Contextual Cognitive Behavioral Therapy

Mindfulness & Acceptance of Addictive Behaviors
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
Host: Counselor Toolbox Podcast

CEUs are available for this presentation at AllCEUs https://allceus.com/member/cart/index/product/id/1001/c/

Objectives
~ Define and review the concepts of contextual cognitive behavioral therapy
~ Explore the impact of context on people’s phenomenological reality
~ Explore how addiction and mental health issues can be influenced by context
~ Explore how acceptance, awareness, mindfulness and psychological flexibility can be used transdiagnostically.

Why Contextual
~ Addiction and mental health issues are often intergenerational
~ Addiction and Mental Health issues are strongly correlated with:
~ Each other
~ Adverse childhood experiences (history of and children with)
~ Impaired occupational and social functioning
~ Health problems
Contextual Approaches
~ Encourage mindfulness in the present moment
~ Accept each person’s “truth” is constructed from their schema and the resulting interpretation of the current moment
~ The goal is to consider the context and function of the past and present issue and empower the person to make a conscious choice toward their valued goals
~ Remember that the prefix RE means to do again
~ REpeat
~ REdo
~ REgress
~ RElapse
~ REaction

Childhood Context and Development
~ The family context can be a preventative or risk factor for the development of issues
~ Children develop schema about themselves, others and the world through these early interactions
~ In later life people continue to develop schema influenced by their past learning.

Caregiver Requirements for Secure Attachment and Healthy Development
~ Consistent Age-Appropriate Responsiveness
~ Trust
~ Autonomy
~ Industry
~ Identity
~ Empathy
~ Compassion
~ Effective Communication Skills
~ Unconditional Love

Think About It
~ What is it like for a child growing up in a house in which one or both parents has:
~ An addiction
~ A mental health issue
Common Addicted Characteristics
~ Difficulty dealing with life on life’s terms
~ Difficulty dealing with distress (poor coping)
~ Impulsivity / lack of patience and distress tolerance
~ Neglectfulness
~ Hostility
~ Defensiveness
~ Blaming
~ Manipulation
~ Withdrawal
~ From others/disconnected
~ No pleasure in other activities
~ Justification/minimization/denial
~ Low self-esteem
~ Guilt and shame

Common Characteristics in People with Mental Health Issues
~ Difficulty dealing with life on life’s terms
~ Difficulty dealing with distress (poor coping)
~ Impulsivity / lack of patience and distress tolerance
~ Neglectfulness
~ Hostility
~ Irritability

~ Withdrawal
~ From others/disconnected
~ Apathy
~ Low self-esteem
~ Guilt and shame
~ Fatigue
~ Sense of hopelessness or helplessness

The End Product
~ People’s REactions to things are based on prior learning + present moment.
~ Bridges
~ Stress
~ Depression
~ Self-esteem

Core Concepts in Contextual CBT
Mindfulness
~ Improves people’s ability to be present in the present
~ Shift from automatically reacting to thoughts and feelings based on schema to being aware of ALL experiences in the present to provide more flexibility

Encouraging Acceptance of Internal Experiences
~ Accepting thoughts, feelings, sensations without having to act on them
~ Radical Acceptance
~ Unhooking
~ Dialectics
~ I can be a good person AND be divorced
~ I can be happy AND grieving
~ I can stay sober AND be stressed
Acceptance of Internal Experiences
~ Accepting thoughts, feelings, sensations without having to act on them
~ Distress Tolerance
~ ACCEPTS
~ Activities
~ Contributing
~ Comparisons
~ Emotions (opposite)
~ Push Away
~ Thoughts
~ Sensations
Focus on Adding vs. Eliminating
~ Help the person define a rich and meaningful life and make choices based on that vs. eliminating a problem
~ Depression
~ What do we do to eliminate depression?
~ What are we left with when we eliminate depression?
~ How do you prove the absence of depression?
~ Addiction
~ What do we do to eliminate addiction?
~ What are we left with when we eliminate addiction?
~ How do you prove the absence of addiction?
~ Accepting feelings thoughts and reactions and changing your relationship with them

