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What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy helps people recognize and change the links between their thoughts and behaviors. Without therapy, many people don’t fully understand why they do what they do; they don’t trace the thought pattern that led to the action. 

Cognitive Behavioral Therapy first gives people the tools to understand their cognition and behaviors—then helps them change both.

Cognitive Behavioral Therapy for Addiction

People experiencing addiction are engaging in a behavior they want to stop. The Cognitive Behavioral model views addictive behaviors as the result of harmful thought patterns that cause negative emotions. These difficult feelings are accepted as truth rather than challenged. 

In CBT, people learn to distinguish between their inner thoughts and reality. The goal is to create long-term change in thoughts and behaviors. 

A large part of understanding how thoughts play into addictive behaviors is understanding triggers. A person may want to change their drinking habits, but not understand what triggers their cravings—making it very hard to stop repeating patterns.

In the book Cognitive Therapy of Substance Abuse, the authors list seven risk factors for substance abuse that can be addressed by CBT:

-“High-risk situations,” or internal or external triggers

-“Dysfunctional beliefs” regarding a person’s relationship to drugs or alcohol

-“Automatic thoughts” that increase resolve to drink or use

-Cravings for drugs and alcohol

-“Permission-giving beliefs” that people use to justify drinking or using

-“Rituals,” or behaviors associated with substance use  

-Feeling ashamed of relapsing, causing a vicious cycle of continuous relapse

CBT helps make people aware of these risk factors, and also offers alternatives. The ultimate goal is to shift behavior. Some of the skills people learn in CBT are:

-Delaying and distracting when it comes to cravings. The therapist may offer healthier distractions such as journaling, going to meetings, exercising—anything to keep a person’s mind off the craving until it subsides.

-Learning to spot unhealthy thoughts and emotions and replace them. For instance, if a person thinks, “I always fail; I might as well drink, because then I can blame it on alcohol,” they can learn to pause and identify that as a dysfunctional belief. They can then replace that thought with one like, “I have succeeded at staying sober before, and I can do it again.”

-Learning to confront their problems. People with substance use disorders may have learned to try to forget issues going on in their lives by drinking or using. In CBT, they are given the coping strategies to face their problems with a clear head.

-Making changes to their daily routine that support sobriety. This could include regularly meditating, doing yoga, exercising, making art, or engaging in other hobbies.

History of Cognitive Behavioral Therapy

Cognitive Behavioral therapy evolved from a few different types of therapy. Early behaviorists suggested that all behaviors happen through conditioning, and therefore that you could change behavior through positive and negative reinforcement. This view emphasized the thought patterns that lead to behaviors, thus paving the way for early iterations of CBT.

In the 1950’s, Albert Ellis developed Rational Emotive Behavior Therapy. In this type of therapy, patients were encouraged to identify, challenge and shift their irrational thinking.

However, what is today considered Cognitive Behavioral Therapy didn’t emerge until the 1960’s. Dr. Aaron T. Beck noticed that his patients had what he called “automatic thoughts,” negative thoughts about themselves or the world around them. These automatic thoughts affected the patients’ response to the therapeutic process. 

For instance, if someone thought, “Dr. Beck looks angry,” their behaviors might shift, not necessarily based on what Dr. Beck was actually saying. Dr. Beck began helping his patients identify and change their thought patterns. He found that this method helped his patients make long-lasting change.

CBT gradually began to take off, with new approaches to the therapy continuing to emerge up to the present day. For instance, a new type of CBT focuses on acceptance of cognition. The patient still learns to understand their thoughts, but doesn’t try to change them. The focus is on changing their response to the thought, or their behavior.

The Cognitive Behavioral Therapy Process

At the first CBT session, your therapist will begin getting to know you and your situation. This may take a few sessions. You and your therapist will likely set goals for the therapy process, as CBT is highly goal-oriented. 

Your therapist may also ask whether you might benefit from supplementary therapy or treatment, such as recreational therapy or medication. 

The first few sessions are also a chance for you to ask questions about the therapist’s approach, and get a sense of whether they are a good fit.

Each therapist will approach CBT differently, based on the person’s unique situation. However, there are some typical general steps:

Identifying areas of your life you want to work on

As mentioned earlier, goal-setting is an important part of the therapeutic process in CBT. You will let your therapist know what is troubling you, whether that be a phobia, a mental health disorder, a substance use disorder, a grieving process, or another issue in your life. You and your therapist will then set goals for what you want to focus on.

Gaining awareness of your automatic thoughts about these issues

Once you’ve identified areas of your life that are troubling you, your therapist will likely ask you to dig deeper about your thoughts on these areas. The therapist will try to get you to understand the way you talk to yourself about these issues, your persistent beliefs about yourself or others in these areas, or the way you interpret the situation.   

Learning to identify feelings in the moment

After you’ve learned how you think about issues in your life overall, the therapist may help you learn to identify your responses to specific situations. These may be physical, emotional or behavioral reactions to particular events. This way you learn to understand your responses, hopefully allowing you to change problematic behaviors. 

Changing your perspective

Your therapist will likely encourage you to investigate whether your perceptions are fact-based. You may learn tips for how to handle discomfort, which may arise when you are asked to challenge long-standing beliefs. 

CBT is usually seen as a collaboration between the patient and therapist, but further on in the process, the patient tends to guide the sessions. The goal is for the person to have the tools to challenge their own thought patterns, so that they can feel empowered to use them in the future. 

Many therapists who employ CBT give homework assignments. These will differ based on the person and situation, but may include reading assignments, journaling, or other activities. As CBT is about working towards goals, homework is a natural step in the process.

Research on Cognitive Behavioral Therapy

Since CBT is often about creating and working towards measurable goals, it is easier to research.

In a review in the journal Cognitive Therapy and Research, the authors surveyed the results of 106 studies about CBT. 11 studies compared the effectiveness of CBT compared to other treatments or controls. They found that participants of CBT showed higher response rates than comparisons in 7 of those 11 studies. Only one had a lower response rate than comparisons. 

The authors also found that “the strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress.”

CBT treatment for Substance Use Disorders has also been studied. A study published in Psychiatric Clinics of North America found evidence that a “Contingency Management” form of CBT might be most effective for treating Substance Use Disorders; in short, this means providing rewards for continued abstinence, such as lottery prizes for negative drug screens. This method is meant to counter the “reinforcing effects” of the substance(s).

The same study also found that CBT for substance use was most effective in treating marijuana dependence, followed by cocaine and opioids.

Get Help at Amatus Recovery Centers

If you are struggling with a substance use or co-occurring disorder, there is help and hope. At Amatus Recovery Centers across the country, we offer a wide range of treatment options and therapies, including Cognitive Behavioral Therapy. We will create a recovery plan customized to your needs. Call 833-216-3079 today to find out how we can help you build a healthier and happier life.

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