Category Archives: CBT

Research on CBT for alcohol use disorder

So I receive email updates from Alcohol Policy UK and recently one of them highlighted a new meta-analysis of published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care.

The researchers conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met their inclusion criteria. The studies had sufficient statistical power to detect small effect sizes.

They concluded that combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual.

Let’s see if my anecdotal experience supports their research findings? I hope so 🙂  If you were prone to depression before when you were drinking has it improved if you’ve stopped?

Riper, H., Andersson, G., Hunter, S.B., de Wit, J., Berking, M. and Cuijpers, P. 2014
Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction. Mar;109(3):394-406. doi: 10.1111/add.12441. Epub 2014 Jan 16.

Why me? Thinking and Drinking

This is the mother load for me.  Everything is my responsibility and my fault, good or bad, happy or sad.  Drinking was my personal stick to beat myself with for years.  I could ‘why me?’ about drinking ad infinitum.  Why am I the only one who can’t drink normally?  What did I do to make this happen to me? On and on and on.

Personalisation is where we attribute personal responsibility for something, including the resulting blame or praise, for events over which we have no control (source) Or, welcome to the world of parenting, I digress 😉

Nothing allows this better than drinking.  Imbibe lip loosening, inhibition dropping addictive substance in vast quantities and stand well back.  OK so I picked up the first glass that IS my responsibility.  But the cascade of events afterwards, however much the bottle of alcohol says ‘drink responsibly’ – sorry this is an oxymoron and paradox rolled into one.

Strategy, for the last time, involves – you guessed it – checking the evidence!  Not everything is our fault and it doesn’t always happen to me only.  I am just not that damn special or ‘terminally unique’ as AA would say 🙂

I should say everything was my responsibility because I’m drawing boundaries around this one and progress is swift when you put down the glass.  Maybe you’d like to join me? 🙂

Booze Crystal Ball

Jumping to conclusions or mind reading, another skill of mine 😉

So when I was considering stopping drinking I thought that all sober people were boring and that any social event without booze would be dull.  So I completely jumped to the wrong conclusion and my fortune telling skills failed epically too.  I also thought that people would like me less sober because I was a mind reader too!

This thinking error means we reach false preliminary conclusions, usually negative ones too, with no evidence to support them.  In reality, I couldn’t have been further from the truth but you have to leap blindly first to find it out.  Or you lurk on sober blogs for a while and learn vicariously before you take the step yourself! 🙂

Jumping to conclusions is a common error because we are cognitive misers and these are “judgmental shortcuts that generally get us where we need to go – and quickly – but at the cost of occasionally sending us off course” (source)

How do we correct?

  • You’re probably sick of me saying this now BUT check for evidence
  • There is no benefit in just accepting something at perceived face value, challenge your thinking first and see if you were right, or most likely wrong!

fortune teller

Is anyone else as bad a fortune teller as me?

Labelling Drinking

This is a real biggie in our world.  We use labelling to connect with people but also to distance ourselves.  So I am happy to be a member of the sober blogging community because that has positive connotations for me but am still stuck on the ‘am I an alcoholic?’ question because the label of alcoholic still carries and attracts very negative stigma.

“This is a more severe type of overgeneralization; attributing a person’s actions to their character instead of some accidental attribute. Rather than assuming the behavior to be accidental or extrinsic, the person assigns a label to someone or something that implies the character of that person or thing” (source)

Being unable to control our drinking is seen as a character defect rather than the reflection of an alcoholic substance that we have accidentally become addicted too because of our cultural acceptance and encouragement of us to drink.  For me it suggests that I am a ‘bad’ person and that I have ‘failed’ in some way.   But I am not defined by my ability to drink alcohol or not, this is just a tiny facet of me as a person, and yet I feel shame.

Strategies to manage:

  • Back to checking for evidence.  I am not the only person struggling with this issue and thanks to the sober blogging community I know this.  I could always go to an AA meeting in real life and check it there too.
  • Beware of labels as they usually hide the truth

What other labels need deconstructing and redefining?  Sober and what that means is the first one that springs to my mind.  What else? Chime in below 🙂

Should Drink Less, Must Drink Less

This is another biggie for me.  When I was moderating and trying to manage my drinking  I struggled with the ‘I should be able to manage my drinking’ and ‘I must have 3 nights off a week as per the Govt recommendations’.  Then when I couldn’t manage it I would beat myself up and feel guilty for being such a failure and not being able to keep my own drinking rules.  Hello, addictive substance alert!

