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Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP.

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Page 1: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Cognitive, Behavioral, & Mindfulness Based

Therapies for Addictions & Compulsive Disorders

William Berry, LMHC., CAP.

Page 2: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

Page 3: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• “Being” in the present, without judgment.

• Often confused with meditation.• Meditation is a practice of mindfulness.

• The “Observer”• e.g. Eckhart Tolle

• Empty Mind• No thoughts, no thinker.

Page 4: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• Being in the present often happens naturally when engrossed in a task.

• This relates to Positive Psychology’s Mihaly Csikszentmihalyi’s concept of “Flow”, which has been identified as a contributor to happiness.

Page 5: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• Nakamura and Csíkszentmihályi identify the following six factors as encompassing an experience of flow. • Intense and focused concentration on the present

moment• Merging of action and awareness• A loss of reflective self-conscious.• A sense of personal control or agency over the situation

or activity• A distortion of temporal experience, one’s subjective

experience of time is altered.• Experience of the activity as intrinsically rewarding.

• Wikipedia

Page 6: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• https://www.ted.com/talks/andy_puddicombe_all_it_takes_is_10_mindful_minutes?language=en

• The video, which can be accessed with the link above, is a TED Talk about mindfulness, and was shown in this slide during the presentation.

Page 7: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Benefits of mindfulness to psychological health report benefiting undergraduate students, community adults, and clinical populations (Keng, Smoski, Robins, p.1043).

Page 8: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Mindfulness has been associated with: • higher levels of life satisfaction• agreeableness• conscientiousness• vitality• self-esteem• empathy• sense of autonomy

• (Keng, Smoski, Robins)

Page 9: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Mindfulness has been associated with: • Competence• Optimism• Pleasant affect

• Studies have also demonstrated significant negative correlations between mindfulness and• depression• neuroticism• absent-mindedness• dissociation• rumination

• (Keng, Smoski, Robins)

Page 10: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Studies have also demonstrated significant negative correlations between mindfulness and• cognitive reactivity• social anxiety• difficulties in emotion regulation• experiential avoidance• alexithymia• intensity of delusional experience in the context of

psychosis• general psychological symptoms.

• (Keng, Smoski, Robins)

Page 11: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Studies have also demonstrated:• Meditators, as compared to non-meditators,

reported significantly higher levels of mindfulness, self-compassion and overall sense of well-being

• significantly lower levels of psychological symptoms, rumination, thought suppression, fear of emotion, and difficulties with emotion regulation,

• changes in these variables were linearly associated with extent of meditation practice.

• (Keng, Smoski, Robins)

Page 12: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• “Mindfulness has been shown to be related not only to self-report measures of psychological health, but also to differences in brain activity observed using functional neuroimaging methods.” (Keng, Smoski, Robins p.1043)

• This indicates meditators may be better able to regulate emotional responses.

• It is also consistent with the ability to let go of negative self-deprecating thoughts. (Keng, Smoski, Robins)

Page 13: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Effectiveness of Mindfulness

• Biological Effects:• A study indicated the 8-week MBSR course

increased positive affect and antibodies to an influenza vaccine. (Davidson, R; Kabat-Zinn, J; Schumacher, J; Et.al; 2003).

• A study suggest that “the rate of skin clearing in patients with moderate to severe psoriasis can be accelerated when subjects engage in an audiotape-guided, meditative stress reduction exercise during their UVB or PUVA treatment sessions.” (Kabat-Zinn, J; Wheeler, E; Light, T; Et.al; p.630).

Page 14: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• You may find it hard to recognize that time is the cause of your suffering or your problems. You believe that they are caused by specific situations in your life, and seen from a conventional viewpoint, this is true. But until you have dealt with the basic problem making dysfunction of the mind- it's attachment to past and future and denial of the Now- problems are actually interchangeable. If all your problems or perceived causes of suffering or unhappiness were miraculously removed for you today, but you had not become more present, more conscious, you would soon find yourself with a similar set of problems or causes of suffering, like a shadow that follows you wherever you go. Ultimately, there is only one problem: the time bound mind itself. Eckhart Tolle- the Power of Now, pgs. 50-51.

Page 15: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness

• The video, which can be accessed at the link below, is an interview Anderson Cooper conducted with Jon Kabat-Zinn.

