A Novel Positive Psychology Framework and Homework Resource for Drinking to Cope Behavior: A Case Study

Abstract

An increasing amount of research documents that women are more likely than men to drink alcohol to cope in response to stress and negative affect. The purpose of this case study is to describe how a Homework Resource based on a novel positive psychological framework of empowered and disempowered patterns (Vitality Types) in behavior and cognition was applied as an assets-based approach in the clinical setting with a woman diagnosed with moderate alcohol use disorder. The framework was applied as an adjunct homework resource to promote positive self-perception and confidence to set healthy boundaries. Self-perception is a significant factor of psychological empowerment and found to be positively related to self-esteem. Through activities designed to enhance self-awareness, she developed personalized self-regulation strategies to manage her negative affect and problematic drinking behavior by learning to set healthy boundaries, manage emotions, and gain a more positive outlook. This case study provides preliminary evidence of feasibility and satisfaction of the Homework Resource for addressing moderate alcohol use disorder with stress and negative affect.

Stress, negative affect, and other mental health problems are particularly salient triggers for alcohol misuse among women. In turn, alcohol misuse may inhibit recovery from mental health issues (McCrady et al., 2020). Previous work has identified several women-specific vulnerabilities for alcohol use disorder (AUD) (Maddur & Shah, 2020; White, 2020) and one of the most well-validated findings indicate women are more likely than men to drink alcohol in response to stress and negative affect (Hussong, 2007; Lau-Barraco et al., 2009; Peltier et al., 2019). Research indicates that poor affect regulation contributes to the development and perpetuation of drinking to cope (DTC) (Anker et al., 2016). The term pre-addiction has been proposed to describe the early stage of addiction to identify criteria of mild or moderate substance use disorder, a vulnerable period of time in which preventive care could help avert serious consequences of drug use and severe substance use disorders (Volkov, 2022). According to the self-medication model, DTC develops with the belief that drinking alcohol alleviates stress and negative affect (Frone, 2016; Hawn et al., 2020). Moreover, DTC with stress and negative affect is linked to increased risk of persistent alcohol misuse and relapse among women (Peltier et al., 2019).

Psychosocial interventions that focus on skills to reduce alcohol misuse while also providing training in other life skills relevant to women such as assertiveness, problem-solving, and communication strategies have outcomes that are more positive compared to programs that focus on alcohol misuse only (McCrady et al., 2020). An overall objective of psychosocial interventions is to empower individuals to learn tools and techniques to self-manage their own healing journey. A significant factor of psychological empowerment is self-perception which has been found to be positively related to self-esteem (Hunter et al., 2013). Qualities and characteristics considered important for women’s empowerment and recovery from substance use include perceptions of autonomy and self-nurturance as well as and interpersonal assertiveness (Hunter et al., 2013).

Empowering individuals with healthy ways to manage stress could minimize their propensity to turn to alcohol (Koob, 2020). Research has shown that cognitive behavior therapy (CBT) combined with positive psychology interventions (PPI) can provide effective treatment strategies for improving self-acceptance, optimism, and positive relations with others (Marrero et al., 2016). Research indicates that positivity can be learned and contribute to increased well-being along with decreased alcohol consumption (Akhtar & Boniwell, 2010). Emerging data suggests that the psychological processes underlying PPI may facilitate more adaptive behavioral choices about substance use (Trinh et al., 2024). and cognitive changes may explain the positive impact of PPIs on emotion regulation (Stone & Schmidt, 2020). Therefore, positive psychological approaches could be helpful tools to personalize interventions and disrupt the cycle of negative affect and problematic alcohol use before this cycle progresses to AUD. PPIs vary in type, delivery mode, and intensity, and they have primarily been studied in non-clinical settings. However, preliminary evidence exists for the efficacy in clinical settings (Chakhssi et al., 2018).

