Cognitive Behavioral Therapy (CBT) For Addiction
Medically reviewed by: Amelia Hasenohrl Lpc CHt
Ms. Hasenohrl is a Licensed Professional Counselor with over 27 years of experience, specializing in helping clients overcome anxiety, panic disorder and the fear that prevents them from effectively managing their everyday lives.
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Cognitive Behavioral Therapy (CBT) For Addiction
As progress has been made in the study of how addiction works, discoveries of new and revolutionary ways to help people dealing with the grips of addiction to heal and change have come along as well. One of these treatments for addiction is known as Cognitive Behavioral Therapy (CBT).
CBT is a type of psychotherapy which utilizes the brain’s abilities to reverse the negative cognitions associated with addiction. This happens through new skills and coping mechanisms, allowing those suffering from addiction to truly change their thoughts and behaviors. This article will explore all things CBT, including where it comes from, how it came to be used for addiction, how it works, and where you can start looking for CBT treatment programs and facilities near you.
What Is Cognitive Behavioral Therapy?
CBT is a type of psychotherapy that uses social learning theory to help people understand how their thoughts deeply affect their feelings—feelings that, in turn, directly affect their behavior. The goal is to show someone that their depression, for example, can be overemphasized by how that person thinks about depression and the world around them, which can then cause their actions and behaviors to reflect that negative thinking.
Therapists who use CBT believe that if they can help the patient to think about their depression differently and give them better and more positive coping skills, the patient will then effectively battle that depression with their most powerful weapon—their own mind. CBT is a short-term therapy that is very direct and easy to study and understand. Unlike traditional therapy techniques that focus on the events of one’s past to determine a reason for the behavior, CBT believes that it isn’t so much what has happened, but how we think about what has happened.
We as humans have what is known in CBT as “automatic thoughts,” the initial ideas we have about something or about ourselves related to an event. For example, if someone is suffering from abandonment issues, their automatic thought may be that they aren’t worthy of love. This negative automatic thought can lead to negative behavior, like intentionally sabotaging relationships. CBT is designed to target these thoughts, trace them as far back as possible, and learn tools and skills that will help replace these negative thoughts with ones more positive and encouraging.
History of Cognitive Behavioral Therapy
Interestingly, though CBT has proven to be an effective treatment for addiction, it was not originally intended to be used for substance use disorders. Rather, CBT is often used with patients suffering from mental ailments such as depression, anxiety, bipolar disorder, and others.
A huge contributor to CBT as a form of therapy was Sigmund Freud, who was at the forefront in the early 1900s of cultivating what we know now as behavioral psychology. Later in the twentieth century, another well-known psychologist, Alfred Alder, filled in the missing pieces of Freud’s work related to CBT. It was Aaron Beck, though, who is generally considered the “pioneer” of CBT, with his groundbreaking insight into cognition. He was the one who developed cognitive therapy to treat conditions like depression.
As its own form of therapy, CBT has been around since the 1960s. During that decade, it was still just a very simple form of cognitive psychology, missing many of the behavioral aspects seen in CBT today. The culmination of cognitive psychology and behavioral psychology formulated what is now known as CBT: cognition relating to thought, and behavior relating to the action. It wasn’t until the mid-to-late 70s, however, that psychologists began to adopt the idea that cognitive therapy and behavioral therapy were more effective joined together than seen as separate forms of therapy.
This conjoining of ideas wasn’t so widely accepted at the time because many scientists, psychologist, and other professionals believed that cognition did not belong with the scientific study of psychology and behavior because it was unobservable. Presently, however, there is no cognitive therapy without behavior therapy and vise-versa.
In 1979 CBT began to find widespread acceptance, as it was proven to be extremely effective in treating depression. In the 1980s CBT was applied to mood disorders like bipolar disorder and anxiety, and even psychosis, although CBT had still not been introduced into treating personality disorders. In the early 1990s, personality disorders such as borderline personality disorder, substance use disorder, and obsessive-compulsive disorder started to be treated with CBT, and thus CBT has grown into an extremely viable option for addiction patients today.
How CBT Works
CBT features so many different types of exercises, tools, and skills to be learned, and not every program will include all of the same elements. If you are considering using a CBT program for addiction or any other psychological ailment, here are some of the important and prominent features of CBT to know before beginning.
