What do you think of when going to therapy?
If you imagine discussing your childhood while lying on a comfy couch, you’re not alone. This is the traditional Freudian psychoanalysis that’s commonly portrayed on TV and in movies.
Cognitive behavioral therapy (CBT) for substance abuse is different. CBT treats problems by modifying dysfunctional thoughts, behaviors, and emotions. This solutions-focused approach puts you in control of your recovery.
With CBT, the therapist is equal parts teacher and teammate. The therapist provides education on specific behavior patterns that affect the development of substance use disorders, but acts as your teammate to help you create a plan to reach your personal recovery goals.
About CBT for Substance Abuse
Our way of viewing the world is based on patterns of thinking that we learned as a child or young adult. Often, we don’t even realize when our thought process is inaccurate or causing harm.
CBT seeks to promote a lasting recovery by helping people with substance use disorders develop a more balanced and healthful way of approaching life’s challenges. This is accomplished through functional analysis and skills training. Functional analysis involves discovering the thoughts, feelings, and circumstances that led to drug or alcohol addiction. Skills training involves developing healthier ways to cope with the issues uncovered via functional analysis.
Some of the specific types of dysfunctional thoughts addressed in CBT sessions include:
- Catastrophizing: Imagining the worst-case scenario when faced with a challenging situation, such as believing you’re going to get fired for making a small mistake at work
- Filtering: Only focusing on upsetting or frustrating circumstances and discounting all of the positive aspects of your life
- Fortune telling: Believing you have the power to predict the future instead of considering all of the variables that affect a specific situation
- Jumping to conclusions: Making assumptions without evidence to support your conclusions, such as concluding recovery is impossible because you experienced a previous relapse
- Mind reading: Assigning specific feelings or thoughts to people in your life instead of making an honest effort to communicate, such as believing other people are shaming or judging you for your substance abuse even though you’ve never discussed the issue with them
- Overgeneralizing: Viewing situations as “all or nothing” instead of realizing that you may need to try several different approaches to deal with a problem
If necessary, CBT sessions may address concerns related to co-occurring mental health disorders such as anxiety and depression. Past trauma such as sexual abuse or domestic violence may be explored as well, although the primary focus remains on achieving specific recovery goals.
CBT is typically incorporated into both individual and group therapy sessions. Homework assignments may be given between sessions to reinforce key concepts and provide an opportunity to practice applying lessons learned to real-life scenarios. For example, homework might involve developing strategies for coping with cravings or learning to recognize how negative thoughts are hindering your recovery efforts.
Subsets of CBT
CBT is a general term used to refer to a number of different therapies. Specific types of CBT used in addiction recovery include:
- Behavior therapy (BT): Based on the behavioral science of learning, BT uses interventions such as exposure or exposure response prevention (a type of desensitization), behavioral activation, social skills training, and communication training.
- Cognitive therapy (CT): CT emphasizes directly changing how a person thinks, which leads to changes in emotional and behavioral reactions. Evidence-based thinking and hypothesis testing of thoughts are two commonly used concepts in this approach.
- Dialectical behavior therapy (DBT): DBT incorporates distress tolerance, acceptance, and mindfulness into CBT techniques for emotional regulation. It is recommended for people who have a tendency to react in extreme ways to emotionally charged situations and struggle to return to an appropriate baseline state.
- Multimodal therapy (MMT): Based on the observation that human beings think, feel, act, sense, imagine, and interact with specific events and that treatment should address each of these modalities, MMT also focuses on the seven influential dimensions of personality: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biology.
- Rational emotive behavior therapy (REBT): In REBT, people with substance use disorders learn that their own beliefs and behaviors are more important in processing an event than the experience itself. The ABC model explains this process: A – something happens, B – you have a belief about the situation, C – you have an emotional reaction to your belief.
CBT Isn’t a Magic Cure
CBT is considered highly effective in promoting the growth mindset that lays the foundation for long-term recovery. However, it’s not a quick fix for substance use disorders.
Ideally, CBT for the treatment of substance use disorders should be used with other evidence-supported interventions that address the specific factors that led to your drug or alcohol abuse. This might include medication-assisted treatment, 12-Step meetings, mindfulness meditation, or expressive arts therapy. At Bel Aire Recovery Center, our treatment services are personalized to fit each client’s unique needs and provide a full continuum of care that supports the recovery process.