Given that stress and negative affect is a strong marker of current and future alcohol misuse among women (Greenfield et al., 2010; McCrady et al., 2020), innovative approaches which incorporate CBT and PPI principles to redirect negative thinking and emotions have the potential to benefit women who use alcohol to cope with stress. Research is lacking in novel interventions that provide an interactive, collaborative approach to identify empowered and disempowered patterns in behavior and cognition to reduce stress and manage negative affect. Homework is an important strategy in the clinical setting as it reinforces learning, promotes practice, and helps individuals apply therapeutic techniques in real-life situations. When clients engage with homework activities this is considered a hopeful step indicating they are feeling empowered and open to the possibility that their own efforts can help them overcome their clinical problems (Strunk, 2022). The homework activities in this case study were applied as an adjunct to treatment in the clinical setting to promote positive self-perception and confidence to set healthy boundaries. The purpose of this clinical case study is to describe how a homework resource based on a novel conceptual framework of patterns in behavior and cognition (Vitality Types), was employed to help a woman with moderate AUD self-identify empowered and disempowered patterns in her communication and behavior and develop self-coaching strategies to manage negative affect and DTC behavior.

Method

Participant Case History

The present case study is based on a Caucasian female in her forties’ seeking counseling to deal with symptoms of poor self-esteem, low mood, negative self-talk, isolation, poor sleep, and concerns about her drinking behavior. A focus of the intervention was to provide Client psychoeducation about disempowered (reactive) and empowered (proactive) patterns in relationships and communication. Goals were for Client to reduce her alcohol consumption, gain new self-awareness, set healthy boundaries and develop personalized self-regulation strategies to advocate for herself, and learn techniques to cultivate a more positive self-perception and optimistic outlook. Written informed consent for publication of their details was obtained from Client. Client and related information have been de-identified.

Client presented to therapy reporting that she was concerned about her drinking behavior, her weight, and her overall health. She was easily teary-eyed and emotional and felt that she was “never measuring up.” She reported that she hated her job, had no close friends, and had taken on the role of family caregiver. Client expressed that she felt exhausted, tired, and depressed: “I quit exercising. I don’t keep the house as clean as I used to. I would prefer to sleep rather than deal with everything.” Client reported that she rarely did not have at least one drink per day. Sometimes she would start early, just to numb her feelings. Client reported that she was embarrassed to admit how much she was drinking every day. On occasion she would drink a pint of liquor in a day. She was unsure if she wanted to quit alcohol altogether or if she could learn to moderate. “I am not sure what my husband will say if I quit drinking alcohol.” Client and her husband attend venues that include alcohol on a regular basis. Client stated she wanted to change her drinking patterns for three important reasons: (1) her health, (2) her disengagement – lack of joy both at home and at work, and (3) her significant relationships (e.g., husband, children, and grandchildren). Client reported that she also wanted help processing her professional life and getting clarity about her future career options - “My ambition levels are non-existent” and “I go through the motions at my work but I’m not being impactful.”

Diagnostic Assessment

F33.1 Major Depressive Disorder, Recurrent Episode, Moderate

F10.20 Alcohol Use Disorder, Moderate

Goal for therapy

“I want to feel better about myself so I don’t need to drink alcohol to feel ok.” The objective for therapy was for Client to learn strategies to manage stress, improve communication skills, and moderate alcohol intake. The treatment plan included individual therapy, psychoeducation about DTC behavior, and self-management strategies coupled with the eight-week pen-and-paper Homework Resource.

Analysis and Procedures

Sources of information analyzed in this case study included Client intake notes, session notes, direct observations, Client observations, and Client homework reflections. Client participated fully during the eight-week Homework Resource, completed all homework assignments and was engaged and actively present in the one-on-one sessions. A narrative was produced; content was analyzed, organized, and clarified using principles of qualitative research. Narrative and documentation of Client’s program participation were sent to Client for her review. Client responded with feedback, clarification, and elaboration. Ultimately, the conclusions of this case study were mailed to Client for final approval. The narrative and information exchange process with Client was monitored by a colleague who had also reviewed the raw data. After synthesizing Client feedback on the narrative, which included iterative checking, a final review of this case study was conducted. The study findings reported in this article are based on the data, reflexive, analytic dialogue with co-authors, and an evaluation of the case study in light of principles of PPI and CBT.

