A brief cognitive behavioural intervention for regular amphetamine users: a treatment guide

Phase 2: Link between thoughts and behaviour

Page last updated: 2003

Rationale for the exercise

Explain to your client that it was important to gather information about the situations in which they are more likely to use speed because it helps to establish what kinds of things are triggering or maintaining their use. The next step is to develop other ways to deal with these 'high-risk' situations without resorting to using speed.

Use the following rationale with your client:

"All people who are trying to reduce their speed use will have thoughts about using, and will increasingly experience urges to seek it out. These thoughts and feelings are quite common, and in themselves do not create problems. Rather, it is important to focus on how you deal with, and respond to, these thoughts and feelings."

Link between thoughts, feelings and behaviour

Explain to your client the link between thoughts, feelings and behaviour using the cognitive model illustrated below (Ellis, 1975). This will enable your client to begin to see the links between their thoughts, feelings and subsequent behaviour (e.g. speed use).

A - Activating events (triggers) lead to B - Beliefs (thoughts) lead to C - Consequences (feelings/behaviour)
Explain to your client that their thinking influences the way they feel and behave. Events/situations that occur in the outside world do not usually cause feelings or behaviour; rather it is an individual's interpretation (or thoughts) about those events that will directly lead to their feelings and subsequent actions. In some cases, the thoughts that they have about a particular situation can be quite unhelpful, and lead to them feeling the urge to use speed to help them cope.

Often, the unhelpful thoughts happen so quickly in response to trigger events that people do not even realise what is happening. That is why these thoughts are often referred to as 'automatic'. Usually, people suddenly realise that they are experiencing a craving/urge to use. These feelings are often a signal that they have slipped into automatic pilot and allowed a trigger situation to lead to an unhelpful thought about that situation, which has then resulted in a craving. Top of page

Exercise 1: Demonstrating the link between thoughts and behaviour

  • Take one of the situations from the homework task in which the client experienced strong urges/cravings to use speed or did use speed.

  • Help the client to identify the A's, B's and C's surrounding that event/situation. Include any unhelpful self-talk/thoughts the client experienced, such as "I can't cope without speed".

  • Explain to the client that an important part in managing those situations that trigger cravings to use speed is to become aware of their unhelpful thinking patterns associated with these situations. The client can then better recognise the patterns associated with a relapse, and develop alternative thoughts or interpretations for those situations.

  • Explain to your client that the thoughts that usually lead to cravings and urges to use characteristically fall into one of five unhelpful patterns of thinking:

    1. Black and white thinking: this pattern of thinking is characterised by the interpretation that things are either all good or all bad – with nothing in between, no balance, no shades of grey. For example, because something has gone wrong once, black and white thinking dictates it will always go wrong. Does your client have strict rules about themselves and their lives? Are they rigid in their need to stick perfectly to their goals? If so, black and white thinking might be an unhelpful thought pattern that your client is using. Examples of black and white thinking include: "If I fail partly, it is as bad as being a complete failure", or "I never get what I want so it's foolish to want anything". In particular, "even if I use once this week, I'm a failure, so why bother" or "I can't change, so it's pointless trying at all".

    2. Jumping to negative conclusions: does your client automatically draw a negative conclusion about an issue more times than not? People who 'jump to negative conclusions' sometimes act like 'mind readers'. They think they can tell what another person is really thinking, often without checking it out or testing the conclusion. Other times, people who 'jump to negative conclusions' may engage in 'fortune telling'. They believe that things will turn out badly, and are certain that this will always be the case. For example, they might think: "Things just won't work out the way I want them to", or "I never get what I want so it's stupid to want anything", or "There's no use in really trying to get something I want because I probably won't get it". In relation to their speed use, people with this pattern of thinking may believe "I'll never be able to change my drug using, it'll never be any different".

    3. Catastrophising: people with this pattern of unhelpful thinking tend to give too much meaning to situations. They convince themselves that if something goes wrong, the result will be totally unbearable and intolerable. For example, "If I get a craving, it will be unbearable and I will be unable to resist it". If 'catastrophisers' have a disagreement with someone, they may think that "the person hates me, doesn't trust me, and things will never change". Or, "if I don't have a hit, I'll never be able to cope with this."

    4. Personalising: 'personalisers' will blame themselves for anything unpleasant that happens. They take a lot of responsibility for other people's feelings and behaviour, and often confuse facts with feelings. For example, "My brother has come home in a bad mood, it must be something that I have done" or "I feel stupid, so I am stupid". People with this pattern of thinking often put themselves down, and think too little of themselves, particularly in response to making a mistake. They may think things like "I'm weak and stupid, there's no way I'll be able to resist my craving". In response to a slip, personalisers will often say to themselves: "see, I knew I'd never be strong enough to resist, I'm such a terrible person."

    5. Shoulds/oughts: people with this pattern of thinking use 'should', 'ought' and 'must' when they think about situations. This often results in feelings of guilt. Shoulds and oughts quite often set a person up to be disappointed, particularly if these thoughts are unreasonable. For example, "I must not get angry", "He should always be on time", and especially, "I should be strong enough to never even experience a craving – I should just be able to stop." 'Should' statements can cause a person to experience anger and frustration when that person directs these statements at others. Top of page

  • In helping your client to better cope in these craving situations, it is important for them to identify the unhelpful thought patterns they are likely to engage in, and then learn ways to deal with these thoughts directly, without using speed.

  • Help the client to identify from their urge diary, which unhelpful thinking patterns they are likely to use.