- CBT for Addictions
- How does CBT work as an addiction treatment?
- What are the benefits of CBT?
- How Cognitive-Behavioral Therapy (CBT) Plays a Role in Addiction Treatment
- What Is Cognitive-Behavioral Therapy (CBT)?
- What Is the History of Cognitive-Behavioral Therapy (CBT)?
- What Are the Goals of Cognitive-Behavioral Therapy (CBT)?
- Phase 1: Functional analysis
- Phase 2: Behavior identification
- Phase 3: Relapse prevention
- What Is the Duration and Frequency of CBT Sessions Needed for Success?
- What Are Cognitive Behavioral Therapy (CBT) Techniques?
- What Other Therapies Can Supplement CBT?
- Cognitive Behavioral Therapy (CBT) is an effective tool for a variety of disorders
- How does CBT work?
- The role of CBT in addiction treatment
- So how effective is Cognitive Behavioral Therapy (CBT)?
CBT for Addictions
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Cognitive behavioural therapy (CBT) is a widely-used therapeutic intervention that is the premise that addictions, including alcohol and drug addictions, broader behavioural addictions, and other mental health conditions such as depression, anxiety and stress, arise and are exacerbated by a series of dysfunctional and deeply-ingrained thought patterns. These negative thought processes and beliefs can undermine your efforts to make healthy choices, and are characteristic symptoms of substance abuse, behavioural addictions and other mental health challenges.
Destructive thought patterns and beliefs can often cause you to doubt your ability to recover; they are usually accompanied by an overall sense of hopelessness.
However, our experts at Priory are able to use CBT to address and interrupt these negative thought patterns, change the way that you respond to stress, learn new ways of thinking, and empower you to develop the tools that you need to resume a healthy, fulfilling and addiction-free life.
How does CBT work as an addiction treatment?
Supporters of cognitive behavioural therapy believe that in order to change a person’s behaviour, you must first change their thoughts. In other words, they believe that by taking the time to gain insight into your beliefs, you can increase your health and wellbeing simply by changing the way that you think and respond to situations.
Our CBT specialists at Priory will work closely with you to identify negative thought patterns and negative beliefs that are ly contributing to your substance or behavioural addiction. By examining negative aspects of your thinking, your therapist will be able to identify specific areas to focus on in treatment.
Once you have identified the specific set of destructive thought patterns that have allowed the cycle of addiction to develop and continue in your life, our Priory specialists will be able to teach you how to replace those dysfunctional beliefs with more positive ones.
Sometimes, these negative beliefs stem from the earliest days of childhood, and are therefore very ingrained into your consciousness. For some, these thought patterns stem from coping skills that are no longer functional or healthy in adult life.
By acknowledging these mistaken beliefs, you will be empowered to change your thinking in the present, leave destructive behavioural patterns in the past, and take steps towards a full and lasting recovery from your addiction.
What are the benefits of CBT?
CBT is a flexible, adaptable treatment tool that has been used successfully in addiction programmes all around the world. It can be used either in individual or group therapy settings, and has been found to be highly effective in the treatment of addictions and addictive behaviours. CBT is evidence-based, recovery-focused, and produces a whole host of short and long-term benefits:
- CBT acknowledges the past but also looks towards the future, meaning that whilst your old ways of thinking will be reviewed and examined, you will be doing so in order to facilitate positive change in the present
- Cognitive behavioural therapy involves the use of homework, so you can expect to do the 'work' of CBT outside your therapy sessions, applying the insight that you have gained in your daily life
- By interrupting patterns of negative thinking with CBT, you will be able to alter the behaviours and feelings associated with those thoughts, resulting in a greater capacity for coping with stress and making healthy choices in the future
- By addressing and confronting self-defeating beliefs, you will gain healthier levels of self-awareness and self-esteem that will assist you in building a strong foundation for addiction recovery
For more information on the treatment that we can offer for addictions at Priory, you can visit our approach to addiction treatment page.
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How Cognitive-Behavioral Therapy (CBT) Plays a Role in Addiction Treatment
Cognitive-behavioral therapy (CBT) plays a major role in addiction treatment. Amongst other therapies, it gives recovering individuals the opportunity to look in. Through evidence-based methods and techniques, patients can begin addressing the roots of addiction.