Creating a Rich and Meaningful Life
~ Increasing Awareness
~ For each of the following areas identify which are important in your RML and what that looks like now and what you want it to look like

Changing Your Relationship
~ Radically accept feelings, thoughts and urges
~ Think of them like road signs
~ You can take them under advisement and decide what to do.
~ Speed limit/Anger
~ Construction/Giving up
~ No passing/Addiction
~ Rest stop/Depression
Motivational Enhancement (Functional)
~ Understanding motivation for change as well as no change in the context of the person’s RML in order to motivate purposeful action

Use a Broad Functional Approach
~ Transdiagnostic
~ Common mechanisms underlying an array of difficulties: Depression, Low Self-Esteem, Addiction
~ Shoulds and Shouldn’ts (Acceptance)
~ I should feel
~ I shouldn’t think
~ I should be
~ Lack of Awareness of Needs/Wants (Mindfulness)
~ Vulnerabilities
~ Autopilot or Rigid Thinking (Psychological Flexibility)
~ A willingness to accept all aspects of ones experience without unnecessary avoidance—Emotional, Cognitive, Behavioral, Physical
~ The ability to ponder multiple possible actions and thoughts and consciously choose
Difficulties with Self-Processes
~ Difficulty with self esteem or self efficacy may cause or maintain problems
~ Self-as-content – Narrative about one’s self and attributes
~ Being overly attached to the conceptualized self can prohibit flexibility
~ Ex. Being a good worker in a bad job
~ Ex. Being a good daughter but getting a divorce

Addressing Self as Content
~ Who do you want to be?
~ Explain why each of those is important?
~ In what ways does the current situation prevent you from being who you want to be?
~ What areas in your life are going as you want them to? (addressing global attributions)
~ Are there other ways to achieve or conceptualize the same end?
~ Examples
~ A size 3 (attractive/lovable)
~ A doctor (successful)
~ Not divorced (not a failure)
~ Loyal/dependable (not a quitter)

Difficulties with Self-Processes cont…
~ Difficulty with self esteem or self efficacy may cause or maintain problems
~ Self-as-process
~ Awareness of internal experience
~ Many people have difficulty attending to their internal experience in a flexible way
~ Handling urges, feelings
~ Identifying thoughts, feelings, urges, sensations etc.
Addressing Self-As-Process
~ Mindfulness journals/logs
~ Meditation to increase awareness
~ CBT Exposure-Noticing / In-Vivo Logs
~ Anger
~ Fear
~ Craving
~ Relapse prevention plans to handle internal processes
~ Make a committed action worksheet for each thing that is important to you.

Difficulties with Self-Processes
~ Difficulty with self esteem or self efficacy may cause or maintain problems
~ Self-as-context
~ Adopting the perspective of the self in the past, present and future—Who you were-are-want to be
~ Ability to take the perspective of others
~ Rigid self as context—or inability to take perspective may inhibit effective problem solving.
~ I am and always will be a failure/an addict/depressed
Addressing Self-As-Context
~ Increasing Perspective
~ Looking at your definition of a RML, what does your…
~ Past self tell you about your current situation? (schema)
~ What might your future self tell you about your current situation? (Flexibility)
~ What might you tell someone else in a similar situation?
~ How do your current thoughts, feelings, behaviors help you move toward what is important to you?

Summary
~ Contextual CBT involves understanding people’s phenomenological truth
~ Problems can arise when people
~ Thinks/feels that they are not who they should be or things are not as they should be
~ Are unaware of their internal feelings, thoughts, urges
~ Are unaware of the motivation (in context) of their feelings, thoughts, urges
~ Use rigid problem solving and conceptualization without considering context or perspective
~ Contextual CBT uses awareness, mindfulness, radical acceptance and psychological flexibility activities to help people move toward a rich and meaningful life instead of trying to escape or avoid discomfort.