Therapist Training and Homework Resource Fidelity

The therapist who administered the Homework Resource for the present case study is a licensed M.S. - level professional counselor, with 10 years of post-degree experience in the treatment of trauma, anger management, marriage and family counseling, and substance use disorders. The therapist has extensive training and practice in implementing the Homework Resource in the clinical setting. She met for weekly consultations with a colleague. The therapist confirms that she followed the standardized Homework Resource throughout the intervention.

Treatment

The Vitality Type Framework

The novel conceptual framework and related materials applied throughout the Homework Resource were developed over the past decade. Through an iterative process, the framework and materials were tested and applied in corporate and clinical settings as a strategy for self-regulation and positive change (Anker et al., 2024; Serck-Hanssen et al., 2024; Solheim-Witt & Serck-Hanssen, 2017, 2018; Solheim-Witt & Serck-Hanssen, 2023). The framework presents four Vitality Type categories – Catalyst, Torchbearer, Pathfinder, and Pragmatist –to illustrate distinctions between patterns in cognition and behavior related to proposed patterns of information processing as a positive framework for self-discovery and emotion regulation (Table 1). The distinctions between Vitality Type categories are applied as an assets-based cognitive tool for clients to explore new terminology to apply in self-development and strategies to manage negative affect. As postulated in the CBT literature, when information processing becomes distorted, systems such as affective, motivational, and behavioral begin to function in a maladaptive manner, causing symptoms of clinical disorders. Shifts in attentional focus will diminish destructive beliefs, while attentional resources previously not available will contribute toward reframing cognitive distortions (Beck & Haigh, 2014). It is proposed that learning about the four Vitality Type patterns illustrate a range of positive self-schemas as a map for self-discovery that can help individuals orient and learn new terminology to reframe negative schemas they have about themselves (Serck-Hanssen et al., 2024). By applying the Vitality Type categories as a framework of schemas and tools to foster cognitive flexibility, the Homework Resource adapts CBT elements with principles of PPI as a therapeutic strategy. Preliminary data indicates that these cognitive tools and techniques can lead to positive self-perception and behavior change (Serck-Hanssen et al., 2024).

Table 1.

Overview of Vitality Type Patterns

Schemas of Vitality Type Patterns
Resources for Emotional Regulation	Catalyst	Torchbearer	Pathfinder	Pragmatist
Information processing pattern	Multi-directional	Urgent	Methodical	Linear
Approach style	Open-Minded	Transformative	Investigative	Scrutinizing
Empowered Proactive Patterns	Discovery Possibilities Ideas Curiosity	Action Impact Decision Achievement	Development Synthesis Process Connection	Clarity Structure Steadfast Completion
Disempowered Patterns	Erratic Impulsive	Restless Aggressive	Overwhelmed Codependent	Rigid Judgmental
Empowered Approach	Open to Change	Direct Decisive	Methodical Considerate	Committed Grounded

Note. An overview of four Vitality Type patterns as tools to map proactive and reactive emotions and behavior. When applied in psychosocial development, the Vitality Type patterns provide an assets-based context for self-discovery and emotion regulation.

The Homework Resource

In the clinical setting, clients are introduced to the Homework Resource (Table 2) as an adjunct strategy to redirect negative coping behavior. Individuals gain a new perspective on their predominant go-to behavior patterns and understand the importance of developing their less dominant patterns to self-advocate, set boundaries, and feel more empowered. Through activities, clients study the Vitality Type categories to self-explore and reflect on their own patterns. Furthermore, through homework activities they apply the words linked to the Vitality Type categories as cognitive tools to explore a range of strategies to redirect negative affect and practice accentuating positive qualities that are already present, albeit minimized or undervalued by themselves and/or others. They also explore positive attributes to practice aspirational approaches by imagining how they could benefit from all four Vitality Type patterns to overcome barriers, manage stress, and become empowered to meet their goals and proactively manage DTC. A core principle of the approach applied in the Homework Resource is that managing our relationship with self and others is essential to managing our relationship with alcohol. As a psychosocial approach, Vitality Type patterns represent a new way of looking at differences in relationships and interpersonal communication.

