Treating Addiction
with Co-Occurring
Anxiety and
Depression
with
Kelly G. Wilson
Olemiss.edu
OneLifellc.com
HometownScience.org
Carl, if you are
listening, I am
betting a career
that you are right...
what is most personal is
most general.
Carl Rogers, 1961
so let’s dig in...
Behavior Therapy
• "operationally defined learning theory
and conformity to well established
experimental paradigms" (Franks &
Wilson, 1974)
• understanding normal and abnormal
behavior using the same set of principles
• Applications might differ in particulars,
but not the principles
And the direction changed...
• We moved to the DSM/FDA model
• Specialization and fractionation
• at a cost
• Let’s see....
EST’s for syndromes
The 500 Year Problem
NIH as the FDA of psychotherapy
265 X 250 X 2 = 132,500 (DSM categories
X treatments X independent replication)
(Parloff, 1982)
1.5 million combinations (Beutler, 1991)
Wilson, K. G. (1997). Science and Treatment Development: Lessons
from the history of behavior therapy. Behavior Therapy, 28,
547-558.
there is suffering
1 of 3
7 of 10
Kessler et al, 1994
Heroin
I’ve seen the needle
and the damage
done
40% Mood
42% Anxiety
52% Axis II
Hayes, et al, 2004
works for academics/researchers
works for specialty journals
works in big research environments
works for clinicians who treat
one and only one sort of client!
Help............
Please someone, throw
me a trans-diagnostic
model
But what about the
destigmatization offered
by the medicalization of
human psychological
suffering?
While some people find a name or a
diagnostic label helpful, our contention is that
this helpfulness results from a knowledge
that their problems are recognised (in both
senses of the word) understood, validated,
explained (and explicable) and have some
relief. Clients often, unfortunately, find that
diagnosis offers only a spurious promise of
such benefits.
•
We therefore believe that alternatives to
diagnostic frameworks exist, should be
preferred, and should be developed with as
much investment of resource and effort as
has been expended on revising DSM-IV.
• British Psychological Society response to DSM V draft criteria,
http://apps.bps.org.uk/_publicationfiles/consultation-responses/
DSM-5%202011%20-%20BPS%20response.pdf
Help............
Please someone, throw
me a trans-diagnostic
model
How are we to
understand the problem
we face?
Organizing
what we know about
anxiety and depression....
Self-Esteem
and the road to
all manor of
good and ill
The
Self-Esteem
Project
30,000 peer-reviewed
articles
>17,000 hits on Amazon
We succeeded!!!!
Gentile, Twenge & Campbell,
2010
Success!!!
adolescent anxiety
academic performance
drug use
Gentile, Twenge & Campbell, 2010
Is there a connection
between self-esteem
and diagnosable
addiction?
The Impact of Pushing Self-Esteem
“I am a lovable person.”
Mood?
Wood et al., 2009, Positive
Self-Statements: Power for
Some, Peril for Others,
Psychological Science
Mood Score
and, lower incentive ratings!
And what happens to people
who take on the task
themselves?
Global Wellbeing?
>
No PTSD
Kashdan, et al., 2010,
Everyday Strivings in War
Veterans With Posttraumatic
Stress Disorder. Behavior
Therapy.
PTSD
High Avoidance and Emotion Regulation
Strivings
>
PTSD
No PTSD
Kashdan, et al., 2010,
Everyday Strivings in War
Veterans With Posttraumatic
Stress Disorder. Behavior
Therapy.
Low Avoidance and Emotion Regulation
Strivings
=
No PTSD
Kashdan, et al., 2010,
Everyday Strivings in War
Veterans With Posttraumatic
Stress Disorder. Behavior
Therapy.
PTSD
Rehospitalization
Valued Living versus Avoidance and
Impact on Global
Wellbeing
Kashdan, et al., 2010,
Everyday Strivings in War
Veterans With Posttraumatic
Stress Disorder. Behavior
Therapy.
Quality of Life
Emotion Regulation
L
H
L
L
H
H
out with the bad theory
in the culture, and
CT/CBT
BT/Exposure/EPT
d
n
io n
t
o tio
m
E ula
g
Re
L
H
oi
v
A
ce
n
a
Out with the bad thoughts?
intervene directly to change
thoughts
Changes in cognitive content during and following
cognitive therapy for recurrent depression:
Substantial and Enduring, but Not Predictive of
Change in Depressive Symptoms
“change in depressive symptoms is moderate to large
even if there is no change in cognitive content” p. 10
Jarrett, et al, 2007
Time Lag MLM
depression does
not predict
engagement, but
lack of
engagement
strongly predicts
depression
Vittengl, Clark, &
Jarrett, 2009
CT/CBT has a lot of pieces
core schema work
FULL
CT
negative automatic thoughts
behavioral activation
Jacobson, N.S., et al. (1996); Gortner, E.T., et al. (1998)
Component Analysis of CT
Jacobson, et al., 1996, Dobson, et al., 1998
just this one
little thing...
