Difference between revisions of "Defusion"

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Note: See Using defusion in isolation, Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (1st Edition). Context Press. p. 360.
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== Metaphors ==
 
== Metaphors ==
−
There are a huge number of metaphors for acceptance, and the ones in this box are a mere sprinkling. Passengers on the Bus (Hayes et al., 1999)<ref>Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.</ref> and Demons on the Boat (Harris, 2007)<ref>Harris, R. (2007). The happiness trap: Stop struggling, start living. Wollombi, NSW, Australia: Exisle Publishing.</ref> are very versatile in that they encapsulate the entire hexaflex in one metaphor, and can therefore be used to accentuate any process in any session. Both metaphors are essentially the same. I changed Passengers on the Bus to Demons on the Boat for three reasons: (1) demons and boats have a much richer cultural heritage than passengers and buses; (2) just about every single book on ACT has Passengers on the Bus as a key metaphor and I felt like a change; and (3) that’s just the kind of guy I am. ''Harris, Russ. ACT Made Simple (The New Harbinger Made Simple Series) . New Harbinger Publications. Kindle Edition.''  See there for a full description.
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There are a huge number of metaphors for acceptance, and the ones in this box are a mere sprinkling. Passengers on the Bus (Hayes et al., 1999)<ref name=":0">Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.</ref> and Demons on the Boat (Harris, 2007)<ref>Harris, R. (2007). The happiness trap: Stop struggling, start living. Wollombi, NSW, Australia: Exisle Publishing.</ref> are very versatile in that they encapsulate the entire hexaflex in one metaphor, and can therefore be used to accentuate any process in any session. Both metaphors are essentially the same. I changed Passengers on the Bus to Demons on the Boat for three reasons: (1) demons and boats have a much richer cultural heritage than passengers and buses; (2) just about every single book on ACT has Passengers on the Bus as a key metaphor and I felt like a change; and (3) that’s just the kind of guy I am. ''Harris, Russ. ACT Made Simple (The New Harbinger Made Simple Series) . New Harbinger Publications. Kindle Edition.''  See there for a full description.
−
* See ''Demons on the Boat''. Ch 9 in  Harris, Russ. The Happiness Trap (p. 76). Shambhala. Kindle Edition.
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* See ''Demons on the Boat''. Ch 9 in  Harris, Russ. The Happiness Trap (p. 76). Shambhala. Kindle Edition.  
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* Passenger on the Bus summary: "The bus each of us is driving is different than the average bus.  It has a steering wheel, but no gas pedal or brakes, and only moves at one speed – the speed of life.  Passengers get on and off the bus all the time, except that once they get on, they may not get off, and may even invite their friends or family on for the ride.  The dilemma for each of us then, is being the driver.  We are always driving the bus, no matter what.  That being the case, we can either stay focused on where we're driving and keep our eyes on the road, or spend our energies trying to make our passengers settle down.  Sometimes passengers can be very unruly, restless, noisy, and disrespectful, which makes it easy to sometimes find ourselves caught up in the struggle to try to get them to behave.  What we come to find though, is that as we struggle with them, we are now no longer paying much attention to where we're headed, and may even get kind of lost for a while before we find our way again." https://coffspsychneuro.com.au/articles/70
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** [https://www.youtube.com/watch?v=z-wyaP6xXwE Video]
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* Another way to defuse language is to objectify it, allowing thoughts to become things or people. Physical metaphors can be used to accomplish this objectification to great effect, since we naturally see external objects and other people as separate from ourselves. The Passengers on the Bus exercise is a core ACT intervention aimed at deliteralizing provocative psychological content through objectification. It contains within it the entire psychological flexibility model. ''Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G.. Acceptance and Commitment Therapy, Second Edition (p. 250). Guilford Publications. Kindle Edition.''
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** [https://forum.psychlinks.ca/showthread.php?24748-The-Passengers-on-the-Bus-Metaphor Full text]
  