• http://www.cbsnews.com/news/mindfulness-anderson-cooper-60-minutes/

Page 16: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Introduction to the Third Wave of Cognitive Behavioral

Therapy

Page 17: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

The Evolution of Therapy

Page 18: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies related to earlier therapies

• “Early classical psychoanalytic mindfulness-like concepts are visible in Freud’s use of nonlinear, non evaluative, moment-to-moment processing via ‘free-association’ and ‘evenly hovering attention’ and in Jung’s Eastern-influenced synthetic-dialectical union of opposites” (Sisti, M; p. 98).

Page 19: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies Related to Earlier Therapies

• “Beginning in the 1960s, interest in the use of meditative techniques in psychotherapy began to grow among clinicians, especially psychoanalysts.” (Keng, Smoski, Robins)

• In 1960, Eric Fromm (a famous Neo-Freudian) collaborated with Zen master D.T. Suzuki to discuss the parallels between Buddhism and Psychoanalysis.

Page 20: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies related to earlier therapies

• “[T]he goals of psychoanalytic psychotherapy have moved away from insight and expression of unconscious fantasy to the attainment of enhanced awareness of one’s complete range of thoughts, emotions, and memories.” (Gold, G; p.26).

Page 21: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies Related to Earlier Therapies

• “The analyst experienced in mindfulness practice will notice the patients tendency to not be in the present moment, to not respond directly to experience but to react to it from within the distortion of one preconception or another, to be oblivious to bodily experience, to relentlessly judge himself and others, to refuse to accept unavoidable adversity, and to struggle against the reality of impermanence.” (Fayne, M; p. 50)

Page 22: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies Related to Earlier Therapies

• “Free association in psychoanalysis asks the patient to attend to all aspects of his or her psychic world as they flow by the window of his or her observing mind. Cognitive behavioral therapists instruct patients to look for and stay with those thoughts and images upon which they might ordinarily be less inclined to dwell. Person-centered and other experiential therapies are based on unguided, honest examination of the patient’s moment-to-moment experience.” (Gold, J; p.24)

Page 23: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies Related to Earlier Therapies

• As mentioned, cognitive therapy requires aspects of mindfulness, without, early on, calling it such. A client is asked to monitor thinking, to step back to a more objective perspective (non-judgmentally observe thoughts) and then to determine if his perspective is distorted. He is then asked to replace the thoughts with more realistic ones.

Page 24: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Traits of Third Wave Therapies Related to Earlier Therapies

• Behavioral therapy is based on contingencies. One of the rewards of mindfulness and acting consciously is a feeling of empowerment.

• Clients realize they have been acting out of operant conditioning, and can reorganize contingencies to alter their behavior. Mindfulness and acting in line with morals / values becomes more rewarding.

• Healthier behavior ensues.

Page 25: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Third Wave Modalities

Page 26: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Dialectical Behavioral Therapy

Page 27: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “Dialectical Behavior Therapy is expressly designed for- and shown to be effective with- clients with serious, multiple problems.”

• (Koerner, 2012, insert)

• Marsha Linehan developed DBT in the 1990s to treat Borderline Personality Disorder. Since then it has been adapted for substance abuse and eating disorders (Kahl, K; Winter, L; Schweiger, U; 2012).

Page 28: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• The treatment includes five essential functions:• improving patient motivation to change,• enhancing patient capabilities,• generalizing new behaviors,• structuring the environment, and• enhancing therapist capability and motivation.

• ” (Dimeff, L; Linehan, M; 2008)

Page 29: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• Linehan described the core problem of BPD as pervasive emotional dysregulation.• This emotional dysregulation came from two

sources.• Vulnerable biology• High sensitivity

• High reactivity

• Slow return to baseline

• Invalidating social environment• “Caregivers consistently and persistently fail to respond

appropriately to primary emotion and its expression.”( p.6)• (Koerner, p. 5&6)

Page 30: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• These vulnerabilities lead to secondary behavioral patterns.• Emotion vulnerability and self-invalidation• Active passivity and apparent competence• This can be daunting because the client will

appear to be able to handle issues, when she is not, and then falls apart at other times.

