Many people aren’t sure what cognitive behavioral therapy (CBT) is. The phrase usually conjures images of a patient lying on a couch, recounting every facet of his or her childhood to find the one incident that caused a problem. Although most clinicians don’t adhere to this stereotype, they can become skeptical of “talk therapy.” Some rehab facilities are moving away from CBT in favor of more active recovery approaches.
Active therapies such as equine, art and music, and psycho-drama are wonderful. They each have their place in addiction recovery. However, cognitive behavioral, or “talk therapy,” is still vital for addicts and their families. It carries myriad benefits most alternative therapies can’t quite touch. The first step in any recovery is communication, and CBT gets it started.
What Is Cognitive Behavioral Therapy?
CBT is a type of psychotherapy that addresses negative thought patterns about the self and the world. Low self-esteem, negative self-concept, and trauma play roles in all addictions. Addicts use their substances of choice to escape physical, mental, and emotional suffering. They tell themselves, “I need this because I’m not normal without it,” “I’m worthless,” “I deserve the trauma that happened to me,” or “I’m not good enough without drugs.”
Addicts undergoing CBT have other thought pattern distortions, too. They often experience all-or-nothing thinking, where everything is black and white (“Either I use this substance or I suffer and die.”). Many addicts have a corrupted mental filter that dwells only on negatives. They don’t want to be fatalistic or depressed – they simply cannot see anything positive about life anymore. Addicts often view their addictions as never-ending patterns (“It’s no use; I can’t quit. I’ll be like this forever.”). They jump to conclusions, assuming beliefs about themselves are true without any evidence other than what they tell themselves.
CBT works to address these destructive thought patterns one at a time. The cognitive behavioral therapist works as a teacher and teammate. He or she analyzes the addict’s behavior and helps him or her see connections between self-concept, cognitive distortions, and addiction. The therapist also suggests intervention plans and helps put them into practice. He or she often gives the addict “homework,” such as journaling, breathing exercises, or affirmations to repeat. This ensures the addict always takes something practical from the CBT session.
Benefits Of Cognitive Behavioral Therapy
CBT does not “cure” addiction, but it does reduce the triggers that cause it. Let’s say Gloria became addicted to alcohol partly because she was molested as a child. CBT helps her identify triggers such as settings, emotions, words, and events that remind her of the molestation and tempt her to drink. Once Gloria can identify the triggers, she can say to herself, “I know what this is and I choose not to drink to deal with it.” She then replaces drinking with exercise, a constructive hobby, or a constructive social outing.
CBT also reduces the chance of relapse. Let’s say Brian is a cocaine addict who has tried to quit numerous times but always relapses. He has learned to tell himself, “I’ll always be addicted to cocaine so I might as well take it.” Brian’s therapist can teach him the choice to stay addicted is in his control. He or she gives Brian affirmations or meditations such as, “I can beat this addiction if I take it one day at a time and stay patient with myself.” Brian might still relapse at first. Yet it may take him longer to relapse and eventually, he will stay sober permanently.
CBT affords more freedom than many other therapies. It can be done almost anywhere at any time. Despite stereotypes, it doesn’t have to involve an office and a couch. Many drug rehab facilities use CBT in conjunction with other activities. For instance, a therapist might start a cognitive session during equine therapy. The addict’s concentration on the horse frees him or her up to talk about difficult subjects.
Addicts struggle to maintain or rebuild relationships. Many of them have lost touch with family members, spouses, fiancés, or children because of addictive behaviors. An addict’s relationship with a CBT professional may be the first he or she has worked on in a long time. The confidentiality and rapport required in CBT helps the addict feel safe. Over time, the addict can use relationship-building skills learned in CBT to reconnect with loved ones.
Finally, CBT lets the addict keep a record of every thought pattern. This is not “thought policing.” Professionals do not discipline or shame addicts for having “incorrect” thoughts. Rather, they help addicts recognize what negative thoughts and prompt them with questions like, “What should you tell yourself instead?” For example, an addict might think, “I have to be ‘perfect’ in therapy or I’ll never recover.” The CBT professional might say, “There is no such thing as ‘perfect.’ What can you do today that will influence your recovery?”
Over time, addicts learn to record and respond to their thoughts without aid from the therapist. Many people journal in conjunction with CBT and after they finish treatment. Some connect affirmations or reminders to spirituality. A Christian addict, for example, might meditate on uplifting Scriptures or song lyrics. Others use hobbies or gifts to remind themselves they are strong, competent, and in control.
CBT For Co-Occurring Disorders
Many addicts struggle to recover completely because they have comorbid mental disorders. They might suffer from depression, bipolar disorder, a variety of other mood disorders, or forms of psychosis. In these cases, it’s difficult to tell whether the mental disorder or addiction came first. CBT is designed to treat comorbid disorders along with addiction. The addict may receive separate coping mechanisms for his or her dual diagnosis. The CBT professional may work with a physician or other clinician to determine if medicine is needed.
CBT is just one of the many therapies that can be used to treat substance abuse, addiction, and mental health issues.