 
== Research ==
 
== Research ==
−
The handout for the cognitive defusion group was titled ‘Seeing your thoughts differently’. The rationale section explained that thoughts can sometimes sabotage intentions and that in situations like these it can be helpful to think of oneself as different from one’s thoughts. The strategy section went on to describe the '''mindbus metaphor''' (i.e., viewing oneself as the driver of a bus and one’s thoughts as passengers, see Hayes & Smith, 2005; Hayes et al., 1999) and gave three examples of strategies the participant could use in response to difficult ‘passengers’ (i.e., difficult thoughts; describing them, letting them know who is in charge, making them talk with a different accent, or sing what they are saying; see Hayes & Smith, 2005; Hayes et al., 1999).
+
The handout for the cognitive defusion group was titled ‘Seeing your thoughts differently’. The rationale section explained that thoughts can sometimes sabotage intentions and that in situations like these it can be helpful to think of oneself as different from one’s thoughts. The strategy section went on to describe the '''mindbus metaphor''' (i.e., viewing oneself as the driver of a bus and one’s thoughts as passengers, see Hayes & Smith, 2005; Hayes et al., 1999) and gave three examples of strategies the participant could use in response to difficult ‘passengers’ (i.e., difficult thoughts; describing them, letting them know who is in charge, making them talk with a different accent, or sing what they are saying; see Hayes & Smith, 2005<ref>Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger</ref>; Hayes et al., 1999<ref name=":0" />).
  
 
In the practice exercise section, participants were asked to select one of the three strategies and spend 5 min imagining themselves using it, either in response to recent difficult chocolate-related thoughts or in response to the types of difficult chocolate-related thoughts they might experience over the next 5 days. The instructions section asked participants to carry the bag of chocolates with them at all times over the next 5 days, to try to resist eating any kind of chocolate, and to use the strategy outlined in the handout whenever they were tempted to eat chocolate. In order to try to limit social desirability bias, the instructions also noted that resisting chocolate is difficult so the participant may find that they cannot always manage this. In which case, they should simply make a note of what they have eaten in their diary.
 
In the practice exercise section, participants were asked to select one of the three strategies and spend 5 min imagining themselves using it, either in response to recent difficult chocolate-related thoughts or in response to the types of difficult chocolate-related thoughts they might experience over the next 5 days. The instructions section asked participants to carry the bag of chocolates with them at all times over the next 5 days, to try to resist eating any kind of chocolate, and to use the strategy outlined in the handout whenever they were tempted to eat chocolate. In order to try to limit social desirability bias, the instructions also noted that resisting chocolate is difficult so the participant may find that they cannot always manage this. In which case, they should simply make a note of what they have eaten in their diary.
  
 
''Jenkins KT, Tapper K. Resisting chocolate temptation using a brief mindfulness strategy. Br J Health Psychol. 2014 Sep;19(3):509-22. doi: 10.1111/bjhp.12050. Epub 2013 May 17. PMID: 23678870.''<ref>For an article on this study, see [https://www.scientificamerican.com/article/control-your-urges-with-a-ride-on-the-mindbus/ here].</ref>
 
