Running head: COD AND TREATMENTS 1
Master's Project
Co-occurring Disorders and Treatments
A Master’s Project
Presented to
The Faculty of the Adler Graduate School
__________________
In Partial Fulfillment of the Requirements for
the Degree of Master of Arts in
Adlerian Counseling and Psychotherapy
__________________
By:
Starla Moore
October, 2015
COD AND TREATMENTS 2
Table of Contents
Introduction ................................................................................. Error! Bookmark not defined.
The COD Manual the Results ........................................................................................................... 3
Literature Review ..................................................................................................................................... 6
Stress and the Brain ............................................................................................................................ 6
Adlerian Approaches .......................................................................................................................... 8
Art Therapy ......................................................................................................................................... 11
Methods ..................................................................................................................................................... 13
Integrated Dual Disorder Treatment ........................................................................................ 13
Brain function ..................................................................................................................................... 15
Adler Therapeutic Approach to Addictions ............................................................................ 16
Cognitive Behavioral Therapy ..................................................................................................... 18
Dialectical Behavior Therapy ....................................................................................................... 19
Discussion ................................................................................................................................................. 20
COD AND TREATMENTS 3
Co-occurring Disorders and Treatments
Counselors have dialogues with clients and apply different concepts of behavioral
change, but do not assess the stages of change a client is presently in. Oftentimes
counselors dialogue with client(s) is for goal setting but have difficulty finding tools to
support their ideas. Clients often depart from a talk therapy session and forget relevant
information that was discussed in the session soon after leaving the session. The Co-
occurring Disorder Manual (COD) is a tool that can assist counselors with practical
application, evidence-based practices, and best practices when addressing the goals of the
client. Learning how to create an action plan and having a tool or tools to use for
preparation of the action plan for the next session is critical to the therapeutic process.
The COD manual can assist the client in the application of new skills in real world
situations after talking in session.
The COD Manual the Results
Learning different approaches, techniques, styles, and attributes of change can help
the counselor to teach the client how to develop resilience and appropriate coping skills.
The goals that are set in session to address client’s mental or chemical imbalance are
practical nevertheless, the COD manual gives applications for the client to apply. Each
client the counselor encounters has a different story to tell and the way that story is told is
different. For example: humans may live in the same habitat yet the way they understand
the world and develop is different. A counselor’s role is to adjust his or her approach to fit
the need of the individual client. The COD manual is designed to help the therapeutic
process and give the counselor tools to use to assist their client in their stages of change.
COD AND TREATMENTS 4
Assigning the COD manual can be helpful in giving the client new ways to learn
how to use all parts of their brain. Worksheets in the COD manual will walk a person
through different stages in life. The cognitive behavioral therapy (CBT) section of the
COD manual’s focus is on minimizing stress, stress triggers, stress management, and
assessing the stress in a person’s life. Each worksheet helps the client to begin to retrain
their brain which gives balance to the decision making process. Moreover, A person
under stress does not have the ability to make rational decisions; therefore, the COD
manual’s CBT section can aide in that process. CBT’s focus is on the cognition and
thought process. The COD manual helps a person to think more rationally and use the
logical, creative, intuitive, and emotional parts of the brain. There are a variety of clients
that do not understand how effective using all parts of their brain can be; because the
potential has been masked by their mental or chemical health disorder. By use of the
COD manual the counselor could teach many clients how to begin to use their brain
functions to its fullest ability.
The COD manual incorporates CBT, Dialectical Behavior therapy, Integrated Dual
Disorder Treatment, and Adlerian Therapy in the formation of the worksheets to train the
brain to be utilized entirely. In this literature review a discussion on: stress, its effect on
brain functioning, and different treatments used to address mental and chemical health
issues will be observed.