One of the important parts of CBT is setting measurable and attainable goals. Being able to sufficiently plan and strive for a goal is of utmost importance, especially in the addiction recovery process. In using CBT for addiction treatment, setting many small and realistic goals will eventually lead to an even larger goal, which is hopefully complete sobriety.
What is more important to CBT than goal setting itself is how goals are set.
That is why most CBT programs focus on these factors when it comes to goal setting:
- Identify the area(s) where you feel change is needed with honesty and integrity.
- Identify what parts of your thoughts and behavior may affect area(s) of life that you wish to change.
- Make sure that your goal is SMART: Specific, Measurable, Attainable, Realistic, and Timely. The key to success with a goal is making sure that goal is actually feasible!
- Assess your starting point and where you are in relation to your goal.
- Be honest and accountable with yourself and have integrity when working towards your goal.
Focus on these factors when setting and working toward your goals, and your chances of success will subsequently rise.
One of the unique parts of CBT different from many other forms of therapy is the amount of participation in conversation with your therapist as well the as participation and influence you have with your sessions. The patient is encouraged to help determine their own agenda for meetings, based on what kinds of things are affecting them in real time or are prominent in their life at the moment.
For example, say that you had a particularly difficult week leading up to your once-weekly CBT session and you are feeling really down, which in turn is causing your urges and cravings for your substance of choice to feel nearly too difficult to bare. When arriving at your therapy session, you will have the opportunity to suggest topics and ideas on which to focus. This gives you not only power over your therapy but can also facilitate power over your life.
Relaxation is a critical part of CBT, as heightened levels of stress can make it even more difficult than usual to avoid urges and temptations. Stress also leads to more health problems as well as difficulty concentrating, both of which could severely impact the efficacy of your treatment.
Some of the ways that your CBT therapist may encourage relaxation is through meditation and breathing exercises, as well as reducing the number of stressors in your life.
Problem-solving is crucial in almost any form of therapy or recovery, as our inability to effectively solve problems in our lives often leads to addictive behaviors. Often times, therapists will use guidelines or worksheets to help monitor problem-solving with their patients.
You can expect to be asked what the potential problem may be, what your initial ideas for a solution may be, advantages and disadvantages to using that solution, what the best solution is, and what steps you need to take to make that solution happen. The goal is to help someone be able to do this same type of process quickly and on their own.
As CBT was originally designed for treating depression, and behavioral activation has much to do with its effectiveness there, behavioral activation is also an important part of CBT for treating addiction. As many who suffer addiction are simultaneously suffering from conditions like depression and anxiety, these ailments often worsen or can be the cause of the addiction, and behavioral activation can prove to be a powerful treatment.
Behavioral activation is typically used in CBT while treating depression due to the fact that many of those who are depressed avoid positive daily activities like exercise, spending time with family, and daily hygiene, among others. Behavioral activation is meant to encourage doing more physical activity as well as making important daily tasks a routine.
Recognizing Cognitive Distortions
While in a CBT program, you will learn much about what cognitive distortions are, and how to recognize them on your own. By definition, cognitive distortions are ways that our minds lie or convince us of something that isn’t true. An example of this might be someone who is overgeneralizing an action, such as failing to learn to swim. They may think that because they failed at swimming, this makes them a likely failure at everything they try.
There are many different kinds of cognitive distortions that we see in many people, especially those who are suffering from addiction. Some of those include:
- Jumping to conclusions—Often times, people tend to jump to conclusions, especially when they have been in a similar situation in the past. An example of jumping to conclusions would be someone assuming that their friend will not show up, because the last time the two of them had plans, the friend got busy and couldn’t come.
- Emotional reasoning—In many cases, people sometimes feel as though their immediate and sometimes irrational first thought about a situation must be true. An example of this would be someone feeling in the moment as though they had done something stupid; therefore they must just be a stupid person.
- Catastrophizing—This is the assumption that everything and everyone is out to get you, or that something bad or horrible is bound to happen. Feelings of hopeless characterize catastrophizing, that no matter what you do, you are doomed. An example of this would be overreacting when your car gets a flat tire. Instead of acting rationally and accepting this normal annoyance that can (and does) happen to anyone, you start to panic and assume that as a result, you could lose your job, and potentially lose everything else because of it.
- All-or-nothing mentality—A very harmful cognitive distortion is having a polarized way of thinking. If something small doesn’t go your way, you might make choices to exactly opposite circumstances, usually reluctantly. This is the mentality that if you don’t have everything you want, you feel like you have nothing.
