Want a good mental work out to cure your bad habits? Try Cognitive Brain Training

 A promising new type of cognitive therapy called “brain training” has been demonstrated to be useful in treating drug addiction, according to an article recently published in the recent issue of Biological Psychiatry:

Warren K. Bickel, Richard Yi, Reid D. Landes, Paul F. Hill, Carole Baxter. Remember the Future: Working Memory Training Decreases Delay Discounting Among Stimulant Addicts. Biological Psychiatry, 2011; 69 (3).

 I use this type of therapy in my office to treat all types of problems ranging from depression, to AD/HD, to addictive problems. This new study adds significant weight to earlier preliminary results that brain training is highly useful for problematic substance abuse.

We have come to learn that drug addiction leads to changes in the actual structure and function of the brain. People with compulsive addictions, especially those that are substance in nature, tend to exhibit a trait called “delay discounting”, or the tendency to devalue rewards and punishments that occur in the future. People with addictions may at the same time have a predisposition towards what is called “reward myopia” which is the tendency towards the immediate gratification that drugs can provide with addictions.

Warren Bickel, Ph.D., a pioneer in Brain Training and his colleagues at the Center for Addiction Research in Little Rock, Arkansas borrowed a rehabilitation approach used successfully with patients suffering from stroke, or traumatic brain injury. The therapy approach involved stretching general memory capabilities. Subjects addicted to stimulants were given brain exercises that focused on strengthening the areas of the brain associated with storing and managing information reasoning to guide behavior. Dr. Bickel’s team found that by strengthening the brain circuitry, they also reduced the addicts devaluation of longer term rewards.

Dr. John Krystal, Editor of Biological Psychiatry comments on the article:“The legal punishments and medical damages associated with the consumption of drugs of abuse may be meaningless to the addict in the moment when they have to choose whether or not to take their drug. Their mind is filled with the imagination of the pleasure to follow. We now see evidence that this myopic view of immediate pleasures and delayed punishments is not a fixed feature of addiction. Perhaps cognitive training is one tool that clinicians may employ to end the hijacking of imagination by drugs of abuse.”

My experience with Brain Training has been equally exciting, in terms of seeing clients learn to develop competing thoughts and goals that not only challenge their maladaptive patterns (e.g., depression, anxiety, impulse delay with AD/HD or substance abuse), but replace those thoughts with real expectations of rewards in the future, if the client were to change his or her old pattern. This “old versus new” brain idea is explained to clients as offering a choice – either clients can revert to old “reptilian” responses that keep them locked in their psychic pain, or give a good mental workout to new neuroconnections that satisfy and encourage new thought and behavior patterns, and rewards! Putting it another way, if we envision in our minds new positive possibilities, we can not only get excited about those potential outcomes in our lives, but we can actually increase our brain’s likelihood that the brain “muscle” will train and grow in response to our cognitive strengthening exercises. How cool is that! So maximize your “brain
plasticity.” Cognitive Brain Training is an extremely useful addition to another great technique I use, Mindfulness Based Cognitive Therapy (MBCT), which will be the topic of my next blog. Stay tuned.

Using Mindfulness and Cognitive Therapy for Treating Self-Doubts

To the outside world, you are successful, attractive or popular. You have a good marriage, your kids are doing well, or you get good reviews at work. But you feel like a worthless fraud on the inside. How could your own perception be so disparate from reality?

“Most people are struggling with difficult thoughts and feelings. But the show we put on for others says ‘I’ve got it handled,'” says Steven C. Hayes, a professor of psychology at University of Nevada-Reno. In reality, however, “there’s a big difference between what’s on the outside and what’s on the inside.”

Cognitive-behavioral therapy aims to help patients identify and dismantle their self doubts in several ways. Identifying the underlying cognitive distortion that may often be unconscious to the person is key. Most people make the mistake of utilizing one or more of several common cognitive distortions in appraising their life situations. Once these distortions are understood and made conscious, labeling the situation and thought error is often a big relief, besides extremely valuable (e.g., “I get all A’s and B’s in my accounting class, but I worry or dream I’m going to fail the class. What catastrophization! How ridiculous.”)

The next step is dismantling, which requires action steps learned with a cognitive therapist. These steps include utilizing the Socratic method (“What is the likelihood that your distortion is real? If so, what will happen next? What is the worst thing that will happen? What else can I do about when I have this thought?”) until the distortion becomes clear to the conscious mind, and renders itself faulty, exaggerated, or better yet, replaced.