COD AND TREATMENTS 5
Figure 1. The Whole Brain
COD AND TREATMENTS 6
Literature Review
Stress and the Brain
Understanding the different origins of stress could assist the individual in
managing distress. Managing stressors and identifying how they affect life could help
individuals to cope with situations better. Phelps 2004 study, talked about the
hippocampal complex forming episodic representations of the emotional significance and
interpretation of events, which can influence the amygdala response when emotionally
stimulated. Individuals that are able to identify their stressors aids in the relief of
emotional dismay, which helps them balance and cope with distress better. Stress is the
body’s response to distressing situations in life (NIMH, 2015). When using drugs or
alcohol the ability to think relationally is hindered. In addition, when suffering from a
mental disorder the ability to rationalize thoughts are suppressed by the disorder. For
Example: According to Rooney, (2015) Adler saw that the feelings of inferiority instilled
or absorbed in childhood could have a lasting negative effect on the adult individual.
Mosak and Maniacci, (1999, p. 79) felt that “stress is the nonspecific response of
the body to any demand made upon it . . . it is immaterial whether the agent or situation
we face is pleasant or unpleasant; all that counts is the intensity of the demand for
readjustment or adaptation. Decision- making is also affected by the body’s reaction to
distress. According to Bechara et al., (2011), advantageous decision-making requires the
contribution of multiple cognitive systems involved in at least two separate but related
processes. Individuals that are under distress have a hard time making rational decisions
perhaps it is because of the emotional instability. “Decision-making is believed to be
COD AND TREATMENTS 7
involved in areas of the brain which is part of emotions and memory” (Bechara, Gupta,
Koscik, & Tranel, 2011, p. 1).
In addition, by being proactive with stressors in a persons life; the individual have
to be able to address and identify those stressors and make appropriate decisions based on
rational thoughts.
The creative and intelligent brain is the higher brain, which separates us from the
primitive species. It is called the CEO or executive center. It sits over the
primitive brain exerting executive control. It is responsible for higher human
function: judgment, planning, moral reasoning, and control of the attention. In
addition, when were under stress, the prefrontal cortex shuts down? Moreover,
when under chronic stress, it shuts down chronically and it fails to develop
properly. (Hagelin, 2014)
COD AND TREATMENTS 8
Figure 2. Brain Functions
Adlerian Approaches
Ansbacher and Ansbacher (1956) stated that Individual Psychology points out that
all behaviors of a human being fits into a unit and is an expression of the individual’s life
style. For example: Identifying a person’s perception on life to help them think
relationally helps in finding a balance between reality and fiction. Adler stated, that in a
person’s lifetime they develop a sense of what life should and should not be (Dinkmeyer
& Sperry, 2000). Based on this theory, an individual forms a fictional final goal, which is
based off their perception of life. Adler also believed that individuals base their style of
COD AND TREATMENTS 9
life on a private logic, which is the way one perceives the world to be based on the
different relationship engaged. A relationship guides a person behavioral view in a good
or possibly bad way of what life is to be. An individual’s private logic of different
relational or irrational interaction in life, directly affects, the way one responds or reacts to
those situations. After those relationships fall apart, it brings on stress, which gears one in
an unconscious goal driven direction. It is hard to manage a life style that one perceives
as positive (Mosak & Maniacci, 1999). For example:
Each person develops in early childhood a fictional image of what she or he needs
to be like, safe, superior, feeling belonging, and so forth. The actualization of the
fictional image becomes the central goal of the lifestyle and, therefore, the
individual is limited in their ability to interact with others. (Dinkmeyer, Dinkmeyer
& Sperry, 1987) ajor depression is an episode of sadness or apathy along with ot
Ansbacher and Ansbacher (1956), stated that the child builds up his whole life,
which we have called the concrete style of life, at a time when he or she has neither an
adequate language nor adequate concepts. Those inadequate beliefs steer one's life in an
inadequate lifestyle that cause dilemmas as one develop into adulthood. Striving for
superiority (private logic) leads to the impossible and one ends up stressed, depressed, and
loses hope in what life should be. As the child grows and develops, the sense of life is
formed, and without a clear interpretation of how life should be, then one ends up
confused and unsure. Adler believed that one seeks to find social significance throughout
their life; depending on the interactions, a perception of what life should be is created.
“Once the goal of the superiority of life has been made concrete, there are no mistakes
made in the style of life” (Ansbacher & Ansbacher, 1956, p. 188).
