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Presentation to World Congress Cognitive and Behavioural Psychotherapies. Barcelona 2007. Modified version presented at IHRA Bangkok, 2009.
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Lost and found in translation:Sharing cognitive Behaviour therapy skills in Mauritius
Frank Ryan
Consultant Clinical Psychologist Honorary Research Fellow
CNWL NHS Foundation Trust Birkbeck College
London University of London
Background and Overview
• Spread of HIV through injecting drug use
• Need to engage injecting drug users into treatment
• Health and social care professionals need to acquire appropriate knowledge and skills
• Conclusion is that basic behaviour change techniques can travel
Psychological Therapy for Addiction Workshop November 7th-11th 2006
Tuesday 7th Weds 8th Thursday 9th Friday 10th Saturday 11th
Opening
Ceremony
Introduction
Setting the
Scene;
managing
expectations.
Motivating
& Engaging
Drug Users
Into
treatment
(Lecture,
Video &
Group work)
Impulse
Control: Using
Cognitive –
behaviour
therapy to
cope with
urges and
craving
Affect
regulation:
Using
Cognitive –
behaviour
therapy to cope
with negative
mood states
Implementing
CHANGE:
How to apply
what we have
learned.
Evaluation.
Lunch Lunch Lunch Lunch Lunch
Introducing
the
CHANGE
Programme
Reflective
listening and
giving
Feedback
(discussion
and practice)
Video
demonstration
& practice:
teaching
clients to
manage
craving &
urges
Video
Demonstration
& practice:
Identifying
negative and
unhelpful
thinking in
ourselves and
clients
Closing
Ceremony
Its all about CHANGE
• Change
• Habits
• And
• Negative
• Generation of
• Emotion
The role of the therapist is to
provide treatment aimed at helping the client acquire insight and self- regulation skills. This involves working with addictive behaviour and emotional dysregulation in a structured,
hierarchical way.
Keep it simple; keep it focused
• The CHANGE model was designed to enable the wider application of CBT techniques among workers in substance misuse and c0-morbidity areas.
• It provides a simple hierarchy to inform treatment planning: address substance misuse/impulse control in advance of emotional disorders –not least because the latter are made worse by the former.
The Four “M’s”
• Motivate (and engage)
• Manage impulses to use
• Manage your mood
• Maintain lifestyle change
Feedback
• The overall mean score was 9.36
• Range 8-10
• Median 10.
• “We would wish that the course can continue so as we can be better professionals to alleviate clients lives, to have a better Mauritius. Many thanks to you Dr Ryan – God bless you.”
• “Nice workshop-some practical sessions in London would also be most welcome”
Do’ s and Don’t s
• Encourage small group work in local language
• Present simple model of change but supply background reading for those more likely to benefit from this
• Emphasise pre-existing core skills and reinforce their use
• Use complex models
• Pre-packaged training materials such as DVDs < “unless home grown”>
Conclusions (i)
• The pragmatic nature of CBT contributed to its success in a diverse cultural context.
• The most highly rated session was an exercise to structure a keyworking session and use techniques such as active listening, expressing accurate empathy, giving feedback
and goal setting.
Conclusions (ii)
Sharing skills is crucial but skills will not share themselves!! Sustained effort over a long period of time is essential.
High level visible support is essential to launch and to sustain new initiatives
WCBCT should address the challenge of a global role
Acknowledgements
United Nations Office on Drugs and Crime
Central &North West London NHS Foundation Trust & colleagues on CBT Diploma Course.
National Treatment & Rehabilitation Centre for Substance Abuse (Republic of Mauritius)
