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Section 5
Deficits in Emotion-Regulation Skills

Question 5 | Test | Table of Contents

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In the last section, we discussed identifying triggers that lead to overdrinking.  This section provided practical information and techniques for dealing with four common triggers.  The four triggers that can lead to excessive alcohol use that we looked at on that section were places, people, time, and feelings.

Your controlled-drinking client may currently use alcohol to relieve tension, or overcome anxiety, fear, panic, or a number of other emotions.  If you have found that your client is using alcohol to manage emotions, you may find this section particularly useful.  Two Cognitive Behavior Therapy methods your client can use to manage emotions in a more productive way than by excessive alcohol use are systematic desensitization and dealing with unpleasant memories

As I describe ways in which systematic desensitization and dealing with unpleasant memories can be used as a tool for controlled drinking, consider your current therapeutic methods which employ these techniques.

Two CBT Methods to Manage Emotions

♦ #1  Systematic Desensitization
First, let’s discuss systematic desensitization.  Clearly, your current use of relaxation techniques and gradual approach may be very similar to the one Max used.  However, as you listen to this example, consider focusing on the alcohol-related aspects of this example. 

Max, age 42, had an important promotional interview coming up.  Max stated, "I’m nervous just thinking about this interview.  And I know I’m gonna start drinking more than I want to the more I think about it." 

a. To begin systematic desensitization with Max, we discussed different possible versions of the interview that could lead to his desire to drink.  A specific scenario Max was concerned with was that he would freeze up and be unable to talk.  We discussed the elements of the interview that made Max want to drink in detail.  Then we arranged these elements in order so that the least difficult ones came first.  Max’s list included about 14 different interview scenarios.  The 14 different interview scenarios included saying something stupid, freezing up, not being taken seriously, and getting laughed at. 

b. The second step for Max’s systematic desensitization was to use relaxation skills to gain mental control.  The relaxation skills Max used consisted of a standard deep breathing exercise.  What type of deep breathing or deep muscle relaxation procedure do you use with your clients? 

c. In addition to listing scenarios and relaxing, the third step in systematic desensitization for Max was to imagine the scenario.  In this third step, I helped Max imagine the first and easiest scene as vividly as possible.  In Max’s first interview scenario, he was concerned about saying something stupid.  Max had stated earlier, "Sometimes I want to say something, but the words don’t come out right!  When I drink, I can speak better!" 

As Max focused on his anticipated feelings and created a mental picture of the interview, I used words that Max had used in describing the situation to me in order to increase how vivid Max was able to imagine the situation.  For example, when Max had described the situation in which he might say something stupid, he stated, "I just wish I could be more eloquent."  So, as Max was trying to mentally picture himself saying something stupid in the interview, I stated, "You are not eloquent.  The words don’t seem to come out right.  " 

Once Max had begun to imagine to the details of the first interview situation, I stated, "If you feel yourself craving a drink, stop imagining the scene and go back to your relaxation exercise.  Your goal is to imagine the scene without feeling like alcohol would make it better."  When Max could picture the first interview situation twice for at least 20 seconds each time without wanting a drink, we moved on to the next situation.  We also discussed creating a positive visualization and affirmation of , "I am an eloquent speaker."

d. The fourth step in systematic desensitization was for Max to continue through his list until he could vividly imagine the most difficult situations without wanting a drink.  Max did so outside of our therapy sessions using the guidelines that we reviewed. 

To help Max with systematic desensitization on his own, I stated, "You might only do a few scenarios each time you try.  When you start a new session, begin with the last scene you were able to visualize without wanting to drink.  Remember, this is not an endurance test.  If you feel any desire to drink, stop and go back to your relaxation skills.  And, when you finish a session, be sure to end it with a successful visualization in which you have no need or desire to drink.

Consider your Max.  Does he or she manage emotions with alcohol?  Could systematic desensitization help eliminate emotional drinking triggers?

Incidentally, if you are into technology, if they are still available, a (Jared or Jim say slowly) Bio-Acoustical Utilization Device, or B.A.U.D. for short, can be purchased from (Jared or Jim say slowly)  This reference is listed in you manual.  Through the use of tonal sound thought patterns to the addictive thought can be desensitized.

