Cognitive Behavioral Therapy (CBT) is a goal-oriented form of psychotherapy (aka "talk therapy") originally designed to treat depression. It is now a widely used therapeutic modality used to treat a number of issues, including drug and alcohol addiction.
What is CBT?
CBT primarily explores the relationship between a person's thoughts, feelings, and behaviors. By discovering and identifying a person's distorted thought patterns and beliefs, the therapist and client can work together to restructure them into realistic, adaptive, and healthy thoughts.
CBT is shown to alter brain activity, which suggests that not only is the brain capable of change, but that brain functioning can be improved with CBT.
What does CBT treat?
- Drug and alcohol addiction
- Behavioral addictions like eating disorders, sex addiction, and gambling addiction
- Depression and anxiety
- Mental illnesses like schizophrenia, bipolar disorder, and PTSD
- Chronic pain
- Sleep issues
- Sexual and relationship problems
How does CBT work?
Cognitive behavioral therapy was invented in the 1960s by psychiatrist Aaron Beck, when he realized his clients were having internal dialogues with themselves. These inner "conversations" affected clients in their decisions and actions in the world. Beck came to realize the critical nature of the link between a person's thoughts and behavior.
For example, if a person feels lonely, their thoughts might say, "No one likes or values me", or, "I'm not good enough". Naturally, they would feel upset about this and think negatively about themselves. However, they would also likely only focus on the "upper thoughts" about how they're not good enough, instead of getting to the bottom or what Beck called "automatic thoughts".
Automatic thoughts are the deep emotional thoughts and beliefs that start the wheel spinning and keep a person in a place of negativity. An example could be a root belief of, "I am unlovable", which prompts all the other thoughts. Such "stuck" thoughts and feelings are then often acted out in negative behaviors, such as substance abuse.
CBT is designed to help clients identify these dysfunctional beliefs, or "automatic thoughts", and shift them to ones that are healthier. With practice, a client learns to adjust unhealthy thoughts patterns on their own and becomes able to adapt emotionally and live a healthier life.
What is a session like?
CBT sessions are practiced by a licensed therapist that specializes in CBT. While usually practiced individually, CBT can also be incorporated into group or family sessions. Sessions are tailored to client needs, but tend to follow a similar structure.
At the beginning of treatment, a particular goal is discussed. The focus is on the client's desire to solve an issue in their life (such as wanting to end drug or alcohol addiction and get sober). Sessions work towards attaining this goal. In each session, the client and therapist discuss the issues they want to address for the week, as well as progress in the client's homework from the previous session. At the end of each session, another homework assignment is planned.
Client homework is an important part of CBT therapy, and varies based on individual needs. For example, since loneliness is a common trigger for many kinds of addiction, a client may be asked to keep a journal of incidents, interactions, or times they felt lonely that week. When they felt lonely, what were the automatic thoughts that came up? Which beliefs were triggered?
Another assignment could be to keep a "thought log". For example, someone struggling with alcohol addiction might write down their thoughts and feelings before, during, and after drinking. The purpose is to start to understand and record things like, what happened right before the desire to drink alcohol? What were the thoughts or feelings? Again, the purpose is to become aware and consciously track unhealthy beliefs, thoughts, and triggers.
By the end of treatment, the goal is for clients to feel empowered enough to continue what they do in sessions on their own.
What are the advantages of CBT?
When a person changes the way they think, they can often change the way they feel, and the way they behave. For example, feeling lonely and having thoughts automatically go to, "No one likes you. You're all alone and worthless", is different than feeling lonely and thinking, "I'm feeling lonely right now. I should call a friend".
In the first case, it's likely that a person struggling with addiction would go back to drinking alcohol or taking drugs to numb the pain of feeling worthless. Being able to stop at the original thought and evaluate it (rather than just react to it) can stop the pattern at its root. With time, this can help someone end the pattern their own addiction.
Every person is different and no one therapy works for everyone. However, CBT has been shown to be quite successful for certain individuals, particularly those recovering from drug and alcohol addiction and issues related to substance abuse.
Changing one's thoughts can change one's entire perception of self and the world. This can, in turn, allow a person to to see other possibilities instead of being fixated on an unhealthy belief. CBT and therapy in general has the potential to help people self-regulate, empower themselves, and become more flexible, resilient, and happy.