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Cognitive Behavioral Therapy

cbt guide

The National Alliance on Mental Illness defines cognitive behavioral therapy (CBT) as an approach to treatment that focuses on the relationships between a person’s thoughts, feelings and behaviors.[i] Cognitive behavioral therapy is one of the most widely used approaches in treating addiction. This guide is designed to help you and your loved ones understand the basics of CBT and know what to expect from treatment using this method.


therapyOne of the most commonly used approaches to the treatment of drug and alcohol addiction is cognitive behavioral therapy. Cognitive behavioral therapy was developed by psychiatrist Aaron Beck in the 1960s. Dr. Beck noticed his patients engaging in a kind of “internal dialog,” or conversation in their own minds. His patients would then base their behavior and reactions on these private trains of thought. By identifying and expressing these thoughts, Beck discovered he could lead a patient to understand why he or she acted in a particular way. Once this understanding was achieved, Beck helped his patients change harmful thought patterns and develop positive behaviors.

According to PsychCentral, Beck called this methodology “cognitive therapy,” because of the strong focus on thinking patterns. The mental health community eventually changed the name to “cognitive behavioral therapy” because CBT encompasses the changing of both thoughts and behaviors from negative to positive.[2]

Changing Neural Pathways

cbt treatsThe American Psychological Association considers cognitive behavioral therapy as the preferred therapeutic approach for the treatment of drug and alcohol addiction[ii]. CBT changes the brain’s neural pathways- the fundamental behind the concept of learning- enabling the patient to make permanent modifications to how he or she approaches situations that might have once precipitated a drinking or drug binge. Positive behaviors continue to create and strengthen these new neural pathways making it easier for the patient to continue making better choices. The combination of talk therapy with an understanding of how thinking patterns shape human behavior makes CBT the frontline treatment for those who are ready to get clean and stay clean.

Elements of Cognitive Behavioral Therapy

5 parts of cbtAccording to the Royal College of Psychiatrists, cognitive behavioral therapy helps a patient understand his or her harmful thought processes by examining the cause-and-effect dynamic in five parts. [iii]

The first part is known as “the situation,” This refers to the environment, surroundings or specific triggers that prompt the patient to react by drinking or using drugs instead of making a healthier choice. A therapist may ask a number of questions to get as comprehensive a picture of the situation as possible.

The second part deals with thoughts. Cognitive behavioral therapy identifies things that upset the patient and the thoughts they associate with events. If a thought is negative, it blocks out all other perspectives. This inhibits the patient’s ability to see any alternative to the situation.

The third part of CBT works on emotions. Emotions are developed from thoughts. Assuming the worst about a situation, for example, can ruin a mood, which in turn affects behavior. This negative habit can have a significant impact on everyday life. Understanding how thought patterns work, and how they influence emotions, gives patients the opportunity to take control of what they think and how they feel.

The fourth part of CBT is based on the physical. Most mental health disorders can manifest physical symptoms, such as headaches, fatigue, insomnia and weight loss. Therapist using CBT might ask a patient to be mindful of her physical condition when she feels an onset of the mental distress. Fostering a sense of awareness that is as comprehensive as possible – one that encompasses thoughts, emotions, and feelings – helps the patient recognize the warning signs. The patient learns to identify these physical symptoms and respond to them in appropriate ways.

The fifth component of CBT is the action of changing behaviors. When a patient understands why she thinks about a situation in a certain way, how those thoughts make her feel and any physical responses or manifestations, she can respond to the temptation to abuse drugs or alcohol in positive and healthy ways.

Cognitive behavioral therapy helps addicts recognize what prompts them to use drugs or alcohol and learn to redirect their thoughts and reactions away from the abused substance.[iv] Helping a victim of addiction deconstruct a problem and break it down in terms of thoughts, feelings, sensations, and actions is the goal of treatment. CBT gives patients new perspective and offers a life free from the control of drugs and alcohol.

[i] National Alliance on Mental Illness. “Psychotherapy. Accessed December 6, 2016.

[ii] The American Psychological Association. “Behaviorial and Cognitive Psychology.” Accessed December 6, 2016.

[iii] Royal College of Psychiatrists. “What is Cognitive Behavioral Therapy.” Accessed December 6, 2016.

[iv] The Mayo Clinic. “Cognitive Behavioral Therapy.” Accessed December 6, 2016.