Cognitive-Behavioral Therapy in Addiction Treatment

Cognitive-behavioral therapy, also known as CBT, addresses distorted thought patterns, making this therapy method an essential part of addiction treatment.

Introduction

Individuals who struggle with addiction typically have distorted and destructive ways of thinking. Although it is difficult for someone to accept that they have these negative thought patterns, managing them can help ensure success during recovery. Cognitive-behavioral therapy, otherwise known as CBT, addresses these distorted thought patterns, making this therapy method an essential part of addiction treatment.

What is Cognitive-Behavioral Therapy?

CBT is a commonly used form of talk therapy for mental conditions and drug addiction. Unlike psychoanalysis, which evaluates problematic events in an individual’s past to resolve their issues in the present, CBT focuses on modifying a person’s current and future behavior by changing their thinking patterns. It uses a combination of behavioral therapy (BT) and cognitive therapy (CT) to achieve its goal of behavioral change.¹

A History of Therapies

Behavioral therapy centers on the belief that behavior can be measured and modified. In behavioral therapy, environmental stimuli play a significant role in shaping how an individual behaves. On the other hand, cognitive therapy focuses on changing thought patterns.

A psychologist named Albert Ellis developed a form of cognitive therapy that centered around how a person’s thoughts about an event can dictate how they behave. Another mental health professional, psychiatrist Aaron T. Beck found that clients often had internal dialogues that affected their emotions and behaviors. In the 1970s, therapists throughout the US began to merge both behavioral therapy strategies and cognitive therapy interventions. They found that an integration of both methods — which was named cognitive-behavioral therapy — produced positive and effective results.²

During CBT therapy, a therapist utilizes psychotherapy to work with individuals in helping to develop healthier and more constructive ways of thinking. A therapist assists in identifying false or negative beliefs and thought processes, and restructuring them to become more beneficial for the individual.

CBT vs. DBT

Dialectical behavioral therapy (DBT) is a specific type of cognitive-behavioral therapy. Although DBT is based heavily on CBT principles and is considered part of the CBT umbrella, it is not entirely the same. A core principle of DBT techniques is that it highlights validation — accepting thoughts that are negative or uncomfortable.

Rather than struggling against these thoughts or denying them, dialectical behavioral therapy assists individuals to accept their thoughts and, later, change them. At its start, DBT was used primarily in the treatment of individuals with borderline personality disorder (BPD) or who are chronically suicidal. Therapists may decide to use DBT techniques depending on an individual’s history or situation.

Cognitive-Behavioral Therapy Techniques

What makes this therapy effective is its use of client involvement to learn and practice positive coping skills. Cognitive-behavioral therapy focuses on the present, finding solutions to imminent problems. A variety of CBT techniques are used to achieve the desired results. The type of technique utilized depends on what would be most beneficial for the individual.

Most Common Methods

The following are some examples of the most commonly used CBT techniques:³

Psychoeducation between the client and individual helps both parties to better understand an individual’s illness and identify problems.
Cognitive restructuring identifies negative and destructive thought processes and helps change them to adaptive and healthier processes.
Exposure therapy assists in reducing anxiety by helping an individual face their fears.
Behavioral activation encourages the use of social support and enjoyable activities — like hobbies and exercising — as positive coping skills.
Relaxation training reduces heightened responses by using relaxation techniques like deep breathing, and guided imagery.
Relapse prevention educates individuals that “slips” into past behavior is normal, and teaches coping skills to manage and prevent future relapse.

A Change in Behavior

Most techniques focus on restructuring negative and maladaptive thought processes to achieve the desired change in behavior. Very often, mental illnesses and addictions persist due to harmful thought processes that are learned over time. CBT therapy works to undo those negative thought patterns by developing new coping skills and problem-solving techniques.

It also includes a substantial degree of self-monitoring by clients, therefore much of the techniques focus on becoming aware of their thoughts and how they are problem-solving within the world around them. “Problem-solving” in CBT means:

Identifying a problem
Generating a list of possible solutions
Evaluating the strengths and weaknesses of each possible solution
Choosing a solution to implement
Implementing the solution

Identifying Problems

The first step in CBT is to identify the negative thoughts that lead to an individual’s most prominent problems. This first step can be exceptionally difficult for individuals who are reluctant to look at their thoughts and emotions, and fortunately, a CBT therapist can help their client overcome their apprehension.

Developing new skills and actively practicing them is also a significant element of this therapy. It is one thing to know what needs to be done, and it is another to actively do it. CBT therapy encourages active and regular use of the skills learned. It also encourages individuals to set goals to solve their problems and learn ways to evaluate whether they’ve been successful at meeting those goals.