COD AND TREATMENTS 10
Adlerian Therapy tends to move individuals towards their driven goal once the
interpretation of one's direction is formed to normalcy. For example: “Every problem
child, every neurotic, every drunkard, criminal, or sexual pervert is making the proper
movements to achieve what he takes to be the position of superiority” (Ansbacher &
Ansbacher, 1956, p. 188). When people do not do what situations calls for they are
operating from their private logic (Dinkmeyer et al., 1987). These situations determine
the way we make rational decisions. In this theory, Adler believed that plans; goals, and
experiences affect the way we act in a certain situation. Our behaviors stem from our
thought processes, and if they are not operating correctly, then our thoughts are irrational
(Dinkmery & Sperry, 2000).
A person’s perception could lead to a misconception of a sense of reality. Adler
believed that individuals would conform their behavior and thoughts in ways that are
congruent to their goals, anything that is most comfortable for them. Adler felt that all
individuals experienced pluses and minuses in life. The counselor’s aim is to provoke the
clients thought process to engage them in positive movement towards a self-selected goal.
The ability to become resilient is the goal thus pluses in life aides in positive movement.
A minus in life is what cause the individual to adapt into a fictional life style that aids to
the mental or chemical disorder. Individuals suffering from a mental or chemical disorder
where positive movement is not allowed until that person wakes up out of a neurosis.
Neurosis is the failures, lack of support, discouragement, and no sense of belonging
(Dinkmeryer & Sperry, 2000). When a person is in a neurotic state of being their ability
to think relationally is altered by the anxiety and the constant state of worry. A
counselor’s obligation in a neurotic situation is to build a positive therapeutic relationship
COD AND TREATMENTS 11
to help the individual move toward their pluses in life. Neurosis affects a person’s
personality and causes mental, chemical, or physical disruptions.
Furthermore , in the neurotic state, counseling is an opportunity to teach coping
skills to the client for address mental or chemical inappropriate behaviors. Adler believed
that all individuals strive to belong to something throughout the lifespan. By belonging,
one foundation is formed no matter the consequence. According to Dinkmeyer et al.
(1987), a counselor’s knows that a person’s ability to learn, yet not able to move forward,
is still a factor in influencing the lifestyle of that individual.
More often than not, a individual purpose in life is to connect with others, not
being accepted changes the idea of self, which depletes ones perception and life is
unfulfilled. The desire to be a part of or accepted into the significant group or groups is
critical and fulfilling. The lack of connection or acceptance in the significant group or
groups forces one to end up in a neurotic state that leads to maladaptive coping
mechanisms, to deal with unwanted feelings. Moreover, Adler stated that all human
beings behaviors have a social meaning; but argued that behavior is apart of a desire to be
socially competent. Dinkmeyer and Sperry, (2000), stated that human are dependent on
each other for survival; those interactions helps our behaviors, and when we do not engage
in social activities, our worth is affected. In other words, being around others helps our
social competencies, which nurture our development in life (Rooney, 2015).
Art Therapy
Paints, fabrics, lumps of clay, pencils and more have the ability to convey what
sometimes cannot be spoken. The pain of parental betrayal, the shame of sexual
violation, the humiliation of spousal abuse, and the indignity of trading sex for
COD AND TREATMENTS 12
drugs. The uncomfortable thoughts and emotions are ultimately transferred into
artwork. For hurting or wounded individuals with Co-occurring Disorders, the
tool used in Art Therapy replaces words not spoken. (Lawna, 2014, p. 5)
The unspoken pain is a build-up of stressors that cause a person to be irrational in
their responses to situations. Art therapy as an expression is used to help a individual to
relieve and communicate stress experienced; whom suffers from a mental or chemical
disorder.
