Our patient, 27 y/o Cynthia, reports drinking four to five glasses of wine most days to manage anxiety and sleep problems from past trauma.
Our patient, 27 y/o Cynthia, reports drinking four to five glasses of wine most days to manage anxiety and sleep problems from past trauma.
Respond to the posts of at least two of your peers and provide a suggestion for another appropriate intervention, or the treatment of a biopsychosocial factor that they may not have addressed. If you are able to, give an example from your clinical experience. How was your suggested intervention received by the client in your practice, and how did they respond to the treatment?
Post 1:
Our patient, 27 y/o Cynthia, reports drinking four to five glasses of wine most days to manage anxiety and sleep problems from past trauma. She is in the process of family planning with a loving and supportive partner and would benefit from therapy and motivational interviewing. For this patient, we would need to start by engaging with the patient through open-ended questions and supportive affirmations. The stronger the rapport and trust established, the better the treatment outcomes become. The second step is focusing the conversation to the topic of what habits or behaviors the patient wants to change. Reflective listening is a specific technique to help focus the patient and generate a patient focused agenda. To respectfully evoke the patients’ thought process is the third step of motivational interviewing. During this step, it is important to guide the conversation to identify positive or negative factors that will affect motivation to change. For example, Cynthia’s desire to become a mother is a positive factor that should help motivate her to start abstaining from drinking. Finally, the next step is talking about a plan with the patient for their change. This must be done carefully as to avoid taking over the planning process and making decisions for the patient (Carroll et al., 2006). Part of the planning process is to lay out the set of practical steps that can be used to put the desired changes into action.
We can encourage the patient to involve ongoing therapy into her plan for change as there are many types of therapy that can help treat addiction such as cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, or 12-step programs. There are some more holistic approaches such as yoga, meditation, music, or art therapy which can even be done as part of self-care tools. Regardless of which type of approach is being used, the goal of the therapist is to facilitate the process of initiating change by helping patients overcome the fear of change and become self-motivated (Carroll et al., 2006).
Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., Kunkel, L. E., Mikulich-Gilbertson, S. K., Morgenstern, J., Obert, J. L., Polcin, D., Snead, N., & Woody, G. E. (2006, February 28). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and alcohol dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC23868…
Post 2:
Cynthia, a 27 year-old female, reports that she has anxiety and sleep problems that developed from a previous abusive relationship. To cope with it, Cynthia drinks four to give glasses of wine on most days. Fortunately, she is now in a healthy and loving relationship but they are trying to conceive. Cynthia’s drinking habits raise concerns about potential alcohol misuse or addition. It is not uncommon to use substances to cope with past traumatic experiences. However, regular and excessive alcohol consumption can lead to physical and mental health problems, and it may also interfere with her ability to conceive and maintain a healthy pregnancy. Addiction-specific therapies and motivation interview strategies are commonly used approaches to treat substance misuse which can be used to help address Cynthia’s situation. According to Jhanjee (2014) addiction-specific therapies are evidence-based treatments that focus on addressing the underlying causes and triggers of substance use disorder, and they include techniques such as cognitive-behavioral therapy (CBT), contingency management, and motivational enhancement therapy (MET). Motivational interview strategies are a person-centered approach that aim to increase an individual’s motivation and readiness to change their behavior by exploring their ambivalence, values, and goals (Bischof et al., 2021).
Cognitive-Behavioral Therapy (CBT) is a type of talk therapy that aims to help individuals identify and change negative thought patterns and behaviors that may be contributing to their substance use (Chand et al., 2022). It has been shown to be effective in treating substance use disorders, and it could be used to help Cynthia address any underlying anxiety or trauma-related issues that may be contributing to her alcohol use. In Cynthia’s case, CBT could also help her develop coping strategies for managing stress and anxiety without turning to alcohol.
Motivational Enhancement Therapy (MET) is a type of therapy that focuses on increasing an individual’s motivation and commitment to change their behavior (Kumar et al., 2021). It could be used to help Cynthia explore her reasons for drinking and her goals for reducing her alcohol use, and to identify strategies to increase her motivation and confidence in making changes. MET could also help Cynthia identify strategies to increase her motivation and confidence in making changes to reduce her alcohol use.
Contingency Management is a behavioral therapy that involves providing tangible rewards for positive behaviors, such as abstaining from alcohol (Petry, 2011). This therapy operates on the principle of positive reinforcement, where individuals receive incentives for making progress towards their goals (Petry, 2011). In Cynthia’s case, contingency management could be an effective technique to help her reduce her alcohol use by providing rewards for sobriety, such as a favorite activity or item. This technique can be particularly helpful for individuals who need immediate reinforcement to help them maintain sobriety. According to Petry (2011), research has shown that contingency management can be effective in promoting long-term abstinence from alcohol and other substances. Additionally, it can be used in conjunction with other therapies such as CBT and MET to help Cynthia achieve her goals of reducing her alcohol use and improving her overall well-being.
Reference:
Bischof, G., Bischof, A., & Rumpf, H. J. (2021). Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Deutsches Arzteblatt international, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014
Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2022). Cognitive Behavior Therapy (CBT). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/
Jhanjee S. (2014). Evidence based psychosocial interventions in substance use. Indian journal of psychological medicine, 36(2), 112–118. https://doi.org/10.4103/0253-7176.130960
Kumar, S., Srivastava, M., Srivastava, M., Yadav, J. S., & Prakash, S. (2021). Effect of Motivational Enhancement Therapy (MET) on the self efficacy of Individuals of Alcohol dependence. Journal of family medicine and primary care, 10(1), 367–372. https://doi.org/10.4103/jfmpc.jfmpc_1578_20
Petry N. M. (2011). Contingency management: what it is and why psychiatrists should want to use it. The psychiatrist, 35(5), 161–163. https://doi.org/10.1192/pb.bp.110.031831
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