What are Cognitive Distortions?

All people have a degree of cognitive distortion, which is faulty or inaccurate thinking. People with addiction or other mental conditions may experience cognitive distortion more frequently, with more of their thinking affected by inaccurate thoughts. CBT therapy helps individuals to recognize harmful thought processes and learn new skills to change them.⁴

Distorted Though Patterns

The following are some examples of the most common forms of distorted ways of thinking:

Overgeneralization is seeing a negative event or aspect of a group and interpreting it as valid for every event or all parts of the group.
Jumping to Conclusions is assuming a negative conclusion although no facts are supporting it.
Catastrophizing exaggerates the importance of a minor negative event, making it look worse than it is.
All-or-Nothing Thinking creates binary categories. Things are either black or white with little or no room for a middle ground.

These other forms of distorted thinking can impede recovery from a mental condition or addiction. Without addressing distorted thinking, individuals may return to old habits and relapse, making a successful recovery much more difficult. With the help of a therapist, CBT allows individuals to identify the types of distorted thinking they are more prone to exhibit and understand how to change their thought patterns.

What Does CBT Therapy Entail?

The American Psychological Association cites several core principles on which CBT is based:

Psychological problems occur, for the most part, because of harmful and faulty ways of thinking.
Psychological problems occur because of learning patterns of harmful behavior.
People can learn better methods to cope with their psychological problems, therefore becoming more functional and effective.

Understanding Therapy Techniques

CBT therapy involves working closely with a therapist on a one-to-one basis over several meetings, though sometimes individuals may work in a group with other people, depending on their situation. A healthy rapport — in CBT meaning collaboration and trust between a therapist and client — facilitates this therapy, enabling clients to learn new coping mechanisms quickly.

Individuals learn to identify their problems and challenging conditions. With these problems come feelings, and individuals are encouraged to familiarize themselves regarding when these thoughts and feelings occur. By becoming knowledgeable about these emotions, individuals can apply CBT interventions to address these issues and change patterns of thinking and behavior. Negative thought patterns and cognitive distortion are replaced with more realistic and fact-based responses, alleviating symptoms and facilitating recovery.

What is Cognitive-Behavioral Therapy Used to Treat?

This therapy treats a broad range of conditions, from addiction to phobias. These are the most common mental health conditions for which CBT interventions are used to treat.

Addiction

Anger management issues

Anxiety and anxiety disorders

Attention deficit hyperactivity disorder

Attention deficit disorder

Bipolar disorder

Depression

Eating disorders

Obsessive compulsive disorder

Panic attacks

Personality disorders

Phobias

Sleep disorders

Trauma history

In addition to diagnosed mental health problems, CBT therapy is also helpful for everyday issues or stressful life events such as:

Chronic pain or serious illnesses

Divorce or break-ups

Grief or loss

Insomnia

Low self-esteem

Relationship problems

Stress management

The Benefits of CBT for Addiction Treatment?

Years of research support the use of cognitive-behavioral therapy for addiction treatment.⁵ It suits the needs and goals of most individuals who have a substance abuse disorder, like establishing a meaningful goal (recovery), learning the skills needed to meet the goal, and planning interventions to prevent relapse. CBT for addiction therapy sessions also explores harmful thought patterns and behaviors, factors that lead to substance abuse, and relapse.⁶

Trauma-focused CBT may also be incorporated, as people with trauma have higher rates of substance abuse disorder. In addition, cognitive-behavioral therapy can be adapted to meet the needs of all individuals and allows for alternative thinking. Whether performed in a group or individual setting, this therapy instills useful practices for treating addiction and, more broadly, managing everyday stressors.

Other Therapies and Treatments Used Alongside CBT

What makes CBT such an essential part of addiction treatment is its adaptability. Rather than overhaul a treatment program to incorporate it, this therapy’s approaches are easy to weave into an existing program. CBT for addiction or trauma-focused CBT can be used in conjunction with approaches like medication-assisted treatment (MAT), motivational interviewing, holistic treatment, and peer support groups.

Practicing CBT therapy skills — known as homework — requires active participation for a client. A client must use the skills learned in a session by applying them in their daily lives. When CBT is implemented in residential treatment settings, leisure activities are ideal scenarios to practice these skills, allowing clients to become confident in their abilities before moving on.

Cognitive-Behavioral Therapy: A Research-Backed Approach to Addiction Therapy

Most therapists consider cognitive-behavioral therapy the gold standard of psychotherapy.⁷ Decades of stringent testing with an evidence-based framework solidifies it as one of the most used and effective forms of treatment for addiction and mental other conditions. Just as with any psychotherapy approach, there is still much to be discovered when it comes to CBT.