''Jenkins KT, Tapper K. Resisting chocolate temptation using a brief mindfulness strategy. Br J Health Psychol. 2014 Sep;19(3):509-22. doi: 10.1111/bjhp.12050. Epub 2013 May 17. PMID: 23678870.''<ref>For an article on this study, see [https://www.scientificamerican.com/article/control-your-urges-with-a-ride-on-the-mindbus/ here].</ref>
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 +
WILLPOWER EXPERIMENT: ACCEPT THOSE CRAVINGS—JUST DON’T ACT ON THEM In the Hershey’s Kisses study, students who learned about the white-bear rebound effect were given the following four-step advice for handling their cravings. This week, try applying this advice to your own most challenging cravings, be they chocolate, cappuccinos, or checking e-mail. 1. Notice that you are thinking about your temptation or feeling a craving. / 2. Accept the thought or feeling without trying to immediately distract yourself or argue with it. Remind yourself of the white-bear rebound effect. / 3. Step back by realizing that thoughts and feelings aren’t always under your control, but you can choose whether to act on them. / 4. Remember your goal. Remind yourself of whatever your commitment is, as the students reminded themselves of their agreement not to eat the Hershey’s Kisses. ''McGonigal Ph.D., Kelly. The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do to Get More of It (pp. 225-226). Penguin Publishing Group. Kindle Edition.''
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 +
===Refocus===
 +
Reference: Refocusing is particularly useful when concentration is needed for the task at hand, such as completing a work assignment, carrying on a conversation, or driving. It is also useful when patients are having obsessive thoughts for which rational evaluation is ineffective. You will teach patients to label and accept their experience: “I’m just having automatic thoughts. I can accept the fact that I’m having them and that I’m feeling badly and refocus on what I was doing.” Then patients should deliberately turn their attention to the report they are writing, to what their fellow conversationalists are saying, to the road ahead. You will rehearse the strategy with them, trying to elicit how they have refocused their attention in the past or how they believe they could in the future. ''Beck, Judith S.. Cognitive Behavior Therapy, Second Edition: Basics and Beyond (Kindle Locations 4938-4944). Guilford Publications. Kindle Edition.''
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== Quotes ==
 +
 +
* "No one ever died from resisting an urge". "There were no reported deaths of people who resisted an urge". (Often heard from @Dov)
 +
* While they may be unpleasant, they will not kill you. ''A/M-6 Acceptance, Velasquez, M. M., Crouch, C., Stephens, N. S., & DiClemente, C. C. (2015). Group Treatment for Substance Abuse Second Edition A Stages-of-Change Therapy Manual. Guilford Press.''
 +
* "No one ever died from an urge" ''Monti (2002)''<ref>Monti, P. M. (2002). Treating alcohol dependence : a coping skills training guide. Guilford Press.</ref>
  
 
== Torah Sources ==
 
== Torah Sources ==
  
−
* See [[Rav Shlomo Wolbe]]
+
* תניא ליקוטי אמרים פרק כח: והוא כמשל אדם המתפלל בכוונ' '''ועומד לנגדו עו"ג רשע ומשיח ומדבר עמו כדי לבלבלו''' שזאת עצתו בודאי '''שלא להשיב לו מטוב ועד רע ולעשות עצמו כחרש לא ישמע''' ולקיים מה שכתו' אל תען כסיל באולתו פן תשוה לו גם אתה כך אל ישיב מאומה ושום טענה ומענה נגד המחשבה זרה '''כי המתאבק עם מנוול מתנוול ג"כ''' רק יעשה עצמו כלא יודע ולא שומע ההרהורי' שנפלו לו ויסירם מדעתו ויוסיף אומץ בכח כוונתו ואם יקשה לו להסירם מדעתו מפני שטורדים דעתו מאד בחזקה אזי ישפיל נפשו לה' ויתחנן לו ית' במחשבתו לרחם עליו ברחמיו המרובים כרחם אב על בנים הנמשכים ממוחו וככה ירחם ה' על נפשו הנמשכת מאתו ית' להצילה ממים הזדונים ולמענו יעשה כי חלק ה' ממש עמו:
 +
* See [[Rav Shlomo Wolbe]], e.g. ואם בכל-זאת היצר מציק, לא יתעצבן על היצר… על היצר לא צריך לשים לב כל כך. חזקה על כל בן-תורה שהוא מתנגד לו עד מאה ועשרים כמה שיוכל, יותר – אין לשים לב אליו.
 +
* ליקוטי מוהר"ן, ח"א סי' רל"ג: שאי אפשר בשום אופן בעולם שיהיו שני מחשבות ביחד בפעם אחד, על כן בקל יכולין לגרש מחשבות רעות רק בשב ועל תעשה, דהיינו שלא לחשב אותו המחשבה רק לחשב איזה מחשבה אחרת בתורה או עבודה או אפילו משא ומתן, כי אי אפשר שיהיו שני מחשבות ביחד בשום אופן… ואין צריכין לעשות מלחמה ולנענע ראשו אנה ואנה כדי לגרש המחשבות רעות כי אין זה מועיל כלל, אדרבא ע"י מתגברים יותר רק לבליי להשגיח עליהם כלל, רק לעשות את שלו במה שהוא עוסק בתורה או תפילה או משא ומתן, ולבלי להסתכל לאחוריו כלל, ועי"ז ממילא תסתלק.
 +
** ליקוטי מוהר"ן תורה עב: אם רוצה להיות ירא ה', ורוצה להתפלל, ואינו רוצה באלו המחשבות רעות, צריך שלא להשגיח עליהם כלל, ושלא יכפת ליה מה שעומדים לפניו, ורק יעשה את שלו במה שהוא עוסק, בתורה או תפלה או מו"מ, ולא ישגיח עליהם כלל. וכמו ששמעתי מעשה באחד שבשעה שעמד להתפלל, היה מזדמן '''ועומד לפניו בדמיונו עכו"ם ערל''', והיה לו יסורים גדולים מזה, וכל מה שרצה להתגבר ולסלק המחשבה, התגברה עליו יותר. ויעץ לו חכם, שלא יכפת ליה, ויעמוד העכו"ם, ואעפ"כ יעשה את שלו ויתפלל, ובזה יסתלק ממנו. אך זה עצה לפי שעה, כל זמן שלא נתקדש גופו עדיין. והעיקר לקדש ולטהר עצמו כנ"ל, וילך לחכם, ויתן לו עצה נכונה על כל דבר כנ"ל.
 +
* קונטרס דרך המלך (הנדפס יחד עם חובת התלמידים), והעיקר הוא שלא לחוש כלל לפניות שבאות למחשבתו בעת עבודתו. '''רק יעבוד ולא יתכוון אפילו לדחותם כלל, ואז ממילא יתבטלו כשלא יחשוב מהם כלל'''. וכן בענין מחשבות זרות שבאות אליו בעת תפילתו, העיקר הוא שלא יחוב מהם כלל לדחותם. כי כל מה שירצה לדחותם הם יתחזקו בו. אלא העיקר הוא להתפלל, ואם באה אליו מחשבה אחרת לא יעיין בה כלל.
 +
* For more see sources in [[What you resist persists]].
  
