Cognitive-Behavioural Integrated Treatment (C-BIT)

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)

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 xi Aims of the Book xv Acknowledgements xvii Part One: Introduction To Cognitive-Behavioural Integrated Treatment (C-Bit) 1 1 Issues in Working with those with Coexisting Severe Mental Health Problems Who Use Substances Problematically 3 The Nature of Coexisting Severe Mental Health and Alcohol/Drug Problems 3 Models of Comorbidity 6 Obstacles to Treatment and Behaviour Change 9 Treatment Needs 10 2 Overview of C-BIT Approach 14 Objectives 14 Structure 15 How to Know When to Move on to the Next Phase 16 Treatment Sessions 20 3 Overview of C-BIT Theory and Techniques 22 Brief Introduction to Cognitive Therapy 22 Cognitive Therapy Techniques in C-BIT 28 Part Two: Cognitive-Behavioural Integrated Treatment (C-Bit) 37 C-Bit Core Components 39 4 Assessment Phase: Screening and Assessment 39 Clinical Assessment of Drug/Alcohol Use 40 Assessment and Screening Tools 42 Case Formulation 46 Treatment Planning 49 5 Treatment Phase 1: Engagement and Building Motivation to Change 51 Strategies to Increase Engagement 51 How to Put Drug/Alcohol Use on the Agenda 55 Building on Motivation for Change 59 Dealing with Resistance 64 Identifying Social Networks Supportive of Change 65 Finances/Money Management 68 6 Treatment Phase 2: Negotiating Some Behaviour Change 73 Identifying and Setting Achievable Harm-Reduction Goals 73 Working with Resistance to Goal Setting 75 Identifying Activities of Interest 79 Engaging the Clients Interest in the Activity 81 How to Build Social Networks Supportive of Change 81 Strategies to Increase Awareness of Problematic Links Between Mental Health and Substance Use 84 7 Treatment Phase 3: Early Relapse Prevention 88 Formulating Problems: Cognitive Model of Substance Use 88 Relapse Prevention: Helping Your Clients Manage Their Substance Use 93 Relapse Prevention: Including Social Network Member(s) 94 Coping with Cravings and the Abstinence-Violation Effect 99 Relapse Prevention: For Substance Use and Its Links with Mental Health 102 8 Treatment Phase 4: Relapse Prevention/Relapse Management 106 Including Social Network Member(s) in Relapse Prevention 107 Identifying a Relapse Signature to Psychotic Relapses and Role of Substance Use 108 Developing a Comprehensive Relapse-Prevention/ Relapse-Management Plan 116 Using a Comprehensive Relapse-Prevention/ Management PlanRelapse Drill 118 Additional Treatment Components ISkills Building 122 9 Coping with Different Moods: Anxiety 122 The Role of Substances in Creating or Maintaining Anxiety 122 Starting Out: Assessing Anxiety 123 Strategies to Manage Anxiety 125 Cognitive-Behavioural Integrated Treatment 10 Coping with Different Moods: Anger and Impulse Control 136 The Role of Drugs/Alcohol in Creating/Maintaining Anger 137 The Role of Psychosis in Creating/Maintaining Anger 138 Starting Out: Assessing Anger 138 Strategies to Manage Anger 140 Impulse Control 148 11 Coping with Different Moods: Depression 151 The Role of Drugs/Alcohol in Creating and Maintaining Depression 152 The Role of Psychosis in Creating/Maintaining Depression 152 Starting Out: Assessing Depression 153 Strategies to Manage Depression 154 12 Communication: Social Skills 164 Social Skills 165 Social Skills Training for Mental Health Problems and Substance Use 166 Social Skills Training 167 Applying Social Skills to Specific Situations 173 Assertiveness 175 Assertiveness Training 178 Strategies to Tackle Lack of Assertiveness 179 Applying Assertiveness Skills to Specific Situations 188 13 Self-Esteem 194 Effect of Low Self-Esteem on Mental Health and Drug/Alcohol Use 194 Effects of Psychosis and Drugs/Alcohol on Self-Esteem 195 Starting Out: Assessing Self-Esteem 196 Strategies to Improve Self-Esteem 197 14 Lifestyle Balance 205 Strategies to Encourage Lifestyle Balance 206 Increasing Activity Levels 206 Time Ma