Cognitive-Behavioural Integrated Treatment (C-BIT)

Dr Hermine L. Graham is a Consultant Clinical Psychologist and Lecturer on the Doctorate in Clinical Psychology course at the University of Birmingham, UK. She has led a programme of collaborative research and service innovation in the NHS focused on the integration of substance misuse treatment into mental health services.

• About the Authors xiAims of the Book xvAcknowledgements xviiPart One: Introduction To Cognitive-Behavioural Integrated Treatment (C-Bit) 11 Issues in Working with those with Coexisting Severe Mental Health Problems Who Use Substances Problematically 3The Nature of Coexisting Severe Mental Health and Alcohol/Drug Problems 3Models of Comorbidity 6Obstacles to Treatment and Behaviour Change 9Treatment Needs 102 Overview of C-BIT Approach 14Objectives 14Structure 15How to Know When to Move on to the Next Phase 16Treatment Sessions 203 Overview of C-BIT Theory and Techniques 22Brief Introduction to Cognitive Therapy 22Cognitive Therapy Techniques in C-BIT 28Part Two: Cognitive-Behavioural Integrated Treatment (C-Bit) 37C-Bit Core Components 394 Assessment Phase: Screening and Assessment 39Clinical Assessment of Drug/Alcohol Use 40Assessment and Screening Tools 42Case Formulation 46Treatment Planning 495 Treatment Phase 1: Engagement and Building Motivation to Change 51Strategies to Increase Engagement 51How to Put Drug/Alcohol Use on the Agenda 55Building on Motivation for Change 59Dealing with Resistance 64Identifying Social Networks Supportive of Change 65Finances/Money Management 686 Treatment Phase 2: Negotiating Some Behaviour Change 73Identifying and Setting Achievable Harm-Reduction Goals 73Working with Resistance to Goal Setting 75Identifying Activities of Interest 79Engaging the Client’s Interest in the Activity 81How to Build Social Networks Supportive of Change 81Strategies to Increase Awareness of Problematic Links Between Mental Health and Substance Use 847 Treatment Phase 3: Early Relapse Prevention 88Formulating Problems: Cognitive Model of Substance Use 88Relapse Prevention: Helping Your Clients Manage Their Substance Use 93Relapse Prevention: Including Social Network Member(s) 94Coping with Cravings and the Abstinence-Violation Effect 99Relapse Prevention: For Substance Use and Its Links with Mental Health 1028 Treatment Phase 4: Relapse Prevention/Relapse Management 106Including Social Network Member(s) in Relapse Prevention 107Identifying a Relapse Signature to Psychotic Relapses and Role of Substance Use 108Developing a Comprehensive Relapse-Prevention/ Relapse-Management Plan 116Using a Comprehensive Relapse-Prevention/ Management Plan—Relapse Drill 118Additional Treatment Components I—Skills Building 1229 Coping with Different Moods: Anxiety 122The Role of Substances in Creating or Maintaining Anxiety 122Starting Out: Assessing Anxiety 123Strategies to Manage Anxiety 125Cognitive-Behavioural Integrated Treatment10 Coping with Different Moods: Anger and Impulse Control 136The Role of Drugs/Alcohol in Creating/Maintaining Anger 137The Role of Psychosis in Creating/Maintaining Anger 138Starting Out: Assessing Anger 138Strategies to Manage Anger 140Impulse Control 14811 Coping with Different Moods: Depression 151The Role of Drugs/Alcohol in Creating and Maintaining Depression 152The Role of Psychosis in Creating/Maintaining Depression 152Starting Out: Assessing Depression 153Strategies to Manage Depression 15412 Communication: Social Skills 164Social Skills 165Social Skills Training for Mental Health Problems and Substance Use 166Social Skills Training 167Applying Social Skills to Specific Situations 173Assertiveness 175Assertiveness Training 178Strategies to Tackle Lack of Assertiveness 179Applying Assertiveness Skills to Specific Situations 18813 Self-Esteem 194Effect of Low Self-Esteem on Mental Health and Drug/Alcohol Use 194Effects of Psychosis and Drugs/Alcohol on Self-Esteem 195Starting Out: Assessing Self-Esteem 196Strategies to Improve Self-Esteem 19714 Lifestyle Balance 205Strategies to Encourage Lifestyle Balance 206Increasing Activity Levels 206Time Management 212Money Management 213Additional Treatment Components Ii—Families And Social Network Members 21515 Working with Families and Social Network Members 215Provision of Psychoeducation 216Encouraging Involvement 221Practical Coping Strategies and Skills 223Part Three: Implementation Issues 23116 Implementation Issues 233Overview 233Implementation Obstacles and Solutions 233Training and Supervision (Capacity Building) 237Organisational Factors 238Overview of the Evidence Base and Future Directions forResearch 239Appendices 245References 285Index 295Cognitive-Behavioural Integrated Treatment

“…an outstanding integrated treatment manual that is current, empirically supported and attractive to therapists and their clients…” (Addiction, June 2004) “…extremely well written and presented…” (Mental Health Nursing, July 04)“...The two most striking characteristics of this excellent book are its authenticity and its usefulness...”  (Clinical Psychology, No.45, January 2005)