What is Cognitive Behavioral Therapy

If you’ve ever discussed or researched addiction therapy options, you may have at some point come across the term CBT. This is shorthand for cognitive behavioral therapy, a very specific short-term approach that’s intended to help people address a wide range of emotional and psychological issues that take the form of habits.

Before you agree to any type of sessions with a counselor, it can be beneficial to know what you’ll be getting into. Let’s explore some of the ideas behind CBT and how it is often applied when working with folks who have formed addiction patterns.

Core Concepts

At its base, cognitive behavioral therapy is about the idea that how you perceive yourself and your existence plays a key role in your behavior. A person who has internalized negative truths about their self can end up acting out behaviors that confirm those negative truths.

For example, someone who has internalized the notion that they can’t succeed might not take steps to improve their life. Furthermore, a person who thinks they’re a loser may make detrimental decisions based on that idea rather than objective reality and their long-term goals.

As it pertains to addiction therapy, CBT is intended to address patterns of addiction that emerge from how we think of ourselves. Some of these can be long-existing issues, such as coming from a family where substance use disorders were common. Other patterns can be related to beliefs that only form once a person has developed an addiction.

Praise for cognitive behavioral therapy is common in the medical community. For example, one NIH report described CBT as “the gold standard” of psychotherapy. It is used to deal with a variety of potentially psychological and emotional problems, including:

  • Depression
  • Anxiety
  • PTSD
  • Childhood trauma
  • Phobias

Generally speaking, if a disorder involves a stimulus and a response to it, there’s a good chance that a CBT process may be used in trying to treat it.

The Goals of CBT

Cognitive behavioral therapy is aimed at helping patients approach the situations they’re dealing with in a more structured and goal-oriented manner. When you visit a counselor, psychologist or therapist, they will not be focused on telling you what to do. Instead, the goal is to help you develop a kit of emotional and mental tools that will allow you to address difficult problems yourself.

At the beginning of the process, you’ll be encouraged to identify specific negative thoughts that churn around in your mind. Alongside this list of thoughts will also be a list of reactions to those thoughts. Tying outcomes to beliefs are one of the distinguishing features of CBT.

One big tool that many therapists employ is called exposure therapy. The idea behind exposure therapy is to teach patients that they can, in fact, withstand the things that make them feel anxious.

A person may have trouble socializing due to earlier life experiences that taught them that they don’t get along well with others. Instead of dwelling on how this past trauma hurts the patient, a therapist will likely encourage them to engage in a small social task that will expose them to success.

For example, a patient might be nudged to start having short conversations with cashiers when they go to the store. This exposes them to a low-risk situation where they can have a positive interaction. In later therapy sessions, they can then discuss:

  • How the interaction unfolded
  • The positive value they got from it
  • Negative feelings they encountered
  • How well they coped with those feelings
  • Ways to curb those feelings and focus on the interaction itself

The patient will be encouraged to try things a few times each day. As they lessen their anxiety, they will then be prompted to try to be more active. Over time, the hope is that the patient will learn to tolerate or even embrace interactions that previously triggered their anxiety.

CBT as a Form of Addiction Therapy

It should be noted that prior to beginning any sort of therapy, an individual trying to address a substance use disorder may need to undergo detoxification in a structured setting. While CBT can be beneficial in many circumstances, it’s important to stabilize potentially dangerous medical issues that can arise from drug or alcohol addiction prior to moving forward with therapy.

Once it is clear that a person is not dealing with withdrawal symptoms, they can then begin working on therapeutic options. So, what can you expect once you have gotten to that point?

The first questions that you should expect to hear are related to motivations. Before a professional can start making recommendations, they have to identify why a person has engaged in misuse of a substance. These kinds of motivations can be surprisingly varied. Someone might be motivated to drink or do drugs because:

  • Feel socially isolated and wish to make friends
  • See it as a reward at the end of a difficult workweek
  • Find it to be a quick release from life’s pressures
  • Feel pressured to succeed and use stimulants to perform
  • Model parental behavior
  • Are feeling bored by life in general
  • Believe it’s expected of them

If you look at those examples, the nature of motivation in each case can be very different. A high school student who wants to fit in and make friends may need to follow a path of addiction therapy that encourages them to discover that they can meet new people without having drugs or alcohol present. Conversely, a computer programmer who’s abusing Adderall in order to pull long work hours may need to learn how to manage a work-life balance. The goal of a motivational intervention is to help a client narrow down why they take drugs in the first place.