Table 2.

Overview of Homework Resource

THE HOMEWORK RESOURCE
Goal for therapy	Description	Activities
Top Priority	Psychoeducation about how outlook and mindset can be developed through intentionality and dedication to positive change and healing. In-session discussion about the impact stress and negative emotions can have on problematic drinking behavior, health and relationships.	Identify the most important area of desired change. Individuals are encouraged to look at themselves as a priority. Exploring healthy boundaries required for positive change.
Tools	Description	Activities
Vitality Type Indicator	A 25-item online questionnaire where responses are sorted and ranked according to the framework of the four Vitality Type patterns with the objective to gain awareness of empowered and disempowered patterns in communication and relationships.	The questionnaire is completed between the intake and first therapy sessions. Results are reviewed in session.
Self-Discovery Matrix	A cognitive tool that illustrates an individual’s Vitality Type scores in context of all four categories.	Self-discovery and reflection about the connection between thoughts, feelings, and behavior in context of the four Vitality Type patterns.
Word Bank	A classification of words linked to Vitality Type patterns to empower individuals with a new frame of reference to consider a fresh perspective on themselves and others.	Development of self-coaching strategies using positive words to change their perspective on themselves and others.
Techniques	Description	Activities
Self-Coaching Guide	The highest Vitality Type Indicator score determines the Vitality Type of the Self-Coaching Guide.	Self-exploration and reflection about individuals’ highest scoring Vitality Type pattern applied to personalize and practice self-coaching skills to regulate emotions and problematic drinking behavior.
Hidden Resource	The lowest Vitality Type score indicates untapped potential and is hence referred to as the Hidden Resource.	Exploring self-coaching methods outside of individuals’ typical behavior pattern as a Hidden Resource to address challenges and redirect disempowered behavior.
Shadow Aspect	Shadow Aspects describe disempowered, reactive behaviors such as being erratic, restless, overwhelmed and judgmental.	Individuals self-identify two Shadow Aspects that best describe their go-to reactive behaviors, thoughts, or feelings when under stress.
Power Words	One Power Word is chosen from the Vitality Type category of the highest score (Self-Coaching Guide); a second Power Word is chosen from the Vitality Type of the lowest score (Hidden Resource).	Individuals explore how their two Power Words can stimulate proactive, empowered behavior instead of reactive, disempowered behavior.

Note. Through the Homework Resource, individuals learn to apply new tools to navigate barriers and redirect negative thinking to better manage emotions and behavior.

Results

Client Data

Top Priority

Through in-session processing, psychoeducation, and self-reflection, Client realized she had to learn to re-evaluate her limiting beliefs, “I feel that I don’t measure up, that I’m not good enough.” Client determined that her top priority for therapy was to “become healthy in all aspects of my life.” Important areas of concerns identified by Client were her drinking behavior, her relationship with her husband and children, and reconsidering her career.

Vitality Type Indicator

Client’s highest score and hence her Self-Coaching Guide was Pathfinder Vitality. This result provided Client with a focus and priority to learn about the Pathfinder pattern and how it could help guide her self-coaching strategies to gain a new perspective on her strengths as well as her vulnerabilities. Client’s lowest score was Pragmatist Vitality which was therefore identified as her Hidden Resource. As the lowest score, Pragmatist Vitality represented an approach style that was not natural to Client. However, this pattern could provide a useful perspective to explore aspects of her untapped potential to self-regulate and make positive changes in her life.

