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What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a psychotherapy used to help people deal with a range of mental health problems, including depression, suicidal thoughts and substance use disorders. For decades, this form of therapy has been used alongside traditional treatment to change behaviors and perceptions about substance use, allowing people to live healthier lives.
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Cognitive behavioral therapy helps people identify, understand and change dysfunctional behaviors related to their personal problems. Through this psychotherapy, people with a substance use disorder can learn the skills needed to improve their quality of life.

This highly structured form of treatment also helps people identify triggers for addiction, manage cravings and recognize high-risk situations. CBT focuses on present problems rather than past difficulties. In doing so, clients learn relaxation, social and communication techniques, and they actively participate in each step of therapy.

 

Nanci Stockwell of Advanced Recovery Systems describes cognitive behavioral therapy and how it’s used to treat underlying causes of addiction.

How Does CBT Work?

During CBT treatment, the dynamic between clients and therapists is important. Positive communication between both parties allows people struggling with substance abuse to replace dysfunctional thoughts with those that promote positive well-being. Together, they create a blueprint that helps the client overcome problematic behaviors.

This psychotherapy allows people to be involved in their own recovery. For example, people struggling with addiction may read literature about substance use, keep records of their appointments and even complete homework assignments related to the lessons taught during therapy.

“The therapy is directed toward helping people develop a set of skills to problem solve and modify the dsyfuctional thinking, as well as their behaviors.”

Robin O’Hearn, Lead Primary Care Psychologist, North Florida/South Georgia Veterans Health System

“They apply these lessons to their daily life by completing home practice,” Dr. Peggilee Wupperman, associate professor in the department of psychology at John Jay College of Criminal Justice in New York, told DrugRehab.com.

Homework assignments could include asking clients to be more aware of their troubling thoughts. During the next session, the therapist and individual review these thoughts and discuss healthy ways to respond to negative emotions.

“[Therapists] give clients home practice to monitor emotions and thoughts,” Wupperman said. “When they realize they’re having [urges], they can use the practices discussed in session.”

How Are CBT Sessions Structured?

The initial CBT session allows clients to establish a relationship with their therapist. During this time, individuals can decide whether the mental health professional would be helpful in treating their substance use disorder or mood disorder.

During CBT, both parties discuss the client’s mood, physical health and feelings since their last meeting. They may talk about potential self-destructive thoughts or behaviors, evaluate symptoms and gauge progress. This process, called a “mood check,” helps provide the itinerary for each session.

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People use CBT meetings to talk about a number of problems, and therapists often ask about the client’s most pressing problems. These issues could include relationship problems or issues associated with eating disorders or depression. Clients and therapists also review homework assignments and lessons from past meetings.

A CBT session generally involves problem-solving. Therapists help individuals assess the accuracy and usefulness of their distressing thoughts. Over time, clients learn the skills needed to change their mindsets. The therapist may ask them to draw conclusions based on learned practices.

Throughout CBT treatment, therapists conduct assessments to evaluate an individual’s symptoms, identify problems and formulate goals to overcome problems. These evaluations also measure progress throughout treatment.

CBT implements pleasant activities designed to increase physical activity, self-confidence and positive feelings in clients. According to research, this approach reduces troubling thoughts and improves mood in these individuals.

Clients receive feedback at the end of each CBT session. During this time, they can review the concepts discussed, including aspects that were confusing or bothersome. They also can request changes for future meetings.

CBT Steps and Duration of Therapy

Cognitive behavioral therapy incorporates several steps that aim to help clients identify patterns of behaviors, thoughts and emotions associated with their health condition.