CBT also allows individuals to address any co-occurring disorders they may have, such as depression or anxiety.
Kicking the habit of addiction is a major achievement. Detox is generally the first part of the treatment process that allows patients to do so. Through medical care and supervision, withdrawal symptoms are monitored as the patient stops the use of the substance. Following detoxification, the core components of treatment, such as CBT, then begin.
Addiction is much more than merely a physical dependence on drugs or alcohol. Oftentimes there are underlying emotional and mental roots. These roots and underlying causes must be worked through in therapy.
Working through these issues in CBT helps prevent the chances of relapse from occurring. After treatment, it is normal to experience temptations and cravings. The key is to have a set of learned tools and coping mechanisms that help you to overcome them.
In CBT, you’ll learn how to work through triggers such as:
- Stress, such as relationship or work-related problems
- Stimuli in the environment, such as visiting an old neighborhood
- Social networks, spending time with friends who continue to use
What Is Cognitive-Behavioral Therapy (CBT)?
CBT is a type of psychotherapy designed to deal with problem behaviors, thoughts, and emotional patterns. Research has already shown that it can be effective in helping people whose minds have been altered by stress or other difficult circumstances. It is one of the most commonly offered forms of therapy in substance abuse treatment programs.
What Is the History of Cognitive-Behavioral Therapy (CBT)?
CBT was borne psychoanalysis, which was pioneered by Sigmund Freud. Psychoanalysis was the most commonly found form of therapy up until the 1940s. It mostly consisted of talk therapy and prescribing medication to patients.
In the 1960s, experts began eschewing practices of the past by ensuring that clients knew it was their responsibility to change maladaptive behaviors. Again, the 1960s were a time of great social change. The Vietnam War and other conflicts, as well as various changes in society, necessitated a new way to treat mental health issues.
Times have changed, and today, some people receive CBT online. While in-person sessions are preferred, online CBT sessions are effective. CBT can be practiced in both individual and group sessions.
What Are the Goals of Cognitive-Behavioral Therapy (CBT)?
Cognitive-behavioral therapy has many applications, such as helping clients with phobias, anxiety, depression, and substance misuse. Its main goal is to help participants recognize negative thoughts that can get in the way of their daily lives.
Eventually, clients should be able to notice thought patterns that have caused problems in their lives. Once these thoughts have been identified, they can be changed. If thoughts are changed, the resulting behavior will also change.
You can expect your CBT treatment to go something this:
Phase 1: Functional analysis
Clients start identifying negative thoughts and beliefs. Most people who deal with substance abuse know they need to stop the behavior, but they make choices that go against this goal.
CBT is a great way to learn and understand why. This involves digging into the underlying issues that led to substance abuse in the first place. The therapist will assess the client’s motivation for change.
Phase 2: Behavior identification
Together, the therapist and client will identify problematic thoughts and behaviors. During this phase, clients will learn strategies to change negative thoughts. This, in turn, alters the linked behavior.
Phase 3: Relapse prevention
The final phase aims to prevent relapse. The client and therapist will identify triggers that could cause a relapse and devise strategies to deal with those triggers.
They also make a plan to end the therapy. CBT is not intended to go on indefinitely. There is generally a set end date, outlined by a certain number of sessions.
What Is the Duration and Frequency of CBT Sessions Needed for Success?
When you start with CBT, you can reasonably expect to attend 5 to 20 sessions. Sessions usually last 30 to 60 minutes.
All clients are different, and you may be dealing with additional mental health issues that necessitate longer treatment.
The American Psychological Association (APA) outlines some estimates for recovery their research: Approximately 50 percent of clients improve after anywhere from 15 to 20 sessions.
Many clients and CBT therapists choose durations of 20 to 30 sessions for up to six months. This allows them to more confidently put their recently learned skills into practice.
Certain people may benefit from longer CBT treatment for some mental health issues or co-occurring disorders. This extended treatment regime can last 12 to 18 months.
Only a small fraction of clients require other therapies after CBT or a course of treatment that is longer than average.
What Are Cognitive Behavioral Therapy (CBT) Techniques?
