11. REBT: General & Specific Strategies
General REBT
Regulate emotions
Tolerate frustration (distress)
Pursue goals
REBT for Addictions
Motivation
Cravings & Urges
Modulating Emotion
Hedonic Calculus
12. REBT: Irrational Beliefs?
What beliefs maintain addictive behaviors?
Urges are unbearable, I can’t tolerate them, I can’t have them and function
They won’t go away, they last until I use
My internal experience directs my behavior
One more (one more time) won’t hurt that bad
I’ll just start tomorrow
I already blew it, so I might as well [What the hell? or F- it!]
F-Them
I’ve tried everything, nothing will work
I don’t deserve to be happy or healthy
I can’t make it, so why try
I can’t take feeling [ Fill in the Blank]
It shouldn’t be this hard
Using will make me feel better, and I have to feel better
13. IB’s
Demandingness = Unconditional demand
LFT/Discomfort Anxiety
Awfulizing
GEW = Absolute value for self or other (across all judges,
across all time)
15. What are the Chains for addiction?
Let’s imagine a few:
A1 = [Fill in the blank]
B1 = [Fill in the blank]
C1 = [Fill in the blank]
16. REBT Secondary Disturbance
A1
Lose job I’m such a loser,
he is a jerk!
Shame, Anger
A1
Shame, Anger LFT Depression Drinks
A3
Depression @
Depression
Doesn’t matter,
no efficacy
Hopelessness
Drinks
17. REBT Secondary Coping
A1
Lose job RB + Rule Discomfort
Anxiety; Ego
Anxiety
A1
Discomfort
Anxiety; Ego
Anxiety
HFT;
Consequential
Thinking/Hedoni
c Calculus
Hope (positive
valenced
uncertainty); less
ego anxiety, less
“feeling” out of
control, more
self-efficacy
A3
Hope (positive
valenced
uncertainty); less
ego anxiety, less
“feeling” out of
control, more
self-efficacy
This isn’t easy,
but I can take it,
and I can do it.
Now what to do?
[Planning]
Resume, call
contacts, etc.
No drinking
18. Cost-benefit Analysis
What are the benefits of using? What are the costs of using?
What are the benefits of being sober? What are the costs of being sober?
19. Goal Setting
Values Driven
Values clarification
SMART
Specific - very
Measurable – Operationalize it
Achievable – Outcome, not value, there is an end
Realistic – it is likely that you (under these circumstances) can
Timed –Time frame
20. Coping with Urges
Monitor urges
Keep a log
Antecedents (Day/time, location, situation, pre-state)
Intensity of urge
Duration
Associated thoughts
Behavior (what did I do)
Consequence or Outcome
Impact on Goal
Reflections
What can be learned from a log?
21. Urge Surging
“Ride the Wave”
“If you die, we’ll throw you a nice funeral, with flowers.” –Ellis
This too, shall pass.
25. Thoughts & Imagery
Positive
Visualize the life you want, the future you want
See the people who appreciate/need/etc. you
Review yourValues & Goals
Negative
Imagine the consequences in the future if you keep going
Construct a punishing scene, i.e., vomit and alcohol, etc…
27. Contact (In-vitro & In-vivo): Professional
Guidance ** Not Brief Intervention
Conjure up an urge + Coping
Go to the avoided place/situation (some places are never going to
be a good idea)
Editor's Notes
Only goal for this:
To get them to plug in examples into ABC1->ABC2 for IB and RB example
Not technically B column is only beliefs, not worrying about that
Now how to get there may be for another time:
Behavioral Health
Goal Setting & Values Clarification
Hedonic Calculus (Cost-Benefit Analysis)
Prime Realistic Expectations
3 P’s
HALT
RB + SIT (HFT for Discomfort Anxiety, Self-efficacy, SIT, USA)
Problem Solving
Relaxation
Communication
Relapse Prevention
Mindfulness
Exposure
Behavioral Activation
GEW = Absolute
So really- we want to understand what comes before and after the behavior.
Then we want to change the Antecedents (Consequential Thinking, Cues Problem solving or alternative coping, or has a covert punisher- ughh that beer will produce a hangover, and I’ll lose my wife) and the Behavior – Reinforcer Pattern by either getting a similar consequence with a different behavior, e.g., engage in relaxation (negatively reinforcing) or a different consequence for a similar behavior, e.g., system responds differently to drinking/drugging behavior or the individual provides his/her own different consequence
SR, RR, SORC
Rule Governed
What are they?
What are some common B’s (addiction?)
Boils down to one process = experiential avoidance.
Typically two domains 1) negative emotions [and thoughts] 2) cravings [and urges]
But, there are other processes, e.g., sensation seeking
**** what we aren’t thinking/believing that matters, e.g., there aren’t negative consequences (or they aren’t that bad), there are other ways to cope with this, tomorrow has as much value as today
p.22 Bish
Demand for Excitement Chain
Sensation seeking personality (Type T)
Sensation seeking mood/learning history
Boredom or lack of stimulation
Demand for excitement
Expectation (cultural) that drinking/drugging lead to excitement [party]
Relapse Chain (Marlatt – from p.23 Bish)
High-risk Situation
No coping response
Decreased self-efficacy & Positive Outcome Expectancy
Initial use of substance
Abstinence violation: dissonance conflict and self-attribution (guilt and percieved loss of control)
Increased probablility of relapse
Beck Chain p.24
Activating Stimulus (Internal Cues, External Cues)
Belifs Activated
Automatic Thoughts
Cravings / Urges
Facilitating Beliefs (Permission)
Focus on instrumental strategies (action)
Continued Use
Example of Beck Chain
Feel sad -> “If I take a fix, I will feel better” -> “What the hell” -> Craving -> “I can do it this time without any harm” -> Look around to get the money -> Purchase and use
Excitement now with costs > Going without it without the benefits – Original
ANSWER to What can be learned from a log?
I can tolerate them
They have a beginning, middle, and an end
If I used there were consequences
If I didn’t use every time, then the urges aren’t the only determining factor, what else could be?
Draw it
Highlight characteristics
-experience (not fused with it)
-temporary (ends)
-unstable (different levels while it is there)