What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy, or CBT, is a proven therapy approach used to treat mental health issues ranging from trauma to addiction. It is slowly replacing traditional psychotherapy due to its success rate. The proof lies in research-based evidence and numerous studies that show CBT for addiction can produce change that will aid in recovery and improve a person's quality of life.

Instead of delving into the past to identify the root cause of a patient's issues, CBT identifies current behaviors and thoughts that influence a person's choices in the moment. Once identified, the patient can then learn to change these patterns of thought and behavior, and create a more positive and healthier outcome. And it does this with an advantage of working in a shorter time span than most other types of therapy.

How Does Cognitive Behavioral Therapy Work?

Cognitive Behavioral Therapy is a treatment done with a trained and certified CBT therapist. It works by helping a person identify internal dialogue that is adversely affecting their actions. The internal dialogue is often a false narrative, which leads to self-destructive behavior, such as substance abuse.

As a most basic example of how distorted internal thoughts can affect behavior consider this: a person needing a job may discover a job opening near them. However, because they were turned down at other job interviews, an automatic thought may intrude to remind them of the rejection. This thought might lead them to the self-defeating act of not applying for the job at all, so they will never truly know what the outcome would have been.

If that same person would have learned to identify the self-destructive thought, they could have made a cognitive decision to make a behavioral choice that could have led them to getting a job; hence, the meaning of Cognitive Behavioral Therapy.

While this is a most basic example, CBT is a hands-on approach to individual problem solving. Dissonant patterns of thought are identified that may be creating a harmful pattern of behavior. The patient learns these thoughts may not always be truthful and can inhibit their lives to the point of blocking happier or more positive outcomes. In other words, the patient learns how negative thoughts are influencing the way they behave, thereby learning that it is possible to change these patterns. This can help the patient deal with a myriad of emotional issues or help transform self-destructive behaviors.

Cognitive Behavioral Therapy and Addiction Treatment

CBT for addiction treatment is proven to be successful, and therefore widely used. Trained therapists can help addicts identify destructive thoughts and then learn healthy ways to cope with the stresses of life. Many people do not realize their automatic, negative thoughts can lead them to self-destructive behaviors.

In the throes of an addiction, it is common for people to have thought patterns they cannot control, either because they feel helpless or they do not possess coping skills to deal with them. Negative, disruptive thoughts can inhibit recovery and lead to relapse.

During CBT therapy, a patient might learn they are using drugs or alcohol to either numb or alter these thoughts, which may be linked to a traumatic event or other outside force. A patient may learn they have been self-medicating, which is often a motivation to avoid reliving traumatic memories.

Co-occurring mental health issues often accompany addiction. These include depression, panic or anxiety disorders that can distort thinking, which can lead to substance abuse as an attempt to self-medicate. Unfortunately, the substance will wear off, so the thoughts once again rear their ugly heads, leading to more attempts to self-medicate; and now they are caught in the cycle of addiction. Cognitive Behavioral Therapy addresses these patterns of distorted thoughts and behaviors to help make the patient aware of the pattern, and then learn to interrupt the pattern.

What is Involved in CBT Therapy?

When utilizing this type of treatment for addiction recovery, a patient may be directed to attend a weekly visit with a CBT certified therapist, often at an outpatient treatment center. The sessions may involve individual or group therapy and involve a range of treatment procedures, which are often determined by the therapist after initial and ongoing evaluation of the patient.

There are specific methods of CBT that professionals commonly use. They include:

  • Cognitive therapy identifies distorted thought patterns along with their emotional and behavioral responses.
  • Dialectical Behavior Therapy identifies thought patterns and teaches the patient how to regulate emotions.
  • Rational Emotive Behavior Therapy, or REBT, identifies irrational beliefs and teaches the patient to challenge these beliefs and recognize that they may be false, which can lead to healthier behavior responses.
  • Multi-modal Therapy is an approach that evaluates seven “BASIC ID” modalities of the patient which includes: Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal and Drug/Biological assessments.