• Unrelenting crisis and inhibited grief• Inhibited grief refers to the avoidance of all

negative feeling.• (Koerner, p.9-12)

Page 31: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBTSkills

Core Mindfulness• Taking Hold of Your Mind

• Reasonable mind

• Logical analysis

• Emotion mind

• Emotional experience

• Wise mind

• Adds intuitive knowledge to reason & emotion

• “What” Skills• Observe

• Describe

• Participate

• “How” Skills• Nonjudgmentally

• One-mindfully

• effectively

Distress Tolerance & Acceptance

• Crisis Survival• TIP your body chemistry

• Temperature (face)

• Intensely exercise

• Progressively relax your muscles

• Distract with wise mind (ACCEPTS)

• Activities

• Contributing

• Comparisons

• Emotions (opposite)

• Pushing away

• Thoughts

• SensationsKoerner p.21

Page 32: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBTSkills

Distress Tolerance & Acceptance

(Cont.)• Self-soothe (with

senses)

• IMPROVE the moment• Imaging

• Meaning

• Prayer

• Relaxation

• One thing at a time

• Vacation

• Encouragement

Distress Tolerance & Acceptance

(Cont.)• Pros & Cons

• Accepting reality

• Willingness

• Turning your mind

• Radical Acceptance

• Mindfulness of current thoughts

Koerner p.21

Page 33: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBTSkills

• Changing the emotional responses• Check the facts

• Opposite action (to the emotion)

• Problem solving

• Reduce vulnerability (ABC PLEASE)• Accumulate positives

• Build mastery

• Cope ahead of time

• PhysicaL illness (treat)

• Eating (Balanced)

• Avoid drugs

• Sleep (Balanced)

• Exercise

• Emotion Regulation

Koerner p.21

Page 34: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBTSkills

• Objective Effectiveness (DEARMAN)• Describe

• Express

• Assert

• Reinforce

• Mindfully

• Appear confident

• Negotiate

• Relationship Effectiveness (GIVE)• Gentle

• Interested

• Validate

• Easy mannered

• Self-Respect (FAST)• Fair

• Avoid apologies

• Stick to values

• Truthful

• Interpersonal effectiveness

Koerner p.21

Page 35: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• Radical Acceptance• “Linehan encourages clinicians to introduce

this skill by telling clients that although pain is a part of life, we suffer only when we refuse to accept that pain. By not accepting reality in a situation that is particularly upsetting or painful, we suffer. Thus, we must radically accept reality, even when it is difficult.”

• (Hollenbaugh, K; 2013)

Page 36: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• Radical Acceptance• “Acceptance doesn’t, by any stretch of the

imagination, mean passive resignation. Quite the opposite. It takes a huge amount of fortitude and motivation to accept what is- especially when you don’t like it-and then work wisely and effectively as best you possibly can with the circumstances you find yourself in and with the resources at your disposal, both inner and outer, to mitigate, heal, redirect, and change what can be changed.” (Kabat-Zinn, p.407)

Page 37: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• Behavioral Chain Analysis• Define the problem behavior• Identify vulnerabilities and precipitating factors.• Identify links between precipitating event and

the problem behavior.• Create a detailed account of thoughts, feelings,

and action that led from one state to the other.

• Identify the consequences of the problem behavior.

• (Koerner, p.42)

Page 38: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• The Target Hierarchy identifies priorities:• Suicidal behavior• Self-injurious behavior & violence

• Emotional dysregulation & invalidation as antecedents to the above are identified.

• Identify which factor lead to these responses:• Skills deficits• Problematic conditioned emotional responses• Contingencies• Cognitive processes (faulty beliefs or assumptions)

• (Koerner, p.47)

Page 39: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “The word dialectic refers to the synthesis of two opposites.” (Dimeff, L; Linehan, M; 2008). An example of this is the idea the clinician accepts the client as she is, but also attempts to motivate the client to change.

• Orienting (linking treatment strategies to the client’s goals) is very important in DBT.

• (Koerner, p.26)

Page 40: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “DBT’s substance-abuse–specific behavioral targets include:• decreasing abuse of substances, including illicit drugs and

legally prescribed drugs taken in a manner not prescribed;• alleviating physical discomfort associated with abstinence

and/or withdrawal;• diminishing urges, cravings, and temptations to abuse;• avoiding opportunities and cues to abuse, for example by

burning bridges to persons, places, and things associated with drug abuse and by destroying the telephone numbers of drug contacts, getting a new telephone number, and throwing away drug paraphernalia;”

• (Dimeff, L; Linehan, M; 2008)

Page 41: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “DBT’s substance-abuse–specific behavioral targets include:• reducing behaviors conducive to drug abuse, such as

momentarily giving up the goal to get off drugs and instead functioning as if the use of drugs cannot be avoided; and

• increasing community reinforcement of healthy behaviors, such as fostering the development of new friends, rekindling old friendships, pursuing social/vocational activities, and seeking environments that support abstinence and punish behaviors related to drug abuse.”