This process often includes:

  • Recognizing difficult situations: Troubling life situations, such as divorce, can affect a person’s psychological well-being and possibly cause the development of mental illness. This step allows therapists and clients to work together to recognize these issues.
  • Identifying thoughts, emotions and beliefs associated with key problems: The next step asks clients to share their thoughts and observations about their problems during a meeting. Clients evaluate their beliefs about themselves, others and events. Some therapists encourage individuals to track their thoughts in a journal.
  • Pinpointing negative thinking: Identifying negative or inaccurate thoughts allows people to understand patterns of thinking that may have contributed to their mental health issue. Concentrating on the physical, emotional and behavioral responses to situations can help people manage their disorders.
  • Reshaping negative or inaccurate thinking: Is your view of a situation based on facts or inaccurate perceptions? Therapists may ask this question to help change a client’s thinking. Positive thinking can be a difficult habit to develop, but it can lead to a more optimistic view on life.

CBT is short-term treatment, generally consisting of 10 to 20 sessions. However, the duration of therapy varies based on the type of disorder, severity of symptoms, levels of stress and whether or not improvements have been made. Therapists and clients typically work together to decide how long therapy should last.

“It all depends on the client and what they bring in,” Wupperman said. “Someone who has used substances to cope will have a different amount of time [in CBT] than those who have depression and a substance use disorder.”

What Does CBT Treat?

People turn to cognitive behavioral therapy when experiencing a host of issues.

These problems may include:

  • Trouble dealing with a mental illness
  • Problems coping with stressful life situations
  • Difficulties managing emotions
  • Relationship conflicts
  • Trouble coping with loss, such as from death or divorce
  • Chronic physical symptoms

Research shows that cognitive behavioral therapy can be used to treat a variety of illnesses.

These medical conditions include:

Rather than targeting specific substance use disorders, CBT aims to change the thoughts, emotions and actions associated with general drug use.

“Truthfully, most researchers and therapists in the field actually use CBT to treat any drug addiction, and then they [cater the plan] to fit the client’s needs,” she said.

Reports have shown that CBT can be used to treat addictions to alcohol, marijuana, cocaine, methamphetamine and nicotine. Studies also have indicated that this treatment approach can assist people in overcoming co-occurring disorders.

A 2009 study published in the journal Addictive Behaviors showed that CBT can be used to treat co-occurring disorders involving substance use and PTSD. People with PTSD who received CBT treatment showed reduced substance use, but they also were receiving intensive outpatient treatment during this time.

The U.S. Department of Veterans Affairs website states that CBT is the most effective type of counseling for people with PTSD. Through CBT, these individuals learn to deal with anger, guilt and fear associated with their traumatic experiences.

How Does CBT Affect the Brain?

Various studies have shown that CBT modifies brain activity.

A 2004 study published in the Archives of General Psychiatry indicated that CBT modifies the limbic system of the brain, which affects emotion, motivation and long-term memory. This treatment technique can help reduce problems associated with drug addiction, including angry outbursts and memory loss.

CBT also affects the brain’s cortical region, linked to attention, perception and awareness, the study found.

In 2009, researchers evaluated multiple studies that used neuroimaging techniques to investigate changes in brain activity in CBT patients with anxiety disorders. The review, published in the Journal of Neuropsychiatry and Clinical Neurosciences, found this therapy approach changes circuits in the brain that affect dysfunctional neural activity, including negative thoughts and fear.

“The literature shows that many mental disorders are involved with the inability to control fear and difficulty in regulating negative emotions,” the study stated.

A 2016 study published in the journal Translational Psychiatry made similar discoveries. Researchers at several Swedish universities studied MRI scans before and after CBT. They confirmed that CBT decreases volume and activity in the brain’s temporal lobes — specifically the amygdala. This part of the brain regulates emotional behavior and is also part of the limbic system.

Researchers discovered a difference in brain function after just nine weeks of therapy.

“The greater the improvement we saw in the patients, the smaller the size of their amygdalae,” co-author Kristoffer Mansson, a doctoral student at Linköping University, said in a press release. “Several studies have reported that certain areas of the brain differ between patients with and without anxiety disorders. We’ve shown that the patients can improve in nine weeks — and that this leads to structural differences in their brains.”

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How Effective Is CBT?

CBT is an empirically based form of therapy that examines the origin of addiction problems and teaches patients how to overcome them. It is one of the most popular treatment techniques available. But does it work?

