What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a structured, short-term and problem-focused type of psychotherapy used to treat various mental health issues such as depression, eating disorders and substance use disorders.  It combines philosophical, behavioral and scientific aspects do aide in overcoming psychological problems. The central concept behind cognitive behavioral therapy is that one feels the way they think. This means that changing your stream of thoughts into a healthier direction will lead to improvement in how you feel, which in return affects your behavior and helps you make better and healthier life choices. It is important not to confuse cognitive behavioral therapy with psychotherapy, which aims to discover the unconscious behind certain behaviors. Unlike psychotherapy, cognitive behavioral therapy is highly goal-oriented and problem-focused. Specific goals are set early, and the entire therapy is guided in the direction of achieving them. Another thing that is characteristic for cognitive behavioral therapy is that it is a short-term type of treatment.

Cognitive behavioral therapy can be conducted on an individual basis or in the form of group therapy. Different types of behavioral therapy are available depending on the individual needs.

Cognitive behavioral therapy has shown to be an effective treatment for less severe forms of mental disorders and substance abuse (except opioid abuse) even when not combined with medications.

As its name explains, the roots of this type of therapy were two different, at that time opposing therapies, behavior therapy that started in the 1920s and cognitive therapy which began in 1960s. By merging these two approaches, cognitive behavioral therapy was created. It has proven to be effective in treating mental health disorders ever since.

Techniques used in CBT

Cognitive behavioral therapy is focused on identifying thought distortions and maladaptive behaviors. Once identified, they are meant to be resolved through acquiring new emotional regulation skills and coping mechanisms. Cognitive behavioral therapy has six phases of recovery:

  • Psychological assessment (using functional analysis) used to identify factors that precede certain unwanted behavior patterns and understanding their consequences;
  • Cognitive restructuring recognizes and deals with cognitive distortions or maladaptive thoughts that usually stem from negative self-image;
  • Acquisition of skills necessary to cope with emotions. Those are skills one may have failed to acquire during lifetime and could be a reason why they have turned to drug abuse;
  • Skills consolidation and application training is a phase of training that consists of smaller assignments meant to be done at home;
  • Generalization and maintenance;
  • Post-treatment assessment follow-up

Various techniques are used in each of the phases of cognitive behavioral therapy, and a professional should determine which one to be used according to patients needs. Still, there are several techniques that are more commonly used than others, for example functional analysis.

Functional analysis is an assessment method used to decipher the antecedents and consequences of certain behaviors. The importance of knowing which factors precede certain behaviors and knowing the consequences is a starting point in changing them as a way to deal with unwanted behavioral patterns. In substance use disorder functional analysis aids in identifying thoughts that precede drug or alcohol cravings. This is an important first step in helping a patient develop a strategy for coping with their feelings in a way that does not lead to drug consumption.  Functional analysis also helps in identifying high-risk situations that result in abuse, so one may recognize them and find a way to successfully avoid them.

Cognitive restructuring is a process that follows identification of high-risk thoughts and situations. It recognizes and disputes maladaptive thoughts also known as cognitive distortions.
Cognitive distortions are flawed perceptions about yourself and your future. They usually stem from several negative thought patterns such as:

  1. Disqualifying the positive – An extreme form of all-or-none thinking. Automatic thoughts are produced that explain away the positive while reinforcing the negative feelings.
  2. Over-generalizingperceiving every future experience to have negative implications due to one negative experience in the past
  3. Jumping to conclusionsAssuming that what we think and feel is true without supporting it with any form of evidence
  4. All-or-none thinkingPerceiving every situation as either completely good or completely bad. For example thinking that if you are not perfect, you must be a failure.
  5. Mental filtering – Ignoring every possible good situation, feeling, experience and dwelling only on the negative.

Motivational and cognitive interventions are used to stimulate a patient to resist their urges and change their core beliefs that lead to substance consumption in the first place.

Skill development is a way of unlearning destructive behaviors and replacing them with healthier ways of responding. Destructive behaviors are usually developed in those who have not acquired effective strategies for coping with everyday problems due to various negative life events. Therefore therapists often give assignments in the form of homework to those being treated with cognitive behavioral therapy to help them develop skills that may aid them in solving their emotional, social or other deficiencies. For example, those with social anxiety may get a task to talk to a stranger. Later in therapy, their feelings and views of this event are discussed in order to overcome an issue. This way one develops emotional regulation skills necessary for dealing with problematic everyday situations.

Who Benefits from Cognitive Behavioral Therapy?

Cognitive behavioral therapy is used to treat depression, anxiety, schizophrenia, psychosis and substance use disorders (addiction, abuse). It can be utilized in those who suffer from multiple mental health issues. It is a recommended therapy for treatment of children and adolescents.
Cognitive behavioral therapy has shown to help in less severe forms of substance use disorders (except opioid addiction) even without the addition of psychotropic medicaments.

This is considered highly desirable as these patients are considered high risk for developing an addiction, and medicament therapy in their case requires lots of supervision which may lead to feelings of discomfort and rejection of rehab further on.

Goals of Cognitive Behavioral Therapy

Cognitive behavioral therapy is problem-oriented, with goals set in advance unlike psychoanalysis for example which only follows the patient’s stream of thoughts and looks for the unconscious. The primary aims of cognitive-behavioral therapy in substance use disorders are to identify problematic behaviors and change them through newly acquired skills. This is done through an increase in patients’ awareness of their thoughts and actions that result in unwanted consequences. Patient and therapist will in the beginning after identifying all the problems one wants to deal with, set a list of goals that are meant to be achieved.

How cognitive behavioral therapy benefits Substance Abuse Treatment

Cognitive behavioral therapy has significant positive effect in treating substance use disorders. This is achieved through improvements of cognitive distortions. Cognitive distortions are often a leading cause of negative self-image. Studies have shown that lower self-confidence and negative self-image are a sign of underdeveloped emotional coping skills. Those who have not acquired adequate skills needed for dealing with emotional burdens of everyday lives tend to solve their problems with drugs and/or alcohol. Addressing the roots of addiction and aiding in resolving them is how cognitive behavioral therapy benefits addiction treatment.

Not only does cognitive behavioral therapy help in dealing with cognitive distortions, but it is often used to help with other mental health disorders that may be caused by substance abuse and addiction. Treating mental health disorders reduces chances of addiction relapse. It also reduces the possibility of developing other unhealthy mechanisms of dealing with emotions such as gambling.

Effectiveness of Cognitive Behavioral Therapy

Several studies pointed out that cognitive behavioral therapy is highly effective in treating less severe forms of depression, anxiety and substance addiction without the help of psychotropic medications. Also, cognitive behavioral therapy was shown to be highly effective in treating individuals with multiple diagnoses, which is why its utility in treating substance abuse cannot be ignored as these patients tend to have an underlying mental health issue.