Effective Behavior Therapy: Motivational Interviewing
Cognitive behavior therapy (CBT) is the same as Motivational interviewing (MI) ,one intervention recommended in recognized guidelines for smoking cessation in the United States. While MI is considered to be effective for those who do not want to quit smoking; CBT is considered to be effective for those who cannot but want to quit smoking, those who repeatedly quit and re-smoke, those who are depressed, and women who are concerned about their weight (Kawai et al., 2013).
In case of Conor, he shows will and motivation to quit smoking like his health that shows signs of being afected by smoking and his girlfriend’s complaints, and also strong relapse factors such as his band colleagues. Assuming that Conor did manage to quit smoking, and is …show more content…
transitioning to abstinence, some concerns of the client are expressed in the case scenario, like being around his band colleagues and spending time that is not busy enough, as Conor states that he will need to “find stuff to do”.
The CBT approach will have to find the cognitive behavior of being aware that smoking will damage Conor’s health and relationship, and identify the behavior that will prevent Conor start smoking again when being with his band or when he is not busy. The cognitive aspect in Conor’s case should also contain the self-awareness aspect, of the moments when Conor feels the need to smoke, discuss with the counselor what did make him feel like smoking and find the proper behavior to counterbalance that issue.
Prochaska and DiClemente (1986), proposed readiness for change as a vital mediator of behavioural change.
Their transtheoretical model of behaviour change (the 'Stages of Change ') describes readiness to change as a dynamic process, in which the pros and cons of changing generates ambivalence. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change, which is the case of Conor. Ambivalence is particularly evident in situations where there is conflict between an immediate reward and longer term adverse consequences (eg. substance abuse, weight management) (Prochaska & DiClemente, 1986). The change process is modeled in five parts as a progression from an initial precontemplative stage, where the individual is not considering change; to a contemplative stage, where the individual is actively ambivalent about change; to preparation, where the individual begins to plan and commit to change. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. If successful, action leads to the final stage, maintenance, where the person works to maintain and sustain long term change (Prochaska & Velasquez, 2002). Relapse is considered an important stage in the change process and is used as an opportunity to learn about sustaining maintenance in the …show more content…
future.
Using MI or CBT techniques, the practitioner can tailor motivational strategies to the individual 's stage of change according to the Prochaska and DiClemente model illustrated below:
Practitioner tasks within the Stages of Change model
Patient stage
Practitioner tasks
Precontemplation
(Not ready)
Raise doubt and increase the patient’s perception of the risks and problems with their current behaviour. Provide harm reduction strategies
Contemplation
(Getting ready)
Weigh up the pros and cons of change with the patient and work on helping them tip the balance by: exploring ambivalence and alternatives identifying reasons for change/risks of not changing increasing the patient’s confidence in their ability to change
Preparation – action
(Ready)
Clear goal setting – help the patient to develop a realistic plan for making a change and to take steps toward change
Maintenance
(Sticking to it)
Help the patient to identify and use strategies to prevent relapse
Relapse
(Learning)
Help the patient renew the processes of contemplation and action without becoming stuck or demoralized
(Prochaska & DiClemente, 1986) Conor’s transition through the abstinence phase is stage of “Maintenance” in the table above and the concerns that the counselor should address come as the authors stated, to help the patient identify and use strategies to prevent relapse. This means that the counselor must identify the alternattives for behavior that Conor can have in the relapse-risk environments. For instance in the presence of his band colleagues, Conor can replace smoking with chewing gum or something that he identifies together with the counselor that is effective. During the times when he is not busy enough, Conor should identify activities that he would enjoy doing, and plan them ahead every day, so that he does not face the moment of “choice”. The girlfriend could also be involved in therapy, and help Conor develop and practice behavior alternative to smoking until the new behavior becomes a habit.
Sykes and Marks (2001) conducted a study about the effectiveness of CBT for smoking cessation in UK, on a sample of 260 individuals that intended to quit smoking. They have shown that CBT has high efficacy among smokers, who included a high proportion of low income adults, a key group whose smoking prevalence rates have increased in spite of multiple health education campaigns and price increases. The study found that approximately one in four smokers in the CBT group were fully abstinent or significantly reduced at 6 months follow-up. CBT was found to be five times more efficacious than health education advice (Sykes & Marks, 2001).
References
Lewis, T.
F. (2014). Substance abuse and addiction treatment: Practical application of counseling theory. Upper Saddle River, NJ: Pearson. ISBN: 9780132542654.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK64197/
Kawai A, Kano M, Sato T. (2013).Motivational interviewing and cognitive behavior therapy for smoking cessation.Nihon Rinsho. 71(3):493-8.
Prochaska J, DiClemente C. (1986).Towards a comprehensive model of change. In: Miller WR, Heather N, editors. Treating addictive behaviours: processes of change. New York: Pergamon.
DiClemente C, Velasquez M. (2002). Motivational interviewing and the stages of change. In: Miller WR, Rollnick S, editors. Motivational interviewing, second edition: Preparing people for change. New York: The Guilford
Press.