 +
== Footnotes ==
 +
See also this [https://www.ted.com/talks/russell_wilson_my_secret_to_staying_focused_under_pressure?language=en#t-211337 video].
 
*  
 
*  
 
[[Category:Urge Management Strategies]]
 
[[Category:Urge Management Strategies]]

Latest revision as of 19:22, 3 January 2021

Note: See Using defusion in isolation, Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (1st Edition). Context Press. p. 360.

Metaphors

There are a huge number of metaphors for acceptance, and the ones in this box are a mere sprinkling. Passengers on the Bus (Hayes et al., 1999)[1] and Demons on the Boat (Harris, 2007)[2] are very versatile in that they encapsulate the entire hexaflex in one metaphor, and can therefore be used to accentuate any process in any session. Both metaphors are essentially the same. I changed Passengers on the Bus to Demons on the Boat for three reasons: (1) demons and boats have a much richer cultural heritage than passengers and buses; (2) just about every single book on ACT has Passengers on the Bus as a key metaphor and I felt like a change; and (3) that’s just the kind of guy I am. Harris, Russ. ACT Made Simple (The New Harbinger Made Simple Series) . New Harbinger Publications. Kindle Edition. See there for a full description.

  • See Demons on the Boat. Ch 9 in Harris, Russ. The Happiness Trap (p. 76). Shambhala. Kindle Edition.
  • Another way to defuse language is to objectify it, allowing thoughts to become things or people. Physical metaphors can be used to accomplish this objectification to great effect, since we naturally see external objects and other people as separate from ourselves. The Passengers on the Bus exercise is a core ACT intervention aimed at deliteralizing provocative psychological content through objectification. It contains within it the entire psychological flexibility model. Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G.. Acceptance and Commitment Therapy, Second Edition (p. 250). Guilford Publications. Kindle Edition.

