Phase 3: The Experiment
Phase 3, in the C.A.R.E. model, gently invites clients to examine whether cannabis use might be connected to some of the challenges they are experiencing. In this phase, we collaboratively consider experimenting with reducing cannabis use while simultaneously focusing on strengthening their coping skills and resources. This process is designed to help us both understand, together, how cannabis use might be impacting the concerns they initially brought to therapy, as well as any other issues that may emerge as we continue our work. It's about gaining clarity, not making demands, and empowering them to make informed choices about their cannabis use and overall well-being.
Approximate Sessions: 2-6
1
How to Prepare
Have the following printed out:
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Diary cards.
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Sleep hygiene handout
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Chain Analysis Worksheets.
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Relevant research can be helpful when first proposing the experiment. See the Myths handouts for common myths and research correlating with them.
Sleep hygiene handouts are helpful for clients using cannabis as a sleep aid. Staying abreast of current research is also important for developing your library of resources.
2
Goals of the Phase
Introduce the “experiment,” A planned short-term change that the client agrees to understand better if their cannabis use is affecting their presenting issue when they have not achieved the progress they would like to make. Plan to decrease cannabis use over several weeks while increasing coping skills and doing some psychoeducation on what withdrawal symptoms may look like.
3
Key Skills
Continue with Motivational Interviewing (MI) skills to elicit change talk. Teach distress tolerance skills to clients to use when they notice a craving for cannabis. ABC Please Skill: Cope head is also practical when at the highest risk. For clients with sleep issues, reviewing sleep hygiene skills. If a client struggles to make small changes, you can also use a DBT Chain analysis to help them understand where they could increase skills and how they could make a change again.
Phase 3: Essentials
Hear about Phase 3: The Experiment
Key Takeaways:
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Phase 3, "The Experiment," is implemented when students haven't made desired progress despite initial treatment.
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It involves a time-limited intervention focused on gradually reducing cannabis use to observe its impact on their presenting problems.
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The experiment aims to increase coping skills while gradually reducing cannabis use.
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A key aspect is finding alternative ways for students to achieve the benefits they previously derived from cannabis (e.g., relaxation, sleep).
What is the Experiment?
The Experiment phase constitutes a proposed behavioral modification regarding the client's cannabis use. In collaboration with the client, the therapist facilitates the establishment of progressive, incremental goals, guiding the client toward a reduction in cannabis use throughout the experimental period. A key tenet of this phase is its time-limited nature, underscoring that the client is not obligated to commit to sustained, long-term change at this time
Time limited
A key reassuring feature of the Experiment is its time-limited nature, allowing clients the option to return to their previous cannabis use if they do not perceive the desired changes. Acknowledging that initial difficulties are a typical part of this process is important. For example, if a client aims to reduce their use over a four-week period but experiences challenges in the first week or plateaus after a few weeks, the Experiment duration can be lengthened to provide them with sufficient time to adapt to reduced cannabis use.
Incremental change
A limited initial reduction target is a prudent approach for the first week of change planning with clients. For clients using cannabis multiple times daily, an appropriate initial step is reducing use by one to two days per week. For clients using cannabis throughout the day, consider reducing daily frequency to a few times daily. Assess client success in the subsequent session. For successful reductions, collaboratively plan further decreases. For unsuccessful attempts, collaboratively analyze contributing factors and identify areas for improved preparation. Chain analysis may be a beneficial technique for understanding barriers to change when initial reduction is not achieved.
Provide coping skills
Recognizing that cannabis use typically serves a meaningful function in a client's life is paramount. The therapist's role is to assist in developing replacement coping skills. Effective skill-building necessitates understanding this functional role. Such understanding validates the client's experience and enables tailored skill instruction responsive to their individual needs, demonstrating respect for their unique context. For example, a student experiencing sleep difficulties and using cannabis for sleep could particularly benefit from sleep hygiene education and skills development.
MI Skills
Motivational Interviewing (MI) is an established therapeutic approach that can effectively assist clients reduce their cannabis use. Although numerous skills are relevant to supporting clients during the Experiment phase, MI techniques are particularly valuable. The following represents a selection of MI techniques that clinicians should be conversant with.
Asking Permission
Seeking permission is essential in client-centered therapeutic interactions. Though conceptually simple, the technique involves a crucial modification of communication: rather than directly imparting clinician viewpoints or knowledge; it necessitates explicitly asking the client for leave to share such information.
Example:
I was recently reading an article about how cannabis effects sleep, I was wondering if I could share what I read?
Pulling for Change Talk
Pulling for "change talk" enables clients to voice their inherent reasons for change. This approach is ultimately more impactful than directly instructing clients on why change is advisable, as it harnesses the power of self-generated motivation.
Reflect on a time you got feedback on something you needed to change, how effective was someone telling you to do it?
Embrace Columbo*
Using a Columbo approach can help understand the client's discrepancies without taking a judgemental stance.
Example:
On one hand, you have said that when you get home, you smoke to chill out and relax but don’t get as much done as you would like. On the other hand, you’re saying doing well in school and looking at grad schools is important. I wonder what might contribute to your anxiety about completing your schoolwork.
Who was Columbo?
Columbo was a persistent TV detective known for his seemingly confused but insightful questioning style, using gentle curiosity to uncover inconsistencies and guide suspects toward self-revelation.
DBT Skills
Dialectical Behavior Therapy (DBT) skills have demonstrated considerable effectiveness in supporting students who are seeking to reduce their cannabis use. This is corroborated by a 2021 study that indicated the efficacy of DBT interventions for cannabis use cessation. Considering the functional role cannabis often plays in students' lives, DBT skills offer constructive alternatives for managing emotions and mitigating stress
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Sleep Hygiene Handout
Cannabis has a public perception of being a sleep aid, and some studies have found that the association and expectations that it will improve sleep are often associated with increases in the frequency of use (Winiger et al. 2021). Knowing this, we should be able to discuess a student's sleep and provide educational materials to help with their sleep hygiene.
If you need a sleep hygiene handout, you can use whatever you have access to, but feel free to download the brochure-style one provided here.
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Case Vignette:
Tony
At our next session, Tony updated me on his progress. He successfully reduced his cannabis use by one day, but struggled to reduce by two. We conducted a chain analysis to identify moments where he could have utilized coping skills instead of cannabis. We discussed incorporating distress tolerance skills when urges to smoke arose. I inquired if he was willing to further reduce his use or maintain 5-6 days a week. Tony expressed a desire to attempt reducing to 4-5 days a week, given our next session was two weeks away.
Alexa Young, CA