• (Dimeff, L; Linehan, M; 2008)

Page 42: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “Rather than punishing patients for the very problems that brought them into treatment, DBT assumes that patients are doing the best they can and must continue working to achieve their goals.”

• (Dimeff, L; Linehan, M; 2008)

Page 43: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• “In DBT, the counselor determines the scope of abstinence appropriate for each patient based on a thorough assessment and three ruling principles:• Target the primary drug(s) of abuse—that is, those that are

causing the most significant problems for the patient, as determined by the patient’s history of abuse, and diagnostic and behavioral assessments.

• Target other drugs that appear to reliably precipitate use of the primary drug of abuse—for example, some patients may not use marijuana frequently but may end up injecting their primary drug of abuse, heroin, every time they do.

• Make sure that the treatment goals are, in fact, attainable.”

• (Dimeff, L; Linehan, M; 2008)

Page 44: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

DBT

• The therapist and the client “discuss the likelihood that the patient may fall out of contact with the therapist during the course of treatment. A “just in case” plan is established: The patient makes a list of all the places the therapist might look, should the patient become lost (e.g., addresses and telephone numbers for drug-abusing friends, places where the patient goes to abuse drugs), as well as supportive family and friends who can be counted on to help the therapist and patient in this event. Other strategies include increasing contact with the patient during the first several months of treatment (e.g., scheduling check-in telephone calls between sessions, exchanging voice mail or e-mail messages); bringing therapy to the patient—that is, conducting sessions at his or her home, in a park, in a car, or at a diner; and shortening or lengthening therapy sessions.”

• (Dimeff, L; Linehan, M; 2008)

Page 45: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Acceptance and Commitment Training

Page 46: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

ACT

• “Acceptance and Commitment Therapy (ACT) is a contextually focused form of cognitive behavioral psychotherapy that uses mindfulness and behavioral activation to increase clients' psychological flexibility--their ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations.”

• http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=191

Page 47: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

ACT

• “ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress).”

• http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=191

Page 48: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

ACT

• “ACT establishes psychological flexibility by focusing on six core processes: • Acceptance of private experiences (i.e., willingness to

experience odd or uncomfortable thoughts, feelings, or physical sensations in the service of response flexibility)

• Cognitive diffusion or emotional separation/distancing (i.e., observing one's own uncomfortable thoughts without automatically taking them literally or attaching any particular value to them)”

• http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=191

Page 49: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

ACT

• “ACT establishes psychological flexibility by focusing on six core processes: • Being present (i.e., being able to direct attention

flexibly and voluntarily to present external and internal events rather than automatically focusing on the past or future)

• A perspective-taking sense of self (i.e., being in touch with a sense of ongoing awareness)

• Identification of values that are personally important• Commitment to action for achieving the personal

values identified”• http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=

191

Page 50: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Mindfulness-Based Cognitive Therapy

Page 51: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

MBCT

• “Mindfulness-based cognitive therapy (MBCT) arose from experiences in the application of Buddhist meditation techniques in medicine. It was specifically developed to reduce the number of relapses in patients with major depression. MBCT uses psychoeducation and encourages the patients to practice mindfulness meditation. A core goal is to develop metacognitive awareness, which is the ability to experience cognitions and emotions as mental events that pass through the mind and may or may not be related to external reality. The focus is not to change 'dysfunctional' thoughts but to learn to experience them as internal events separated from the self.”• Kahl, K; Winter, L; Schweiger, U; 2012

Page 52: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Applying Strategies to Addictive Behaviors

Page 53: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

My Approach

Page 54: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Philosophy

• The “helper” accepts the following philosophy, and educates the client through the course of therapy:

• It begins with evolution.• Our minds are preset to the goals of survival• Hypersensitive to perceived threats• Negative bias, perceiving world as more dangerous than it

actually is.

• Seeking procreation• Hence sex being a major part of psychological theory.

• (Sex Affects your Thinking, and You Don't Seem to Care)

• Being accepted to the in-group• Can lead to fear of not pairing and dying alone.