Cognitive-behavioral therapists use specific exercises to help addiction recovery. Examples of CBT techniques used in addiction treatment include:
Recovering individuals learn to recognize negative thoughts in CBT. They then look for objective evidence disproving those thoughts. Through thought records, negative thoughts are dissected. Then, the patient will replace these negative thoughts with positive ones.
The goal of CBT behavioral experiments is to contrast negative thoughts against a positive one. In other words, some people may respond better to self-kindness and others to self-criticism.
To change our behavior, we must first understand how we best receive information. Behavioral experiments are about figuring out what makes you tick and then working with that to fix negative thinking patterns.
This technique helps to recover individuals recall a memory that produces strong negative feelings. They take note of every sight, sound, emotion, thought, and impulse at that moment. Remembering these painful memories can reduce the anxiety caused by them over time.
- Pleasant Activity Schedule
Creating a schedule that fulfills and fuels you is key. This CBT technique helps the patient create a weekly list of healthy, fun activities to break up daily routines. The goal of these activities is to encourage positive emotions.
Scheduling these hobbies can also help reduce negative thoughts and temptations.
What Other Therapies Can Supplement CBT?
Cognitive behavior therapy is not the only method used to treat people with substance use disorders. Other therapies can also supplement CBT, thus making addiction treatment effective and well-rounded.
The following forms of evidence-based therapy are also commonly used:
- Contingency management: This is sometimes referred to as motivational incentives. This therapy provides incentives or prizes to encourage clients to abstain from substances of abuse.
Some examples include giving clients a voucher every time a urine sample is negative for drugs. Vouchers may start with a small value, and they may increase in value as treatment continues and the person has more days of sustained sobriety. Other programs give participants raffle or prize tickets.
- Motivational enhancement therapy (MET): This is meant to prevent clients from being indifferent to treatment. The goal is to motivate clients to want to change their lives. Clients learn how to abstain from drugs and commit to change.
- The Matrix Model: This form of therapy is most commonly used for those who abuse stimulants. It creates an engaging framework of treatment that involves self-help groups, education about drug addiction and relapse, and counseling. Urine samples are monitored to ensure treatment compliance.
Therapy is certainly the core of treatment for substance use disorders. However, medication and support group participation is also vital pillars of the recovery process. The following are a handful of the many treatment services you’ll receive alongside CBT:
- Support groups: Often in the form of 12-step groups, social support groups are led by people in recovery. They provide essential support for ongoing recovery. Also, they can be particularly important during the early stages of recovery.
This is when the risk of relapse is often highest. People often need to visit and try out multiple support groups before they find the one that is the best fit.
Besides the well-known Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) chapters, there are many secular and alternative support group options, such as SMART Recovery (smartrecovery.org) and Secular Organizations for Sobriety (S.O.S).
- Medication: People may be prescribed medication that lessens withdrawal symptoms and alleviates cravings for certain substances of abuse, such as opioids and alcohol.
- Besides, people who deal with mental health issues can be prescribed antidepressants, anti-anxiety drugs, or other medications to address specific disorders.
CBT has been shown to greatly benefit those in recovery from substance abuse as well as those with various mental health issues. It works best when it is tailored to the individual and part of a complete treatment program.
At Footprints Recovery, we’re here to guide you from beginning through the end of your treatment plan. We believe that each member of our facility deserves a personalized approach, with their needs being put first.
If you have any questions, comments, or concerns, please don’t hesitate to find your location here and reach out to us. We’re waiting for your call!
Cognitive Behavioral Therapy (CBT) is an effective tool for a variety of disorders
According to the American Psychological Association (APA) , “Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness.”
That’s well and good, but how does it work? To get a full understanding, it’s a good idea to understand where Cognitive Behavioral Therapy (CBT) comes from — and its origins go back much further than contemporary psychology.
In fact, a 2015 piece in the Journal of Evidence-Based Psychotherapies  points out that the philosophical foundations of CBT can be traced all the way back to ancient Buddhist, Taoist, Existentialist and Greek Stoicist traditions.
In their discourse, they trace those origins to the findings of Albert Ellis, one of the originators of CBT, who determined that “there are three fundamental sources of cognitive disturbance which he labeled ‘IB’s’ or ‘irrational beliefs,’ beliefs that caused individuals to react in dysfunctional ways to events in their lives.