And, perhaps more so for
the severely depressed...
76%
80%
60%
49%
48%
42%
40%
Response
40%
52%
Remission
20%
0
Meds
Full CT
Dimidjian, et al., 2006
Behavioral
Activation
Only
out with the bad emotion?
intervene directly to change fear
“evidence...indicates that neither the degree
by which fear reduces nor the ending fear
level predict therapeutic outcome”
Craske, et al, 2008
Patient:
“I feel sad,
no appetite,
no interest,
no hope,
no concentration....”
Doctor:
“Take these and you
will.....
PS please read Whitaker’s book
Anatomy of an Epidemic
And, just this one other
little thing......
Mindfulness as Method
Overall Sample
anxiety: Hedges’ g = 0.63 and
mood: Hedges’ g = 0.59
Diagnosable
Anxiety: Hedges’ g = 0.97
Mood: Hedges’ g = 0.95
Hofmann, et al., 2010, The Effect of Mindfulness-Based
Therapy on Anxiety and Depression: A Meta-Analytic Review,
JCCP.
not sayin....
symptoms do not go down
CT/CBT/BT does not work
exposure does not work
just sayin....
the data suggest, on multiple fronts,
that change is produced by:
1. a change in relationship to negative
content
dance with the difficult: exposure)
2. active engagement in living
behavioral activation
just sayin’ pay
attention to small,
simple things
and, just sayin....
hard thoughts and emotions are
often, very often, quite persistent
Psych Flex Model
PRESENT MOMENT
ACCEPTANCE
VALUES
Psych
Flexibility
DEFUSION
COMMITMENT
SELF PROCESSES
Psych Flex Model
engaged in the
present moment
authoring
valued
patterns
open to
experience
Psych
Flexibility
holding stories
lightly
returning to
valued patterns
flexibility in
perspective
VLQ2
Possibility
Current
Importance
Overall
Importance
Action
Satisfied with
Action
Concern
1. Family (other than
couples or parenting)
2. Marriage/Couples/
Intimate Relation
1BSFOUJOH
Use it for the basis of a
values centered ACT interview
and exercises
4. Friends/Social Life
8PSL
&EVDBUJPO5SBJOJOH
7. Recreation/Fun
8. Spirituality
9. Community Life
1IZTJDBM4FMG$BSF
(diet/ exercise/sleep)
5IF&OWJSPONFOU
(caring for the planet)
12. Aesthetics (art, music,
literature, beauty)
from Mindfulness for Two, DPQZSJHIUª,FMMZ(8JMTPOBOE5SPZ%V'SFOFtGPSQFSNJTTJPOT/FX)BSCJOHFS1VCMJDBUJPOT
XXXPOMFMJGFMMDDPNtXXXNJOEGVMOFTTGPSUXPDPN
Finding Our Way to the Gift of Stillness Inventory (with an inclined
heart)—Part One
In this inventory, we will ask you to see if you can make a
beginning at noticing places in your own life where you have been
absent or perhaps less present in some way. See if you can let go
of self-condemnation for now. You can always condemn yourself
later. There will be plenty of time for that if you decide later on
that you need to give yourself a beating. For now, let this be more
like an exercise in noticing. Notice first, the ways you have been
absent.
from “The Wisdom to Know the Difference,” Wilson & DuFrene,
forthcoming
substances.
Finding Our Way to the Gift of Stillness Inventory (with an inclined
heart)—Part One
Second, let eyes go closed a minute and let yourself ponder a gift
from you to you. Imagine that you could offer yourself the gift of
care and full attention to each area. Let go of outcomes for right
now. Let go of what is possible and impossible for right now. Let
yourself wonder about possibilities, silently, with eyes closed. There
are twelve domains of living on the inventory. These are areas of
living that some people care about. You can do all twelve, but we
recommend starting with 3 or 4. What is proposed here is 12 little
snippets of not being present, providing just a few details and
examples of ways you have not been present, followed by a short
meditation on each.
from “The Wisdom to Know the Difference,” Wilson & DuFrene,
forthcoming
substances.
Practicing Our Way to the Gift of Stillness Inventory-Part 2
!
This inventory is not an exercise in “what is wrong with me,”
though that sort of thought may well be called up as you fill the
inventory out. The purpose of the inventory is to begin our practice of
pausing, of coming to stillness when hard things are in front of us.
Notice any tendency to hide, run, or fight. Hiding may sound like: I
don’t need to do this. Running may sound like: I’ll do this later.
Fighting may sound like: Why do I need to do this! You can’t make me
do this! And, of course, I cannot. But, if you can learn to slow down
and to pause in the face of hard things, you will be better practiced
at pausing later on when we start talking about taking a direction,
about choosing a path.
from “The Wisdom to Know the Difference,” Wilson & DuFrene,
forthcoming
Interested...
Join ACBS -(values-based dues)
www.contextualpsychology.org
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Mindfulness for Two
www.mindfulnessfortwo.com
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Things Might Go Terribly, Horribly Wrong
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