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NMU 146 – 10 Core Psychotherapy Processes for Addictions and Mental Health

Nutrition / Natural Medicine Update No 146 (October 1, 2019)

with Dr. James Meschino


Topic: 10 Psychotherapy Strategies Shown to Improve Outcomes in Addictions, Stress Management, and Mental Health Conditions

Source: Dual Diagnosis: An Integrative Approach (Watkins TR, Lewellen A, Barrett C. (Sage Publications)


Studies suggest that the management of stress, burn-out, various mental health problems (i.e. depression, anxiety) and addiction problems require more than just treatment with pharmaceutical medications. In 1984 two top psychotherapy researchers (Prochaska and DiClemente) published data to show the 10 core processes that are related to the therapeutic change in addiction behavior. But many of them also apply to stress, burn-out and mental health management as well. Their approach, known as the transtheoretical model, has become a foundation for counseling and peer-support within the psychotherapy world. I want to briefly outline the 10 core processes for you, to help you appreciate their importance in the comprehensive management of addiction and mental health problems:

  1. Consciousness Raising – This means increasing the patient’s awareness of their behavior and its consequences on their own mental state and functional state and the impact it is having on others close to them.
  2. Self-Liberating – This means freeing the patient from victim-hood. Helping the patient realize that they have other choices they can make and are not a passive victim of mental health or substance abuse.
  3. Social Liberation – This means helping the patient establish a social environment that offers opportunities for the patient to get needs meet through nondestructive means. This means helping them create a more positive social circle, peer-support from a person who has gone through a similar experience and came out the other side, creating a productive life for themselves, and showing them how to access other positive resources in their vicinity.
  4. Counterconditioning – This means unlearning the destructive behaviors that have become automatic triggering events. For substance abuse, it means replacing drugs or alcohol with exercise or a positive hobby, or meaningful activities aimed at helping others. For mental health patients, it means replacing symptomatic behavior with more socially appropriate behavior. It’s understanding the gap between stimulus and response and catching yourself in the moment when you feel triggered to do something destructive, but instead, you choose a more positive choice in your behavior or response.
  5. Stimulus Control – This means teaching the patient to avoid emotional states or situations that tend to trigger undesirable behaviors. It might involve avoiding certain friends, staying away from certain situations or environments and avoiding stimuli that threaten one’s emotional control.
  6. Self- Reevaluation – This means helping the patient discover and appreciate their strengths and weaknesses, in light of new insights about themselves. The idea is to help them see that they are not their drug addiction or their mental health challenge. They have many other positive aspects and talents that should be recognized and nurtured.
  7. Environmental Reevaluation – This means helping the patient recognize how their behavior affects the well being of others, and helping them realize that whatever social rejection they may have experienced in the past is not because people don’t like them, but because of their actions and behaviors – which can be changed to engender more positive relationships with friends, family, and co-workers.
  8. Contingency Management – This means changing the consequences of behavior. In many cases, the patient with an addiction or mental health challenge was excused for their unacceptable public behavior, when holding them accountable would make such behavior less rewarding and less self-reinforcing.
  9. Dramatic Relief – This entails an opportunity for the patient to fully verbalize all frustrations with a life they have endured, allowing full ventilation of their emotions. This is often a cathartic moment, which resets the clock for change to begin. Dramatic relief should occur early in psychotherapy when the patient can no longer mask their pent-up feelings and emotions with drugs, alcohol or other avoidance tactics or destructive emotions or behaviors.
  10. Helping Relationships – This is the therapeutic bond between the patient and the therapist, who provides one-on-one support and encouragement for the patient’s efforts towards positive changes. The sense of being understood and accepted is particularly meaningful to patients with both addiction and mental health problems.


In addition to these 10 core processes, a highly skilled psychotherapist can also zero in which of the five levels of intervention are most important in the patient’s case. The five levels of intervention include:

  1. Symptoms/Situational – which deals with immediate stimuli that trigger behavior and its consequences
  2. Maladaptive Cognition – focuses on correcting the dysfunctional thought patterns that lead to symptomatic behavior.
  3. Interpersonal Problems – addresses difficulties the patient has in dealing with the world outside their intimate circle. This can be due to lack of social skills, coping skills or lack of acceptance on the part of the larger society.
  4. Family Conflicts – relates to dysfunction with their intimate circle of family and friends, which often triggers and feeds the symptomatic behavior.
  5. Intrapersonal Conflicts – deals with pain from deep psychological problems rooted in early-life experiences and reinforced by continuing maladaptive effective responses.


In summary, the transtheoretical model deals with where the patient is, which level of intervention is most suited to their circumstances, and the elements that are necessary to bring about meaningful change. After considering all this, you probably agree with me that this type of targeted psychotherapy, which considers the whole person,  should be a foundational aspect of the comprehensive management of addictions and various mental health challenges, as it complements and is likely to enhance the pharmaceutical treatment used to treat many of these problems.

I have included the reference for this information in the text below.



Watkins TR, Lewellen A, Barrett C. Dual Diagnosis. Sage Publications Inc. 2001. Pages 6-10.


Eat Smart, Live Well, Look Great,

Dr. Meschino

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