These three are: 1) ‘I must be successful,’ 2) ‘Others must treat me well’ and 3) ‘Conditions under which I live must be agreeable to me.’”
Greek philosophers — particularly Epictetus, the article points out — recognized this disconnect thousands of years ago: “Men are disturbed not by the things that happen, but by their opinion of the things that happen,” he once wrote, meaning that it’s the perception of events in the lives of men and women that determine the effect they have on the mind. Negative thought patterns developed around the perception of specific events can lead to attitudes, behaviors and feelings that that are psychologically harmful, and in the case of addiction and alcoholism, using and drinking often become maladaptive coping skills to deal with them.
By the same token, the CBT approach also takes its cue from Greek Stoicism and the Socratic Method. According to the National Association of Cognitive-Behavioral Therapists , “cognitive-behavioral therapy does not tell people how they should feel. However, most people seeking therapy do not want to feel the way they have been feeling.
The approaches that emphasize stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations … when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.
How does CBT work?
The website goes on to point out that therapists using CBT ask questions of their patients, but more importantly, encourage patients to ask questions of themselves.
Someone who sees a group of individuals laughing, for example, might immediately assume they’re being made fun of or privately insulted.
A therapist would encourage such an individual to ask, “‘How do I really know that those people are laughing at me? Could they be laughing about something else?’”
According to The Mayo Clinic , CBT is generally a four-pronged approach:
- Patients identify problematic situations or conditions, such as divorce, grief, anger or other issues.
- Patients focus on awareness of the thoughts, emotions and beliefs associated with those problems, and once they identify them, begin to explore the power they have over the patient’s thought process: “This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events,” according to The Mayo Clinic.
- Patients are then encouraged to identify “negative or inaccurate thinking,” especially those that repeat as patterns of behavior that contribute to the previously identified problems, paying particular attention to the “physical, emotional and behavioral responses in different situations.”
- Patients are then taught to reshape and correct negative or inaccurate thinking.
This isn’t an overnight process; in many instances, repeated CBT sessions are necessary to break these negative thought processes. Essentially, these processes are built around intense emotional experiences associated with a particular event — something that has led to psychological trauma, no matter how innocuous or tragic it may seem to an outside observer.
In one way of looking at it, the emotions surrounding those traumas are never stored properly within the brain, and whenever the individual recalls or thinks about that trauma, those emotions present as fresh.
It’s a psychic wound that never quite heals, and to deal with the lingering pain of such wounds, the afflicted individuals turn to coping skills that may inflict equal, if not greater, amounts of damage — both psychological and spiritual.
Addiction and alcoholism are prime examples.
The role of CBT in addiction treatment
Because the emotions associated with a problematic event in an individual’s life tend to be negative or painful, that person can turn to drugs and alcohol as a way of coping.
While there are plenty of social drinkers and even casual “soft” drug users who partake regularly with no ill effects or consequences, those who drink and use to fill an internal void run the risk of developing a problem.
And once they become a problem, they can be difficult to overcome, even with CBT, according to a writer for the Beck Institute of Cognitive Behavior Therapy : “When people habitually misuse a psychoactive chemical … they typically receive significant, immediate positive reinforcement (e.g., a sense of ‘high’) as well as powerful, immediate negative reinforcement (e.g.
, relief from negative emotions and/or withdrawal symptoms). Even when people are motivated to change, these experiences are formidable opponents to healthier, more stable, more meaningful sources of gratification, such as the pride one feels in having the ability to say ‘no’ to urges, the satisfaction of having spent a productive day, and the trust of caring others, including therapists.”
However, the writer goes on to point out, CBT can provide a way out — or rather, a way forward: “In a nutshell, this includes skills in self-awareness (e.g.
, of the onset of cravings and urges), self-instruction, planning, problem-solving, well-practiced behavioral strategies to reduce risk and to increase enjoyable sober activities, and methods of responding effectively to dysfunctional beliefs (about drugs, oneself, and one’s ‘relationship’ to drugs).”
The founder of the Beck Institute, Aaron Beck, co-authored a novel about this very process in 1993.