Page 55: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Philosophy

• Conditioning beginning in infancy and childhood, and continuing throughout adulthood (including right now) contribute to the perceptions of reality.• This leads to behaving unconsciously much of

the time.• (Unconsciously Rushing to be Unconscious found

in Thoughts on Existence)

• We are then burdened with defense mechanisms (for reasons previously stated as well as major psychological philosophies).

Page 56: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Philosophy

• Defense mechanisms make perceiving the world accurately nearly impossible.• Included here is some quantum physics, which

demonstrate our perceptions are incomplete at best.

• All things considered, we can assume our perceptions are inaccurate.

• (Why Don’t You Want To Feel Better) (How Psychology Can Help And Hinder Enlightenment)

(“The Truth Won’t Set You Free”, “Your Dream World”; found in Thoughts on Existence)

Page 57: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Philosophy

• We come to believe our distorted reality, and accept the stories we have been taught and believe about ourselves and the world we inhabit.• We buy into our identity (as an addict, as

unlovable, as inherently flawed, etc.).

• We enter therapy with an issue we wish to overcome.

Page 58: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy Begins

• The therapist approaches the client in a humanistic fashion• Unconditional positive regard

• (“Were The Hippies Right?” found in Thoughts on Existence)

• Existential• The client believes his “truth”, which is a story he

has about reality.• (“The Truth Will Not Set You Free” found in

Thoughts on Existence)

• The client defines his/ her goals.

Page 59: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy Begins

• The therapist approaches the client in a humanistic fashion (cont.)• The therapist offers hope, that the client can

overcome the presenting (and any additional) problems.

• Texting, emailing of articles, are all used between sessions to keep therapy goals fresh in client’s awareness, as well as demonstrate the therapist cares.

• The therapist joins with the client, understanding the client at the deepest possible level.• Empathy• Compassion

Page 60: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy Begins

• When the client can tolerate it, and in small doses, alternative explanations can be explored regarding the issue at hand.• Reframing• Some cognitive challenging.

• If the past is important to the client, it is explored. But a Positive Psychology approach is dominant: what works in the now is more important than the cause.

Page 61: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• The client is educated about the philosophy. • Evolution and Neuroscience

• The client is educated about conditioning, and how unconscious they actually are.

• Ideas about who they want to be are explored.• Values• Ideal self• Legacy

• The client is encouraged to identify her purpose(s) in life.

• (Your Purpose in Life, found in Thoughts on Existence)

Page 62: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• Mindfulness practice is introduced.• The client learns the ability to calm through

breathing.• And it’s reverse, how to raise attention / focus

through breathing.

• The client learns how to become the observer.• The client learns to clear the mind.• There is only the now. No past. No future.

• Homework should include meditation practice, exercise.

Page 63: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• The client is educated about the ability to choose who they are through his or her actions. • The client gets assignments having to do with making

mindful choices, i.e. delaying urges• This is especially important in addiction treatment, and

should be expanded to many urges (speaking, eating a certain thing, etc.).

• (You and the Manifesting of Reality)

• Discussion centers on making value choices.

• Some focus on how it feels to be honestly making choices, to delaying urges, etc.• This reinforces the behavior.

Page 64: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• The client is educated about mindfulness and meditation leading to rewiring neurological aspects of the brain• “What fires together, wires together.”

• Thought Stopping• Clients learn and practice thought stopping, where

they can stop their thinking, breath, and move away from the disturbing ruminating thoughts.• Sometimes distraction is used, where clients engage

in another activity to lessen the power of their thoughts.

Page 65: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• The ultimate cognitive challenge:• Everything is a lie you are telling yourself.• You don’t have to believe what you think, feel, even

perceive.• It is all absurd• It isn’t going to matter (if it even really did).• What you are telling yourself is bullshit.

• (“You’re Unimportant, But it Doesn’t Mean You Can’t Be Happy”) (The Big Lie)

(The Truth Will Not Set You Free found in Thoughts on Existence)

• Come back to the breath. Be in the Now.

Page 66: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• Continue challenging the client’s perceived (and assumed dysfunctional) reality, both in their reality (personalizing, magnifying and exaggeration, etc.) and with the big challenge.

• Continue evaluating how the client is progressing towards who they want to be (value choices, etcetera).

• Work towards acceptance of reality that cannot be changed, and empowerment toward what can be.

• (Acceptance: It’s Not What You Think)

• The client becomes more and more conscious.