- Filtering, or selective memory—Many people have false, preconceived notions about things because they are filtering or selectively removing certain parts of their memory of a situation that paints it in a different light than reality. For example, someone might have had an auto accident and recalled their car being carelessly bumped into by such a rude person when in reality, they filtered out the detail of the person apologizing for accidentally bumping them. This left-out information leads people to feel differently about a situation than they might if they recalled the full story.
These are just some of the few different cognitive distortions that many people make on a daily basis to be targeted and focused on within CBT programs, especially for those seeking addiction treatment. Understanding these distortions will allow people to recognize and remove negative thinking and behaviors from their lives.
An integral and unique part of CBT is homework assignments. One of the ways that your therapist will encourage you to participate in your recovery is by doing exercises and learning at home, outside of therapy.
An example of a homework assignment in a CBT program might be a challenging thoughts worksheet. This worksheet could ask questions about your particular situation and what you’re thinking about it at the moment, how strong or weak you feel, how your idea of something or about yourself may or may not be true, and why you may be feeling the way you do. This is designed to help you to recognize the connection between your thoughts, behaviors, and feelings.
Trauma Focused CBT
Unfortunately, many of those who are struggling with addiction are doing so potentially as a result of past trauma in their life. CBT is extremely effective in helping people overcome trauma, and this can be all that someone may need to quit their crippling addiction. A lot of the struggles we face as a result of trauma comes from having cognitive distortions in relation to these events. Being able to identify and understand these things have proven to be very influential in the success of recovery.
Trauma-focused CBT is not much different from standard CBT except that it is focused on your feelings about one or more pinnacle events rather than focusing solely on how you are feeling at the present moment. Many people have found relief and freedom from past traumas and resulting in bad behavior through cognitive behavioral therapy with this focus.
Cognitive Behavioral Therapy for Addiction
As mentioned before, CBT was not originally intended to be used for substance use disorders; however, this type of therapy has proven effective for many who suffer from addiction. For this reason, it has become more and more popular among treatment centers, therapists, and rehabilitation programs across the country.
When it comes to treating patients who are dealing with addiction, it takes a significant shift of thought and understanding to make such a radical change. Cognitive Behavioral Therapy encourages patients to track their thoughts and analyze which situations, thoughts, and behaviors are typically associated with their drug use. Being able to recognize these triggers gives patients the opportunity to control their thoughts and behavior in order to resist temptations and urges to use the addictive substance(s).
Is CBT Effective for Addiction Treatment?
Much research and many studies have proven great efficacy with CBT as a whole, and especially pertaining to addiction. Studies have shown that CBT has proven to target operant conditioning processes in patients, as well as to build motivation and remove barriers that pertain to those suffering from addiction.
While not all that much research has been done yet due to the lack of psychotherapists practicing CBT, researchers have been able to show that a measurable effect is present in patients who are suffering from addiction. More studies and tests are needed to really explore and understand how broadly effective CBT really is, but in the meantime, conclusive results are there that that do prove its efficacy overall.
Benefits of Cognitive Behavioral Therapy
There are many benefits that could come to those who participate in cognitive behavioral therapy. Some of these benefits include:
- A shorter yet more effective time frame for treatment, usually lasting from twelve to sixteen weekly sessions.
- Having a very present and active therapist.
- Being able to play a significant role in the structure of your therapy.
- Learning lifelong skills and behaviors that will allow you to take control of your life.
- Receiving treatment for addiction without having to step away from your normal routine.
- Having insurance options for coverage and relative affordability.
These benefits and others are reasons that CBT may be of help to you or someone you know who is suffering from any kind of mental ailment, especially addiction.
Cognitive Behavioral Therapy Online
With an increase in technology and the ability to use the Internet in place of physical attendance, there has been a greater demand for online or mobile therapy options. These are ideal for those who are unable to leave the house due to lack of transportation, money, or because of disability. This option allows them to still receive the knowledge and resources that they need, to find success in recovery without having to physically be present.
Online CBT resources and programs are accessible with a little research, and positive results have also been seen from this means of therapy.
Never Too Late for Change
Doing your research and finding the right options for your mental illness or addiction is the first and one of the most important steps in making a change in your life. Remember that it’s never too late to change, and you can always find someone who is willing to help you. Use this information as a tool in determining if CBT may be right for you or a loved one suffering from addiction.