These kind of thoughts make heavy demands on us emotionally and I love that Albert Ellis termed this “musturbation,” probably because it appeals to my sometimes purile mind (source).  It is one thing to want to try to do something positive about your drinking, like reduce the amount you drink on a daily or weekly basis.  It is quite another to say that you ‘should’ or ‘must always’ be like that.

Strategies:

  • When you find yourself using ‘shoulds and musts’ recognise and acknowledge the thought and then forgive yourself the perfectionism and give it up.
  • Yes, of course it is important to try and change thoughts, feelings and behaviours but don’t punish yourself if you can’t always keep it up or don’t succeed.

This, for me is, is why I stopped drinking.  Because if I drank I’d break my own self-imposed rules and then think ‘what the hell, may as well be hung for a sheep as a lamb’ (explanation).

If you don’t drink the only should or must is not to drink.  There is no sliding scale on the perfectionism.  In this instance all or nothing thinking actually works to your advantage 🙂

Discounting the Positives of Not Drinking

This is a kind of selective attention like ‘Mental Filtering’ except this time you are discounting the positives of an experience.  The moderation examples used in the last post would be equally applicable to this.

Or again using my blogging example someone might congratulate me on a post and I would dismiss it out-of-hand, believing it to be undeserved.  I might also automatically inwardly interpret the compliment as an attempt at flattery or perhaps as a result of naivety on their part, as in ‘wait until you find some of the really good sober blogs’.  I might then dwell on how much better these other bloggers are instead.  This is a genuine thought process of mine at times and I’m not looking for people to blow smoke up my arse (thanks FFF!)

As with mental filtering, if you have to accept something as not really bad, then you discount it by saying well it wasn’t really good either.  It was nothing.  Damned if you do, damned if you don’t ….

Here it is important to remind ourselves that filtering out good experiences only leaves negative ones to focus on and that increases the risk of depression.  I’m not suggesting we become all Polyanna-like but I think some balance in our thinking is critical and crucial to our recovery.  We need to celebrate the wins of not drinking rather than dismissing or minimising them as that way drinking again lies.  Sober treats and self-care reminder! 🙂

Mental Filtering and Drinking

This is times when I focusing entirely on negative elements of a situation, to the exclusion of the positive.  I guess for me and drinking that would be thinking about when I was moderating and how when I started to drink heavily again how I could not think about the times of moderating as positive and how each time I was learning new tools for my sober toolkit.  They weren’t wasted they were valuable learning opportunities but I saw them as negative relapses.

Also, it is the brain’s tendency to filter out information which does not conform to already held beliefs.  So if someone said something nice about this blog post I might still think it was not good enough and that it should have been better written because I believe I am not creative.

This is mental filtering.

As Almost Alcohol wrote: Look at how I drink. Obviously I’m an alcoholic. I can’t even quit when I try really hard. I fucking relapsed.  In this piece of writing she focused on the fictional relapse and not on the successful quitting before that night.

The new way of thinking includes:

  • Checking the evidence to support the statement
  • Write a list of all the ‘good bits’ no matter how small they seem by comparison
  • Try not to filter out all the bad stuff and just focus on that

Every time you attempt to moderate and do so successfully, for however long a duration, this is a good thing if you are trying to cut down or stop completely.  I spent years moderating before I finally nailed this quit and I wouldn’t have done it without all the good things I learned about my drinking and myself during the process.  It’s not always the outcome but the process which teaches us the most or to use the oft used expression ‘it is not the destination but the journey’.

What great things did you learn when you turn your mental filter to positive?  I’d love to hear them 🙂

 

Emotional Reasoning and Drink

It could be argued that once I drank there was no reasoning with me.  I became completely at the mercy of my emotions.  But now I don’t drink and so I am less ‘tired and emotional’ (code for pissed and sobbing) and my reasoning is more reasonable 🙂

So emotional reasoning is when we react emotionally and let our hearts rule our heads.  Where we are presuming that negative feelings expose the true nature of things, and experiencing reality as a reflection of emotionally linked thoughts. Thinking something is true, solely based on a feeling (source)

So sometimes in the early days of stopping I felt bored in the evenings because I’d stopped drinking so I felt I was boring.  Feeling = being.  Or when I’m due to clean my house and I think that it’s hopeless to do it because I’m overwhelmed by the prospect of doing it!  Not helpful and also not true as I always feel tons better when it’s done with a real sense of achievement.

