When our patients want CBT for anxiety but......

Prof. Cory Newman

Wednesday, 11 May 2022

Introduction

At times patients present for treatment complaining of anxiety-related problems including excessive worry, anticipatory ruminations, physiological hyperarousal, and avoidance behaviors, among other problems. Many times the patient’s explicit goal is to “get rid of the anxiety,” which in itself is an unnecessary and unrealistic outcome for well-functioning. When we conduct a thorough assessment, we sometimes find that the clinical picture is complicated by the patient’s attempts to “self-medicate” via the use of such chemicals as alcohol and marijuana, and/or overuse of prescribed medications such as benzodiazepines. The patient may have no intention of receiving treatment for the self-medication behaviors, but we as therapists recognize that these behaviors are clinically relevant targets in themselves, serving to maintain the patient’s anxiety, low self-efficacy, and tendency to use avoidance as a coping tool. This half-day presentation will address the challenges that CBT therapists face in such situations – namely, how to collaborate with patients on a case conceptualization and treatment plan that the patients will find acceptable, while addressing additional clinically relevant problems they did not intend to change. Elements of motivational interviewing will be included, as seen in a video clip of a role-play with a mock patient who wants to work on his anxiety, but who does not view his drinking or use of marijuana as anything other than normal.


The event will be equivalent to 2.3/4hrs of CPD.

Content

This workshop will:
1. Demonstrate the sometimes delicate process of collaborating with the patient on a mutually agreed-upon treatment plan.
2. Highlight the psycho-educational aspects of treating patients whose alcohol and other substance misuse play a role in their anxiety and other difficulties.
3. Illustrate the implicit use of the stages of change (Prochaska et al., 2013) model within CBT.
4. Outline some of the central interventions to combat the maladaptive avoidance habits that maintain anxiety and related low self-efficacy.
5. Present some of the central interventions in the CBT of substance misuse (Beck et al., 1993), along with their congruence in treating anxiety.
6. Reinforce the importance of using self-monitoring homework assignments so that patients keep track not only of their anxiety, but also their use of alcohol and other substances, and the relation between the two.

Learning Objectives

Participants will learn to…
1. Provide patients with user-friendly psychoeducation about the role of self-medication in maintaining their anxiety.
2. Address the patients’ misuse of chemicals in a way that is non-stigmatic and non-judgmental.
3. Modify the patients’ maladaptive beliefs about anxiety, avoidance, and self-medicating behaviors.
4. Utilize guided discovery questions to help patients self-reflect on their problems and goals, so they feel like full participants in their treatment, and so they collaborate willingly with a solid treatment plan.

Training Modalities

Didactic presentation with slides.
Video clip of a role-play of a relevant clinical interaction.
Q & A

Key References

Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of
substance abuse. Guilford Press.

Black, J. J., Chung, T., & Clark, D. B. (2016). Anxiety disorders and substance use disorders.
In Y. Kaminer (Ed.), Youth substance abuse and co-occurring disorders (pp. 169-195).
American Psychiatric Publishing.

Kushner, M. G. (2014). Treatment of comorbid anxiety disorders and substance use
disorder. In P. Emmelkamp & T. Ehring (Eds.), The Wiley handbook of anxiety disorders –
Vol. 2: Clinical assessment and treatment (pp. 1147-1164). Wiley Blackwell.

McHugh, R. K. (2015). Treatment of co-occurring anxiety disorders and substance use
disorders. Harvard Review of Psychiatry, 23, 99-111.

Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (2013). Applying the stages of change.
In G. P. Koocher, J. C. Norcross, & B. A., Greene (Eds.), Psychologists’ desk reference
(3rd ed.). Oxford University Press.

Robinson, J., Sareen, J., Cox, B., & Bolton, J. M. (2011). Role of self-medication in the
development of comorbid anxiety and substance use disorders: A longitudinal
investigation. Archives of General Anxiety, 68, 800-807.

About the presenter

Cory F. Newman, Ph.D. is Director of the Center for Cognitive Therapy, Professor of Psychology, in Psychiatry at the University of Pennsylvania Perelman School of Medicine (in Philadelphia, Pennsylvania, USA), and Adjunct Faculty at the Beck Institute for Cognitive Behavior Therapy. Dr. Newman did his postdoctoral training under the mentorship of Dr. Aaron T. Beck, and he is a Founding Fellow of the Academy of Cognitive Therapy. Dr. Newman has maintained a full clinical caseload and has extensive experience as a CBT supervisor, having supervised over 350 professionals-in-training, both at the University of Pennsylvania, and through the Beck Institute’s international training programs. Dr. Newman was recognized by the Association of Behavioral and Cognitive Therapy with the Outstanding Clinician Award for 2019. Dr. Newman is an international lecturer, having presented nearly 300 cognitive-behavioral therapy workshops and seminars at home in the U.S. as well as in twenty-three other countries. Dr. Newman is author of over 100 articles and chapters on cognitive-behavioral therapy for a wide range of disorders and clinical issues, and he has authored or co-authored six books, including two with Aaron T. Beck. On the side, Dr. Newman is an avid classical pianist.

Who should attend

This presentation is suitable for mental health practitioners across disciplines and substance use counsellors. Therapists who practice high intensity CBT as well as standard-course CBT will benefit from this presentation, as will clinicians of all levels of experience.