Self-Discovery Matrix

By studying the self-discovery matrix (Table 3), Client was able to identify that her husband’s behavior and communication style aligned with that of the Torchbearer Vitality pattern. “I can see how we misunderstand each other.” A significant discovery for Client was the connection between her information processing pattern, and her communication and behavior. Making this connection with the Pathfinder’s need and inclination to process and connect the dots helped her understand the yielding, people-pleasing role she had taken on all her life, and why feeling connected was so important to her. Reflecting on this discovery also helped her understand why setting healthy boundaries for herself and others had been such a struggle.

Table 3.

Psychoeducational Tool for Self-Discovery

Self-Discovery Matrix
Vitality Patterns	Catalyst	Torchbearer	Pathfinder	Pragmatist
Vitality Type Indicator Scores
Focus	Discovery	Accomplishment	Development	Completion
Approach	Open-Minded	Transformative	Investigative	Scrutinizing
Contribution	Ideation	Initiation	Process	Structure
Key Questions	What if?	What?	Why?	How?
Needs	Variety	Challenge	Connection	Stability
Verbal Clues	“Let’s try it now!”	“What can I do?”	“I’ll think about it.”	“It has to be done right.”
Negative Coping	Self-indulgence	Lashing out	Emotional fog	Procrastination
Shadow Aspect	Erratic	Restless	Overwhelmed	Judgmental

Note. This self-discovery matrix provides an overview of four Vitality Type patterns in context of an individual’s Vitality Types scores as tools to map proactive (empowered) and reactive (disempowered) emotions and behavior.

Word Bank

By studying the Word Bank and applying the words in homework activities, Client learned how she could benefit from all four Vitality Type patterns by practicing strategies and prioritizing which of the four Vitality Type patterns she believed would be the most empowering to achieve her personal goals. As Client learned more about how to incorporate Torchbearer proactive behavior into her daily routine, she reported “I spoke up” and “I did something for me.” Client reported that she applied the Torchbearer icon (a lightning bolt) as representing “the fire I need in my belly” to create positive change. She generated a positive shift in her mindset by practicing using the words “decisive, energetic, and straightforward,” which are words associated with the Torchbearer Vitality pattern, in her inner dialogue. Client reported that reflecting on and repeating these words daily helped motivate her to take a break from alcohol. “Every time I am able to speak up for myself or do something for me, I feel stronger.” As she began to feel better about herself it became easier for her to change her relationship with alcohol. During this process, she also realized that she had not been setting boundaries for herself – specifically as it related to her drinking behavior. She came to understand that how she thinks about herself and her surroundings is a choice. This insight helped her take back some of her lost power, and as a result, her outlook, demeanor, and behavior changed. This shift in Client’s sense of her own power is documented in one of the homework activities where she chose the Torchbearer Vitality word “direct.” When asked, to list some positive outcomes (using present tense) as a result of embracing the word “direct” as an intention, Client wrote, “I feel empowered and enabled (I want to have control over my feelings).“ At the conclusion of this homework activity, Client wrote “When I am direct, I feel empowered, I am in command of my emotions, I act confident, I get satisfied.”

Self-Coaching Guide

Receiving a high score in the Pathfinder category in her self-assessment results provided Client with a new perspective. It was validating for her to learn that the Pathfinder approach is being considerate of others, “I always want people to feel comfortable and happy.” However, she also reported that some aspects of Pathfinder Vitality felt threatening, “I am low-key but also often overlooked.” Pathfinder Vitality provided a positive view of characteristics she had previously minimized or had not recognized as attributes in herself such as “needing time to process” and “a feeling that everyone’s voice should be heard.” Client reported that she resonated with both the empowered and disempowered aspects of Pathfinder Vitality, including the infinity symbol. She realized that the Pathfinder Vitality propensity to endlessly process information could represent a barrier which she described as “I can get endlessly lost.” Client reported that she thought something was wrong with her because, “I am living in a constant state of feeling overwhelmed,” a Shadow Aspect of Pathfinder Vitality. “Now I know that I am a Pathfinder, and I can work with that.” Client reported that for the first time in her life, she felt she had a tool she could identify with and “that gives me much hope.”

