Challenge the thought. Check out how realistic the thought is. Change the thought. Substitute a more realistic, positive thought in its place. (An additional activity, Handout A/M-11.4, can be used as needed, as an example of how to apply these strategies.) Encourage clients to add strategies that have worked for them. Then revisit the maladaptive thought examples in Handout A/M-11.1 and, using Handout A/M-11.2 as a guide, facilitate a discussion about how members might challenge or change each maladaptive thought. Ask members to create their own Tools for Managing My Thoughts by completing Handout A/M Encourage members to share their strategies and affirm their creative and positive ideas. Step 6: Close the Session Summarize the session by reviewing the importance of thoughts in maintaining sobriety. Briefly check in with the group members and ask them to begin noticing their thoughts, speaking them aloud, and practicing the tools to manage harmful thoughts as they arise. Ask each member what seemed to be most helpful from the meeting s discussion. Step by Step Session Tasks Step 1: Open the session and check in with the group (approximately 5 minutes). Step 2: Introduce the topic: Positive thinking (approximately 5 minutes). Explain the role that thoughts play in making decisions and taking action. Define maladaptive thoughts as those that are self- defeating and lead to unhealthy decisions and behaviors.

6 A/M Session 11: Positive Thinking 247 Step 3: Notice and redirect maladaptive thoughts (approximately 10 minutes). Introduce ways to notice and redirect maladaptive thoughts. Step 4: Brainstorm and discuss examples of maladaptive thoughts (approximately 15 minutes). Explain that some maladaptive thoughts result in negative emotions like sadness, frustration, and anger, which lead to substance use; other types of maladaptive thoughts can lead directly to substance use. Distribute Examples of Maladaptive Thoughts (Handout A/M-11.1) and discuss different ways people can perceive situations. Ask clients to recall their last use and re- create the thoughts that precipitated that use. Step 5: Brainstorm and discuss ways to manage maladaptive thoughts (approximately 20 minutes). Have members recall times when they let go or ignored a thought that could have resulted in substance use and write these suggestions on the whiteboard or flipchart. Review the strategies for managing maladaptive thoughts at the bottom of Handout A/M Discuss the examples of challenging and changing maladaptive thoughts in Handout A/M Ask clients to write down their personal tools for managing their thoughts (see Handout A/M-11.3). Discuss the group s examples. Step 6: Close the session (approximately 5 minutes). Summarize the session and check in with group members. Ask clients to begin noticing their thoughts and to practice managing thoughts that could lead to substance use.

7 Handout A/M-11.1 Examples of Maladaptive Thoughts Below are some examples of maladaptive thoughts. Think about which maladaptive thoughts you may have noticed in yourself or others. Expecting the worst: I know I ll make a mess of this job interview. Feeling that you (or other people) should do everything perfectly: I have to cook a perfect dinner this time I can t make a mistake like I did before or I ll feel like a fool. Thinking that it is a catastrophe when things do not work out the way you want them to: It s horrible that I didn t find a job today. Putting yourself down: I m such a loser... Thinking that your past will determine your future: I messed up so many times before, the future is hopeless. Things must go the way you want them to: They have to do it my way. Overgeneralizing: She never listens to me! Personalizing, thinking everything is all about you: That guy was grinning because he thinks I m stupid. Strategies for Managing Maladaptive Thoughts There are several ways we can handle negative thinking, but the first step is to notice our maladaptive thoughts! If you have other ideas about how to stop negative thoughts, add them to the list. Notice it. Name the kind of thought, such as irritable, critical, resigned, or angry. Speak out loud. Say the thought out loud. Wait. Decide to wait 30 minutes before taking action on the thought. Distract yourself. Get busy doing something different. Consider the consequences. Remind yourself that the thought will not be in your best interest. Challenge the reality of the thought (is it really always true?). Talk yourself out of it. Change or substitute a more realistic or more positive thought. Other ideas... From Velasquez, Crouch, Stephens, and DiClemente (2016). Copyright by The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for professional use only (see copyright page for details). Purchasers can download additional copies of this handout (see the box at the end of the table of contents). 248

8 Handout A/M-11.2 Challenging and Changing Maladaptive Thoughts Below are some examples of dealing with maladaptive thoughts by reframing them. These can be helpful when attempting to counter maladaptive thoughts. Expecting the worst: I know I ll make a mess of this job interview. Challenging/changing it: I worked hard to prepare for the interview. Regardless of how it turns out, it will be good practice. Feeling that you (or other people) should do everything perfectly: I have to cook a perfect dinner this time I can t make a mistake like I did before or I ll feel like a fool. Challenging/changing it: Nobody is perfect; everyone makes mistakes that s how we learn. Thinking that it is a catastrophe when things don t work out the way you want them to: It s horrible that I didn t find a job today! Challenging/changing it: I m disappointed that I didn t get the job, but I m not going to let that stop me. I ll try again tomorrow. Putting yourself down: I m such a loser... Challenging/changing it: I work hard... Just because this didn t turn out well, that doesn t mean I haven t succeeded before. Thinking that your past will determine your future: I messed up so many times before, the future is hopeless. Challenging/changing it: Nobody s perfect... I ve learned some new ideas about making my own choices. Things must go the way you want them to: They have to do it my way. Challenging/changing it: I d like for them to do it this way, but if not, I ll see what the next steps are. Overgeneralizing: She never listens to me! Challenging/changing it: She didn t listen this time. Personalizing, thinking everything is all about you: That guy was grinning because he thinks I m stupid. Challenging/changing it: That guy seems to be enjoying his own joke. From Velasquez, Crouch, Stephens, and DiClemente (2016). Copyright by The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for professional use only (see copyright page for details). Purchasers can download additional copies of this handout (see the box at the end of the table of contents). 249

9 Handout A/M-11.3 Tools for Managing My Thoughts What are some examples of your thoughts that could lead to substance use and can get you into trouble? What are some ways you can stop, change, or redirect those kinds of unhealthy thoughts? From Velasquez, Crouch, Stephens, and DiClemente (2016). Copyright by The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for professional use only (see copyright page for details). Purchasers can download additional copies of this handout (see the box at the end of the table of contents). 250

10 Handout A/M-11.4 Practice Managing Maladaptive Thoughts As Ben was walking home from work, he kept thinking about the bad mood his boss was in. He thought that his boss had no right to act that way, and the more he thought about it, the more frustrated and resentful he felt. How could Ben manage his thoughts so that they would not manage him? 1. Catch the thought become aware of it, even say it out loud. I am feeling really frustrated because my boss was in a terrible mood. 2. Distract himself by humming a song, calling a friend on his cell phone to see how he s doing, trying to remember how many presidents of the United States he could name, etc. 3. Consider the consequences by telling himself that being frustrated might lead to actions he would later regret which would not help anybody. If I keep thinking about my boss, it may get me off track and make me want to drink that would only hurt me. 4. Challenge and change the thought: He s probably got a lot on his mind. Even though he was in an awful mood, I got my part of the job done. I m not going to let his bad mood push me into a bad mood, too. His bad mood is a reminder for me about how my mood can affect others around me. I was able to put up with him all day. I didn t let his mood interfere with what I needed to do. I m pretty proud of myself. I m in charge of my actions I won t let his grumblings rule me! From Velasquez, Crouch, Stephens, and DiClemente (2016). Copyright by The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for professional use only (see copyright page for details). Purchasers can download additional copies of this handout (see the box at the end of the table of contents). Copyright 2016 The Guilford Press. No part of this text may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Purchase this book now: Guilford Publications 370 Seventh Avenue Suite 1200 New York, NY