Research

The handout for the cognitive defusion group was titled ‘Seeing your thoughts differently’. The rationale section explained that thoughts can sometimes sabotage intentions and that in situations like these it can be helpful to think of oneself as different from one’s thoughts. The strategy section went on to describe the mindbus metaphor (i.e., viewing oneself as the driver of a bus and one’s thoughts as passengers, see Hayes & Smith, 2005; Hayes et al., 1999) and gave three examples of strategies the participant could use in response to difficult ‘passengers’ (i.e., difficult thoughts; describing them, letting them know who is in charge, making them talk with a different accent, or sing what they are saying; see Hayes & Smith, 2005[3]; Hayes et al., 1999[1]).

In the practice exercise section, participants were asked to select one of the three strategies and spend 5 min imagining themselves using it, either in response to recent difficult chocolate-related thoughts or in response to the types of difficult chocolate-related thoughts they might experience over the next 5 days. The instructions section asked participants to carry the bag of chocolates with them at all times over the next 5 days, to try to resist eating any kind of chocolate, and to use the strategy outlined in the handout whenever they were tempted to eat chocolate. In order to try to limit social desirability bias, the instructions also noted that resisting chocolate is difficult so the participant may find that they cannot always manage this. In which case, they should simply make a note of what they have eaten in their diary.

Jenkins KT, Tapper K. Resisting chocolate temptation using a brief mindfulness strategy. Br J Health Psychol. 2014 Sep;19(3):509-22. doi: 10.1111/bjhp.12050. Epub 2013 May 17. PMID: 23678870.[4]

WILLPOWER EXPERIMENT: ACCEPT THOSE CRAVINGS—JUST DON’T ACT ON THEM In the Hershey’s Kisses study, students who learned about the white-bear rebound effect were given the following four-step advice for handling their cravings. This week, try applying this advice to your own most challenging cravings, be they chocolate, cappuccinos, or checking e-mail. 1. Notice that you are thinking about your temptation or feeling a craving. / 2. Accept the thought or feeling without trying to immediately distract yourself or argue with it. Remind yourself of the white-bear rebound effect. / 3. Step back by realizing that thoughts and feelings aren’t always under your control, but you can choose whether to act on them. / 4. Remember your goal. Remind yourself of whatever your commitment is, as the students reminded themselves of their agreement not to eat the Hershey’s Kisses. McGonigal Ph.D., Kelly. The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do to Get More of It (pp. 225-226). Penguin Publishing Group. Kindle Edition.

Refocus

Reference: Refocusing is particularly useful when concentration is needed for the task at hand, such as completing a work assignment, carrying on a conversation, or driving. It is also useful when patients are having obsessive thoughts for which rational evaluation is ineffective. You will teach patients to label and accept their experience: “I’m just having automatic thoughts. I can accept the fact that I’m having them and that I’m feeling badly and refocus on what I was doing.” Then patients should deliberately turn their attention to the report they are writing, to what their fellow conversationalists are saying, to the road ahead. You will rehearse the strategy with them, trying to elicit how they have refocused their attention in the past or how they believe they could in the future. Beck, Judith S.. Cognitive Behavior Therapy, Second Edition: Basics and Beyond (Kindle Locations 4938-4944). Guilford Publications. Kindle Edition.

Quotes

  • "No one ever died from resisting an urge". "There were no reported deaths of people who resisted an urge". (Often heard from @Dov)
  • While they may be unpleasant, they will not kill you. A/M-6 Acceptance, Velasquez, M. M., Crouch, C., Stephens, N. S., & DiClemente, C. C. (2015). Group Treatment for Substance Abuse Second Edition A Stages-of-Change Therapy Manual. Guilford Press.
  • "No one ever died from an urge" Monti (2002)[5]

