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More About This Title Cognitive Therapy for Addiction - Motivation andChange
English
- Offers a focus on addiction that is lacking in existing cognitive therapy accounts
- Utilizes various approaches, including mindfulness, 12-step facilitation, cognitive bias modification, motivational enhancement and goal-setting and, to combat common road blocks on the road to addiction recovery
- Uses neuroscientific findings to explain how willpower becomes compromised-and how it can be effectively utilized in the clinical arena
English
Frank Ryan is a consultant clinical psychologist in Camden and Islington NHS Foundation Trust in London, UK. An Honorary Senior Lecturer in Faculty of Medicine at Imperial College and an Honorary Research Fellow at Birkbeck, University of London, he is a practicing cognitive therapist and an active trainer, lecturer and researcher.
English
Preface xi
1 The Tenacity of Addiction 1
Introduction and Overview 1
Discovering Cognition 5
Implicit Cognition and Addiction 6
Neuropsychological Findings 9
Addictive Behaviour is Primary, Not Compensatory 11
Changing Habits is the Priority 14
Diagnostic Criteria 15
Towards Integration 15
Equivocal Findings from Research Trials 16
Time for CHANGE 16
Evolution, Not Revolution 17
Something Old, Something New 18
2 Existing Cognitive Behavioural Accounts of Addiction and Substance Misuse 21
The Evidential Basis of CBT for Addiction 23
Meta-analytic Findings 23
Behavioural Approaches 24
Diverse Treatments Mostly Deliver Equivalent Outcomes 25
What Are the Mechanisms of Change? 26
The Missing Variable? 27
A Dual-Processing Framework 28
3 Core Motivational Processes in Addiction 33
Is Addiction About Avoiding Pain or Seeking Reward? 33
How Formulation Can Go Astray 34
Incentive Theories of Addiction 35
Learning Mechanisms in Addiction 36
Distorted Motivation and Aberrant Learning: the Emergence of Compulsion 41
‘Wanting and Liking’ in the Clinic 41
The Role of Secondary Reinforcers 43
Beyond Pleasure and Pain: a Psychoanalytic Perspective 43
Conclusion 44
4 A Cognitive Approach to Understanding the Compulsive Nature of Addiction 45
Theories of Attention 46
Top-Down Influences Can Be Automatic 47
Automatic Processes Can Be Practically Limitless 48
Motivationally Relevant Cues are Prioritized 48
Biased Competition 50
Attention and Volition 51
Appetitive Cues Usually Win 52
Purposeful Behaviour Can Occur in the Absence of Consciousness 53
Attentional Bias and Craving 54
Cognitive Cycle of Preoccupation 56
5 Vulnerability Factors In Addiction 63
Individual Differences in Addiction Liability 63
Personality Traits 63
The ‘Big Five’ Personality Factors 65
Personality Disorders 66
Affective Vulnerability Factors 67
Brain-Derived Neurotrophic Factors 69
Neurocognitive Vulnerability 70
Findings from the Addiction Clinic 71
From Research to Practice 72
6 Motivation and Engagement 75
Impaired Insight and the Therapeutic Relationship 75
The Sad Case of Julia 80
Conflicted Motivation is the Key 81
Goal Setting and Maintenance 82
The Importance of Between-Session Change 83
Neurocognitive Perspectives on Motivation 83
Motivational Interviewing in Practice 84
Formulating and Planning the Intervention 88
Attributional Biases: the Blame Game 90
Case Formulation 91
Summary 97
7 Managing Impulses 99
Introduction and Overview 99
Structuring the Session 99
Building Resilience 100
Impulse Control 102
Craving and Urge Report 103
Cognitive Processing and Craving 104
Cognitive Bias Modification 105
Attentional Bias in the Context of Addiction 106
The Alcohol Attention-Control Training Programme 108
Modifying Implicit Approach Tendencies 110
Reversing the Bias: Conclusion 112
Brain Training and Neurocognitive Rehabilitation Approaches 112
Clinical Implications of Delayed Reward Discounting 117
Tried and Tested Techniques 119
The Road to Recovery is Paved with Good Implementation Intentions! 125
Neurophysiological Techniques 129
Neuropsychopharmacological Approaches 130
8 Managing Mood 135
The Reciprocal Relationship Between Mood and Addiction 135
Pre-existing Vulnerability to Emotional Distress 137
Negative Affect Due To Drug Effects 141
Stepped Care for Addiction 145
An Integrated Approach to Addressing Negative Emotion 147
9 Maintaining Change 155
Relapse Prevention Strategies from a Neurocognitive Perspective 155
The Importance of Goal Maintenance in the Long Term 158
A Neurocognitive Perspective on Relapse 159
Twelve-Step Facilitation Therapy 161
Implicit Denial 162
10 Future Directions 171
Neurocognitive Therapy 171
Increasing Cognitive Control is the Goal 172
Do We Know Anything New? 173
Appendix Self-Help Guide Six Tips – a Pocket Guide to Preventing Relapse 179
Introduction: Why Six Tips? 179
1. Don’t Always Trust Your Memory! 180
2. Beware of the ‘Booze Bias’! 180
3. Separate Thoughts from Actions 181
4. Learn How to Distract Yourself 181
5. Willpower Is Sometimes Not Enough 182
6. Beware of the Dog that Doesn’t Bark. . . 182
References 185
Index 201
English
“Nevertheless, I would recommend this book to practitioners in the alcohol and other drugs, and gambling treatment field, and to postgraduate students in health sciences.” (Drug And Alcohol Review, 1 May 2015
“It is refreshing to read a book of quality that is not only relevant to the UK but is also authored by a UK clinical practitioner.” (DrugLink, 1 September 2013)
“There has been much growth in forms of therapy to treat addiction in recent years. In this book, Frank Ryan has done a truly excellent job of demonstrating the enormous value of cognitive therapy as an effective treatment for addiction. It is a tour de force.”—Michael Eysenck, Emeritus Professor of Psychology,Royal Holloway, London
“Frank Ryan’s Cognitive Therapy for Addiction makes a unique contribution to the field of treatment for addictive disorders. The book includes a comprehensive, up-to-date review of the latest research on cognitive-motivational principles and goes on to show how these principles can be applied to the treatment of addictive disorders. Dr Ryan illustrates these principles through case examples drawn from his own extensive clinical practice. He has a unique way of bringing hard science to life, showing how practitioners can apply cognitive-motivational principles in order to help real clients overcome their entrenched, maladaptive patterns of substance misuse.”—W. Miles Cox, Professor of Psychology of Addictive Behaviours, School of Psychology, Bangor University
“Frank Ryan is in a unique position to bridge the exciting new findings in research on cognitive bias modification in addiction and cognitive therapy for addiction, because he has been active as a researcher and as a clinician. He writes in an enthusiastic and clear manner about both too separate worlds and provides the highly needed integration.”—Reinout W. Wiers, Ph.D., Professor of Developmental Psychopathology, University of Amsterdam