Unlike spoken words, which possess no longevity, the art is tangible. A
painting, drawing, or clay sculpture becomes a concrete representation
of emotion. The sorrow, guilt, shame or pain (discussed in The COD
Manual) a patient has felt for years, perhaps decades, is now literally on
the table. Being creative allows the individual a sense of freedom from
that bondage and is immensely powerful. Art therapy is expressive and
beneficial for everyone, regardless of disorder(s), addiction, or degree of
trauma experienced throughout a lifetime. (Lawna, 2014, p. 5)
The body’s natural response to stress is to forget the problems or issues that have
caused the interruptions in the brains functioning (Mosak & Maniacci, 1999). The use of
“Art therapy can be beneficial to people of all ages, including adults who have emotional,
cognitive, and/or physical disabilities” (AATA, 2010, Art Therapy Posttraumatic stress
disorder, veterans section, About Art therapy, para. #1).
According to American Art Therapy Association (2015), a therapist uses a wide
variety of art-based techniques in the assessment and treatment of adults with emotional
dismay for the expression of a persons’ feeling. Art therapy helps an individual to
COD AND TREATMENTS 13
communicate the unspoken feeling, hurts, pain, stressors, or disappointments of life that a
person bears. Using art as a way to express a persons feeling can help release the weight
of stress or distress in life. Unspoken words, nonverbal, or verbal communication is a
healthy way to release unwanted stress or distresses from a person’s life through the
expression of art.
Method
Integrated Dual Disorder Treatment
National Institute on Alcohol Abuse and Alcoholism (2007) stated that people who
suffer from mental illness, most often always deal with substance abuse issues at some
point in their lives. Alcohol is a substance that affects a person’s ability to cope or
manage stress. Individuals who have co-occurring disorders have a difficult time
managing difficult situations in their lives. These situations caused stress, and the lack of
coping skills tend to lead to negative consequences. Combining treatment can assist the
person in depth and ultimately improve all mental and chemical health symptoms because
the substance slows down the brain's function ability.
In order to combine treatment, a counselor first has to build a relationship to
identify what a person is suffering from in order to help in the recovery process
(Dinkmeyer & Dinkmeyer, 1987).
Back and Brady, (2008) study stated that comorbidity was found to be a
National Epidemiological condition related to Drug, Alcohol, and criteria for
Anxiety along with other mental disorders. For example: When dually
diagnosed the substance takes over the mental ability to function in a normal
capacity, thus drugs and alcohol have their own unique affects. Individuals
COD AND TREATMENTS 14
suffering from comorbidity not only have to find a way to manage one illness
but two at the same time. “Drugs are a pleasure producing chemical that activate
or imitate chemical pathways of the brain which is associated with feelings of
well-being, pleasure, and euphoria” (Stalcup, 2006, p. 3). “A major depressive
disorder is an illness which have significant neurobiological consequences that
involves structural, functional, and molecular alterations in several areas of the
brain” (Maletic et al., 2008, p. 1).
Using different tools, approaches, and treatments that are geared toward both
disorders, such as the COD Manual, will help battle both disorders at the same time.
Besides, both disorders affect a person’s ability function when it is intermingled therefore;
prevention is a way to assist the function ability of that individual.
Neuroadaptation. Is damage caused by neurotransmitter insensitivity
that leads the user to feel, when sober, the opposite of feeling high. Under
unstimulated conditions, there is profound interference with the ability to
experience pleasure. Exclusive of drugs or alcohol, the process by which
receptors in the reward and pleasure centers of the brain adapts to high
concentrations of neurotransmitters is changed; thus, “user feels as if s/he is
experiencing an unmet instinctive drive: dysphoria anxiety, anger, frustration,
and craving” (Stalcup, 2006, p. 4).
Dual diagnosis is a term used to describe people with mental illness who also
have problems with drugs or alcohol. The relationship between the two is
complex, and the treatment of a person with co-occurring substance abuse (or
dependence) and mental illness is more complicated than the processing of either
COD AND TREATMENTS 15
condition alone. Unfortunately a common situation—many individuals with
mental illness have ongoing substance abuse problems, and many people who
abuse drugs and alcohol experience mental illness. (NAMI, 2014)
The COD Manual is one part of a preventive plan that can assist an individual
though the recovery process. In other words, treatments that address both disorders are
relapse preventive plans and relapse prevention programs. There are many different
models of treatment plans and prevention that aid in the individual’s recovery. Most
treatment models also measure up to the psychological and neuroimaging technology to
provide compelling neurobiological evidence for the nature of addiction and relapse as a
process for recovery (McGovern et al., 2005, p. 10). “Relapse prevention models have
evolved from purely cognitive-behavioral that are linear towards a dynamic interplay
among dispositions, contexts, and past or current behaviors” (McGovern, Wrisley, &
Drake, 2005, p. 10).