A 2013 study published in Cognitive Therapy and Research measured the effectiveness of CBT using 269 meta-analyses. The evaluations covered CBT involving various illnesses, including personality disorders, psychotic disorders and substance use disorders.

The study found evidence proving the efficacy of CBT among individuals with addiction. This treatment approach was very successful in treating nicotine and marijuana addiction. However, CBT proved less effective in treating opioid and alcohol addiction.

Those who attended multiple sessions had a greater rate of success than those who participated in a single session, according to the study.

Other research has shown that CBT helps individuals with alcohol addiction. Researchers at Boston University found that transdiagnostic CBT was more effective in reducing heavy drinking in people with anxiety and alcoholism than progressive muscle relaxation therapy, a treatment technique used to ease tension. Transdiagnostic CBT applies the same treatment principals to all mental disorders rather than specific techniques to certain illnesses.

Using medication in conjunction with CBT did not reduce alcohol consumption, according to Boston University researchers.

“This study points to the importance of behavioral approaches to decrease heavy drinking through strategies to improve emotional regulation,” Dr. Domenic Ciraulo, chair of psychiatry at Boston University School of Medicine, said in a press release.

Can CBT Help Teens and Senior Citizens?

Research has shown that CBT can be used to help children, teens and older adults overcome mental health problems.

A 2012 report published in the journal Child and Adolescent Psychiatric Clinics of North America reviewed several studies that found CBT to be effective in treating adolescent depression or suicidality.

The report referenced a study that suggested CBT offered independently or in combination with a selective serotonin reuptake inhibitor medication helped reduce suicidal ideation in people aged 12 to 18 with a major depressive disorder who had undergone acute treatment.

Many CBT programs for seniors address their physical health and spirituality — a slight alteration from the traditional approach. Also, older adults may require additional accommodations, such as the incorporation of explicit learning and memory aides.

“Older adults with a range of mental health problems can benefit from cognitive behavioral therapy,” stated the authors of a 2011 report published in BC Medical Journal. “Empirical support exists for using CBT alone or in combination with appropriate medications for the treatment of depression and generalized anxiety disorder.”

What Other Therapies Use CBT?

Many behavioral therapies integrate CBT components into their core principles. These therapy approaches help people with a variety of conditions, ranging from suicidal thoughts and depression to PTSD.

Types of therapies that use CBT:

Exposure Therapy:
Exposure therapy is a form of CBT that exposes clients to a traumatic situation or object. The goal of this technique is for individuals to learn to become less fearful over time.
Dialectical Behavior Therapy:
Dialectical behavior therapy incorporates elements of CBT with concepts of acceptance and change. This therapy is primarily used to reduce suicidal thoughts and self-injurious behaviors.
Brief CBT:
Brief CBT is a condensed version of the traditional approach. Therapists aim to change an individual’s behaviors in four to eight sessions.
Cognitive Emotional Behavioral Therapy:
Cognitive emotional behavioral therapy uses elements of CBT, DBT and other therapy techniques to help people overcome their emotional distress.
Moral Reconation Therapy:
Moral reconation therapy is a CBT program for drug offenders. This approach is designed to enhance moral reasoning and improve decision making among adults and juveniles with substance abuse problems.
Stress Inoculation Training:
Mind-altering substance use during adolescence and young adulthood has been linked to schizophrenia, and substance use can speed the rate of schizophrenia development.

Where to Find CBT Treatment

Dr. Aaron Beck developed CBT at the University of Pennsylvania in the 1960s. About three decades later, he and his daughter, Dr. Judith Beck, started The Beck Institute for Cognitive Behavior Therapy, a source of training, therapy and resources associated with the psychotherapy.

Beck Institute offers information on CBT treatment. Its website allows people to schedule an appointment with a therapist that specializes in CBT. It also shows readers how to refer a family member to a therapist.

Additionally, cognitive behavioral therapists can be found across the United States. Treatment centers often use CBT in conjunction with evidence-based treatment. Many people in treatment who also receive CBT go on to live healthier lives.

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