What Is Cognitive Behavioral Therapy?
To someone with a drug addiction issue, handling a difficult emotion is as easy as taking another hit. The drugs can work to numb and distract, and in no time at all, the difficulties and misery the person is feeling could simply be washed away. But what happens when the person wants to stop taking drugs? How can that same person learn to handle difficult emotions in a way that is healthy and safe?
Cognitive Behavioral Therapy (CBT) may help. This form of therapy aims to help people explore the connections between the way they think, the way they feel, and the way they behave. That process could help people to handle difficult emotions and unusual feelings without putting their sobriety at risk.
Fundamentals of CBT
Unlike other forms of therapy that can be intense and last for months and months, CBT is designed to be self-limiting and short. In fact, according to the Association for Behavioral and Cognitive Therapies, most people who access CBT get 6-20 treatments. That is all the time it might take for the lessons to take hold and blossom.
Those CBT lessons may begin with an examination of thought processes.
Changing the way people think about themselves and the world is a key part of the healing CBT can bring.
CBT practitioners believe that most people lay down opinions or thought patterns when they are very young. For some, those thought patterns are positive and uplifting, and they allow these people to move through very difficult times without worry, stress, or anger. But for others, those thought patterns are negative or downright harmful.
To someone practicing CBT, those negative thoughts provide the key to change. While people might never be able to change the world and the distressing things that come from participation in the world, they might be able to change the way they feel about the things that happen, and that could help them to tolerate life just a little better.
As Psych Central puts it, if a person’s thoughts are too negative, that person might not be able to see things in a new way or try new behaviors. People with negative thoughts can be completely blocked from experiments that could help, and that could keep them from healing.
The National Association of Cognitive-Behavioral Therapists suggests that CBT practitioners use questions to help their clients see things in a new light. The practitioner may provide advice from time to time, but people who participate may come up with their own insights and their own lessons as the therapy moves on and they continue to answer questions. In time, they can become their own therapists.
The best way to understand CBT is to enroll in the therapy and participate in sessions. Reading through a few examples of how the therapy might help someone in need could help to boost understanding of how the sessions might progress.
In the beginning of the therapy process, a CBT practitioner might ask the client why the same behaviors keep appearing in that person’s life, even though the behaviors do not seem to help. The practitioner might ask the person to name what sorts of consequences might happen if the person did something different.
In the case of social drinking, the therapist might ask why the person feels the need to drink before a social engagement. The person might say:
- “People do not like me when I have not been drinking.”
- “I am boring when I do not drink.”
- “No one likes me, so I might as well do what I want.”
- “I have never been good in social situations, so I need an alcohol boost to get through.”
All of these statements are terribly damaging, and they could keep this person from doing any sort of work toward sobriety. Those statements could also keep this person in a state of depression, simply because there is a great deal of self-hatred expressed here.
Once people can name what thoughts might drive the decisions they make, the team can come up with solutions that involve challenging those thoughts and either proving them or disproving them.
This is the behavioral part of CBT, and it involves experimentation. A person who participates in CBT might learn to meditate or visualize during this stage of therapy, or the person might learn to exercise or sleep better, to boost the chances of a positive mood. All the solutions are personalized, but all of them are aimed to help change the way the person responds to those negative thoughts. Instead of assuming they are true and acting accordingly, people can learn to challenge and confront those thoughts, and then make a decision to do something different.
To return to the example of the person getting help for social drinking, the CBT practitioner might suggest that the man heads to just one party without drinking anything either before or during the festivities. The person and the counselor might prepare by:
- Outlining what sorts of topics the person could discuss with strangers
- Practicing deep-breathing skills, so the person has an out if things get stressful
- Boosting observational skills, so the person can notice how others react in real time
- Highlighting the person’s good qualities, so confidence is high when the party starts
When the person goes to the party, the person might be asked to put all of these lessons into action and take note of how others behave. Were conversations really stilted? Did the person have no one to talk to? Were things really difficult? Or did it go better than expected?
With that feedback, the team can work on plans for the next party, so the success rate can be even higher.
What CBT Is Used For
CBT is a common component of addiction treatment programs. By helping people to examine the thoughts and feelings that come just before a drug or alcohol binge, therapists hope to eliminate the need for substance abuse altogether. CBT has the proven ability to help reduce the amount of substances people take in.
For example, caffeine has been called one of the most addictive substances in the world. It is easy to obtain, pleasant to use, and causes symptoms of withdrawal upon discontinuation. People can stick with a caffeine habit for years, simply because they do not know how to stop.
In a study highlighted by ScienceDaily, researchers found that people getting CBT for problematic caffeine use were able to reduce their consumption by 77 percent, and the reductions stuck for a year or longer. This study shows how CBT can help people with even persistent addictions, and similar results have been seen in people who got CBT to assist with an addiction to illicit drugs.
CBT has been helpful in reducing underlying mental health issues that could contribute to an addiction issue.
For example, people with symptoms of depression might use drugs or alcohol as a form of self-medication, rather that getting therapies that could assist with this mental illness.
In a study of CBT’s power against one form of depression, published in the American Journal of Psychiatry, researchers found that CBT was an effective tool to use, especially when combined with the conventional therapy used against that form of depression. About half of the people got better in about three weeks with this approach.
Preparing for CBT
This form of therapy is far from passive. People who get CBT cannot simply sit in a chair and wait for the healing to begin. They need to take an active role, and that work can start before therapy begins. The Beck Institute recommends thinking about specific changes that should take hold at work, at home, in relationships, and with oneself. New goals and new plans should be identified. Any targets should be written down. Walking into therapy with this to-do list, and a willingness to make that wish list a reality, could be the key to ensuring the effectiveness of this therapy.