Over to Almost Alcohol‘s passage: I’m just a pretty crap person. I might as well learn to live with that. Fuck it. Lots of people are crappy. We all grow up and learn the truth, that we are just not that great.  Because I feel like crap I am crap.

Solutions involve:

  • Searching for the evidence to support feeling this way.
  • If you do find them you may have to accept you are being ’emotional’
  • You can accept that you are putting yourself down for no good reason
  • But you do have a choice
  • You can continue to feel this way
  • OR you can tell yourself that there is no reason why you are feeling this way
  • And then try to work out how you should be feeling

As a female I get caught up in this type of thinking because I am unfortunately hormonally challenged fairly regularly which doesn’t help.  And sometimes I just accept that this is the reason and it will pass.  How ’bout you?

PS I am using a piece of writing by another sober blogger because it was SO good and illustrated so many examples of these types of thinking without me having to write a forced piece including them all.  I am using it because it completely reflects how I felt and is not a reflection on her individually.  I am also mentioning and linking every time because I don’t want to not acknowledge her brilliant writing talent 🙂

Drinking Catastrophes

Ooh this one was a biggie for me.  Catastrophising.  I had an old nursing colleague who said that I could take one problem and split that into ten and then split each of those ten into another ten until I had a pyramid of problems, worries and anxieties.  Maybe being a nurse doesn’t help as during your career you get to see the worst possible things happen and you just end up with a jaded view.  Who knows.

But I can magnify a problem like a pro.  Exaggeration? No, just disaster/risk management in my book 😉  But the thing about this line of thinking is that if you see the problem as SO big it becomes unmanageable; the ‘you can’t eat an elephant in one bite’ approach as Belle would say.  You’re also minimising and underestimating your ability to deal with it, like you are looking down a telescope from the wrong end.  So I end up paralysed, in analysis paralysis.

Here’s some catastrophising: I must be an alcoholic, and most alcoholics relapse and can’t quit and keep drinking and ruin their lives.

And here’s some minimising: Sobriety is just beyond me, I have no willpower, I’m just a pretty crap person (Almost Alcohol)

So what to do?

  • When things do go wrong I try to avoid turning a small problem into a disaster.  Mountains out of molehills anyone?
  • I search for the evidence.  How bad is it really?
  • I assess my ability to manage it.  Am I really not able to manage it?
  • I make a list of things I could try to do
  • If all else fails I call in the professionals

the professionals

Sorry not trying to make light – I couldn’t help myself 😀

So this one has taken some major work on my part.  How do you catastrophise around your drinking thinking?

 

 

 

 

Overgeneralisation and Drinking

This is similar in some ways to ‘black and white thinking’.  Overgeneralisation is where we use an experience in one part of our life to influence other parts of it.  A negative example would be the ‘I never get anything right’ kind of thinking where a single negative event is seen as a never-ending pattern of defeat..  A positive example would be ‘everyone drinks like me’ which may be true, as for me personally, most of my friends and family did drink like me – apart from the pre and post event hidden drinking at home, ‘livener’ and ‘night cap’ anyone? 😉

It is a cognitive bias and a logical fallacy but that doesn’t stop me using it to support a line of thinking whether positive or negative.  Who says our brains are rational and logical?

Just because we fail at one thing does not mean that we will fail at everything and transposing negative feelings from one experience to another can become a self-fulfilling prophecy.  If I’d relapsed on my drinking yesterday, smoked, eaten crap and not run I’d have been wallowing in overgeneralisations a bit like this I’m just going to have a crappy life, I’ll be one of those people who disappoint their families, I’ll always regret never making anything of myself. Poor me. Thanks Almost Alcohol 🙂

So how am I working on this line of faulty thinking:

  • Again I look for evidence to support this view.  Does everyone drink like me? Do I never get anything right?
  • I don’t pretend there isn’t a problem.
  • But I am learning to recognise that there is no value in generalising my unhappiness from one situation to the rest of my life.
  • I try to distinguish between things which genuinely are ‘bad’ or unpleasant from other areas of my life that are not and that I am viewing under the same black cloud.

It is a much happier way to be 🙂  How bout you?  What overgeneralisations related to your drinking would you be happy to share?