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Introduction:

Cognitive behavioral therapy (CBT) changes the negative thoughts that an individual believes about themselves. The therapist educates their client on how to think positively and more realistically. Individuals with substance abuse disorder experience many negative thoughts and anxiety that leads them to want to drink more to reduce stress. Occupational therapists can use strategies from CBT in order to improve the negative patterns of thought that individuals with substance abuse disorder tend to experience and thus alter their behavior.

Theory

Cognitive Behavioral Theory believes that by changing your thoughts, you can change your behavior. CBT assumes that cognition affects behavior, and that it can be monitored and altered. By teaching Edie how to replace her distorted thinking and unrealistic cognitive appraisals with more realistic and adaptive appraisals, she will be able to alter her attitude and behavior in order to improve her social participation and academic performance.

Evidence

Cognitive behavioral therapy is unique in its systematic and central focus on teaching coping skills. For individuals with higher dependence severity, such as Edie, the focus on coping skills in CBT may be particularly helpful in enabling her to acquire and implement an adequate repertoire of coping skills (Roo, Maisto, & Witkiewitz, 2017, p.1548).

Case Study

Edie is a 26-year-old woman attending medical school. She has been abusing alcohol for over two years, since starting the program, secondary to the intensity of the program and the stress that comes with it. Lately, she has been experiencing excessive negative thoughts when studying for upcoming exams, causing her to drink more. These negative thoughts are not allowing her to reach her fullest potential in her professional development. These thoughts also hinder her confidence, which prevent her from attending any social events because she fears that her colleagues and professors will think poorly of her. Edie is currently on academic probation due to her heavy drinking on school nights, which is hindering her from meeting the minimal program requirements.

Edie has begun using the University’s resources at the healthy living program to help her with her alcohol dependency and negative thoughts. This program provides a variety of services that include stress management, aromatherapy, massage therapy, and counseling. She has begun to make new friends within the healthy living program. However, she will not attend any social gatherings apart from these meetings due to fear that she will not be able to refuse temptation if alcohol were present. Edie was referred by the school counselor to see an occupational therapist in order to help her reach her goals.

Intervention Plan

Problem Statement:

Edie is having difficulties with her academic performance due to maladaptive coping strategies to manage stress.

Short-Term Goals:

1. Edie will independently identify 2 adaptive coping strategies she can use while attending a study group once per week in order to improve her social participation in her school setting in 2 weeks.
2. Edie will demonstrate 1 relaxation strategy to use in order to reduce her stress while taking exams in 2 weeks.
3. Edie will log in a daily journal 3 out of 7 days every time she used an adaptive coping strategy in order to improve her mood while attending class in 2 weeks.

Long-Term Goals:

1. Edie will implement an adaptive coping strategy independently in her school setting to improve her academic performance in 4 weeks.
2. Edie will independently log every time she utilizes an adaptive coping strategy in order to improve her academic performance in 4 weeks.

Intervention Format:

Individual

Setting:

Edie will meet with the occupational therapist in the university clinic for 1 hour 2x per week for 1 month.

Supplies:

• Diary / Journal
• Pencil / Pen

Agenda:

• Therapist meets and builds rapport with Edie (5 min)
• Therapist interviews Edie and conducts initial assessment (10 min)
• Therapist collaborates with Edie to define problems and create a problem list (5 min)
• Therapist sets goals with Edie(5 min)
• Therapist determines the appropriateness and readiness for Edie to commence cognitive behavioral therapy
• Teach Edie CBT (15 min)
  • • Process
    • Cognitive model
    • Importance of homework
    • Learning to become her own therapist
• Educate Edie on the effectiveness of CBT on substance abuse (10 min)
• Assign Edie homework
  • • Therapist will assign homework first as an example and then Edie will assign herself homework (5 min)
• Provide a summary of the session and elicit feedback (5 min)

Documentation

S: Client states that she is having trouble keeping up with the demands of medical school. She is constantly thinking that people don’t like her and does not want to attend class because of this reason. Client also does not attend any social gatherings for fear that she will not be able to refuse alcohol as a maladaptive coping strategy.

O: Client verbalized maladaptive coping skills, which include alcohol abuse and self-isolation. The therapist educated client on guided imagery which can be used to manage stress. Client then role-played using positive guided imagery with minimum verbal cues. We discussed how the exercise made her feel, and how she’s going to utilize this strategy on a daily basis. Client committed to practicing guided imagery 5 out 7 days in the upcoming week.

A: Client’s maladaptive behaviors such as alcohol abuse when feeling stressed from school are preventing her from succeeding in her studies. Client demonstrated improved knowledge of positive imagery via role playing. Client indicated improvement by reporting that she felt more optimistic about her academic endeavors.  She will benefit from cognitive behavioral therapy in order to complete guided imagery independently.

P: Client will continue cognitive behavioral therapy training in order to increase her adaptive coping skills. Edie’s improvement will be evaluated by her ability to use coping strategies throughout the week as evidenced by her journal entries every time she uses an adaptive coping strategy. Continue to enhance tx activities when necessary. Client is to see OT 2x per week for 1 month.

References:

Roos, C. R., Maisto, S. A., & Witkiewitz, K. (2017). Coping mediates the effects of cognitive-behavioral therapy for alcohol use disorder among outpatient clients in Project MATCH when dependence severity is high. Addiction, (9), 1547. doi:10.1111/add.13841