Joseph Hyde MA, LMHC, CAS, is a Lecturer/Clinical Instructor in the Department of Social Welfare and Continuing Education at Stony Brook University. He serves as Senior Subject Matter Expert at JBS International supporting health and behavioral centers throughout the US. Maria Torres LMHC, PhD, is Assistant Professor, Stony Brook University School of Social Welfare. Win Turner LADC, PhD, is Co-Director of the Center for Behavioral Health Integration/Vermont and has served as project director for multiple federal and state initiatives. R. Lyle Cooper MSW, PhD, is an associate professor in Meharry Medical College’s Department of Family and Community Medicine. Dr. Cooper also serves as the Associate Director of the Meharry Addiction Clinic.

• Figures and Tables viiAcknowledgements viiiIntroduction 1To Students and Fellow Practitioners 1Key References Include 1The Following Features Help Make this Guide Practical 2The Guide is Organized Into Three Main Sections 21 An Overview of Proven Tools and Techniques for Motivational Interviewing/Motivational Enhancement Theory, and Cognitive Behavioral Therapy Treatment 3Motivational Interviewing and Motivational Enhancement Therapy 3Motivational Interviewing and the Process of Change 5The Two Phases of Motivational Interviewing 6Cognitive Behavioral Therapy 14Treating Co-occurring Disorders 18Recovery Supports 20Patient Activation Within the Context of ICBT 20On Spirituality 20Enhancing Cultural Relevance in Clinical Practice 222 Clinician Guidance for 16 Sessions of Integrated Cognitive Behavioral Therapy 28Introduction 28Law of Thirds 29Review of Progress and Between-session Challenges 33Session 1. Eliciting The Life Movie 36Session 2. Enhancing Situational Awareness 55Session 3. Learning Assertiveness 69Session 4. Supporting Recovery Through Enhanced Social Supports 85Session 5. Supporting Recovery Through Healthy Replacement Activities 97Session 6. Problem Solving 107Session 7. Handling Urges, Cravings, and Discomfort 120Session 8. Working with Thoughts: Part 1 139Session 9. Working with Emotions 154Session 10. Making Important Life Decisions 172Session 11. Enhancing Self-awareness of Substance Use 191Session 12. Using Mindfulness, Meditation, and Stepping Back 208Session 13. Addressing Suicidality 220Session 14. Using Medication in Support of Treatment and Recovery 229Session 15. Engaging with Self-help 244Session 16. Using an MI/CBT Approach for Traumatic Stress and Substance Use 2523 Techniques and Tools Supporting Fidelity of Implementation and Clinical Supervision 279Introduction 279Acronyms 280Adherence Tools and Techniques: Checklists 281Clinical Supervision Techniques to Improve Adherence 282ICBT Clinician Checklist Protocol 283References 290Index 297

Joseph Hyde MA, LMHC, CAS, is a Lecturer/Clinical Instructor in the Department of Social Welfare and Continuing Education at Stony Brook University. He serves as Senior Subject Matter Expert at JBS International supporting health and behavioral centers throughout the US. Maria Torres LMHC, PhD, is Assistant Professor, Stony Brook University School of Social Welfare. Win Turner LADC, PhD, is Co-Director of the Center for Behavioral Health Integration/Vermont and has served as project director for multiple federal and state initiatives. R. Lyle Cooper MSW, PhD, is an associate professor in Meharry Medical College’s Department of Family and Community Medicine. Dr. Cooper also serves as the Associate Director of the Meharry Addiction Clinic.