Page 67: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

Therapy

• The ultimate goal is enlightenment, the ability to see the illusion of a reality we need to function in.

• The client can use mindfulness to experience great control, and further, to experience the serenity and euphoria of the moment.• “My thinking mind is a perfect servant and a

lousy master.” Ram Dass • Making the mind a servant rather than master

feels empowering. Allowing this feeling to resonate and being with it, wires positive feeling.

Page 68: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

End with Meditation

• The video, which can be accessed below, is a meditation that closed the seminar.

• https://www.youtube.com/watch?v=92i5m3tV5XY

Page 69: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• Berry, W; Ramnath, R; 2013; Addiction: A Human Experience; Cognella Publishing

• Berry, W; The Second Noble Truth; Monthly Blog Post on Psychology Today. Includes “Sex Affects your thinking, and you don't seem to care”, “Why Don’t You Want To Feel Better?”, “You and the Manifesting of Reality”, “You’re Unimportant, But it Doesn’t Mean You Can’t Be Happy” & “Acceptance: It’s Not What You Think”

• Berry, W; 2013; Thoughts on Existence; Self Published through Amazon Publishing

Page 70: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• CBS News; 60 Minutes; 2014; Mindfulness; Retrieved from: http://www.cbsnews.com/news/mindfulness-anderson-cooper-60-minutes/

• Fromm, E; Suzuki, D.T; De Martino, R; 1960; Zen Buddhism And Psychoanalysis; Harper & Brothers Publishing

• Fayne, M; in Stewart, J; Mindfulness, Acceptance, and the Psychodynamic Evolution; P. 37-54; New Harbinger Publications.

Page 71: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• Davidson, R; Kabat-Zinn, J; Schumacher, J; Et.al; 2003; Alterations in Brain and Immune Function Produced by Mindfulness Meditation; Psychosomatic Medicine 65:564–570; Retrieved from: http://puredhamma.net/wp-content/uploads/Alterations-in-Brain..by-Mindful-Meditation-Davidson-2003.pdf

• Dimeff, L; Linehan, M; 2008; Dialectical Behavior Therapy for Substance Abusers; Addict Sci Clin Pract. 2008 Jun; 4(2): 39–47. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/

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References

• Gold, J; 2014; in Stewart, J; Mindfulness, Acceptance, and the Psychodynamic Evolution; P. 19-34; New Harbinger Publications.

• Hollenbaugh, K; 2013; DBT: An introduction and application with adolescents. Counseling Today, 55, 9 (pp. 69-71).

• Kabat-Zinn, J; Wheeler, E; Light, T; Et.al;1998 Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients With Moderate to Severe Psoriasis Undergoing Phototherapy (UVB) and Photochemotherapy (PUVA); Psychosomatic Medicine 60:625-632.

Page 73: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• Kabat-Zinn, J; 2005; Coming to Our Senses: Healing Ourselves and the World Through Mindfulness; Hyperion Publishers, New York, N.Y.

• Kahl, K; Winter, L; Schweiger, U; 2012; The Third Wave of Cognitive Behavioural Therapies: What Is New and What Is Effective?; Curr Opin Psychiatry. 25(6):522-52 retrieved from: http://www.medscape.com/viewarticle/772441

• Keng, S; Smoski, M; Robins, C; 2011; Effects of mindfulness on psychological health: A review of empirical studies; Clinical Psychology Review; Volume 31, Issue 6, August 2011, P.1041-1056; Retrieved from: http://www.sciencedirect.com/science/article/pii/S027273581100081X

Page 74: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• Koerner, K; 2012; Doing Dialectical Behavior Therapy: A practical Guide; The Guilford Press.

• Puddicombe, A; 2012; TED Talk: All it takes is 10 mindful minutes; Retrieved from: https://www.ted.com/talks/andy_puddicombe_all_it_takes_is_10_mindful_minutes?language=en

• Sisti, M; 2014; in Stewart, J; Mindfulness, Acceptance, and the Psychodynamic Evolution, P. 91-110; New Harbinger Publications.

Page 75: Cognitive, Behavioral, & Mindfulness Based Therapies for Addictions & Compulsive Disorders William Berry, LMHC., CAP

References

• Tolle, E; 2004; The Power of Now; Namaste Publishing

• Wikipedia; 2013; Retrieved from https://en.wikipedia.org/wiki/Flow_(psychology) on July 2nd, 2015.