What’s Cognitive Behavioral Therapy and How Does It Work?

Most people know that addiction is a chronic, but treatable, condition. We also know that the right treatment is effective in helping people get sober and stay that way. Cognitive behavioral therapy has been around for some time, but let’s dive deeper into this and other forms of therapy to find out which treatments are most helpful.

There are many options, but the one that has proven time and again to be fundamental in helping treat addictions as well as mental health issues is Cognitive behavioral therapy, or CBT. Other evidence-based therapies that have proven successful include Contingency Management, the Community Reinforcement Approach, Motivational Interviewing, the Matrix Model, 12-step Facilitation Therapy, and Family Behavior Therapy.

Virtually every drug and alcohol treatment program will tell you that cognitive behavioral therapy (CBT) is their cornerstone form of treatment — and deservedly so.

CBT has been extensively studied and demonstrated to be highly effective during treatment and the skills learned in therapy will last long after a patient leaves the program. It changes the way the brain thinks, the way individuals handle stresses and becomes instinctive behavior with a little practice.

The History of CBT

So where did cognitive behavioral therapy come from? And what is cognitive behavioral therapy, exactly? A little background is in order.

CBT was originally developed to treat mental health disorders in young people, but today it remains the gold standard for treatment in children and adolescents. Since its inception, clinicians have expanded CBT to effectively work with other disorders in adults, including anxiety, depression, and substance use disorders.

CBT incorporates the most effective aspects of behavior therapy and cognitive therapy. CBT operates on the premise that your thoughts create emotions, which lead to behaviors. To change your behaviors, then, you must monitor your thoughts, emotions, and behaviors. This can only happen by replacing these negative thoughts with positive ones to create lasting emotional and behavioral change.

It also incorporates aspects of operant learning theory, which proposes that your behaviors are strengthened or lessened by positive and negative reinforcement. Additionally, CBT represents a melding of emotional, familial, and peer influences.

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How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy shows that many harmful actions and emotions are not logical or rational. These feelings and behaviors may come from past experiences or environmental factors.

When an addicted person understands why they feel or act a certain way — and how those feelings and actions lead to substance use — they are better equipped to overcome their addiction.

Cognitive behavioral therapists help recovering addicts identify their negative “automatic thoughts.” An automatic thought is based on impulse and often comes from misconceptions and internalized feelings of self-doubt and fear. Often, people try to self-medicate these painful thoughts and feelings by drinking or abusing drugs.

By continually revisiting painful memories, recovering addicts can reduce the pain caused by them. They can then learn new, positive behaviors to replace their drug or alcohol use.

How Positive and Negative Reinforcement Works

Positive reinforcement is a behavioral technique that adds in something positive to reinforce a behavior. This practice has been part of human nature since the dawn of time. Today, we see it in how school-age children respond when teachers or parents give them stickers for completing an assignment. Another example might be having a party when the students in the class achieve a collective goal. Things like good driver discounts from insurance companies, good driving records and frequent flyer miles are other examples.

The positive reward reinforces the likelihood that you will continue a certain behavior. Negative reinforcement, on the other hand, is not punishment for undesirable behaviors, as many people think it is. It is actually the removal of an unwanted effect when you do a certain behavior. A simple example is when you take ibuprofen for a sore back and your soreness goes away, thereby increasing the chances that you’ll take ibuprofen next time your back aches. This concept is often misunderstood since most people don’t think of the term negative in these terms.

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Benefits of Cognitive Behavioral Therapy and Addiction Treatment

A built-in tendency toward negative thoughts in some people are often a root cause of depression and anxiety disorders. This is a common co-occurring disorder associated with addiction. This means automatic thoughts can make someone more likely to abuse drugs and alcohol as well.

CBT helps patients overcome drug addiction and alcoholism by:

  • Helping you overcome false beliefs and insecurities that lead you to substance abuse
  • Providing self-help tools to better your mood and outlook on life
  • Teaching more effective communication skills

Triggers — situations that “trigger” cravings throughout the day — keep many addicted people from getting sober. Cognitive behavioral therapy helps recovering addicts deal with triggers in three key ways, according to the National Institute on Drug Abuse.

What to Expect:

In cognitive behavioral therapy treatment, patients work collaboratively with a trained therapist to learn about their thought patterns and how they can contribute to any maladaptive or self-destructive behaviors. A typical CBT session might take place in an individual or group setting. The first few sessions are exploratory and provide an opportunity for the therapist to get to know you. They’ll discuss your concerns, and will develop a plan to help find the best way to treat these concerns.

A typical CBT session generally includes the following:

  • Exploring your triggers — those situations or conditions that may be causing trouble in your life. This is how you and the therapist will decide which concerns to concentrate on first.
  • Increasing insight into your thoughts, feelings, and views about these concerns. This can include monitoring your self-talk (thoughts) about the situation, how situations are interpreted, and the ideas you hold about yourself, others, and circumstances. You may do this by maintaining a thought journal or completing a thought chart.
  • Once this is done, any negative or erroneous thoughts will be identified through a technique known as reality testing. The therapist may ask you to focus on how you respond to different situations, specifically your physical, emotional, and behavioral responses.
  • The next step involves cognitive restructuring, which is working to reframe the negative or harmful thoughts you and your therapist identified. This takes a lot of practice on your part: monitoring your self-talk, identifying if your views are accurate or not, and if they are inaccurate, replacing them with more realistic or positive thoughts.
  • In CBT treatment, the therapist often assigns homework to help you monitor your thoughts and reactions and to work on creating lasting change.

Cognitive behavioral therapy is a relatively brief treatment technique, usually involving between 10 and 20 sessions. Follow-up sessions involve reviewing the progress you made in previous sessions and on the homework assignments, and identifying any difficulties, further concerns, or successes.

If you identify that certain situations cause a lot of stress or anxiety, the therapist may introduce relaxation techniques and practice them with you in session. Further sessions then focus on maintaining the positive changes made and overcoming any challenges to reaching your goals.

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Sober Living and Cognitive Behavioral  Therapy

Most sober living homes rely upon some form of CBT. The District Recovery Community, one of the leading sober living communities in Orange County, California, uses it to help its residents shed their old way of thinking and form the foundation of a sober living attitude. In sober living houses, residents attend group and individual therapy sessions where they can discuss their problems and their underlying causes of their addiction. Community and individual support acts as positive reinforcement along the way.

This is one of the many reasons that sober living is the best path after rehab because, as we all know, rehab is little more than detox. Once free from the substances, the real healing comes from finding new ways to handle the feelings and emotions that initially triggered addiction.

Getting sober is the first step. The next step must be sober living to help addicts transition from addiction to sobriety.


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