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Cognitive-Behavioral Therapy

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Cognitive-behavioral therapy (CBT) is a widely used talking 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 substance abuse.

Through counseling sessions, patients learn to respond to their thoughts and emotions in more constructive ways, rather than with substance use or addictive behaviors.

CBT is done in a structured way, sometimes within a limited number of treatment sessions. In this way it can be more effective than other therapies as it can quickly help people identify and address problem areas in their lives. It is often combined with other treatments, and can be easily integrated into a larger treatment plan.

What is Cognitive-Behavioral Therapy?

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 a person learn to solve their problems by examining their thoughts and actions and working to modify them.

Conditions that Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapies are used in a variety of situations, and the treatment is individualized depending on what a particular patient is going through. Some conditions that CBT is commonly used in the treatment for are:

  • Anxiety
  • Substance abuse treatment – both for achieving sobriety and preventing relapse
  • Trauma
  • 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

How Does CBT 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 problem or another ‘thing’ can affect how you feel about it, emotionally and physically, and can impact how you act on it. Recognizing those thoughts and beliefs can allow you to modify them, thus contributing to your behavior and actions.

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 encourage you and 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 thoughts and reactions. You may be encouraged to try criticizing yourself after using drugs and on a different occasion talking kindly (more encouragingly) to yourself. You would monitor your subsequent drug use to see which method (talking nicely vs. using criticism) helped you better maintain abstinence. You would then have objective feedback and ideas as to how to manage your drug use.

Thought records

Thought records are also meant to help patients determine the validity of their thoughts. Either working with a therapist or alone, you may identify a particular thought, such as “my therapist thinks I’m useless” and evaluate evidence for and against that thought. Doing a record, mentally or written down, of concrete pieces of evidence for and against that thought can help people come up with more balanced, supported thoughts.

Pleasant activity scheduling

As it sounds, pleasant activity scheduling involves actually writing down a schedule of daily activities that you enjoy, are not unhealthy, 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 is to schedule an activity a day that gives you a sense of mastery, competence, or accomplishment.

Situation exposure hierarchies

In this method you will put things you normally avoid on a list, such as things that distress you or would normally lead to substance use. You rate those situations or things on a scale by how distressed they make you or how likely they are to lead to substance use. You then work through the list from lowest to highest, exposing yourself to these situations so that you can get comfortable with them and avoid distress or substance use, or any other unwanted behavior or feeling that usually comes with them.

Imagery based exposure

This is similar to situation exposure hierarchies but involves picturing the situations instead of experiencing them. You bring experiences to mind that provoked strong negative emotions or behaviors, and work to remember it in lots of sensory detail. You try to label the thoughts and emotions you felt at the time, and what your behavioral urges were. This type of exposure may be repeated until the level of distress decreases, or the behavioral response also becomes less likely.

Cognitive Behavioral Therapy in Addiction Treatment

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. It is used to stop substance abuse, as well as to address a range of issues related to it such as mental health challenges, trauma, and family issues.

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 behavioral therapy. It can be effective as a standalone therapy as well.

How CBT is Different from Other Psychotherapies

CBT works more quickly 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 basis.

You may also expect to have homework assignments and other types of active practice outside of counseling sessions.

  • Problem-focused
  • More structured
  • Set methods
  • Goal-oriented

Pros and Cons of CBT


  • Can be used in different settings
  • Can be completed over a short period of time
  • May be able to prevent lifelong pharmacological dependence
  • Skills can be incorporated into everyday life


  • 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