Addiction Treatment
Addiction Treatment

Cognitive-Behavioral Therapy

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Medically reviewed: 07/06/2018
Last updated: 06/5/2019
Author: Addictions.com Medical Review

Reading Time: 6 minutes

Cognitive-behavioral therapy (CBT) is a widely-used form of talk therapy that helps people overcome a variety of mental health and substance use disorders. In CBT, individuals work with counselors to identify patterns of thought and belief that lead to unwanted behaviors, such as the misuse of drugs or alcohol. Through counseling sessions, activities and exercises patients learn to respond to their thoughts and emotions in more constructive ways, rather than with addictive behaviors.

Table of Contents

What is Cognitive Behavioral Therapy?

CBT was first used in addiction treatment as a method to prevent relapse for problem drinkers. It was later adapted for users of cocaine and is now used in the treatment of other addictions, as well as to address a range of mental health issues such as psychological disorders, co-occurring disorders, trauma, and family conflicts.

CBT is done in a structured way, sometimes within a limited number of treatment sessions that can help people quickly identify and address problem areas in their lives. It is often combined with other treatments, such as medications and/or traditional psychotherapy, and can be easily integrated into a larger treatment plan.

CBT is a blend of two forms of therapy: cognitive therapy and behavioral therapy.

  • Cognitive therapy:
    • Focuses on how a person’s thoughts and beliefs influence their moods and actions
    • Aims to change their thinking to be more adaptive and healthy
  • Behavioral therapy:
    • Focuses on a person’s actions
    • Works to change unhealthy behavior patterns.

CBT helps individuals learn to solve their problems by examining their thoughts and actions and working to modify them in ways that can be applied to daily life. If used regularly, these techniques can become habits that make a life free from drugs and alcohol feel less challenging and more natural.

What are the Benefits of Cognitive Behavioral Therapy?

Cognitive-behavioral therapy provides people in recovery with the means to manage and alter their emotional state. This powerful tool allows people to take responsibility for their own emotions, and even exercise some degree of control over what they feel and how intensely they feel it.

Specific techniques used in CBT for substance abuse include:

  • Exploring positive and negative consequences of substance abuse
  • Self-monitoring to recognize cravings and identify situations that may lead to substance use
  • Developing strategies for coping with cravings and for avoiding high-risk situations that are likely to undermine treatment goals

In substance abuse and addiction treatment, CBT is often combined with medications, or with other forms of therapy, but it can be effective as a standalone treatment as well.

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy is often conducted on a one-on-one basis with a counselor, but it can also be conducted in a group setting. In CBT, patients break down their problems into smaller parts so that they can identify the thoughts, feelings, and beliefs that lead to unwanted behaviors.

The logic behind CBT a bit like this: your thoughts and beliefs about a situation or event in your life can affect how you feel about it emotionally, which in turn affects how you behave in response. Recognizing those thoughts and beliefs can allow you to modify them in ways that support healthier, more productive and positive behavior.

Types of Cognitive-Behavioral Therapy Interventions and Techniques

There are different techniques and approaches that a therapist may use in cognitive-behavioral therapy. While being treated with CBT your therapist may coach you through several of these methods in an effort to meet treatment goals and alleviate the symptoms you are experiencing.

Behavioral experiments

Behavioral experiments are used to test the validity of false or irrational beliefs and thought patterns, so they can be modified to change how the patient reacts to life in the future.

For example, a patient who believes that they must always do everything perfectly may be instructed to show up late to a session or to turn an assignment in late. By actively testing the faulty belief, the patient can acquire actual proof to support a more positive state of mind.

Thought records

Thought records also help patients determine the validity of their thoughts and beliefs. By working with a therapist or alone, patients may identify a particular belief, such as “my therapist thinks I’m useless” and come up with evidence for and against the idea. This evidence can be spoken out loud, thought through silently, or written down on paper. The point is to come up with concrete evidence to evaluate, weigh, and provide the individual with support for more balanced, realistic, and healthier thoughts and beliefs.

Pleasant activity scheduling

Pleasant activity scheduling involves scheduling healthy daily activities that you enjoy, and that you may not normally do. It can be simple or more complex – from reading a chapter in a novel to making a nice dinner.

Another method of this strategy is to schedule an activity a day that gives you a sense of mastery, competence, or accomplishment. By scheduling these positive actions as if they are official appointments for a haircut or dental checkup, the individual is much more likely to follow through. Scheduling also emphasizes the importance of nurturing the self and the recovery process, so good self-care doesn’t get neglected.

Situation exposure hierarchies

In this method, a patient will put things they normally avoid on a list, such as things that distress them or would normally lead to substance use. They rate those situations or things on a scale by how distressed they make you or how likely they are to lead to substance use. Then, with the support of a therapist or a trusted friend or family member, the patient can work through the list from lowest to highest, exposing themselves (safely) to these situations so that they can become more comfortable and confident in response. Patients are guided through this process with their cognitive behavioral therapist and are discouraged from doing anything that could endanger their recovery. Exposure to high-risk situations should be avoided.

Imagery based exposure

This is similar to situation exposure hierarchies but involves picturing the situations instead of experiencing them. With imagery-based exposure, the patient can safely confront higher risk situations and build up confidence and coping skills within the safety of a counseling session.

Patients bring experiences to mind that usually provoke strong negative emotions or behaviors, trying to remember with lots of sensory detail to make the exercise as vivid as possible. They then try to label the thoughts, emotions, and behavioral urges experienced. This type of exposure may be repeated until the level of distress decreases, and/or a more constructive response to the situation begins to feel natural.

How CBT is Different from Other Psychotherapies

Cognitive-behavioral therapy works faster than other talk therapies. CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily, moment to moment basis.

With CBT, patients often have homework assignments and other types of active practice outside of counseling sessions.

Pros and Cons of Cognitive-Behavioral Therapy

Pros

  • Structured to deal with problems
  • Goal-oriented
  • Can be used in different settings
  • Can be done at home
  • Can be completed over a short period of time
  • May be able to prevent lifelong pharmacological dependence
  • Skills can be incorporated into everyday life

Cons

  • Requires full and active participation from the patient
  • May be difficult to motivate some patients to commit to the treatment
  • Does not look much into issues from a person’s past

Who Should Get Cognitive Behavioral Therapy?

Cognitive behavioral therapy can help any addiction and any co-occurring disorder, as long as the patient is able to understand and implement the methods. This means that patients in the midst of a crisis, or in the early days of detoxing from substances may not be ready for CBT, but as soon as the crisis is stabilized and/or withdrawal symptoms are controlled, CBT can begin.

CBT can be used in a variety of situations, with the treatment adjusted to target each patient’s unique needs. Some conditions that CBT is commonly used in the treatment for are:

  • Anxiety
  • Trauma
  • Substance abuse treatment
  • Managing chronic physical symptoms, such as chronic pain
  • Anger management
  • Coping with grief
  • Coping with stressful life situations, such as trouble at work
  • Coping with relationship conflicts
  • Sleep disorders
  • Sexual disorders
  • Depression
  • Bipolar disorder
  • Post-traumatic stress disorder
  • Schizophrenia
  • Eating disorders

Where Can I Receive Cognitive Behavioral Therapy?

Most addiction treatment programs will include cognitive behavioral therapy in their treatment plans. Before attending a treatment facility, you can call and speak to a specialist about your options.

After patients finish a course of cognitive behavioral therapy, the skills, tools, and techniques acquired during the sessions can then be applied every day throughout recovery. Eventually, CBT strategies will become second nature, and living without drugs and alcohol will feel more natural than active addiction does.