Catherine M. Syke, C.M., Marks, D.F. (2001).Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, UK. Health Promot. Int. 16 (3): 255-260.
In case of Conor, he shows will and motivation to quit smoking like his health that shows signs of being afected by smoking and his girlfriend’s complaints, and also strong relapse factors such as his band colleagues. Assuming that Conor did manage to quit smoking, and is …show more content…
transitioning to abstinence, some concerns of the client are expressed in the case scenario, like being around his band colleagues and spending time that is not busy enough, as Conor states that he will need to “find stuff to do”.
The CBT approach will have to find the cognitive behavior of being aware that smoking will damage Conor’s health and relationship, and identify the behavior that will prevent Conor start smoking again when being with his band or when he is not busy. The cognitive aspect in Conor’s case should also contain the self-awareness aspect, of the moments when Conor feels the need to smoke, discuss with the counselor what did make him feel like smoking and find the proper behavior to counterbalance that issue.
Prochaska and DiClemente (1986), proposed readiness for change as a vital mediator of behavioural change.
Their transtheoretical model of behaviour change (the 'Stages of Change ') describes readiness to change as a dynamic process, in which the pros and cons of changing generates ambivalence. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change, which is the case of Conor. Ambivalence is particularly evident in situations where there is conflict between an immediate reward and longer term adverse consequences (eg. substance abuse, weight management) (Prochaska & DiClemente, 1986). The change process is modeled in five parts as a progression from an initial precontemplative stage, where the individual is not considering change; to a contemplative stage, where the individual is actively ambivalent about change; to preparation, where the individual begins to plan and commit to change. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. If successful, action leads to the final stage, maintenance, where the person works to maintain and sustain long term change (Prochaska & Velasquez, 2002). Relapse is considered an important stage in the change process and is used as an opportunity to learn about sustaining maintenance in the …show more content…
future.
Using MI or CBT techniques, the practitioner can tailor motivational strategies to the individual 's stage of change according to the Prochaska and DiClemente model illustrated below:
Practitioner tasks within the Stages of Change model
Patient stage
Practitioner tasks
Precontemplation
(Not ready)
Raise doubt and increase the patient’s perception of the risks and problems with their current behaviour. Provide harm reduction strategies
Contemplation
(Getting ready)
Weigh up the pros and cons of change with the patient and work on helping them tip the balance by: exploring ambivalence and alternatives identifying reasons for change/risks of not changing increasing the patient’s confidence in their ability to change
Preparation – action
(Ready)
Clear goal setting – help the patient to develop a realistic plan for making a change and to take steps toward change
Maintenance
(Sticking to it)
Help the patient to identify and use strategies to prevent relapse
Relapse
(Learning)
Help the patient renew the processes of contemplation and action without becoming stuck or demoralized
(Prochaska & DiClemente, 1986) Conor’s transition through the abstinence phase is stage of “Maintenance” in the table above and the concerns that the counselor should address come as the authors stated, to help the patient identify and use strategies to prevent relapse. This means that the counselor must identify the alternattives for behavior that Conor can have in the relapse-risk environments. For instance in the presence of his band colleagues, Conor can replace smoking with chewing gum or something that he identifies together with the counselor that is effective. During the times when he is not busy enough, Conor should identify activities that he would enjoy doing, and plan them ahead every day, so that he does not face the moment of “choice”. The girlfriend could also be involved in therapy, and help Conor develop and practice behavior alternative to smoking until the new behavior becomes a habit.
Sykes and Marks (2001) conducted a study about the effectiveness of CBT for smoking cessation in UK, on a sample of 260 individuals that intended to quit smoking. They have shown that CBT has high efficacy among smokers, who included a high proportion of low income adults, a key group whose smoking prevalence rates have increased in spite of multiple health education campaigns and price increases. The study found that approximately one in four smokers in the CBT group were fully abstinent or significantly reduced at 6 months follow-up. CBT was found to be five times more efficacious than health education advice (Sykes & Marks, 2001).
References
Lewis, T.
F. (2014). Substance abuse and addiction treatment: Practical application of counseling theory. Upper Saddle River, NJ: Pearson. ISBN: 9780132542654.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK64197/
Kawai A, Kano M, Sato T. (2013).Motivational interviewing and cognitive behavior therapy for smoking cessation.Nihon Rinsho. 71(3):493-8.
Prochaska J, DiClemente C. (1986).Towards a comprehensive model of change. In: Miller WR, Heather N, editors. Treating addictive behaviours: processes of change. New York: Pergamon.
DiClemente C, Velasquez M. (2002). Motivational interviewing and the stages of change. In: Miller WR, Rollnick S, editors. Motivational interviewing, second edition: Preparing people for change. New York: The Guilford
Press.
Catherine M. Syke, C.M., Marks, D.F. (2001).Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, UK. Health Promot. Int. 16 (3): 255-260.