Now, a third-wave of cognitive-behavioral therapy movement centers on mindfulness—paying attention to the present moment. One way I have found it useful to apply with clients is to help them imagine their thoughts as fluid, just passing through their minds, rather than sticking or having legitimate power or meaning (like “passing clouds.”) This technique can diffuse their emotional power (“Here’s that old ‘stupid’ feeling again. You know, this happens every time I compare myself to George in my class. But wait, my grades are good! I am sure mean to myself. I’m just going to let that thought pass and take a deep breath. Then, I’m going to get back to studying, or take a break. Or I could remind myself/focus upon when I did well on my tests or reports.”)

Here’s an example summary of how to address the thoughts of being a fraud:

Worried about being a fraud: Resolve to try to remember that you are valuable or capable, and have come by successes honestly.

Deny: Remember past decent exam scores and/or praise from a teacher/colleague.

Accept: Understand that everyone feels this way from time to time and ask yourself if worrying is worth it.

“Part of what mindfulness does is get to you to recognize that these critical thoughts are really stories you have created about yourself. They are not necessarily true, but they can have self-fulfilling consequences,” says Zindel V. Segal, a professor of psychiatry at the University of Toronto who devised Mindfulness-Based Cognitive Therapy to help depressed patients. “If you can get some distance from them, you can see that there are choices about how to respond.”

Mindfulness also involves paying attention to your breathing and other physical sensations while observing your thoughts so you have a tapestry of information to consider, says Dr. Segal. In fact, neuro-imaging studies have shown that when people consider problems mindfully, they use additional brain circuits beyond those that simply involve problem-solving. Randomized-controlled trials within the past ten years have shown extremely effective responses for people using the techniques for treating depression, anxiety, and even the personality disorders. I use many of these techniques also for addressing cravings for alcohol or drugs, or for addressing fears about change while undertaking sobriety.

My colleague Marsha Linehan, Ph.D., a professor of psychology at the University of Washington, summed up nicely the negative power behind such cognitive distortions: “It’s the nonjudgmental part that trips most people up,” says Dr. Linehan. “Most of us think that if we are judgmental enough, things will change. But judgment makes it harder to change.” She adds: “What happens in mindfulness over the long haul is that you finally accept that you’ve seen this soap opera before and you can turn off the TV.”

My work at Wayne State University

My desire to help to treat psychological and addiction problems has been something of a passion of mine for many years. This article linked below was written in 1998 for the Wayne State University School of Medicine newspaper “The Scribe” about a program to treat adolescents with psychological and addiction problems, that I developed and directed while on faculty at WSU. Actually, I have another fond memory that emanates for me from this article, in addition to my work, at WSU. My daughter, with whom I was pregnant in this photo, was born just days after the journalism staff had interviewed me for this article! My commitment  to helping individualize treatment and provide the best possible help for your problems, whether they are psychological or substance related, continues just as strongly today:

http://www.med.wayne.edu/Scribe/scribe97-98/scribes98/adoles_get_dual.htm

The Effectiveness of Cognitive Therapy for Depression

This is a landmark study – a meta-analysis by Dr. Keith Dobson that reported that cognitive therapy was even more effective than medication treatment or other psychological treatments for treating most depression. Medication treatment, however, when added to cognitive therapy with more severe depression, results in the best outcomes:

http://psycnet.apa.org/?fa=main.doiLanding&fuseaction=showUIDAbstract&uid=1989-30221-001

Cognitive Therapy for Substance Abuse

Here’s an interesting article by well-known and respected Dr. Kadden at the University of Connecticut, explaining in great detail the functional analysis and approach to substance abuse treatment from the cognitive therapy perspective. It is written for other psychologists, so it contains psycho-lingo, but is very descriptive for anyone interested in this level of understanding of our approach as cognitive therapists:

http://www.bhrm.org/guidelines/CBT-Kadden.pdf

How to Find the Right Therapist

Once you have made the decision to seek treatment for your psychological and/or addiction concern, the next thing you will need to decide is with whom to treat.  You will also need to make this decision as you look for someone to prepare you substance abuse evaluation for your Michigan Driver License Restoration Hearing.

One thing to consider is the specialized background of your particular therapist.  It is also important for you to have a good professional relationship with the person you choose.

Keep in mind that the area of addiction medicine is very complex and does require specialization.  Also, and I know this is confusing to the public, training levels of professionals vary widely and the term “therapist” tells you very little about the person’s education level.

Master Degree Therapists:

People that have obtained master’s degree level training often call themselves counselors, therapists, psychotherapists, social workers or limited-licensed psychologists.  By Michigan law they may not call themselves “clinical psychologists” because this title is reserved exclusively for PhD level training.

