Natural Highs: The Cutting Natural Highs: The Cutting Edge of Mood AlterationEdge of Mood Alteration

The Cognitive-BehavioralThe Cognitive-Behavioral

RevolutionRevolution

Zest for life is Zest for life is a virtuea virtue

• Compulsive pleasure-seeking can produce Compulsive pleasure-seeking can produce hardship & despair if not controlled.hardship & despair if not controlled.

• Cognitive-behavioral revolution means Cognitive-behavioral revolution means humans are expected to take charge of humans are expected to take charge of emotions/actions by managing emotions/actions by managing dysfunctional thoughtdysfunctional thought

• Cognitive-behavioral restructuring (CBR) Cognitive-behavioral restructuring (CBR) can improve quality of life by offering can improve quality of life by offering control of how we interpret events & control of how we interpret events & respondrespond

The greatest weapon against The greatest weapon against stress is our ability to choose stress is our ability to choose

one thought over another- one thought over another- William William JamesJames

• Acceptance and commitment therapy Acceptance and commitment therapy (ACT)(ACT)• uses uses acceptance and and mindfulness strategies together strategies together

with commitment and behavior change strategies to with commitment and behavior change strategies to increase psychological flexibility increase psychological flexibility

• ACT teaches them to "just notice", accept, and ACT teaches them to "just notice", accept, and embrace their private events, especially previously embrace their private events, especially previously unwanted ones unwanted ones

• Dialectical behavioral therapy (DBT)Dialectical behavioral therapy (DBT)• techniques for emotion regulation and reality-testing techniques for emotion regulation and reality-testing

with concepts of with concepts of mindful awareness, distress , distress tolerance, and acceptance tolerance, and acceptance

• goal is to become capable of calmly recognizing goal is to become capable of calmly recognizing negative situations and their impact, rather than negative situations and their impact, rather than

becoming overwhelmed or hiding from thembecoming overwhelmed or hiding from them

Mindfulness techniques allow Mindfulness techniques allow one to observe events without one to observe events without

judgment or reactivityjudgment or reactivity• What to do skillsWhat to do skills in mindfulness: in mindfulness:

• Observing, noticing the presentObserving, noticing the present• Verbally describing what is experiencedVerbally describing what is experienced• Taking part & letting goTaking part & letting go

• How to do skillsHow to do skills in mindfulness: in mindfulness:• Not being evaluative of the thoughts or experiencesNot being evaluative of the thoughts or experiences• Focusing on the present momentFocusing on the present moment

• Radical Radical acceptanceacceptance of things as they are of things as they are• Engaging in actions congruent with one’s goals & Engaging in actions congruent with one’s goals &

valuesvalues

Radical Acceptance- Radical Acceptance- The Serenity PrayerThe Serenity Prayer

• Exercise: Floating Leaves Exercise: Floating Leaves on a Moving Stream on a Moving Stream

The Cognitive-Behavioral The Cognitive-Behavioral ModelModel

• We are what we think- BuddhaWe are what we think- Buddha• Men are not disturbed by things which Men are not disturbed by things which

happen but by their opinions about happen but by their opinions about things- Epictetusthings- Epictetus

• Our life is what our thoughts make it- Our life is what our thoughts make it- Marcus AureliusMarcus Aurelius

• The greatest discovery of my generation The greatest discovery of my generation is that a man can alter his life simply by is that a man can alter his life simply by altering his attitude of mind- William altering his attitude of mind- William JamesJames

• I am convinced that a person’s behavior I am convinced that a person’s behavior springs from his ideas- Alfred Adlersprings from his ideas- Alfred Adler

Ellis developed rational Ellis developed rational emotive therapy (RET)emotive therapy (RET)

• Ellis wanted a more efficient mode Ellis wanted a more efficient mode of behavior change than of behavior change than psychoanalytic therapy.psychoanalytic therapy.

