Ideas for Treatment Improvement APRIL 2005 • VOLUME 8, ISSUE 4 PLEASE COPY OR POST Cognitive Behavioral Therapy (CBT) - Part 1 SERIES 18 CBT and Anger Management Northwest Frontier cognitive-behavioral therapies share the Addiction Technology following characteristics: Transfer Center “ Man’s mind, once stretched Focuses on thoughts 810 “D” Street NE by a new idea, never regains Cognitive-behavioral therapy is based on Salem, OR 97301 the premise that our thoughts cause our Phone: (503) 373-1322 its original dimensions.” FAX: (503) 373-7348 feelings and behaviors, not external things, ~ Oliver Wendell Holmes ~ like people, situations, and events. Clients A project of are viewed as having the ability to change OHSU the way they think to feel and act better Department of Public even if the situation does not change. Health & Preventive Medicine ognitive-Behavioral Therapy (CBT) Is brief and time-limited is a general classification of psy- CBT can yield positive results for the client Steve Gallon, Ph.D., Cchotherapy with many different in a relatively short period of time. The Principal Investigator names, including Rational Emotive Behav- average number of sessions clients receive Wendy Hausotter, MPH ior Therapy, Cognitive Therapy, Rational is approximately 16, while other forms of Project Director Behavior Therapy, Rational Living Therapy, therapy can take years. CBT is brief Schema Focused Therapy, and Dialectical because it is highly instructional and makes Mary Anne Bryan, MS Behavior Therapy. use of homework assignments. Editor [email protected] The focus of this Addiction Messenger Uses a sound therapeutic series is to provide a basic understanding relationship for effective therapy, Be sure to check out of CBT and illustrate CBT techniques used but not as the main focus our web page at: in several manuals that are readily avail- Many forms of therapy rely heavily on the www.nfattc.org able to counselors. The first manual, high- positive relationship between the counselor lighted in this issue, features CBT ap- and client to facilitate positive growth. With proaches to managing anger. CBT it is important to have a good, trusting Elements of CBT relationship, but equally important is teaching clients rational self-counseling CBT emphasizes the important role of our Unifying science, skills that can help them gain positive thoughts and feelings in what we do. The education and changes as they learn to think differently. typical CBT strategy teaches clients that services to it is important to identify unwanted thinking Is a collaborative effort between the transform lives that causes negative feelings/behaviors and counselor and the client learn to replace this thinking with more Counselors using cognitive-behavioral desirable thoughts and reactions. Most approaches focus on learning what their PAGE2 NFATTC ADDICTION MESSENGER • APRIL 2005 clients want out of life and their personal goals, and then ment (CSAT) describes a combined CBT approach using work with them to help them achieve those goals. The relaxation, cognitive and communication skills interventions counselor’s role is to listen, teach, and encourage, while to help clients deal with anger. There is both a counselor the client’s role is to express concerns, learn, and guide and a participant workbook which present clients with implement that learning. several different intervention options and provides tools for them to develop individualized anger control plans. The Teaches, doesn’t prescribe manual can be accessed electronically through the follow- Cognitive-behavioral therapy does not prescribe how the ing website: www.samhsa.gov client should feel, but rather, it teaches the benefits of thinking and feeling differently when confronted with The manuals describe several types of interventions which stressful situations. are CBT-based, including: Fosters the asking of questions Relaxation Interventions Counselors using cognitive-behavioral approaches Targets the emotional and physiological components of develop a good understanding of their clients’ concerns anger. This intervention focuses on developing awareness by asking questions. They also encourage their clients of changes in the body that result from anger and using to ask questions of themselves and encourage clients to relaxation techniques (eg. “belly breathing”) to counteract look at thoughts as hypotheses that can be questioned physical changes such as increased heart rate and muscle and tested. If clients find that their hypotheses are not tightness. accurate (because they have considered new Cognitive Skills Interventions information), they can change their thinking to be more Targets cognitive processes such as hostile appraisals and reflective of the reality of their