• Figures and Tables viiAcknowledgements viiiIntroduction 1To Students and Fellow Practitioners 1Key References Include 1The Following Features Help Make this Guide Practical 2The Guide is Organized Into Three Main Sections 21 An Overview of Proven Tools and Techniques for Motivational Interviewing/Motivational Enhancement Theory, and Cognitive Behavioral Therapy Treatment 3Motivational Interviewing and Motivational Enhancement Therapy 3Motivational Interviewing and the Process of Change 5The Two Phases of Motivational Interviewing 6Cognitive Behavioral Therapy 14Treating Co-occurring Disorders 18Recovery Supports 20Patient Activation Within the Context of ICBT 20On Spirituality 20Enhancing Cultural Relevance in Clinical Practice 222 Clinician Guidance for 16 Sessions of Integrated Cognitive Behavioral Therapy 28Introduction 28Law of Thirds 29Review of Progress and Between-session Challenges 33Session 1. Eliciting The Life Movie 36Session 2. Enhancing Situational Awareness 55Session 3. Learning Assertiveness 69Session 4. Supporting Recovery Through Enhanced Social Supports 85Session 5. Supporting Recovery Through Healthy Replacement Activities 97Session 6. Problem Solving 107Session 7. Handling Urges, Cravings, and Discomfort 120Session 8. Working with Thoughts: Part 1 139Session 9. Working with Emotions 154Session 10. Making Important Life Decisions 172Session 11. Enhancing Self-awareness of Substance Use 191Session 12. Using Mindfulness, Meditation, and Stepping Back 208Session 13. Addressing Suicidality 220Session 14. Using Medication in Support of Treatment and Recovery 229Session 15. Engaging with Self-help 244Session 16. Using an MI/CBT Approach for Traumatic Stress and Substance Use 2523 Techniques and Tools Supporting Fidelity of Implementation and Clinical Supervision 279Introduction 279Acronyms 280Adherence Tools and Techniques: Checklists 281Clinical Supervision Techniques to Improve Adherence 282ICBT Clinician Checklist Protocol 283References 290Index 297

Joseph Hyde MA, LMHC, CAS, is a Lecturer/Clinical Instructor in the Department of Social Welfare and Continuing Education at Stony Brook University. He serves as Senior Subject Matter Expert at JBS International supporting health and behavioral centers throughout the US. Maria Torres LMHC, PhD, is Assistant Professor, Stony Brook University School of Social Welfare. Win Turner LADC, PhD, is Co-Director of the Center for Behavioral Health Integration/Vermont and has served as project director for multiple federal and state initiatives. R. Lyle Cooper MSW, PhD, is an associate professor in Meharry Medical College’s Department of Family and Community Medicine. Dr. Cooper also serves as the Associate Director of the Meharry Addiction Clinic.

• Figures and Tables viiAcknowledgements viiiIntroduction 1To Students and Fellow Practitioners 1Key References Include 1The Following Features Help Make this Guide Practical 2The Guide is Organized Into Three Main Sections 21 An Overview of Proven Tools and Techniques for Motivational Interviewing/Motivational Enhancement Theory, and Cognitive Behavioral Therapy Treatment 3Motivational Interviewing and Motivational Enhancement Therapy 3Motivational Interviewing and the Process of Change 5The Two Phases of Motivational Interviewing 6Cognitive Behavioral Therapy 14Treating Co-occurring Disorders 18Recovery Supports 20Patient Activation Within the Context of ICBT 20On Spirituality 20Enhancing Cultural Relevance in Clinical Practice 222 Clinician Guidance for 16 Sessions of Integrated Cognitive Behavioral Therapy 28Introduction 28Law of Thirds 29Review of Progress and Between-session Challenges 33Session 1. Eliciting The Life Movie 36Session 2. Enhancing Situational Awareness 55Session 3. Learning Assertiveness 69Session 4. Supporting Recovery Through Enhanced Social Supports 85Session 5. Supporting Recovery Through Healthy Replacement Activities 97Session 6. Problem Solving 107Session 7. Handling Urges, Cravings, and Discomfort 120Session 8. Working with Thoughts: Part 1 139Session 9. Working with Emotions 154Session 10. Making Important Life Decisions 172Session 11. Enhancing Self-awareness of Substance Use 191Session 12. Using Mindfulness, Meditation, and Stepping Back 208Session 13. Addressing Suicidality 220Session 14. Using Medication in Support of Treatment and Recovery 229Session 15. Engaging with Self-help 244Session 16. Using an MI/CBT Approach for Traumatic Stress and Substance Use 2523 Techniques and Tools Supporting Fidelity of Implementation and Clinical Supervision 279Introduction 279Acronyms 280Adherence Tools and Techniques: Checklists 281Clinical Supervision Techniques to Improve Adherence 282ICBT Clinician Checklist Protocol 283References 290Index 297