Brain Function
The human brain is the body’s engine, and it is very complex. The three pounds of
mass that sits at the center of the brain controls the human activity. The human activities
are controlling a car, eating, feeling pleasure, breathing, imagination, or any active thing
the body does. In contrast, a person’s brain controls their body’s function ability. The
brain helps an individual to translate and react to all experiences. In addition, the brain
controls feelings, thoughts, conduct, and emotions, which is the body’s engine. The U.S
department of Health and Human Services (2009), reported that substance use is a
problem in teenagers and tends to coexist with other psychiatric conditions, and
COD AND TREATMENTS 16
approximately 75% of adolescents with current substance abuse issues also meet criteria
for mood, anxiety, or conduct disorders (Boger et al., 2014, p. 109).
Addiction is a disease of the pleasure-producing chemistry of the brain;
neuroadaptation is the mechanism of the disease. Over-stimulation of pleasure
pathways causes them to neuroadaption, interfering with the normal experience
of pleasure. Transition to addiction from substance abuse arises from the
development of tolerance and withdrawal. Once neuroadaptation occurs,
cessation of drug use leads to ‘inversion of the high’; sobriety becomes pleasure
less. (Stalcup, 2006, p. 5)
Adler Therapeutic Approach to Addictions
Social interest. “In Adler’s, mature theory, social interest is not a second dynamic
force counterbalancing a striving for superiority; social interest denotes the innate aptitude
through which the individual becomes responsive to reality, which is primarily the social
situation” (Ansbacher & Ansbacher, 1957, p. 133). Adler believed that humans all strive
to belong to a group of importance. As counselors using this theory, the objective is to
investigate and identify the motive behind a behavior because, as Adler would say, (there
is a purpose behind all behaviors). How a person behaves under the influence of drugs or
alcohol is important to the recovery process. For example, Adler’s social interest
perspective theory, suggests that; individuals can move toward making some gains from
disadvantages in life. Those disadvantages of life can take a toll on a person thus gaining
a new perspective through treatment could benefit both counselor and client in recovery.
In the recovery process, a counselor obligation is gaining an understanding of the client
state of being to help the client understand of self. The knowledge of self will help the
COD AND TREATMENTS 17
recovery process. Furthermore, it helps the client to be more aware of the pluses and
minuses of life that is endured. Counselors and clients that builds a therapeutic
relationship, helps in the growth and movement into the individuals driven goal.
Relationship. Counselors in this stage are more prone to reducing the superiority
energy; that allows the client to feel at ease and comfortable with the therapeutic process.
In addition, in addiction counseling, it is important to make the client to feel sense of
sincerity which aides in the relationship process of development and decision-making.
“Adlerian counselors, while actively using their knowledge and experience to help others,
also maintain respect for individual’s capabilities and power to make independent
choices” (Sweeney, 1989, pg. 242).
Interpretation. “Having listened to the individual discuss concerns, possibly
explore family constellation and/or early recollections, and having observed
behavior in counseling and/or elsewhere, the counselor tentatively will offer
observations that are descriptive of the individual and may have implications for
meeting the individual’s life tasks” (Sweeney, 1989, p. 246).
At this point, the counselor is gaining a better understanding of the client’s
lifestyle, which is centered on the individual’s knowledge of self. Now that a picture has
been painted for the counselor, the expression of how the client’s lifestyle is played out
through their private logic is reviewed. Therefore, the counselor is able to interpret the
client’s point of view and help the client to make rational decision, which was once
influenced by substance abuse or mental illness. In other words, the interpretation process
of interaction is for a clinician to develop a relationship and get an understanding of the
client(s) through their lens.