• He realized he saw the error of He realized he saw the error of clients’ thinking long before they did clients’ thinking long before they did & they could benefit from seeing the & they could benefit from seeing the rational errors they were making rational errors they were making that caused them painthat caused them pain

• REBT evolved to help clients dispute REBT evolved to help clients dispute their irrational belief patternstheir irrational belief patterns

Primary themes of REBTPrimary themes of REBT

• Rational vs. irrational beliefsRational vs. irrational beliefs• Rational beliefs help people get what Rational beliefs help people get what

they want; irrational beliefs interfere they want; irrational beliefs interfere because they are inflexible & self-because they are inflexible & self-condemning (shoulds & musts)condemning (shoulds & musts)

• ABC- Activating event produces ABC- Activating event produces beliefs which result in consequencesbeliefs which result in consequences• C can be changed by changing B C can be changed by changing B

whether A changes or notwhether A changes or not

Beck- Cognitive therapy Beck- Cognitive therapy for depression for depression

• Depression/anxiety are caused by Depression/anxiety are caused by faulty thinking- stinkin’ thinkin’faulty thinking- stinkin’ thinkin’

• Negative cognitive triad: negative Negative cognitive triad: negative thoughts about self, world & future thoughts about self, world & future

• Automatic thoughts, expectations, Automatic thoughts, expectations, appraisals & attributions are not helpfulappraisals & attributions are not helpful

• Therapy teaches client to recognize Therapy teaches client to recognize cognitive errors by seeing schemas that cognitive errors by seeing schemas that guide automatic thinkingguide automatic thinking• Maladaptive schemas (diathesis) may be Maladaptive schemas (diathesis) may be

dormant until a stressor activates core dormant until a stressor activates core beliefsbeliefs

How do people know they are How do people know they are reacting to automatic reacting to automatic

thoughts?thoughts?• Strong emotions accompany these thoughtsStrong emotions accompany these thoughts• In emotionally charged situations, there is a In emotionally charged situations, there is a

breakdown of logic & civilitybreakdown of logic & civility• Under stress, deep-seated beliefs erupt to Under stress, deep-seated beliefs erupt to

drive thinking & behaviordrive thinking & behavior• Mel Gibson’s anti-Semitic tirade upon being arrested Mel Gibson’s anti-Semitic tirade upon being arrested

for drunk-drivingfor drunk-driving• ““The Jews are responsible for all the wars The Jews are responsible for all the wars

in the world. Are you a Jew?!” in the world. Are you a Jew?!” • Particularly interesting in the light of Particularly interesting in the light of

criticism of his film, The Passion of the criticism of his film, The Passion of the Christ as anti-SemiticChrist as anti-Semitic

• Automatic thinking is subject to Automatic thinking is subject to distortion of logic & overreactiondistortion of logic & overreaction

• Mindfulness training can derail this patternMindfulness training can derail this pattern

Groups of SchemasGroups of Schemas

• Simple schemasSimple schemas• Rules of general behavior, physical nature Rules of general behavior, physical nature

of the environment- get a good educationof the environment- get a good education• Intermediary beliefs & assumptionsIntermediary beliefs & assumptions

• Conditional beliefs- if-then statements Conditional beliefs- if-then statements that affect self esteem- I must be that affect self esteem- I must be pleasing/ attractive to others all the timepleasing/ attractive to others all the time

• Core beliefs about the selfCore beliefs about the self• Global rules for interpreting feedback Global rules for interpreting feedback

regarding the self- I’m stupid, unlovable, regarding the self- I’m stupid, unlovable, better than others, can’t trust others…better than others, can’t trust others…

Stress may activate Stress may activate dysfunctional core beliefs that dysfunctional core beliefs that produce automatic thoughtsproduce automatic thoughts

Cognitive therapies reacted to narrow Cognitive therapies reacted to narrow behavioral theories that denied internal behavioral theories that denied internal

thoughts affected behaviorsthoughts affected behaviors

• Bandura’s Social Learning ModelBandura’s Social Learning Model

• Reciprocal determinismReciprocal determinism• Modeling effects on aggression- Bobo dollModeling effects on aggression- Bobo doll• Vicarious reinforcementVicarious reinforcement

• Meichenbaum’s Stress Inoculation ModelMeichenbaum’s Stress Inoculation Model

• Self-talk & private speech can regulate Self-talk & private speech can regulate behavior & can be taught- behavior & can be taught-