Hidden Resource

Client’s lowest self-assessment score was Pragmatist Vitality and thus determined to be her Hidden Resource. When exploring the attributes linked to Pragmatist Vitality, Client reported that there were no aspects of this pattern she wanted to tap into. She said it would require effort to learn to apply Pragmatist attributes. Through in-session processing, homework and reflection activities, Client explored how Pragmatist attributes could be a Hidden Resource to her after all by representing new ways of approaching challenging situations. After some reflection, she was willing to try to tap into two Pragmatist attributes: structure and completion. As she started to incorporate structure and completion into her life, she recognized that Pragmatist Vitality could help her achieve some of her desired changes. She started to schedule time daily for self-care and used calendar reminders to avoid falling back into old routines. Part of her new self-care regimen included listening to music, journaling, reading, and exercise. Her Hidden Resource eventually became a source of empowerment to Client and helped her become grounded and confident enough to begin to practice setting some boundaries. She also reported that by exercising and being mindful of being kind to herself, she found it easier to say no to alcohol.

Shadow Aspects

Client uses homework activities to self-identify two predominant Shadow Aspects in her behavior and cognition. While working on the Shadow Aspect activity, Client reported that she struggled to choose only two Shadow Aspect words because she could relate to so many of them. She also reported “I feel depressed all the time.” Ultimately, Client chose the word “overwhelmed” (a word from the Pathfinder Shadow Aspect category) and the word “escape” (a word from the Catalyst Shadow Aspect category) which she identified with as describing her disempowered state. She again reported that it was very difficult for her to set healthy boundaries. Client reported that a main reason for not setting boundaries was to “keep the peace.” She also reported not feeling worthy to speak up, and that her immediate payoff for keeping silent was that people would not be angry and upset with her; meanwhile she would experience the negative payoff of “getting to feel hurt, sad, and escape and wallow in my sorrow.” While exploring her Shadow Aspects in light of the key questions associated with the Pathfinder and Catalyst categories (Table 3), Client realized that constantly asking herself “why?” was contributing to her feelings of being overwhelmed. “When things don’t make sense, I can’t just let it go.” Hence, her tendency was to endlessly ruminate. Furthermore, Client’s second highest score was Catalyst Vitality. Client reported that she could see how exploring many possibilities (a Catalyst tendency) – had the downside of pulling her in many different directions. When combined with her need to connect the dots (a Pathfinder tendency), this contributed to her getting erratic and “just wanting to escape.” Client reported that she recognized that alcohol offered her instant gratification and helped her escape the pressure she felt to make others feel good. By reflecting on the key questions of the other Vitality Type patterns (Torchbearer and Pragmatist) she started instead to ask herself, “What do I want?” and “How can I get it?” This practice helped her to recognize that these questions could help her break some of the disempowering patterns she had fallen into.

Power Words

The Power Words Client chose were “introspective” (a word linked to Pathfinder Vitality) and “focused” (a word linked to Pragmatist Vitality). By repeating her Power Words, Client reinforced a more positive outlook and attitude, which in turn was needed to boost self-confidence and motivation. As a result of going through the Homework Resource, reflecting on her patterns in cognition and behavior, and completing the in-session and homework activities, Client reported that she now had techniques such as her Self-Coaching Guide and her Hidden Resource to model a new kind of self-awareness and self-acceptance, “I have started to be nicer to myself.” She applied these cognitive techniques in accountability strategies to manage her emotions and DTC behavior. “When I wanted to have a drink, I started to ask myself; ‘What is it I really need?’” Client reflected on how her two Power Words could help her stay the course. She shared that being “introspective” helped her pay attention to herself and her own needs and being “focused” helped to set boundaries for herself and others. Applying her Power Words as a strategy, she discovered how she could support her own needs as well as feel empowered to hold her ground and limit her drinking behavior. When faced with challenging situations or overwhelming emotions, Client practiced reminding herself to recite her Power Words to get focused and bring a sense of calmness and clarity.