Most master’s degree therapists have anywhere from 1 ½ to 3 years of graduate training after the college degree. You should also be aware that there are health care workers who do not have any or very minimal formal college training who can call themselves counselors.

Clinical Psychologist:

To add to the confusion, there are different kinds of clinical psychologists which depend on the type of specialized training.  Some PhD level psychologists have training that is geared toward research only while others such as myself have PhD training that is geared toward research and treatment.

Typically, clinical psychologists have over 10 years of higher education.  Clinical psychologists must complete a doctoral dissertation or independent full-scale research project as a requirement for the degree. Many clinical psychologists continue research and continue publishing research throughout their careers. At the early part of my career I did research and publishing in the area of cognitive behavioral therapy and addiction and treatment of addiction.  I now devote my practice solely to seeing patients.

After completing their “formal” training, clinical psychologists also must work in the field for one year in internship before being granted the final degree. Then they must pass a grueling state licensing exam which they cannot even take until they have been practicing in the field for two years after receiving their PhDs. In addition, many psychologists like myself, undergo even more training, such as my additional two year post-doctoral fellowship and year-long training for certification in cognitive therapy through the Academy of Cognitive Therapy in Philadelphia.

Finally, once they jump through all these hoops and can finally practice independently (whereas most other counselors, incidentally, can never can practice independently, but must always be supervised), PhDs generally partake in continued education to stay up-to-date on research and techniques to keep them on top of the field.

Because of all this dual training clinical psychologists are true “scientists-practitioners,” and the best always keep their pulse on the cutting edge of biological and psychosocial treatment research, while bringing the developments of science to you in the treatment office. Many clinical psychologists also serve as faculty members at major colleges and universities.

Knowing the background of your evaluator and/or therapist can help you make an informed choice of the best person to meet your needs, and can make a big difference in your treatment outcome.

Rule 13 Makes License Restoration Difficult

When I prepare a substance abuse evaluation I am doing so because you have been convicted for multiple drunk driving cases and your license has been revoked.  Under these cirumstances the rules from the Secretary of State require that you present a substance abuse evaluation before you can regain your license.

The rule also requires that in order to regain your license, you must present clear and convincing evidence, which I understand to be a very high standard, just below the standard of beyond a reasonable doubt.  Your experienced driver license restoration lawyer can explain these various standards to you.

According to rule 13, your substance abuse evaluation must help you establish by clear and convincing evidence:

  • That any alcohol or substance abuse problems you have are under control and likely to remain under control.
  • You are at low or minimal risk of relapse.
  • You have the ability and motivation to drive safely.
  • You must also demonstrate complete abstinence from alcohol and/or controlled substances for at least six months but usually for one year.

 When I perform my substance abuse evaluation these factors are some of the things that I will be looking at and thinking about and I will cover them in your evaluation.

 If I believe that I cannot help your attorney make out your burden of proof, then I may recommend further treatment and/or a longer period of abstinence.

You can find more information about Michigan driver license restoration at the Win Back Your Life web site.

Criminal Competency

I found the following article to be very interesting.  This of course is just an excerpt.

Psychological evaluations and the competency to waive Miranda rights

By I. Bruce Frumkin; Alfredo Garcia

Psychology and the law of confessions share a symbiotic relationship. As the “queen of proofs,” confessions play a prominent role in the investigation and prosecution of crimes. The question that has plagued the law is whether an individual who faces a “police-dominated” atmosphere can withstand the psychological, emotional and physical pressures that inhere in the confessional “box.” Before the advent of Miranda, the Supreme Court applied the abstruse and indeterminate “voluntariness” standard to determine the admissibility of a confession. That criterion, as two thoughtful scholars have observed, “required inquiry into metaphysical states of mind that, by the 1960s, were believed to be inherently unknowable.”This metaphysical inquiry represented the apogee of the intersection between law and psychology.

[November 2003, Page p12]

How I Can Help With Your Driver License Restoration Case

If your Michigan driver’s license has been revoked or suspended you may have a need to seek treatment for a drug or alcohol problem.  In fact, it is likely that such treatment will be necessary in order for you to regain your driving privileges.

At the office of Dr. Elizabeth A. Corby we are here to help.  For over two decades I have been helping individuals to overcome their substance abuse problems through cognitive therapy, alcohol treatment and drug counseling. 

I may also refer you to an in-patient or out-patient program, or recommend a 12 step program with counseling and aftercare follow-up. 

If you are ready to show long term abstinence, then I can write a substance abuse evaluation to assist your lawyer in a driver license restoration hearing.