Torah Sources

  • תניא ליקוטי אמרים פרק כח: והוא כמשל אדם המתפלל בכוונ' ועומד לנגדו עו"ג רשע ומשיח ומדבר עמו כדי לבלבלו שזאת עצתו בודאי שלא להשיב לו מטוב ועד רע ולעשות עצמו כחרש לא ישמע ולקיים מה שכתו' אל תען כסיל באולתו פן תשוה לו גם אתה כך אל ישיב מאומה ושום טענה ומענה נגד המחשבה זרה כי המתאבק עם מנוול מתנוול ג"כ רק יעשה עצמו כלא יודע ולא שומע ההרהורי' שנפלו לו ויסירם מדעתו ויוסיף אומץ בכח כוונתו ואם יקשה לו להסירם מדעתו מפני שטורדים דעתו מאד בחזקה אזי ישפיל נפשו לה' ויתחנן לו ית' במחשבתו לרחם עליו ברחמיו המרובים כרחם אב על בנים הנמשכים ממוחו וככה ירחם ה' על נפשו הנמשכת מאתו ית' להצילה ממים הזדונים ולמענו יעשה כי חלק ה' ממש עמו:
  • See Rav Shlomo Wolbe, e.g. ואם בכל-זאת היצר מציק, לא יתעצבן על היצר… על היצר לא צריך לשים לב כל כך. חזקה על כל בן-תורה שהוא מתנגד לו עד מאה ועשרים כמה שיוכל, יותר – אין לשים לב אליו.
  • ליקוטי מוהר"ן, ח"א סי' רל"ג: שאי אפשר בשום אופן בעולם שיהיו שני מחשבות ביחד בפעם אחד, על כן בקל יכולין לגרש מחשבות רעות רק בשב ועל תעשה, דהיינו שלא לחשב אותו המחשבה רק לחשב איזה מחשבה אחרת בתורה או עבודה או אפילו משא ומתן, כי אי אפשר שיהיו שני מחשבות ביחד בשום אופן… ואין צריכין לעשות מלחמה ולנענע ראשו אנה ואנה כדי לגרש המחשבות רעות כי אין זה מועיל כלל, אדרבא ע"י מתגברים יותר רק לבליי להשגיח עליהם כלל, רק לעשות את שלו במה שהוא עוסק בתורה או תפילה או משא ומתן, ולבלי להסתכל לאחוריו כלל, ועי"ז ממילא תסתלק.
    • ליקוטי מוהר"ן תורה עב: אם רוצה להיות ירא ה', ורוצה להתפלל, ואינו רוצה באלו המחשבות רעות, צריך שלא להשגיח עליהם כלל, ושלא יכפת ליה מה שעומדים לפניו, ורק יעשה את שלו במה שהוא עוסק, בתורה או תפלה או מו"מ, ולא ישגיח עליהם כלל. וכמו ששמעתי מעשה באחד שבשעה שעמד להתפלל, היה מזדמן ועומד לפניו בדמיונו עכו"ם ערל, והיה לו יסורים גדולים מזה, וכל מה שרצה להתגבר ולסלק המחשבה, התגברה עליו יותר. ויעץ לו חכם, שלא יכפת ליה, ויעמוד העכו"ם, ואעפ"כ יעשה את שלו ויתפלל, ובזה יסתלק ממנו. אך זה עצה לפי שעה, כל זמן שלא נתקדש גופו עדיין. והעיקר לקדש ולטהר עצמו כנ"ל, וילך לחכם, ויתן לו עצה נכונה על כל דבר כנ"ל.
  • קונטרס דרך המלך (הנדפס יחד עם חובת התלמידים), והעיקר הוא שלא לחוש כלל לפניות שבאות למחשבתו בעת עבודתו. רק יעבוד ולא יתכוון אפילו לדחותם כלל, ואז ממילא יתבטלו כשלא יחשוב מהם כלל. וכן בענין מחשבות זרות שבאות אליו בעת תפילתו, העיקר הוא שלא יחוב מהם כלל לדחותם. כי כל מה שירצה לדחותם הם יתחזקו בו. אלא העיקר הוא להתפלל, ואם באה אליו מחשבה אחרת לא יעיין בה כלל.
  • For more see sources in What you resist persists.

Footnotes

See also this video.

  1. ↑ 1.0 1.1 Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.
  2. ↑ Harris, R. (2007). The happiness trap: Stop struggling, start living. Wollombi, NSW, Australia: Exisle Publishing.
  3. ↑ Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger
  4. ↑ For an article on this study, see here.
  5. ↑ Monti, P. M. (2002). Treating alcohol dependence : a coping skills training guide. Guilford Press.
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