COD AND TREATMENTS 18
Reorientation. In this process, the counselor is leaving it all up to the client(s) to
make movement or not towards the individual’s driven goal. As a result, it helps the
counselor to gain an “Understanding and meaning of the clients’ behaviors and goals of
life, which he or she pursues, that frees, the individual to decide what other behaviors he
or she might wish to try” (Sweeney, 1989, pg. 256). As an Adlerian counselor, the client
is allowed the power to make a step towards change or not.
Cognitive Behavioral Therapy
Psychology Today (2015) defined Cognitive Behavioral Therapy (CBT) as a form
of psychotherapy that treats problems and boosts happiness by modifying dysfunctional
emotions, behaviors, and thought, and the focus is on solutions, encouraging clients to
challenge distorted cognitions, and change destructive patterns of behaviors. For example
the University of Wisconsin-Madison (2015), found that emotions could be elicited by
external stimuli, but that stimuli must have relevance or motivational significance in order
to guide appropriate and adaptive behaviors. CBT treatment helps an individual to guide
their emotions in the right direction; by exploring patterns of thinking that lead to self-
destructive actions. Improving a person ability to cope with their mental illness would
help them to understand self and make better choices. The beliefs that direct people
thoughts with mental illness can be modified through improvement of coping skills and
thinking (National Alliance on Mental Illness, 2014). Moreover, being mindful of one's
ability to process thoughts will give the counselor the knowledge needed to help one
improve their functioning. CBT treatment helps individuals learn how to make rational
decisions. It also tends to elaborate on one's ability to modify irrational feelings and
understand how to tolerate undesirable emotions as suitable. In addition, to the cognitive
COD AND TREATMENTS 19
emotion of an individual’s brain function, CBT helps the individual to navigate rationally
through all situations. Therefore, an emotional balance is needed, when making decisions.
Being cognitive of how a person’s process is through situations; will help the individual to
make better choices that will improve their ability to function.
Dialectical Behavior Therapy
The dialectical behavior therapy (DBT) is an approach that can answer the
question of what is a basic emotion and how do a person cope with those emotions when
they are unbalanced?
What are basic building blocks of emotional life --- a science of emotion should
focus on --- basic emotion is described as anger, sadness, fear, happiness, and
disgust, are the biological inherited that reflex modules that cause a distinct and
recognized behavioral and physiological patterns. (Barrett & Wager, 2006, p. 79)
When an individual is under the influence of a substance or emotionally
imbalance, DBT educates individuals on how to enhance their skills to regulate thoughts,
emotions, feelings, and behaviors. The dialectical method involves helping individuals to
increase their ability to regulate emotions and become more rational in their thought
process; through learning of triggers that lead to reactive responses. DBT also assist in the
individual learning how to resolve behavioral approaches that are not appropriate and
develop more resolutions that are appropriate. In addition to helping identify
inappropriate behavioral responses DBT help in learning how to utilize the skills
developed in the appropriate manner. Once a person understands how frustration can
disable them; the two components of DBT are there to assist in behavioral changes.
COD AND TREATMENTS 20
The DBT model has two components: behavioral, solution emphasis combined
with recognition that is focused on dialectical method.
DBT teaches individuals a better way of dealing with their mood imbalance. DBT
instructs one on how to regulate emotions rationally (Harvey 2012). The ability to manage
their emotions and behaviors such as judgments, aggression, self-awareness, character
building, and crisis stabilization increases through DBT training (Mathew 2012). Being
aware of moods and reactions to those mood changes teaches a person to be more
proactive in the management of mental illness or substance abuse. Moreover, mood
regulation will improve the ability to interact with others appropriately.
Alves, Fukusima, & Aznar-Casanova (2008), offered the insight that the prefrontal
cortex mediates the control of high-level of cognitive functions and is associated with the
regulation of many aspects of the affective system. The use of DBT will assist individuals
in learning how to regulate emotions. As a result, the person becomes emotionally
healthy. The affective system represents the goals, achievements, and working emotion-
bases of decision making in which process DBT aids. Managing emotions will also
benefit a person’s mental health. A person with substance abuse issues loses the ability to
control their thoughts; feeling, emotions, and caring for self tend to be difficult. Learning
how to manage stress could help maintain sobriety.