Accountability

After completing the eight-week Homework Resource, Client reported she had changed her drinking habits. Instead of drinking alcohol every day, she was now intentional about moderating her alcohol intake. For example, she practiced having three abstinent days per week and was mindful of limiting her alcohol consumption to two drinks on the days she did drink alcohol. Client reported that she felt more empowered and that she had many tools to work with. She returned for accountability sessions when she felt she needed support.

Discussion

The present case study provides preliminary support (N = 1) for feasibility, acceptability, and satisfaction of the Homework Resource to effectively target problematic drinking with negative affect. In this case, negative affect and faulty thinking patterns fueled Client’s symptoms of anxiety and depression which contributed to a downward spiral of increased alcohol misuse to relieve these symptoms. This downward spiral where negative emotional states drive negative reinforcement for seeking temporary relief is a pattern associated with addiction (Koob, 2017). A wide range of research documents that negative emotions and poor affect regulation contribute to the development and perpetuation of DTC behavior (Anker & Kushner, 2019; Anker et al., 2016). Factors identified as more prevalent in women that may affect their treatment outcomes include trauma, co-occurring psychiatric disorders, relationships with children and intimate partners, as well as physical health issues (Sugarman et al., 2020). In this case, a number of psychosocial and mental health issues brought up by Client such as her low self-esteem, feeling invalidated in significant relationships, ruminating about her shortcomings, weight problems coupled with her co-occurring disorders, reflected the accumulating impact these issues had on her.

The concept of DTC with negative affect falls under the cognitive-behavioral umbrella where problematic drinking develops as well as escalates when negative affect such as anxiety, depression or stress is coupled with low self-efficacy to resist drinking along with the belief that drinking is the most viable coping option available (Anker et al., 2017). Cognitive restructuring is a strategy that targets distorted expectancies and beliefs about the consequences of their actions such as when clients maintain a belief that use of a particular substance will help some problematic aspect of their lives (McHugh et al., 2010). After therapy and the adjunct Homework Resource, Client in this case developed cognitive reframing skills, felt more positive, empowered, and socially connected. Her destructive drinking pattern changed. She chose to limit the frequency and amount of alcohol she consumed.

The relationship between thoughts and the affective system is complex and at the center of cognitive restructuring. CBT is best known for its focus on identifying and evaluating thoughts (Strunk, 2022), however the affective system is viewed as providing the emotional fabric of our lives (Beck & Haigh, 2014). Further research is needed to clarify what cognitive changes are producing the emotional regulating effects of PPIs (Stone & Schmidt, 2020). It is at the intersection of thoughts and the affective system where an individual can get lost in a downward spiral that is fueled by distorted cognitions about themselves, their surroundings, their abilities and self-worth, as well as their relationships. The result is stress, disempowerment and despair which can be a precursor to addiction. When seeking therapy, the client in this case study reported persistent low mood and worry about drinking behavior, her health, and relationships. After engaging in therapy and completing the Homework Resource curriculum she reported improvements in her self-perception and in her abilities to set boundaries and limit DTC behavior.

Preliminary data from a quality improvement (QI) study of a web-based platform utilizing the Homework Resource framework and activities indicated high usability (Serck-Hanssen et al., 2024) Specifically, individuals rated the Vitality Type categories as understandable and the Vitality Type Indicator self-assessment as helpful in their self-development. The QI study also indicated that participants found the Homework Resource to be engaging and that concepts unique to the framework, such as Self-Coaching Guide and Hidden Resource, were clear to them. Reflecting the results reported in the present case study, participants in the QI study also reported improved self-perception and that the activities of the Homework Resource inspired behavioral changes (Serck-Hanssen et al., 2024).

