Cognitive Behavior Therapy (CBT) for Addiction

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Anyone suffering from addiction has a handful of therapy options. These include psychotherapy with a trained professional, group therapy, medication, and cognitive behavioral therapy.

What is Cognitive Behavioral Therapy (CBT) for addiction?

Cognitive behavioral therapy or CBT, is a newer form of therapy that addresses an individual’s background and the things in their personal lives that impact them as they try to move forward. This strategy doesn’t rely on medication exclusively as a form of treatment but instead psychotherapy.

What makes CBT different?

Cognitive behavioral therapy has individuals work with counselors and those counselors help them recognize things like automatic thoughts in their mind, unhelpful behaviors, and how these automatic thoughts or unhelpful behaviors can lead to addiction.

For example:  Michael has automatic thoughts that lead to negative emotional reactions. Whenever something bad happens, whenever Michael uses drugs again or makes bad decisions while on drugs, he thinks that the situation is completely hopeless. This feeling that everything is completely hopeless is his automatic thought and it causes an emotional reaction. His emotional reaction is depression. Because Michael is depressed he ends up using more drugs to try and fix his depression.

Cognitive behavioral therapy is built on the idea that feelings, knowledge, and behavior all work together. Therefore the way an individual thinks and the ideas they have will impact how they feel and how they act. So, individuals have to learn how to change the way they think, the ideas they have. In doing so, they can change the way they feel and behave.

Understanding Automatic Thoughts

Automatic thoughts are emotion-filled ideas that automatically pop into your mind. You might not even recognize that you have them. But they lead to an emotion. These automatic thoughts can be good or bad and can lead to good or bad emotions.

Type of automatic thoughtExample
Perfectionism“I feel anxious a lot so I’ve failed in Rehabilitation”
Mind readingEveryone thinks I’m a screwup”
Emotional reasoning (If I feel it, it must be true)“I feel so worthless, so I must be worthless”
All or nothing thinking“I’ve never quit drugs before so I’ll just keep using them”
“Should” statements“I should always be able to stop” or “I shouldn’t show others how depressed I am”
Jumping to conclusions“my boss asked me to stop by his office at the end of the day so he must be firing me”
Labelling“I’m a loser”
Dwelling on the negatives“ I always screw it up, why should this time be any different?”

When an individual has these automatic thoughts it can become a self-fulfilling prophecy. This result in low self-esteem, stress, depression or anger all of which leads to negative emotions. It can also force people to return to old behaviors.

The automatic thoughts a person has can lead to negative emotions such as:

  • Feelings of sadness
  • Feelings of hopelessness
  • A lack of enjoyment in life
  • Crying spells
  • Nervousness
  • Suicidal thoughts and depression
  • Difficulty sleeping
  • Anxiety
  • Worry
  • Difficulty concentrating
  • Feelings of worthlessness
  • Feeling overwhelmed

These negative emotions can lead to negative actions such as:

  • Reckless driving
  • Ignoring bills
  • Skipping work or school
  • Performing poorly at work or school
  • Avoiding friends and family
  • Fighting
  • Vandalizing or stealing
  • Using drugs or alcohol more frequently

Consider Michael.  Michael has an automatic thought so he feels upset and depressed. But then he remembers that drugs help him when he’s upset to feel relaxed so he uses drugs again. However, using drugs only temporarily helps change how Michael feels.

With cognitive behavioral therapy, and a trained Louisiana therapist, an individual can learn to identify what these automatic thoughts are and change the emotional feelings and behaviors that come from them.

SituationA person who came into work hungover just submitted a report to their boss. Now their boss wants to see them.
Automatic Thoughts“My boss knows I’m hungover, and because I’m hungover I did a bad job, and now he’s going to fire me”
Physical feelings and psychological effectsFeeling anxious, sick to the stomach, and sweating
Emotional feelingsAnxious and upset
BehaviorsWalks into the boss’s office apologizing for the report and trying to explain why they were so drunk last night and hungover this morning.

