Loss of control in its broader sense encompasses both the relative inability of an addict to terminate consumption once initiated and the inability to refrain from substance use following a period of abstinence (Lyvers, 2000). This has been attributed to impairments in the area of the brain that is responsible for executive functions including behavioural autonomy and self control.

Impairments to the frontal lobe following long term chronic substance use may result in compulsive behaviour (Lyvers, 2000).  Typically, addicts cannot predict or determine how much of the drug they intend to use and for how long they will use it.  Loss of control is manifested by the following:

Using more of the substance than intended

Once a person with an addiction gets rolling, it can be hard to stop.  Substance use almost always takes longer than they say because they have little ability to control the amount they have.  When addicted, the person can become oblivious to the passage of time or other obligations they may have.

For example:

Your roommate says he’s just going to have one or two beers over at a friend’s place. You drop by about an hour later and find that he’s finished a six pack and is heading into a new one.  A woman tells her husband she’s going to have a drink after supper. Two hours later, her husband has noticed her refilling at least four times. 

Using the substance longer than the intended time

It is often difficult for addicted individuals to stop use once they have start (Coombs & Howatt, 2005). 

For example:

A husband tells his wife he’s just going to watch the game and drink a few beers at a friend’s house, then he’ll come home and they’ll go out for dinner. However, he doesn’t come home in time for dinner, and his wife can’t reach him.  He and his friends had gotten drunk during the game and went down to the public bar for a few hours.

Not being able to keep track of how much of the substance they have used

Addicts almost always underestimate the amount they have used.  They usually are not keeping track in the first place because again, their indulgence is not done in a socially responsible manner.

For example:

If you ask an alcoholic how much they have consumed, you will invariably get some strange answers.  Some will swear they only had four or five, even when their Blood Alcohol Content shows higher concentrations than what would be accountable if having four or five. Or, they may simply say, “I don’t know,” which is probably the most accurate answer.

Source: www.mentalhealthacademy.com.au

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Duration: 70 minutes
Category: Clinical Interventions & Counselling Strategies

This video has been designed to provide an introduction to Counselling and the Counselling Process. The presenter, Dr Clive Jones (Dipt, DipCouns, BEd, MEd, GradDipPsych, PhD(psych), MAPS), highlights three key areas and provide a general framework from which to develop your own structure for counselling sessions.

Dr Clive Jones is a registered psychologist and registered teacher. He is a full member of the Australian Psychological Society (APS), a full member of the Australian Psychological Society’s College of Counselling Psychologists, and a full member of the Australian Psychological Society’s College of Sport Psychologists.

Watch this video from Mental Health Academy.

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This special report includes the following topics:

Counselling Microskills – An Overview
Focusing
Encouragers, Paraphrasing and Summarising
Questioning
Confrontation
Reflection of Meaning
Self-Disclosure
Active Listening
Body Language – An Overview
Observation Skills
Attending Behaviour
Empathy

Click here to download your copy!

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Cognitive restructuring, straight thinking or logical reanalysis is based on the belief that the way we feel, behave and respond to situations is based on the way we think. This approach attempts to modify unhelpful thought patterns and beliefs. Cognitive restructuring, also known as cognitive reframing, is a technique drawn from cognitive therapy that can help people identify, challenge and alter anxiety provoking thought patterns and beliefs.

Thinking that is not straight or accurate is based on false assumptions about other people and the world in general and is often the basis of anxiety and other negative mood states. For example, a woman who suffers social anxiety may hate to stand in line in the grocery store because she is afraid that everyone is watching her.

Once a false assumption has been made, it will then often be used as a basis for prompting key behaviours that end up acting in response to the false assumption as if it were true. Irrational thoughts like this, and their accompanying behaviours, play a big part in the onset of anxiety.

For example; thoughts like; “What if I do something stupid?”, “What if something terrible happens to me or my family?”, “What if I can’t escape?”, “What if they end up hating me” or “What if I have another panic attack?”, can clearly evoke emotions of fear and anxiety through believing the thought and then reinforcing the thought through shaping behaviour in accord with it. 

The first step in cognitive restructuring is to identify what the unhelpful thoughts or self talk are and when they are most likely to occur. For example, a person who notices they become anxious before meeting new people might be asked to write down their thoughts prior to such an event. They might end up recording such unhelpful thoughts and self talk like:

1. What if it all goes wrong?
2. I’m not good enough to do this.
3. What will people think if I say the wrong thing?
4. I couldn’t relax last time; I’ll be useless this time.

