Session 9 Protocol: Elective Skill Topic 3

The counselor welcomes the client and provides an overview of the session. In this session, the counselor assesses the client’s level of depression and determines whether additional services are required. The client learns to recognize and cope with negative affective states.

Address the Possibility of Negative Moods

The counselor explains that negative moods (e.g., anxiety, irritability, depression) are common among people overcoming marijuana dependence:

Counselor (C): Moods may relate to the effects of stopping marijuana use or the losses in one’s life (e.g., family, job, finances) resulting from marijuana use. Difficulties with negative mood states (e.g., depression) may have started before marijuana use and may serve as a trigger for continued use. Abstinence from marijuana usually leads to improved mood (especially as clients start to cope effectively with other problems), but some individuals experience depression or other moods even after being abstinent for several weeks.

Because negative moods often pose a risk for relapse, the client should address them directly during treatment. The counselor focuses on negative moods through problemsolving and increasing pleasant activities. If after session 3 the counselor suspects that the client can benefit from additional counseling or psychotropic medications, the counselor explores these possibilities with the client, particularly a client who is severely depressed, has an anxiety disorder, or has a personal or family history of mental disorders or aggression.

The counselor discusses the following strategies to help clients with mild to moderate levels of depression identify negative feelings:

• Increase awareness of negative moods and overly negative thinking

• Challenge negative thoughts

• Solve problems

• Change the client’s activity level

• Decrease negative activities.

The counselor asks the client whether he or she experiences mood swings, low energy level, changes in appetite and sleep, and suicidality. If indicated (e.g., in the case of suicidality) the client should be referred for assessment by a mental health professional. He or she encourages the client to be aware of possible distorted perceptions that may precede or coincide with negative moods. The counselor encourages the client to pay attention to the contexts associated with mood changes and to watch for times when confidence level changes.

Discuss the Importance of Emotional Triggers

The counselor and client review Thinking Errors That Dampen One’s Mood (form 9D). The counselor explains that a connection exists among how people think, feel, and behave and that the client can experience fewer negative moods if he or she thinks in realistic, balanced ways rather than in overly negative, self-defeating ways. The client identifies which automatic negative thoughts he or she engages in. If the client has difficulty identifying these thoughts, the counselor tells the client to slow down the action (as if watching a movie in slow motion) or look at what the situation means. Sometimes writing down the most distressing thoughts helps a client remember his or her thoughts.

Once the client identifies his or her automatic negative thoughts, the counselor gives the client Managing Negative Moods and Depression (form 9E). The counselor tells the client to fill out the form thinking about distressing situations to avoid and recognizing that an event often can be interpreted in more than one way (Emery 1981).

The counselor engages the client in problemsolving to address problems contributing to negative moods. The problemsolving steps are reviewed briefly, emphasizing brainstorming and selecting the most promising approach.

The counselor encourages the client to consider increasing involvement in positive activities and reducing involvement in negative ones. Increasing positive activities improves mood by counteracting fatigue and improving motivation. Pleasant Activities (form 4C) (adapted from MacPhillamy and Lewinsohn 1982) or the calendar of events section in the local newspaper may help the client generate a list of enjoyable activities.

The counselor tells the client to consider activities that vary in price and that can be enjoyed when a person is abstinent and to balance pleasant activities (e.g., a walk in a park, attending the theater) with required activities (e.g., working, cleaning, studying). Engaging in a pleasant activity for 30 minutes two or three times a week (e.g., exercising, reading a favorite author) can fit easily into the client’s schedule.

A depressed client may need to schedule fewer activities and record them on a calendar. The client may need to be rewarded in some way (unrelated to using substances) for completing these activities (e.g., spouse agrees to prepare dinner).

Decide which activities the client must do and which can be delegated to others. If the activity cannot be delegated, the client explores ways to change the context associated with the activity (e.g., call a friend only after an hour of studying, combine studying with music that is not distracting). If the client reports difficulty starting a necessary activity, he or she might try to do the activity for only a short time, perhaps 15 minutes. Some less desirable activities can be eliminated by problemsolving, time management (e.g., prioritizing tasks, setting time limits to complete tasks), and setting appropriate limits on others’ requests.