Making lifestyle changes can be difficult. How many times have you thought, “I am going to stop eating junk food,” and the next thing you know, you’re shoving cake in your face while the shame and guilt slowly starts to creep in! You were so well intentioned; what happened? There are many things that can go wrong when you are trying to achieve a goal. CBT skills can help you create a thorough plan to stay on track with all of your goals, whether related to substance use or not.
A good first step for changing a behavior is to clearly define your goal. A clearly defined goal should be specific, concrete, and achievable. Some questions that might help you create a clear goal are, “What specifically am I trying to achieve?,” “What will things look like after I have made changes; what will I be doing?”, or “How will life be better if I make these changes?”. An example of a vague goal is, “I will eat healthier.” A more specific version of this goal is, "I will eat healthier by including vegetables into every meal and limiting the number of baked goods I eat each week to 2". Here, we've considered what we will be doing in our life when we are achieving our goal. This goal is specific and concrete and we will know very quickly if we are achieving it.
After you’ve defined the goal, it’s time to create a plan of action. Look at your goal and create a plan that makes sense and that is, again, specific. What are the logical steps that will help you achieve your goal? For the goal mentioned above, a good plan of action could be to look up healthy vegetable side dishes, purchase vegetables at the grocery store, and to not keep the house stocked with baked goods
Next, examine the barriers that could get in the way of achieving your goal. Good questions to ask yourself are, “What is going to get in the way or prevent me from achieving my goal?” and “What has gotten in the way in the past?”. Once you've identified barriers, you can plan how you will overcome them. A possible barrier for our goal might be that eating healthy can be expensive and that we don’t have too much time to prepare side dishes. A solution to our barriers could be to purchase frozen vegetables that tend to be cheaper and quick to prepare.
Some goals are more straightforward and easier to create a plan of action, while other goals are more difficult. Let's look at our second goal: to cut down on sweets. This goal may be more difficult to plan for because we cannot anticipate every time we will be triggered to eat a baked good. Let's start by considering what might prevent us from putting down cookies (or drugs, cigarettes, etc.). What would help us remember our goals and motivations for cutting down when we are in the moment when its harder to think clearly? These types of questions may be harder to answer, but will be helpful for achieving your goals. It might also be helpful to think about what is typically happening (both inside you and in your environment) when you are triggered to eat a baked good. If you are going to use a skill to avoid eating cookies, the trigger to eat a baked good could become a trigger to use the skill! For our example, a big trigger for wanting to eat sweets might be the cookie aisle in the grocery store. When we hit the cookie aisle and notice we are triggered to buy/eat cookies, we can pull out a list of all our motivations to quit eating junk.
In a nutshell, we’ve talked about some ways to go about making changes in your life, whether these are related to substance use or not. When it comes to making changes, it’s important to define your goals specifically, create a specific plan of action, and anticipate barriers and plan for them. If you would like to learn more about changing your behaviors, send an email and we will lead you through problem solving skills and functional analyses.
I wanted to walk through the resources under the self help tab. The newest addition thanks to Arin is a list of helpful smart phone applications that can be used. Some of these applications are free and others are available at low cost. Arin found applications for many of the popular kinds of phones. I highly recommend the CBT referee for those who may be struggling with negative thoughts. You can journal your thoughts and the referee will challenge those negative thoughts with realisitic positive affirmations that you programmed ahead of time. Also recommended are the various applications on anxiety. Many of these application are valueable at times where support may not be available (i.e. middle of the night).
For those without a smart phone, we have also added links to the AA and NA websites. Both have search capabilities for meetings (both online and in person) and also have the ability for support 24/7. Both sites provide open and closed meetings in a variety of settings (i.e. men only, women only, Gay/Lesbian, military personal, regional, profession specific).
We have also posted three self help manuals. One is developed by David Loveland and Hilary Driscoll at HSC . It focuses on both alcohol and drug use as does the World Health organization manual. Both of these manuals can be helpful if you are struggling with a specific topic related to recovery, or if you are just in the contemplation stage thinking about making a change. The third manual titled Rethinking Drinking is specifically for people who are thinking "Do I have a problem?" It takes you through several exercises to examine your use and how it compares to the national averages. We have also included that information at the bottom of the Self Help page to reference.
