Cognitive Behavioral Therapy In Treatment

Cognitive behavioral therapy (CBT) is a form of short-term psychotherapeutic treatment focused on creating and meeting goals, altering thinking patterns, and changing behaviors that are harmful or problematic.

By changing behaviors and thinking patterns, CBT aims to change how the person feels. The goal is to help a client feel more stable and effective in their life.

The Overall Plan

CBT focuses on changing a client’s overall attitudes by focusing on specific negative behaviors, thoughts, images, and beliefs. These are the client’s cognitive processes, which influence how they relate to the world.

By changing approaches to thinking and acting, CBT aims to change harmful approaches to life. It makes the individual more capable of managing emotional response, dealing with stress, and creating positive behaviors.

The process of CBT tends to be short, usually around five to 10 months for most emotional conditions. Attendance at therapy sessions starts at once a week, on average, although people in crisis may attend more sessions for the first weeks or months.

Individual therapy sessions typically last 50 minutes, but they may run longer if the client’s needs require more time with a counselor. Group therapy sessions may last longer, depending on the needs of the group.

How Does Cognitive Behavioral Therapy Work?  

Cognitive behavioral therapy approaches an issue as though it is not an event itself that upsets a person, but the meaning the person assigns to the event. 

For example, if you speak with a loved one and they do not respond with enthusiasm, you may wonder if the loved one is having a bad day, or you may wonder if they are mad at you. Your interpretation of someone else’s behaviors can vary and may not reflect reality. 

CBT seeks to address these assumptions and change them to reduce stress and improve relationships with oneself, one’s family and friends, and the rest of the world.

CBT has numerous applications because it is a step-by-step process with measurable success and outcomes. This form of therapy is often applied to conditions like: 

• Sleep trouble like chronic insomnia
• Relationship problems
• Mood disorder behaviors like depression
• Anxiety conditions
• Addiction to drugs or alcohol, which involves compulsive behaviors

This approach to counseling was developed in the 1960s by a therapist named Aaron Beck. He observed during his analytical sessions that his patients often had an internal dialogue going in their minds, like they were speaking with themselves, but would only report a small part of that dialogue to Beck.

He coined the term automatic thoughts for these internal dialogues, which were often filled with emotional reactions to Beck or the patient’s surroundings based on assumptions and past bad experiences. 

During sessions, Beck found that his patients were not always aware of all these thoughts or assumptions, but they could learn to identify them and then report them objectively. The process of identifying these thoughts, which could lead to negative behaviors, improved their understanding of themselves and the world around them, reduced anxiety and mental health issues, and helped them overcome emotional difficulties.

The founding principles of CBT include:

• Psychological problems are based, in part, on unhelpful ways of thinking
• Psychological problems are based on unhelpful, learned, or maladaptive behaviors
• Psychological problems can be treated by unlearning these methods of thinking and behaving by learning new, better coping mechanisms with understanding and intention

Beck did not pioneer the behavioral aspects of CBT, but these were soon added to the process of cognitive therapy because thinking patterns are often associated with how individuals work in the world.

Decades of research into the treatment approach have shown that CBT is very effective for many different conditions. It is often combined with prescription medication to manage brain chemistry. CBT can lead to a better understanding of the underlying, chronic condition, so new symptoms or relapsed behaviors can be more easily identified and treated.

Strategies used in CBT treatment may include:

• Learning to recognize distorted thinking patterns
• Learning to relax when panicking and stay in the moment
• Using problem-solving skills to understand situations better
• Understanding one’s positive attributes and abilities to leverage these into a happier, healthier approach to life
• Facing fears instead of avoiding them
• Using role-playing to work through problematic interactions with others

Cognitive Behavioral Therapy as Addiction Treatment

According to the National Institute on Drug Abuse (NIDA), CBT works well to treat addictions specifically to alcohol, marijuana, cocaine, methamphetamine, and nicotine. The cognitive-behavioral model was first applied to people struggling with alcohol use disorder (AUD) as a way of preventing relapses back into drinking. It then moved to treating cocaine addiction.

In the CBT model, compulsive consumption of drugs and alcohol is a maladaptive strategy for managing stress and life problems. Identifying the triggers of compulsive behaviors around substances can help to identify the mental and emotional states that may be associated with substance abuse, so the mental state can be managed without giving in to cravings for intoxicating substances. Other coping mechanisms to manage these stresses and cravings will be developed during the CBT process for addiction too.