Because of the self doubt plaguing him, he prematurely decided what the meeting is about. He admitted to something that the boss possibly had no inkling of and invited disaster.

If individuals can learn to stop those automatic thoughts, they can change the physical feelings, the emotional feelings, and the behaviors for good instead of bad.

Consider the same scenario but after successful CBT:

SituationA person who came into work hungover just submitted a report to their boss. Now they’re boss wants to see them.
Automatic Thoughts“My boss wants to talk with me. I don’t know what about. I will find out when I get there. If it is good, okay. If it is bad, that doesn’t mean I’m a bad person or I should be upset, at most they might be angry with me or even fire me but I can always get a new job.”
Physical feelings and psychological effectsCalm, happy
Emotional feelingsFeeling fine, goes about regular work without worrying about the meeting with the boss
BehaviorsWalks into the boss’s office and sits down, and the boss congratulates them for a good job. The boss asks them to train another person on writing reports. 

How CBT Works

Most cognitive behavioral therapy for addiction in Louisiana will take place over several weeks. The length of time required is based on the individual and their level of performance. Therapy sessions typically last between 30 minutes and one hour.  Therapy sessions are typically organized on a weekly basis. Therapists will often ask individuals to perform small homework tasks in between each session.

Consider Michael again.

Michael starts out his cognitive behavioral therapy with a therapist who evaluates Michael to figure out what his addiction is, what his current situation is, and what changes Michael wants to make.

With that, Michael and the therapist work together to set treatment objectives. They determine what goals Michael has for the end of his treatment. Michael might say that his goals are to change the way he thinks so that he doesn’t turn to drugs when he believes something bad will happen, or when he gets depressed because something bad did happen.

After this, Michael starts his first level of treatment. His therapist asked him to keep a journal of what he does in preparation for his meetings and to complete different activities in between each session.

CBT is typically divided into 3 segments, and in each section there are individual goals:

Goals for Segment 1 (typically the first 2 therapy sessions):

  • Develop a good relationship with the therapist.
  • Identify problems.
  • Determine which problems are most important to change.
  • Increase hope in people like Michael that they can improve.
  • Clarify the relationship between automatic thoughts, emotions, and behavior.
  • Emphasize the importance of homework.

Goals for Segment 2 (typically sessions 3-10):

  • Learn about cognitive disorders.
  • Identify wants to change negative automatic thoughts and behaviors.
  • Work to improve beliefs of self.
  • Practice better coping skills, problem solving strategies, and social skills.

Goals for Segment 3 (typically sessions 11- final session):

  • Continue finding better automatic thoughts.
  • Work on relapse prevention.

Homework in CBT

Homework is a very big part of CBT. Individuals have to study themselves, their thoughts and their behaviors regularly so that they can figure out what negative automatic thoughts and behaviors they have and find new ways to handle pressure or to deal with depression.

Homework gives people like Michael the chance to use the new coping mechanisms they have learned during their treatment and to keep track of their progress.

Benefits of CBT for Addiction

Overall, individuals who struggle with addiction typically have a lot of destructive, negative automatic thoughts. Not being able to recognize these harmful thoughts leads people to seek self treatment or self medication for their depression by way of more addiction. CBT helps address these harmful thought patterns with problem-focused and goal-oriented treatment for addiction.

  • CBT explores what patterns of behavior lead to self destructive actions and what motivates that behavior
  • CBT allows individuals to work in a therapeutic relationship with their therapist. They identify the negative thought patterns they have and find alternatives that are more useful
  • CBT sessions are augmented with additional homework outside of each session
  • CBT can be used in individual therapy or group therapy
  • CBT skills are useful and practical, and can be incorporated into an individual’s everyday life
  • CBT gives clients coping strategies to help them with the difficulties they faced after they have overcome addiction. It allows them to handle potential stressors in their life without turning to drugs or alcohol

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Brooke Abner,

Motivational Coach