Once this self-talk has been identified, clients are assisted in modifying them into a more realistic assessment and belief.

For example:

1. Worrying about something going wrong won’t stop it from happening; it just makes me more anxious. I can take positive steps to prepare for possible problems and that’s all anyone can do. Anyway what really is the worst thing that can happen if it does go wrong? When I think about it – there really isn’t that much that would happen if it did go wrong. The word keeps spinning and the sun stays in the sky…
2. I do things well most of the time but like everyone, I will occasionally make a mistake. I will feel bad about this but I can handle that and take constructive steps to do better next time.
3. I don’t know what other people will think, but if I say the wrong thing I can cope. I’ve coped with this before. Anyway – What is ‘the wrong thing’ anyway? If its what I think or feel… then why should that be considered wrong? I have thoughts and feelings like anyone else. Just because they might be different from someone else doesn’t mean its wrong.
4. I experienced symptoms of anxiety last time which made things harder. I’ll use my anxiety management skills this time because the more I use them, the more relaxed I will become as I get the hang of it. Anyway, it’s not about focusing on the anxiety; it’s about focusing on what I need to do. I mean why worry about getting anxious… it happens to everyone… and anyway if I get anxious its not like my head is going to explode or my vital organs are going to get ripped out. I’ve got to keep it in perspective.

In teaching the client to make more accurate appraisals of each situation, they will begin to identify the unrealistic thinking that has been contributing to their anxiety.

When clients first begin to make reappraisals of their irrational thoughts, they will often state the new reappraised thought back accurately and they will usually see the logic and sense in the newly appraised thought. However, deep down, they may still feel emotionally connected to the irrational thought and somehow still believe the irrational thought over the newly appraised one. This is fairly typical as beliefs and perceptions are not always that easy to change.

One reason why irrational thoughts, beliefs and perceptions can stay fixed is because often the client’s behaviour will continue to reinforce the older more irrational thought rather than the newly appraised thoughts.

For example, if a client was trying to have the reappraised thought that closing the front door 30 times before going to work will not do anything by way of stopping a personal tragedy but continues to close the front door 30 times each morning, then the behaviour is continually reinforcing the irrational thought that closing the door 30 times will help stop the likelihood of a personal tragedy.

Therefore, to encourage a greater level of ownership or more deeply held belief in the newly appraised thought of; closing the door 30 times before work does not stop personal tragedies, the client will often need to be encouraged to act as if the new thought was true – even if deep down they still had their doubts and even when their emotional response was still anxiety laden in contradiction to the newly acquired thought.

In the context of the example already mentioned, the client would need to choose not to close the front door 30 times before work and behave instead as if the newly appraised belief was true. Even if they walked away feeling very anxious, worried and apprehensive over the strong likelihood of a personal tragedy occurring, by acting as if the new appraised thought was true, they reinforce the new appraised thought, thus encouraging a greater belief in it over time.

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The Beck Depression Inventory is copyrighted by the Psychological Corporation. Material here presented is only for educational purpose because the BDI should be used only by registered professionals. The original version of the BDI was introduced by Beck, Ward, Mendelson, Mock and Erbaugh in 1961 (cited in Victims’ Web, 2007). The BDI was revised in 1971 and made copyright in 1978.

The BDI is a 21 item self-report rating inventory measuring characteristic attitudes and symptoms of depression. Each item represents one attitude, such as sadness, pessimism, sense of failure, dissatisfaction, guilt, expectation of punishment, dislike of self, self accusation, suicidal ideation, episodes of crying, irritability, social withdrawal, indecisiveness, change in body image, retardation, insomnia, fatigability, loss of appetite, loss of weight, somatic preoccupation and low level of energy.

The highest score on each of the twenty-one questions is three (3), the highest possible total for the whole test is sixty-three (63). The lowest possible score for the whole test is zero. The total is obtained when the scores are added for all of the twenty-one questions.

Levels of Depression according to the BDI:

05 - 09   Healthy score
10 - 18   Mild to moderate depression
19 - 29   Moderate to severe depression
30 - 63   Severe depression

Samples items of the BDI questions:

Item 7 – Dislike of self

0  I don’t feel disappointed in myself.
1  I am disappointed in myself.
2  I am disgusted with myself.
3  I hate myself.

Item 20 – Somatic preoccupation

0  I am no more worried about my health than usual
1  I am worried about physical problems such as aches or pains, or upset stomach, or constipation.
2  I am very worried about physical problems and it’s hard to think of much else.
3  I am so worried about my physical problems that I cannot think about anything else.

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