A core component of CBT treatment for substance abuse involves anticipating potential problems and bolstering the individual’s self-control to live with cravings and stress until they can be released through CBT methods. Specific techniques may include: 

• Thinking about the positive and negative consequences of ongoing substance abuse
• Self-monitoring to recognize cravings and stress early
• Identifying situations, like parties, that put one at risk of substance abuse
• Developing strategies for coping with cravings in a healthy manner
• Avoiding high-risk situations like places or people that trigger memories of substance abuse

Research has repeatedly shown that the results of CBT for substance abuse, when it lasts for long enough for coping mechanisms to become a normal part of thinking and acting, remain in place well after therapy has been completed. Even a computer-based CBT program has proven helpful in reducing drug abuse and relapse when used to support people who have exited a more intensive, short-term drug treatment program.

When applied to addiction treatment, the critical tasks of CBT include:

• Fostering the motivation to stay abstinent despite cravings, stress, or withdrawal symptoms
• Teaching coping skills
• Changing reinforcers, which involves finding new, healthy methods of stimulating the brain’s reward center
• Cultivating new, healthy methods to manage painful feelings
• Improving personal relationships and social support, such as healing harmed relationships over time and creating a drug-free and supportive social group

Structure of a Cognitive Behavioral Therapy Session

A CBT session to treat addiction be structured like this:

First 20 minutes

Assess or discuss substance use and any high-risk situations that came up since the previous session. Listen to the client’s concerns.  Review and discuss homework or practice behaviors.

Second 20 minutes

Introduce and discuss the session topic. Relate the topic to the client’s current concerns. 

Third 10 or 20 minutes

Explore the client’s understanding of and reactions to the topic. Assign new practice exercises or homework. Review plans for potential high-risk situations for the week.

For some high-risk groups — like people who have just entered addiction treatment, those who have co-occurring mental illnesses, and those who have suffered an overdose or recent hospitalization due to high-dose substance abuse — visiting a therapist for individual therapy more than once per week for a few weeks or months is the best way to start overcoming addiction.

Rehabilitation programs can be either inpatient (residential) or outpatient, but either type may offer varying numbers of counseling sessions, depending on individual client needs. NIDA states that remaining in a rehabilitation program for at least 90 days, or three months, is the minimum needed for behaviors to change and healthy coping mechanisms to become a normal part of life.

Cognitive Behavioral Therapy Is Very Successful

Studies involving several subsets of CBT have found that each approach is equally as effective in treatment for most forms of drug or alcohol abuse. The point is that the patient remains in treatment for long enough for strategies to become effective. Then, the client is slowly reintroduced to their life with new tools so they can feel supported and safe while trying new methods to avoid relapse.

For example, one survey on alcohol use found that there were fewer days of alcohol abuse after motivational interviewing (MI), a brief form of CBT used to encourage people to seek help. However, MI did not work well for people who abused cannabis or use nicotine. Different types of CBT work better for these conditions, but each form of cognitive behavioral therapy can work for a specific form of substance abuse or addiction.

Some forms of drug abuse have associated medication-assisted treatments (MAT), like buprenorphine or benzodiazepines, which manage symptoms of withdrawal while slowly tapering the body off physical dependence on a drug like opioids or alcohol. Many drugs do not have the advantage of MAT yet, so working with medical professionals in a supervised detox program will help you manage withdrawal symptoms from the substance of abuse.

After detox, rehabilitation is the next core component of treatment. A good rehabilitation program will have group and individual therapy available to help you change behaviors and avoid relapse. Psychiatric medications can be useful, but the basis of overcoming addiction involves changing how your mind responds to stress and cravings.

Sources

(October 8, 2018). In-Depth: Cognitive Behavioral Therapy. Psych Central. Retrieved February 2019 from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

What is Cognitive Behavioral Therapy? Clinical and Practical Guideline for the Treatment of Posttraumatic Stress Disorder, American Psychological Association (APA) from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

(January 2018). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). National Institute on Drug Abuse (NIDA) from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral

Cognitive Behavioral Therapy. Substance Abuse and Mental Health Services Administration (SAMHSA) from https://www.samhsa.gov/sites/default/files/programs_campaigns/samhsa_hrsa/cognitive-behavioral-therapy.pdf

(September 1, 2011). Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/

(February 7, 2018). Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA) from https://www.samhsa.gov/medication-assisted-treatment