Discussion
According to Ansbacher and Ansbacher (1956) Adlerian counseling is about
engaging continuously in the eyesight of the client through their lens. For example: The
identification of one's interpretation through their interactions with the world around them
helps counselors understand life from the client’s viewpoint. Adler’s focus is on how one
COD AND TREATMENTS 21
perceives life and how those interactions with others are interpreted. Our perception
affects our thoughts, which ultimately hinders the way they are processed through one's
understanding. In Adlerian therapy, to understand one's perception, a counselor has to
investigate the inner subjective person being counseled (Ansbacher & Ansbacher, 1956).
For example: A distressed individual is in a disruptive frame of mind. The mind is
not thinking in a manner that will allow it to function properly. Being dispirited makes an
individual feel inferior to the world around them and in turn cause inappropriate
behaviors. Gaining a relationship with the therapist helps in that process of understanding
the individual; which ultimately helps the recovery process.
Adlerian therapist's purpose is to build a therapeutic relationship to help the client
identify and define their private logic. Helping, clients identify their perceived
perceptions will aid with the development of goals that are congruent with rational
thinking. When a person does not feel that they received positive feedback, they engage
in behaviors that are provoking to others. Moreover, the therapeutic emphasis is placed on
building a relationship to prevent provoking behaviors and to develop healthy
relationships and skills to manage those healthy relationships as a part of the therapeutic
process (Ansbacher & Ansbacher, 1956).
The COD Manual would help individuals to learn new ways to manage unpleasant
situations to recover and gain mental stability. Learning how to process through problems
gives a person a healthier balance in difficult situations in life. The inability to manage
life’s stressors could lead to the use of maladaptive coping strategies (Dinkmeyer &
Sperry, 2000).
COD AND TREATMENTS 22
To cope and interact appropriately in a problematic relationship is to define it,
tackle it, and arrange life through the situation. It is important to identify who, what, and
where individuals in one's life stand. Taking a moment to look at how a person views
others that relates to oneself will help in regulating relationships. Sometimes it is
impossible to do anything about how a person views others, and the use of substances
hinders their ability to rationalize these relationships. Individuals with mental health
issues suffer because they are not looking through a clear lens. On the other hand, just
properly placing those relationships will help manage the symptoms better. The Help
Guide (2014) discussed the issue of alcohol and drug abuse, which increased mental
health complications as well as the substance abuse problems individuals face.
The use of DBT, IDDT, CBT, and Adlerian treatment approaches will assist in the
treatment goals of regulating emotions and maintaining sobriety. Along with the evidence
based practices of DBT, IDDT CBT, and Adlerian therapy the cod manual promises to
address mental and chemical health disorders issues. The attached example illustrates
coping strategies when someone is under stress (Appendix, A, B).
COD AND TREATMENTS 23
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COD AND TREATMENTS 26
Appendix
COD AND TREATMENTS 27
Appendix A
Minimizing Stress
Below some coping strategies you can use when under stress. They might not
take the stress away but can give you some ease of mind, while dealing with the
stressful situation. Put an (X) by the strategies tried and an (O) by the strategies
you would like to try now or in the future.
____ go on a date
____ go get a movie from the movie box
____ cook for your loved ones
____ read something
____ play music
____ sit in the rain
____ let up the windows in the house or apartment
____ scream
____ work-out
____ eat healthy foods
____ go on a walk
____ turn on the radio
____ watch your favorite show
____ take a walk in a mall
____ visit people you haven’t seen in a while
____ go to the coffee shop
COD AND TREATMENTS 28
____ go to the library
____ go dancing
____ go get manicure
____ go get your hair done
____ go get pedicure
Now, can you think of something else you have not done in a while that you could
do? Write your answer below.
© 2015 Starla Moore
COD AND TREATMENTS 29
Appendix B
Stress Triggers
What is something that made you upset?
What was your reaction? How could you handle it differently?
So, what is the biggest issue you’re having today? How will you handle it?
© 2015 Starla Moore
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