What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT), which is often part of drug and/or alcohol treatment programs, is a form of psychotherapy that is based on the concept that changing a person’s negative thoughts and behavior patterns can have a powerful effect on their emotions. It emphasizes the important role our thoughts have in how we feel and what we do. CBT helps identify, analyze, and then change, counterproductive behaviors and thoughts. This helps alleviate feelings of anxiety and depression and facilitates change.

How CBT Differs From Other Therapies

CBT is more than just talk – and it doesn’t dwell on what happened in the person’s childhood. It addresses the here and now, and what you can do about tomorrow. CBT is based on the scientific method, logic and belief in the power of the individual to take charge and then change their negative thoughts, feelings and actions. CBT is action-oriented and lasts only a short period of time.

What Happens In CBT?

Years of scientific research have uncovered the fact that by changing the way a person thinks and behaves, you can have a profound effect on their emotional state. Discussion centers on triggers to begin with, those thoughts and feelings you have that lead to your getting involved in destructive behavior. Since triggers bring about episodes of drug, alcohol and prescription drug abuse and addiction, it’s important that they be first identified. CBT uses a direct, action-oriented approach to explore, identify and analyze dysfunctional patterns of thinking and acting. After these have been identified, the therapist teaches the patient how to challenge and restructure their thinking and behavior. Their behavior then becomes based on rational and reality-based thinking. Anxiety, depression and other negative emotional states are soon alleviated or disappear.

Describe How a Session Works

Although sessions may differ somewhat, they all fall into a pattern: explore, identify, analyze and action-oriented techniques.

• In the initial session, the therapist seeks to establish a strong therapeutic alliance with the patient or client. Other areas covered during the first meeting include education about their diagnosis, explaining how treatment works, setting goals, and instilling hope. Concrete goals are established, such as “I want to be drug- and/or alcohol-free.” The therapist and the patient or client work toward the specific goal during each session.

• Next, the therapist sets an agenda for the patients, such as discussing current problems and what the patient wants to accomplish during the meeting. They talk about anything that happened since the last meeting that the therapist needs to know. Review of educational homework assignments comes next.

• Then the next problems on the agenda are discussed, a new set of homework assignments given, and problem-solving skills that can be implemented to deal with them. The therapist and/or the patient summarize the most important elements of the current session, and conclude with any suggestions for the next meeting.

In cases of drug, alcohol and/or prescription drug abuse, the primary tasks of treatment are to identify the specific needs the drugs or alcohol are being used to meet, and to develop skills to provide alternative ways of meeting those needs.

Relapse prevention provides a systematic way of assessing the full range of what precipitates relapse and the consequences of drinking and drug use that influence a person’s relapse potential, and to devise interventions to deal with them that are likely to reduce the probability (but not the certainty) of a future relapse. Other CBT approaches include community reinforcement and behavioral couples’ therapy.

Determinants of Drug/Alcohol Use

While helping the patient/client with CBT, the therapist may focus on five separate domains. These are the social, environmental, emotional, cognitive and physical domains. Who is the patient with when they do drugs/alcohol, where are they that precipitates this most often, how do they feel (depressed, anxious), what are they thinking (I can’t do this without getting high, etc.), and what happens to them (they fall into a stupor, blackout, hallucinate, etc.)?

Learning New Skills and Coping Mechanisms

For CBT to be successful, the patient or client needs to learn new skills and coping mechanisms so they don’t fall back into their previous negative thinking and resultant destructive behavior. This takes time and repetition. By the time that patients enter drug or alcohol rehab their habits have already become deeply ingrained. Therapists have to recognize how difficult, frightening and threatening it is to patients to attempt to change their old ways. It may take several attempts for the patient to be able to master a new approach.

Chronic drug and/or alcohol abusers may also suffer from cognitive impairment (attention, concentration, memory, ability to learn and comprehend) due to their drug and alcohol usage over time. Others, who may have entered treatment after a period of extreme stress, may be so preoccupied with those thoughts that it takes time to overcome them. In both cases, the treatment involves repetition so that the patients are better able to retain and understand a new concept or idea.

The therapist gives a rationale for each assignment, elicits a commitment from the patient, anticipates any obstacles, monitors the patient’s progress closely, explores any resistance and gives praise for the patients’ efforts to accomplish their assignments.

Can CBT Help Everyone?

According to experts, CBT is best used with persons who are motivated to make a change in their lives. It is based on a collaborative relationship with the therapist and the patient or client. It has proven highly effective in helping patients recover from drug, alcohol and prescription drug abuse, as well as persons with anxiety, depression, obsessive compulsion, mood swings, panic attacks, phobias and other disorders.

CBT places a strong emphasis on relapse prevention, which is another reason why it is so effective in drug, alcohol and prescription drug recovery. It essentially teaches the patient or client the skills they need so that they can become their own therapists.

In short, CBT can help the person trying to recover from alcoholism, drug addiction and other disorders to stop their symptoms and get their lives back on track. It is a powerful and effective treatment for motivated individuals.

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