During this period, it’s also common for a counselor to focus on determining if there are comorbid disorders. A person who engages in drug use might be self-medicating in order to cope with an undiagnosed anxiety disorder, for example. In assessing someone’s motivations, it may be helpful to treat these issues alongside the concerns about addiction.

Once motivations have been identified, contingency reinforcement comes into play. The goal at this point is to provide a non-drug reward that will reinforce desired behavior. For example, a small prize might be offered every time a client comes back with a clean drug screening.

The logic behind this has a lot to do with the way the reward centers in the brain respond to drugs. The neuroreceptor dopamine plays a key role in how we learn to like the things we like. Drugs like cocaine and amphetamines directly hijack this process.

In other cases, though, the reinforcement that dopamine provides may be more subtle. For example, a person may get a dopamine boost that reinforces drug use due to the fact that they were having fun at the time. They may not be predisposed to full-on chemical addiction, but they can still form a drug habit because their brain begins to form a connection between drugs and the enjoyment they experienced.

When using contingency management, a CBT therapist is attempting to step into the middle of these processes. In other words, they’re trying to find a healthier way to supply a dopamine rush to the patient.

Relapse Prevention Methods

A final tool that has to go into a patient’s mental toolbox is relapse prevention. The idea here is to help them better identify risk factors that might lead them into situations where drugs are available. Someone might be encouraged to make a list that includes:

  • Places where activity occurs, such as their favorite bars
  • Specific friends or family members who may offer drugs or drinks
  • Home situations that often precede instances of substance misuse
  • Work events that prompt a desire to drink
  • Times of the year when drug use or drinking becomes more common

In a previous example, we noted a scenario involving a professional who abused attention-enhancing drugs to get work done. Such a person might be encouraged to identify work pressures that drove abuse patterns. They can then take small steps to keep their situation from becoming too high-pressure to deal with, reducing the risk that they’ll have a relapse. A similar approach might be applied by a student facing pressure before finals or someone who drinks to excess during the holidays.

Another part of relapse prevention is identifying sources of support. A person can start making a list of the people they trust to be there when they’re feeling pressures to drink or do drugs. Family members and close friends are often helpful. Folks may also be paired up with someone who has been through the recovery process, especially if they don’t have a large number of friends outside of a previous social circle involved in drug use.

Moving Forward

Cognitive behavioral therapy options are typically structured to take place over weeks or months. As part of an addiction therapy plan, follow-up with patients can be built around the post-cure process. For example, someone may continue working with a substance abuse counselor after they’ve been through a recovery program. They might also engage in group therapy sessions or meetings organized through AA or NA.

A person might be set up with a 30-day rehab alongside three months of CBT sessions. In this instance, they would complete the rehab and continue meeting with a therapist to assess how their progress is coming along.

One main goal in CBT as it relates to addiction therapy is to send patients back into the world better armed to deal with the pressures that led them to use drugs. Relapse is always a major concern, but the hope is that by identifying issues before they get too hard to handle, you can head things off.

A big benefit that can come from CBT is building a new support structure. Socialization issues, work pressures, and home-life problems don’t magically go away just because you’ve ceased using a particular drug. Having a more orderly approach in coping with them, however, can improve the chances that you won’t experience a relapse.

As is the case with any other aspect of the recovery process, it takes time. Cognitive behavioral therapy, though, can be there by your side as you continue to get better. By stacking good experiences on top of each other, you’ll come to appreciate that life can be led without drugs or alcohol interfering with it. Likewise, by learning to identify bad experiences and respond to them proactively, you can begin to take back control of your life.

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