Therapy sessions often begin with a functional analysis by the therapist to help them learn about the patient. This is often the most difficult part of therapy as many people are not used to self-reflection or self-evaluation. Often, patients have internalized feelings or thoughts for so long they are not accustomed to recognizing or sharing them. They may even believe their distorted thoughts are “normal,” so they don't bother sharing them. A skilled professional can help the patient feel safe and guide them through this process.

Once the initial analysis is completed and the therapist and patient have identified destructive patterns of thought, they can then focus on the resulting behaviors. This part takes practice and will be different for each person. In some cases, a person who is in addiction recovery may practice having conversations with family about their addiction through role playing, while others may practice what to do in the face of temptation and relapse by first imagining in their head what action they would take.

These are just some of the methods used in CBT therapy. But there are a variety of tools that can be incorporated and adjusted to suit the patient's personality, mental health issue and responses to treatment. Some other methods incorporated may include:

  • Journaling
  • Learning mental distraction
  • Learning how to use stress relieving or relaxation techniques

No matter what method is used, the patient and therapist work together to establish mutual goals along with a plan of action. Each week the patient is given work to do at home, on their own, to ensure they move forward with their recovery until their next session.

How Long Does it Take for Cognitive Behavioral Therapy to Work?

One of the favored assets of Cognitive Behavioral Therapy is the short length of time involved. Treatment commonly lasts anywhere from 12 to 20 weeks, depending upon the patient's needs. This is helpful as the patient can look forward to reaching their goals in a certain time frame and is more affordable than ongoing treatment. But while this time frame is the most common, there are factors that will influence each stage of therapy.

When using CBT for addiction, some of the basic factors that will influence the length of time for it to work are:

  • the substance of addiction
  • how the substance was taken
  • how much of it was used at a time
  • how long the addiction was influencing the patient's life

The substance, amount used and length of time are important because substance abuse can be both mental and physical. Lifestyle, such as where a person lives or works, is another factor that will play a role in how long the person needs therapy.

Other factors that will influence the length of time for treatment to work will depend on the patient's life situation including if they have a network of support of family and/or friends. Their level of self-confidence, motivation for recovery and if they are using other therapies will also contribute to how long CBT therapy can take to work.

Getting Addiction Treatment

Getting help for addiction treatment should begin with physical detoxification. This phase may include Medically Assisted Treatment (MAT), tapering off the drug or a “cold-turkey” approach where the addict immediately abstains from use of the substance of abuse. This phase is best done with professional oversight because it can be extremely physically and emotionally uncomfortable and, in some cases, painful.

Cognitive Behavioral Therapy is often used as part of addiction recovery once a person completes the detoxification phase of treatment. Addiction often comes with co-existing conditions, including PTDS, or Post Traumatic Stress Disorder. In this case, Trauma-Focused Cognitive Behavioral Therapy (TF CBT) is an evidence-based treatment that will address both the trauma and addiction that may be associated with it.

Studies show that CBT therapy modifies the limbic system of the brain, which can help with addiction treatment. A study published in the Journal of Neuropsychiatry and Clinical Neurosciences indicated CBT changes brain circuitry that affects dysfunctional brain activity including fear and negative emotions; both are associated with addictive behaviors as well as relapse.

More studies showed that CBT relaxes activity in the temporal lobes, which helps regulate emotional behavior. And the best part of these studies is that nine weeks of therapy was enough to positively influence brain function.

CBT may be especially useful to help those who have experienced trauma in their lives to help them learn how to cope and avoid addiction, or fully recover from both. There are core elements that are considered in TF-CBT. Some include gradual exposure to possible triggers of the trauma, coping skills, and cognitive processing. Each patient is evaluated, and their therapy tailored according to the issues and specific trauma.

Addiction is a multi-faceted problem that requires a variety of approaches. Physical detoxification is a common factor for treatment, and recovery treatment therapies may vary widely. Cognitive Behavioral Therapy can aid recovery by teaching patients how to identify triggers that can cause relapse, guide them in ways to avoid relapse and learning how to cope. Trauma-Focused CBT can help address co-occurring issues that have led to or arisen from addiction. Together, this powerful technique is a tool used for long term recovery and a happier, healthier life. If you or a loved one is experiencing the trauma of addiction, cognitive behavioral therapy may be a wonderful solution