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Cognitive Behavioral Therapy Enduring Effects and Mechanisms Bruce J. Rounsaville Yale University

Explore the enduring effects and mechanisms of Cognitive Behavioral Therapy in coping with substance use and other problems. Learn about functional analysis, coping skills, motivation, refusal skills, problem-solving, and more.

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Cognitive Behavioral Therapy Enduring Effects and Mechanisms Bruce J. Rounsaville Yale University

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  1. Cognitive Behavioral Therapy Enduring Effects and Mechanisms Bruce J. Rounsaville Yale University

  2. Cognitive Behavioral Coping Skills • Based on social learning theory • Substance use is functionally related to other problems • Emphasizes learning of coping skills • Initiation and mastery of skills through practice, role playing, and extra-sessions tasks

  3. Functional Analysis Exploration of substance use in relationship to antecedents and consequences

  4. CBT for drug dependence • Introduction to functional analysis • Coping with craving • Shoring up motivation • Refusal skills and assertiveness • Seemingly Irrelevant Decisions • All purpose coping plan • Problem solving • Case management • Termination

  5. Empirical support for CBT • CBT may be more effective for more severe cocaine abusers • Carroll et al., 1994, 1998; McKay et al 1997; Maude-Griffin et al, 1998

  6. Empirical support for CBT • CBT’s effects appear to be durable up to one year after treatment ends • CBT appears to be associated with continuing improvement in substance use

  7. Point (0)

  8. Carroll et al., 1999:

  9. Rawson et al., 2002: CM vs CBT in methadone maintenance

  10. MTP: Marijuana use through 15 months

  11. Does CBT work the way we think it works? Initial exploration of mechanisms of action of CBT: • Does CBT differentially increase coping skills? • Are coping skills related to outcome?

  12. Cocaine Risk Response Test • Role playing task based on Chaney’s work, administered pre-and posttreatment • Example: “You are at a party, where you didn’t think cocaine would be available. However, you notice people going in and out of a back bedroom, and a friend invites you to join them. What do you do?

  13. Cocaine Risk Response Test Audiotaped responses to 10 high risk situations scored on 6 dimensions: • Latency • Number of coping plans • Quality of best plan • Overall quality • Specificity • Type of coping response

  14. Psychometric properties • Good interrater reliability (.74-.89) • Good internal consistency (.79-.96) • Significant pre-posttreatment increases in number of coping plans, quality of response, specificity of response

  15. Treatment and coping skills acquisition • Significant treatment condition by time interactions suggest patients assigned to CBT, TSF, or Clinical Management show greater increases in coping skills associated with that treatment condition • Higher posttreatment CBT skills associated with significantly less cocaine use during follow-up

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