• Stress inoculation:Stress inoculation:• Educational phase/ modeling & rehearsing Educational phase/ modeling & rehearsing

new skills/ practicing in the environment new skills/ practicing in the environment

These techniques can aid These techniques can aid addicts in remaining soberaddicts in remaining sober

• Self-reinforcement is the combination of Self-reinforcement is the combination of cognitive & behavioral approaches:cognitive & behavioral approaches:

• Bandura- social learningBandura- social learning• Meichenbaum- internal dialogueMeichenbaum- internal dialogue• Beck- cognitive errorsBeck- cognitive errors

• The other part is learning to recognize high-The other part is learning to recognize high-risk situations & develop strategies to deal risk situations & develop strategies to deal with stressorswith stressors

• As the client chooses positive behaviors/ As the client chooses positive behaviors/ thoughts there is reinforcement for ongoing thoughts there is reinforcement for ongoing positive thought processes (the opposite is positive thought processes (the opposite is true also)true also)

The greatest weapon against The greatest weapon against stress is our ability to choose stress is our ability to choose

one thought over another- one thought over another- William JamesWilliam James

• We are never We are never

at the mercy at the mercy

of our thoughtsof our thoughts• We can always We can always

think differently think differently

How can CBT reduce How can CBT reduce relapse?relapse?

• Helping the client recognize the thoughts s/he Helping the client recognize the thoughts s/he is generating that produces anxiety/ is generating that produces anxiety/ helplessness is the first stephelplessness is the first step• I’m worthless. Life isn’t fair. I’ll never I’m worthless. Life isn’t fair. I’ll never

overcome this…overcome this…• Tx helps the client to challenge polarized belief Tx helps the client to challenge polarized belief

structures that box in thinkingstructures that box in thinking• It’s all my fault. My dad was right about me. It’s all my fault. My dad was right about me.

I may as well drink, what difference does it I may as well drink, what difference does it make? I’ll never get another good job, make? I’ll never get another good job, lover…lover…

• Alternative ways of appraising aAlternative ways of appraising a situation can situation can be generated & practicedbe generated & practiced

• Our choice ofOur choice of

thinking producesthinking produces

outcomes that outcomes that

are reinforcedare reinforced• No one determines No one determines

our thinking except our thinking except

our selvesour selves

CBT similarities with CBT similarities with BuddhismBuddhism

• Both approaches use the mind to heal the mindBoth approaches use the mind to heal the mind• They share goals of serenity, peace of mind, They share goals of serenity, peace of mind,

relief of sufferingrelief of suffering• They share common values- acceptance, They share common values- acceptance,

compassion, knowledge, understanding, altruism compassion, knowledge, understanding, altruism & universalism (as opposed to groupism)& universalism (as opposed to groupism)

• Buddhism focuses on positive thought to Buddhism focuses on positive thought to neutralize negativityneutralize negativity

• CT focuses on thinking errorsCT focuses on thinking errors• Both focus on the present, using imagery, Both focus on the present, using imagery,

exercises, perspective takingexercises, perspective taking

Automatic thoughts Automatic thoughts exerciseexercise

• Draw 3 columns on a sheet of paper- label Draw 3 columns on a sheet of paper- label them Event/ Thoughts/ Emotionsthem Event/ Thoughts/ Emotions

• Recall a recent situation/memory that stirred Recall a recent situation/memory that stirred up strong emotionsup strong emotions

• Try to imagine being back in the situation, just Try to imagine being back in the situation, just as it happenedas it happened

• What automatic thoughts were occurring in What automatic thoughts were occurring in this situation? Write down the event, the this situation? Write down the event, the thoughts, & the emotions in each columnthoughts, & the emotions in each column

• Try to identify the underlying beliefs that Try to identify the underlying beliefs that energized these thoughtsenergized these thoughts

• What kind of errors in logic might you be What kind of errors in logic might you be using?using?

• What alternative cognitive process can you What alternative cognitive process can you use to alter your emotional states?use to alter your emotional states?