situation. attributions, irrational beliefs and inflammatory thinking. Structured and specific Cognitive skills interventions focus on, for example, having Counselors have an agenda for each session when using the client listen to their “self talk” which may be critical and CBT. Clients are taught specific techniques and hostile. Clients are taught to evaluate their beliefs for ac- concepts during each session. CBT focuses on helping curacy and reframe their thoughts in a more positive way. the client achieve their goals not by telling them what to Communication Skills Interventions do, but rather, how to make changes that will bring them Targets deficits in assertiveness and conflict resolution skills. closer to their goals. Assertiveness training allows clients to learn alternatives to Behavior can be “unlearned” using aggressive behaviors. The Conflict Resolution Model CBT is based on the assumption that most emotional facilitates using assertive responses to manage interper- and behavioral reactions are learned. The goal of the sonal conflicts more effectively. counselor is to help their client unlearn negative Combined Interventions reactions and to learn new, more positive, ways of Integration of two or more CBT interventions, such a re- reacting. laxation and communication skills, which can target several Homework is a central feature response areas. Helping clients achieve their goals would take a long The information presented in this manual can help substance time if they only thought about the techniques and topics abuse counselors deliver group cognitive-behavioral anger they were being taught for one hour per week. management treatment to clients in twelve 90-minute weekly Therefore, CBT counselors often assign reading and sessions. Treatment should be delivered to adults in a group other assignments and encourage the client to practice setting of between 5 to10 participants. the techniques learned. The counselor manual is designed to be used in conjuction Anger Management: A CBT Approach with the Anger Management for Substance Abuse and CBT has been found to be an effective treatment for Mental Health Clients: Participant Workbook which anger problems. Anger Management for Substance summarizes information presented in each session, provides Abuse and Mental Health Clients: A Cognitive Be- blank worksheets for homework assignments and reinforces havioral Therapy Manual, a set of two manuals from the concepts presented over the course of treatment. Substance Abuse and Mental Health Services Adminis- Topics addressed in these manuals include: tration (SAMHSA) Center for Substance Abuse Treat- Overview of Group Anger Management Treatment, NFATTC ADDICTION MESSENGER • APRIL 2005 PAGE3 You Can Receive the Addiction Messenger Via E-Mail ! Just send an e-mail to Mary Anne Bryan at [email protected] asking to be put on the Addiction Messenger mail or e-mail list or visit our website at www.nfattc.org to subscribe. Earn Continuing Education Hours by reading the Addiction Messenger. Visit our website at www.nfattc.org Click on the Addiction Messenger button, then go to the first issue in the Series you would like to earn CEUs for and scroll down to the registration form for more detailed information. Events and Cues: A Conceptual Framework for Un- flags”, personally sensitive areas, and some long-stand- derstanding Anger, Anger Control Plans: Helping Group ing issues from the past that may provoke anger. Members Develop a Plan for Controlling Anger, The • Cues to Anger Aggression Cycle: How To Change the Cycle, Cogni- Discuss understanding and identifying the cues (which tive Restructuring: The A-B-C-D model and Thought are important aspects of anger monitoring) that occur Stopping, Assertiveness Training and the Conflict in response to anger-provoking events , including: Resolution Model: Alternatives for Expressing Anger, Physical Cues - the way our bodies respond when we Anger and the Family: How Past Learning Can Influ- become angry. ence Present Behavior, two Review Sessions: Reinforc- ing Learned Concepts, and Closing and Graduation: Behavioral Cues - the behaviors we display when we Closing Exercise and Awarding of Certificates. are angry. An Example from the Manual Emotional Cues - other feelings that may occur concur- rently when we are angry. Each session is presented in four sections: Instructions to Group Leader, Check-In Procedure, Suggested Remarks, Cognitive Cues - the thoughts that occur in response to and Homework Assignments. Below is an excerpt from the anger-provoking event. the session called “Events and Cues: A Conceptual Frame- Homework Assignment (example of what counselor work for Understanding Anger” which provides an ex- assigns; participant manual provides template for cli- ample of the manual’s content