Cognitive Behavioral Therapy
It’s been said that actions speak louder than words. But what if words could influence actions? That’s the idea behind Cognitive Behavioral Therapy (CBT). According to the National Association of Cognitive-Behavioral Therapists, CBT can be defined as, “a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.” Therapists who use CBT techniques help their patients to address their thoughts, and correct any negative thought patterns, before they have a chance to act upon those thoughts. For people struggling with addiction, or addiction and another mental illness, this can be a powerful technique that can lead to lasting change.
How It Works
There are many forms of Cognitive Behavioral Therapy available, including:
- Rational emotive behavioral therapy
- Rational behavioral therapy
- Rational living therapy
- Cognitive therapy
- Dialectical Behavior Therapy
Some therapists choose a form of CBT based on the patient’s history, while other therapists specialize in only one form of CBT and that’s the only form they use with their patients. In addition, each therapist is likely to use the techniques in a slightly different way. There are some basic concepts that hold, however, no matter what form of CBT is used and no matter who is performing the therapy.
A therapist using Cognitive Behavioral Therapy may have medical knowledge to contribute, but the patient is considered the expert on himself/herself. In other words, the patient must contribute to the sessions and spend a significant amount of time talking and planning. This isn’t a passive sort of therapy where the patient can just listen and absorb. Instead, the patient takes an active role. The patient and the therapist create a list of goals for the patient, and they work together to come up with reasonable methods to use to achieve those goals. In addition, the patient is encouraged to believe that he or she is powerful and can truly change behavior. For people who have felt powerless over their addictions or their mental illness, this can be a new and innovative way of thinking that can be truly inspiring.
In order to make needed changes, the patient begins to examine his or her deeply held beliefs. These thoughts lie at the base of why a person acts the way he or she does. According to the Association for Behavioral and Cognitive Therapies, many patients behave in certain ways because this behavior has been inadvertently rewarded in the past. For example, a person with an anxiety disorder may believe that drugs make him or her feel calmer. After all, when the anxious person takes drugs, he or she can sleep deeply, which implies relaxation and a benefit. But, the therapist may point out, when the person awakens and realizes he’s spent the rent money on drugs, the anxiety returns, and perhaps has doubled in intensity. Therefore, is it really true that the drugs relieve anxiety? By thinking about the costs of the behavior, the person sees that the “benefit” isn’t so beneficial after all and the deeply held belief may not be true.
In addition, some people are asked to challenge their deeply held beliefs in a series of tests or practice sessions. Is it really true that the man needs to drink at a party, or else he’ll be bored? Is it really true that the woman must accept a cigarette from her husband or he’ll stop talking to her? The therapist can help the person devise, and act out, these tests and see that the deeply held belief isn’t true after all.
These sessions can be intense, and often, patients are asked to do a significant amount of “homework” when the sessions are done. They may be asked to practice their techniques on their family members or friends, or they may have written assignments to complete and bring to the next session. This work can be time-consuming, to be sure, but it can help the person reap big benefits in a short period of time. Unlike some other forms of psychotherapy that can require a patient to work with a therapist for years, cognitive behavioral techniques are designed to elicit rapid change. Often, patients complete the treatment in just a few months.
Cognitive Behavioral Therapy and Addiction
It’s easy to understand why this therapy appeals to medical professionals treating people for addiction. After all, addiction is often rooted in behavior. Asking the addict to consider the cost of a relapse can make the reward of the relapse less appealing. And, by testing the boundaries of the sobriety, the addict can learn how to cope when he or she is tempted to stray when therapy is over. In CBT sessions, the addict can learn what thoughts lead to addictive behaviors, and then can practice conquering those thoughts without resorting to substances. Slowly, the addict builds up confidence and develops a toolkit he or she can use to change negative thought patterns and therefore change behavior.
The effectiveness of Cognitive Behavioral Therapy in treating addiction has been studied extensively. One such study, published in the journal Alcoholism: Clinical and Experimental Research found that combining CBT with medication was remarkably effective in keeping people away from alcohol abuse. The medications stopped the cravings while the therapy helped the person correct the behavior. Other studies, however, have come up with slightly different results. For example, one study published in the journal Drug and Alcohol Dependence found that cocaine addicts didn’t seem to benefit from CBT in the same dramatic fashion. The authors theorize that this form of drug use damages the brain, and makes it harder for the addicts to participate in the clear thinking required of CBT. It’s possible, then, that the treatment might not be the right method to use for all forms of addiction. As always, the treatment must match the addict. For people who are unable or unwilling to do the work, the therapy might not be effective. But for people who are motivated to take control, and able to think clearly, the technique has real power.
Dual Diagnosis and CBT
Medical professionals use the term “Dual Diagnosis” to identify patients who have both a mental illness and an addiction issue. People who fall into this category might experience even more benefits from Cognitive Behavioral Therapy. After all, as demonstrated, the technique has been proven to help treat people who have some forms of addiction. The technique also has proven power to help people with certain types of mental illnesses. According to the Mayo Clinic, CBT is particularly helpful in treating:
- Bipolar disorder
- Eating disorders
The National Alliance on Mental Illness suggests that Cognitive Behavioral Therapy can help people with mental illnesses by encouraging them to pull the veil of their illnesses aside so they can see the results of their actions more clearly. To give an example, a woman develops a persistent thought that everyone is talking about her, and this thought makes her feel anxious in crowds. The therapist might encourage the woman to think, just for a moment, that perhaps they’re all discussing last night’s ball game. Why would they discuss her? Is it possible that she believes something that isn’t true? As therapy progresses, the woman might begin to identify these sorts of destructive thoughts as simple thoughts, not as facts, and she may be able to walk through crowds without anxiety.
Therapists using cognitive behavioral techniques on patients with Dual Diagnoses can help patients learn more about their addiction and mental illness, and how the two combine and encourage the addict to act in incredibly destructive ways. Some sessions might focus only on the addiction, some only on the mental illness and others on the intersection of the two disease processes. The Dual Diagnosis is attacked on all fronts.
This approach has proven quite effective. For example, according to a study published in the British Journal of Psychiatry, people with both schizophrenia and substance abuse who participated in CBT experienced “significant improvements in patient functioning.” This is a remarkable outcome, as schizophrenia has long been considered resistant to psychotherapy techniques. A similar result was published in the journal Psychiatric Services. Here, researchers observed people who had a personality disorder and a substance abuse disorder. Those who had CBT had significant improvements in their relationships with friends and family members, and those who did not receive the therapies did not have the same benefits. As patients begin to learn more about the intertwining of addiction and mental illness, they can learn to change their thought processes and make better behavioral choices as a result.
At The Canyon, we specialize in providing help to people struggling with Dual Diagnosis. Our therapists use Cognitive Behavioral Therapy techniques to influence change, and we support that change through medications, healthy foods, group meetings and a serene living environment. We encourage you to call us to find out more about these remarkable treatments.