The association between intimate relationships and substance/alcohol misuse is well documented (McHugh et al., 2018). This case study illustrates that by learning about the proactive (empowered) and reactive (disempowered) aspects of the four Vitality Type patterns, Client gained a new view of herself and others - specifically her husband. Instead of viewing him as dominating and strong-willed she started to see him as a person with a predominant Torchbearer pattern in his behavior and communication. She became less threatened, more positive, and empowered in her relationship with her husband. As described by Hunter et al. (2013), perceived control, autonomy, and interpersonal assertiveness as well as self-nurturance are significant factors of psychological empowerment found to be positively related to self-esteem. A combination of CBT and PPI principles might include resources that foster deeper self-understanding, strategies of focusing on positive affect, personal control, and meaningful goals, as well as behaviors for improving well-being and self-regulation (Marrero et al., 2016).

Client’s learning process and shifts in thinking in this case study indicate the Homework Resource provided tools and techniques to guide discovery and cognitive restructuring. One challenge to understanding psychological disorders relates to “how information processing is activated and deactivated and how the content is modified” (Beck & Haigh (2014), p.9). By reflecting on characteristics linked to the Pathfinder pattern, the Client in this case gained a new perspective on several disempowering aspects of her behavior. She began to recognize the relationship between her need for connection and the yielding approach associated with Pathfinder Vitality pattern and certain aspects of her poor self-esteem.

Setting boundaries is a key skill in self-regulation and vital to fostering healthy relationships. As a PPI approach, strategies for setting boundaries in the Homework Resource focus on positive aspects of what Client wants to achieve, such as feeling good about herself, managing her relationship with alcohol, and having the confidence to be in social situations without necessarily consuming alcohol. Power Words are positive psychology and cognitive tools that can be used as personalized mantras to repeat and practice in self-coaching strategies to inspire positive self-talk, empowerment, and optimism. Applying the Power Word technique by consciously repeating these words to herself, Client practiced cognitive reframing skills that helped her gain confidence and commitment to make positive changes. Significantly, she reported that by exercising and being mindful of being kind to herself, it became easier to say no to alcohol.

Self-discovery and reflective learning are central to psychosocial interventions. Methods of verbal and behavioral guided discovery help individuals self-evaluate and engage in reflective learning. Through homework activities and in-session discussions, Client reflected on patterns in her mood and behavior and examined her beliefs about herself. This self-observation was beneficial for Client and provided her with motivation for disrupting her endless ruminating.

This case study provides preliminary evidence of feasibility and satisfaction of the Homework Resource for addressing moderate alcohol use disorder with stress and negative affect. Findings from this case study indicate that introducing the conceptual framework of four Vitality Types as an adjunct Homework Resource in the clinical setting is a tool to engage clients in self-investigation, explore a range of patterns and terminology that can lead to cognitive flexibility, inspire positive self-perception and behavior change. By completing the activities in the Homework Resource, Client developed personalized self-coaching strategies along with skills to manage her negative emotions. She gained skills and confidence to set boundaries and stick to her self-care routines. These practices helped Client gain a more positive outlook along with skills to manage negative emotions and DTC behavior.

Limitations and Future Directions

Although this case study illustrates initial feasibility of the Homework Resource for reducing negative affect and problematic drinking behavior, Client in this case study represents only one individual with a unique history and presenting circumstances. At the time of therapy, her socio-economic situation was stable; she had the time, resources, and support to commit to therapy. Intervention efficacy, causalities, and long-term outcomes cannot be inferred from this case study. However, additional research is urgently needed to facilitate development, dissemination, and implementation of innovative alcohol misuse prevention intervention approaches for the increasing number of women who are using alcohol to cope with stress and negative affect. Future steps in this field might include a focus on documenting mechanisms of change during and after the Homework Resource. Furthermore, in order to reach the increasing number of women struggling with negative affect and DTC, research is needed to understand how the Homework Resource could be applied onto a digital therapeutic platform to increase access. This emerging research will inform development of novel CBT and PPI prevention interventions for addressing DTC with negative affect.