♦ #2  Dealing with Unpleasant Memories
In addition to systematic desensitization, a second CBT method for managing emotions is dealing with unpleasant memories.  Does your controlled-drinking client ‘drink to forget?’  If so, would you agree that he or she has set themselves up to become dependent on alcohol to deal with unpleasant memories?  Perhaps you could utilize systematic desensitization techniques to help a client ease unpleasant memories. 

However, if systematic desensitization as a therapeutic approach is not the desired model for dealing with unpleasant memories, you might consider these alternatives.  As I list these four alternatives for dealing with unpleasant or unresolved memories, consider which might work best for your client.  Perhaps playing this section for your client could provide him or her with a choice as to which alternative he or she might prefer. 

Here are the four alternatives as I give them to my clients.

  1. Get memories off your chest by telling them to someone you trust.  Sometimes just hearing yourself talk about it helps.  You can even ask your friend to just listen, being understanding but not giving any advice or opinions.
  2. Write down your unpleasant memories.  Putting it on paper can make the memory more manageable.  Set aside some time to this and write down the full memory.  Record all that you feel, such as good feelings, bad feelings, hopes and fears, doubts and certainties.  If the memory has to do with a particular person, consider writing your thoughts in the form of a letter to that person.  You can decide later whether or not to mail the letter.
  3. Set aside time to just to remember without alcohol.  During this reserved time, just focus on the memory.  Don’t distract yourself with work, recreation, eating, or drinking.  However, during the rest of the day, don’t allow yourself to think about the memory.  If the memory intrudes, imagine yourself yelling "STOP!"  Or merely say to yourself, "I will devote time to this memory later."  The idea behind this approach is that, by controlling when the memory occurs, you can begin to control the memory itself, diminishing its emotional charge.
  4. Experiment with reshaping the memory.  If the way you think about a past event continually brings about emotional pain, you might be able to think about the memory in other ways.  It can help to conceive of the memory as though it were a physical object that can be turned over, dismantled, or even discarded.

Could your client benefit form alternatives to dealing with unpleasant memories such as reshaping?  Could playing this section in one of your sessions be productive?

In this section, we have discussed using alcohol to manage emotions.  Two methods your client can use to manage emotions in a more productive way than by excessive alcohol use are systematic desensitization and dealing with unpleasant memories. 

In the next section, we will discuss preserving positive self-concepts.  Three steps that you can use to help your clients in preserving positive self-concepts are increasing positive self-thoughts, decreasing negative self-thoughts and setting standards.

Peer-Reviewed Journal Article References:
Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318.

Breuninger, M. M., Grosso, J. A., Hunter, W., & Dolan, S. L. (2020). Treatment of alcohol use disorder: Integration of Alcoholics Anonymous and cognitive behavioral therapy. Training and Education in Professional Psychology, 14(1), 19–26.

Cho, S. B., Su, J., Kuo, S. I-C., Bucholz, K. K., Chan, G., Edenberg, H. J., McCutcheon, V. V., Schuckit, M. A., Kramer, J. R., & Dick, D. M. (2019). Positive and negative reinforcement are differentially associated with alcohol consumption as a function of alcohol dependence. Psychology of Addictive Behaviors, 33(1), 58–68.

Fama, R. (2019). Introduction to the special section on alcohol: Review of cognitive, emotional, and neural deficits and recovery with sustained abstinence and treatment. Neuropsychology, 33(6), 757–759.

Shaver, J. A., Veilleux, J. C., & Ham, L. S. (2013). Meta-emotions as predictors of drinking to cope: A comparison of competing models. Psychology of Addictive Behaviors, 27(4), 1019–1026.

Solloway, T., Slater, M. D., Chung, A., & Goodall, C. E. (2013). Anger, sadness, and fear responses to crime and accident news stories: How emotions influence alcohol-control policies support via risk concern. Journal of Media Psychology: Theories, Methods, and Applications, 25(4), 160–170.

What are two CBT methods your client can use to manage emotions in a more productive way than by excessive
alcohol use? To select and enter your answer go to Test.

Section 6
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