CARN Counseling and Therapeutic Modalities 5 — Questions and Answers
Question 1: A patient in early recovery asks what 'urge surfing' means. The nurse BEST explains it as:
- Avoiding all situations that trigger cravings
- Observing cravings as waves that rise and fall without acting on them (Correct answer)
- Using medication to reduce craving intensity
- Distracting oneself with physical exercise during cravings
Correct answer: Observing cravings as waves that rise and fall without acting on them
Urge surfing, from mindfulness-based relapse prevention, teaches patients to ride out cravings like waves — observing them without acting on them until they pass naturally.
Question 2: In Solution-Focused Brief Therapy (SFBT) with an addictions patient, the 'miracle question' is used to:
- Assess the severity of the patient's addiction
- Help the patient envision a future without the problem to identify goals (Correct answer)
- Explore childhood trauma contributing to substance use
- Evaluate the patient's spiritual beliefs about recovery
Correct answer: Help the patient envision a future without the problem to identify goals
The miracle question invites patients to imagine life if the problem were suddenly gone, helping to articulate concrete goals and identify existing strengths.
Question 3: When a nurse identifies countertransference during addiction counseling, the MOST appropriate action is to:
- Immediately end the therapeutic relationship
- Use personal feelings as clinical data and seek supervision (Correct answer)
- Disclose all personal feelings to the patient
- Ignore the feelings to maintain professional boundaries
Correct answer: Use personal feelings as clinical data and seek supervision
Countertransference provides clinical data; the nurse should use self-awareness and supervision to prevent it from interfering with patient care.
Question 4: A patient with alcohol use disorder consistently arrives at sessions minimizing consequences and blaming others. Which counselor behavior is MOST consistent with MI principles?
- Directly challenging the patient's denial
- Rolling with resistance by asking the patient to explore their own perspective further (Correct answer)
- Providing a list of consequences of drinking
- Involving family members to confront the patient
Correct answer: Rolling with resistance by asking the patient to explore their own perspective further
MI principle of 'rolling with resistance' means the counselor avoids arguing and instead explores the patient's perspective, reducing defensiveness.
Question 5: Which of the following BEST describes the purpose of 'decisional balancing' in Motivational Interviewing?
- Helping patients weigh the pros and cons of changing their substance use (Correct answer)
- Teaching patients to balance work and recovery activities
- Assessing a patient's readiness to take medication
- Developing a daily schedule to balance therapy and social activities
Correct answer: Helping patients weigh the pros and cons of changing their substance use
Decisional balancing involves exploring the benefits and costs of both continuing substance use and making a change to help resolve ambivalence.
Question 6: Mindfulness-Based Relapse Prevention (MBRP) differs from standard relapse prevention PRIMARILY by:
- Eliminating cognitive restructuring techniques
- Incorporating formal meditation practices to increase awareness of triggers and cravings (Correct answer)
- Focusing exclusively on medication compliance
- Using peer confrontation to address denial
Correct answer: Incorporating formal meditation practices to increase awareness of triggers and cravings
MBRP integrates formal mindfulness meditation to increase non-judgmental awareness of internal triggers, cravings, and high-risk situations.
Question 7: A CARN facilitating a psychoeducational group on high-risk situations covers the concept of 'HALT.' Which patient statement indicates correct understanding?
- 'I should halt all social activities in recovery.'
- 'I'm most vulnerable to relapse when I'm Hungry, Angry, Lonely, or Tired.' (Correct answer)
- 'HALT means I must stop therapy if I feel cravings.'
- 'I should halt medication when I feel better.'
Correct answer: 'I'm most vulnerable to relapse when I'm Hungry, Angry, Lonely, or Tired.'
HALT is a relapse prevention acronym reminding patients that Hungry, Angry, Lonely, and Tired states increase vulnerability to cravings and relapse.
CARN Counseling and Therapeutic Modalities 5
A patient in early recovery asks what 'urge surfing' means.
The nurse BEST explains it as: