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Cognitive Behavioral Therapy

In an infamous television and radio campaign, the NAACP used this phrase: “A mind is a terrible thing to waste.”

It’s a profound statement, and while it was originally generated as a comment about racism, it could also be applied to the fields of addiction medicine and mental health.

Your mind can do more than help you remember names, dates and your address. In fact, your mind and your hidden thoughts could trap you in a cycle of substance abuse, or it could help you to escape that substance abuse and move forward with your life. Cognitive behavioral therapy is designed to help you understand what your mind can do. In this form of therapy, you’ll train your mind to help you reach the goals you set.


Questions to Ask

Cognitive behavioral therapy is far from passive. In fact, in your very first session, your therapist is likely to ask you to define your goals in a variety of different areas in your life. To help you prepare, think of answers to these questions:

  1. How would I like to be different when therapy is over?
  2. What do I want to change in my relationships with family members and friends?
  3. What symptoms of problems am I experiencing that I want to reduce or eliminate?
  4. Are there spiritual or physical changes I can make to improve my life?
  5. Do I have bad habits I want to get rid of?
  6. Do I need to beef up my interpersonal skills or management skills?

Source: Academy of Cognitive Therapy

Forming a Partnership

During your very first session with your therapist, you’ll learn quite a bit about how cognitive behavioral therapy works, and you’ll also be given a significant amount of time in which to ask questions or bring up any concerns you might have. Your therapist might even prompt you to ask questions now and then, just to make sure you’re truly listening and not withdrawing into an inner world. It’s important that you know what you’re expected to do and how the therapy works, so your therapist may spend a significant amount of time making sure you’re truly listening.

While you might expect that your therapist will ask you to talk about things that have happened in the past, including your history of drug use and how that abuse has impacted your family, you might be surprised to hear that your therapist wants to focus on the future. While it might be true that the things that happened in the past have a big impact on who you are now, the things that happened in the past can’t be changed. Your therapist wants to help you change, and this means looking forward, not looking back.

Instead of talking about the past, you’ll spend time in your therapy sessions talking about what you want to change in your life as it moves forward.

You could focus on almost anything, but common goals include:

  • A cessation of substance abuse
  • A better relationship with family members
  • Gainful employment
  • Improved parenting skills
  • Improved communication skills

Once your goals are set, you’ll come up with a treatment plan that dictates how long you’ll come to therapy sessions and whether or not medications will play a role in the therapy you’ll receive. You might be given a short homework assignment to complete, such as reading a chapter of a book about the therapy, and then you’ll be free to go.

A Unique Experience

“I was dreading therapy, as I’ve been on and off the therapy couch for most of my life. This experience was completely different, though. My therapist treated me like an equal, and we really formed a tight team that was focused on getting things done. Instead of wallowing in things I couldn’t change, I felt like I was learning and really making progress. Honestly, I loved the experience. I learned so much.” — Robert G.

The Cognitive Component

Cognitive behavioral therapy is built out of two concepts: a cognitive component, involving thought, and a behavioral component, involving actions. Often, people who are new to therapy spend a significant amount of time in the early stages of therapy working on the thought part of the equation. Once those skills are strengthened, the person can more effectively focus on making changes in behavior.

According to the Association for Behavioral and Cognitive Therapies, this portion of therapy has four specific goals:

  • To help you distinguish between thoughts and feelings. A feeling is an emotion that springs from deep inside. A thought is an impression, developed by the mind. It’s easy to mix the two up, and people often do so. Phrases such as “I felt that she didn’t like me,” are good examples. These are thoughts, not feelings and thoughts, unlike feelings, are easy to investigate and change.
  • To help you understand how thoughts influence feelings, and understand that the influence isn’t always helpful. There are some hidden, automatic thoughts that could cause you to feel a specific way. Looking in the mirror and thinking, “Boy, am I fat!” could make you feel sad and low. Almost everyone has these sorts of thoughts from time to time.
  • To help you evaluate thoughts and assumptions. Here, you’re encouraged to identify your hidden thoughts and challenge them directly. What evidence do you have that the thought is true or false?
  • To help you learn to notice, interrupt and intervene when negative thoughts arise. You’ll develop the ability to seek out these destructive thoughts and root them out, right away.

Putting Cognition Into Action

An example might help to make the goals of therapy a bit easier to understand. Before you go to therapy, you might walk into a room and think, “Everyone notices that I am different, and no one will like me.” This thought is incredibly depressing, and it makes you feel sad. You might compensate by drinking. After therapy, you might walk into a room and begin to think this same destructive thought, but then, you’ll begin to notice that no one is really watching you. It’s not true that everyone notices that you’re different. In fact, you might not be different at all. Therefore, no drinking is needed.

The Behavioral Component

This portion of therapy can vary a bit, depending on the issues you’re facing and how those issues are best approached. No matter the variation, however, the behavioral portion of therapy is designed to help you test the skills you’ve begun to develop in the cognitive portion of therapy.

Practice can help make these lessons become more real to you, and as a result, you might be more likely to put them into practice in your everyday life when therapy is over.

If you have an underlying anxiety disorder, you might be afraid of specific objects or locations. In cognitive therapy, you might have learned that these objects or locations can’t truly hurt you, but the lesson has been academic up to this point. Now, in a series of homework assignments, you’ll prove that this lesson is true. If you’re afraid of dogs, for example, you might begin by looking at pictures of dogs. Then you might look at videos of dogs. Then you might see dogs through glass. Then sit in a room with a dog. Then maybe, just maybe, you’ll pet a dog. With each challenge, you’ll learn that the dog didn’t hurt you. Nothing happened to you at all. Perhaps, your hidden thought (“Dogs will kill me!”) isn’t true after all.

If you have an underlying depression disorder, you might have enjoyed specific activities or locations before you became ill, but as the syndrome progressed, you found these activities less and less pleasurable. In your therapy sessions, you might revisit these activities again, paying attention to the tiny upticks in happiness you feel as you try these activities again. You learn how to use the power of your mind to move past the barriers depression slams down for you.

In order to help you handle the experimentation portion of therapy, your therapist might teach you how to meditate or do breathing exercises.

These techniques can help reduce the amount of stress and anxiety you’re feeling in the moment, so you can push past the thoughts of your mind and do your activities as you had planned. Sometimes, your therapist will be with you during these exercises, reminding you of how to push past your thoughts by using techniques you learned in your sessions. Soon, you’ll be able to do these exercises alone. When you do so, you’ll take notes for your therapist about how the experiment went, what you thought about and what you think you could do next time to make the experiment run just a bit more smoothly. At your next session, you’ll discuss your notes with your therapist and come up with other homework assignments you can try out the following week.

Who Does It Help?

According to the National Alliance on Mental Illness, cognitive behavioral therapy is useful in the treatment of a variety of conditions, including:

  • Mood disorders
  • Anxiety disorders
  • Personality disorders
  • Eating disorders
  • Substance abuse and addiction
  • Psychotic disorders

Does It Work?

Cognitive behavioral therapy is considered an evidence-based therapy because it’s been proven effective in treating a variety of disorders.

In fact, there have been literally hundreds of studies on cognitive behavioral therapy over the years, and many of them have demonstrated remarkable results. For example, according to the Substance Abuse and Mental Health Administration, a study on cognitive behavioral therapy and teen depression found that 17.1 percent of teens who received this therapy still had depressive symptoms when the treatment was over, compared to 42.2 percent of teens who did not receive this form of therapy. This is a staggering difference, and it seems to indicate that this form of therapy has specific and measurable success rates for some people.

On the other hand, some studies seem to indicate that cognitive behavioral therapy isn’t as effective as other forms of therapy. For example, a review of multiple studies on the issue, published in the journal Addiction, found that cognitive behavioral therapy wasn’t definitively effective in helping people overcome an alcohol addiction. There are many reasons why this might be the case, but one interesting theory involves complexity. Cognitive behavioral therapy works quite well in helping people with clear-cut problems that have one source and one solution. People who have multiple, complex issues all at the same time, weaving around one another, might need other forms of therapy in order to unpack their problems and disentangle them from one another. Since cognitive behavioral therapy is designed to work in the short term, with one problem, it might not be the best choice for complex cases like this.

If your therapist determines that cognitive behavioral therapy isn’t the right choice for you, that doesn’t mean you won’t have any therapy at all. Instead, your therapist might use another approach to help you improve, or your therapist might modify the cognitive behavioral technique in order to address your specific concern. Therapists make these sorts of modifications all the time as they work with their clients.

Your therapist is sure to find just the right way to reach you and help you improve.

Stopping Circular Thinking

Negative thoughts could include messages about yourself and how others view you, but they could also include endless rehashing of events or conversations you’ve had. Some people even become obsessed with negative news stories, playing the images over and over in their minds. These circular thoughts can be extremely damaging, and it’s easy to see how drug and alcohol abuse could stem from these issues.

In cognitive behavioral therapy, you’ll learn how to shut off a stream of repeating thoughts by focusing on something else instead. Meditation, running, reading, artwork or petting your dog might all be good, positive diversionary tactics to help you get back on track.