The final document under the self help manuals is a guide of what to look for and ask of a treatment provider when researching what type of treatment would meet your needs. I encourage everyone to review that and to ask those questions of your treatment provider to insure that you are receiving the best possible treatment to assist you on your recovery path. Feel free to email us if you see or read something that doesn't make sense or if you would like to know more about these topics. We will continue to add to the resource library as we come accross material. Thanks for checking in!
Update: 2/20- Arin also put up over the weekend links to some excellent smoking cessation programs. Please check these out if you want to know more information about how to quit smoking!
It’s been awhile since we blogged, but we are hoping to increase our blogging activity now that enrollment in the program has started. We already have several clients enrolled to MW&R who are receiving treatment for their substance use using the internet, phone, and texting! Our team is so excited to be able to make treatment accessible to those who wouldn’t be able to get treatment otherwise!
One of the best features of our program is that it is based on evidence-based Cognitive Behavior Therapy (CBT) (evidence-based means CBT has been proven to be effective). Many people have a general understanding of CBT, but I wanted to take some time to give a nice detailed account of CBT and how we are using it in our program. Let's start
You'll notice the four different points (feelings, thoughts, behaviors, and environment) and the arrows connecting each of the points. The arrows indicate all of the points have influence over each other. Sometimes the model is best understood with an example:
Let’s say your drug of choice is alcohol. You walk into Walmart and see the big display of cases of beer stacked up for the Super Bowl (environment). You start to think “It’s the Super Bowl! Everyone drinks, so I should be able to drink, too! (thought).” The thought of drinking gets you excited (feeling) and you pick up a case, buy it, and later drink it (behavior).
In this example, the environment led to the thought which led to the feeling which led to the behavior. You don’t have to start with environment; you can start and end anywhere in the model! Let’s look at another example:
You’re standing around in your kitchen when you start feeling anxious; your hands start sweating, your heart and thoughts are racing, and it’s getting hard to breathe (feelings). You get the thought, “If I use, all of this will go away!” (thought). You quickly slip on your shoes and run to the liquor store to buy some alcohol (environment). When you get home, you pop open a beer and drink (behavior).
In this example, it was the feeling that led to the thought which led to the environment which led to the behavior.
We can use the model to identify the patterns of your use, triggers, and high risk situations as well as where your skills need strengthened. If anxiety is a trigger, we’re going to give you coping skills for anxiety. If thoughts are what typically lead you to use, we want to help you challenge those thoughts. If being around certain environments, situations, and people are high risk, we want to give you skills to approach or avoid those situations without using.
As you learn the skills, you will probably notice they seem like common sense; many skills in CBT are straightforward and many people do them without realizing they are skills! However, people are not always able to think clearly or act sensibly and may find it difficult to use the skills naturally. CBT helps people identify the useful skills they are already using and sharpen them so they can use them intentionally and purposefully when needed.
So that’s CBT in a nutshell! I know it was a lot to throw at you at once! If you have any questions or something seems unclear, please email us at firstname.lastname@example.org; I’m happy to clarify or explain!
Now, you might be wondering how we are going to give you CBT using the internet and phone. Everyone who enrolls to MW&R will be given access to a web-based CBT program called TES (Therapeutic Education System). TES contains tons of CBT-based modules (complete with videos!) that clients click through to learn the skills. These modules include assertive refusal skills, decision making skills, managing negative thinking skills, identifying high risk situations and triggers, and much more! Corey (our counselor) will work with you to choose which modules will best help you achieve your recovery goals. Each week you’ll complete your modules and maybe a worksheet. Corey will call you later in the week to make sure you understood the material, answer any questions you may have, and review which modules are scheduled for the next week. In addition to TES, clients who have a smart phone will be given access to an app called ACHESS that has all sorts of awesome functions to help you stay on your recovery path! My personal favorite is the function that allows you to flag areas that are high risk. When you get close to your high risk areas, the phone will warn you! In addition to the CBT programs, our staff has been trained extensively in CBT and are always working to sharpen our skills.
I hope this blog entry has been helpful and has even increased your interest in CBT and MW&R! I just want to remind readers that this program is FREE and allows you to complete substance use treatment at your own pace in your own space. Even probation officers are getting on board! We have had several probation officers give the OK for their clients to complete this program in place of other court ordered treatments! Again, please send us an email or fill out the “contact us” form if you have any questions about CBT, TES, ACHESS, or MW&R!
Corey Campbell is a clinician/trainer with the Human Service Center of Peoria, IL. All thoughts on this blog are representative of only Corey and do not reflect the Human Service Center.