Titled “Cognitive Therapy of Substance Abuse,” it  “describes seven main areas of potential psychological vulnerability, each of which represents a factor that contributes to the patient’s risk of alcohol and other substance misuse, and each of which suggests a potential area for therapeutic intervention.” These include:
- High-risk situations, including external ones (people, places and things) and internal ones (changes in mood, stress);
- “Dysfunctional beliefs about drugs, oneself and about one’s ‘relationship’ with drugs”;
- “Automatic thoughts that increase arousal and the intention to drink and/or use”;
- Cravings and urges to use;
- Justification and rationalization that lead addicts and alcoholics to give themselves permission to drink or use;
- Behaviors (rituals) associated with drug use; and
- “Adverse psychological reactions to a lapse or relapse that lead to a vicious cycle.”
In other words, addiction and alcoholism can become traumatic experiences associated with problematic emotions, behaviors and thinking patterns. Fortunately, CBT can be used to treat both addiction and underlying psychological trauma that may have precipitated the addiction.
When it comes to substance abuse, Beck writes, the goal of CBT is “(1) to reduce the intensity and frequency of the urges by undermining the underlying beliefs, and (2) to teach the patient specific techniques for controlling or managing their urges.
In a nutshell, the aim is to reduce the pressure and increase control.”
So how effective is Cognitive Behavioral Therapy (CBT)?
In a 2006 paper published in the journal Clinical Psychology Review , researchers found that Cognitive Behavioral Therapy (CBT) “is highly effective for adult unipolar depression, adolescent unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, PTSD, and childhood depressive and anxiety disorders,” “is associated with large improvements in symptoms for bulimia nervosa” (with better results than those found using pharmacotherapy, the study adds) and “has shown promising results as an adjunct to pharmacotherapy in the treatment of schizophrenia.”
But that’s not all: CBT was found to be moderately effective in treating “marital distress, anger, childhood somatic disorders and several chronic pain variables (i.e.
, pain expression behavior, activity level, social role functioning and cognitive coping and appraisal),” and was even “somewhat superior to antidepressants in the treatment of adult unipolar depression.” Even more importantly: The benefits of CBT “are maintained for substantial periods beyond the cessation of treatment.
More specifically, significant evidence for long-term effectiveness was found for depression, generalized anxiety, panic, social phobia, OCD, sexual offending, schizophrenia and childhood internalizing disorders.”
In addition, numerous studies have shown CBT to be effective in drug and alcohol treatment settings.
In a 2011 article for the peer review journal JAMA Psychiatry , researchers concluded “Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care.” Even the National Institute on Drug Abuse recognizes the value of CBT in addiction treatment : “Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment. Current research focuses on how to produce even more powerful effects by combining CBT with medications for drug abuse and with other types of behavioral therapies.”
Such scientific studies on the effectiveness of CBT give it an important distinction: It’s a psychotherapeutic tool that’s evidence-based, which should be a hallmark of any successful treatment protocol.
According to a 2017 article in the journal Neurotherapeutics , “By incorporating research into clinical practice, providers use research-driven evidence rather than rely solely on personal opinion … incorporating research inevitably promotes the development of guidelines, databases, and other clinical tools that can help clinicians make critical treatment decisions.”
In other words: Evidence-based therapies are guided by more rigorous, peer-reviewed standards, are implemented acceptable and ethical practices and contribute to the trust in an organization’s overall standard of care.
When included as part of a comprehensive treatment modality for alcoholism and addiction, it can be extremely effective — for dealing with the issues surrounding the substances, and those with which the substances have been used to cope.
SOURCES: http://www.williamwhitepapers.com/pr/2007ConfrontationinAddictionTreatment.pdf : https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral : https://philarchive.org/archive/DIATPF : http://www.nacbt.org/whatiscbt-htm/ : https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610 : https://beckinstitute.org/treating-substance-misuse-disorders-cbt/ : https://books.google.com/books?hl=en&lr=&id=FQajDwAAQBAJ : https://get.gg/docs/Empirical-Status-of-CBT.pdf : https://jamanetwork.com/journals/jamapsychiatry/fullarticle/211313 : https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509639/