In my nearly forty years of working with others to help them overcome addiction and other mental health problems, there have been many advances in the tools we have at our disposal to change behaviors.  One of the most powerful modalities we use in our treatment program is cognitive behavioral therapy (CBT).

CBT originated in the work of psychiatrist Aaron Beck, who noted that certain types of thinking contributed to emotional problems. Beck labeled these “automatic negative thoughts” and developed the process of cognitive therapy. While this work started in the 1960s, it took time until CBT was widely used in the treatment of substance use disorders (SUDs).

Many experts in the field of psychotherapy consider CBT the ‘gold standard’ of treatment among psychological modalities.  As opposed to other many other therapeutic processes, cognitive behavioral therapy (CBT) does not rely heavily on discussing your history.

“Thoughts Become Things”

CBT is a psychological therapy that enables the patient to recognize thoughts that lead to negative behavior. This allows recovering patients to connect the influence of triggers and thought patterns with negative behaviors.  This is particularly useful in the life of a recovering individual, who faces an ongoing daily decision about “whether or not to relapse.”

With the aid of CBT, you can become more in touch with your thoughts and emotions, and how they influence your behavior.  Once you become aware of these habits, you can begin to practice other ways of thinking.

The Basic Concepts of CBT

The core premise of cognitive behavioral therapy (CBT) is that your ideas, feelings, and behaviors are all intertwined. What you think and feel about a situation might influence your actions.

People who are under a lot of stress at work, for example, may view circumstances negatively and make the wrong decisions. Therefore, an essential tenet of CBT is that you can change your thinking so you can resolve behavioral issues and outcomes.

The American Psychological Association (APA) sums up the core concepts of CBT as follows:

• Negative thinking patterns that hinder a person’s behavior have been learned.
• People who think negatively can improve their behavior by recognizing negative thought patterns.

The therapist’s role in CBT is to guide the patient to better behaviors by identifying the negative thought patterns and implementing coping mechanisms to alleviate the stress that has previously been connected to the use of drugs or alcohol.

How CBT Works: The Typical Treatment

CBT reinforces ‘problem-solving’ by guiding the patient to identify negative thought patterns and replace the self-defeating thoughts and practices with more helpful responses. A typical summary of the process is:

• The patient reviews how thinking a certain way can worsen an issue.
• He or she then learns new problem-solving skills.
• In turn, the patient develops self-esteem by learning to tackle anxieties through role-play or relaxation techniques.

For example, by practicing CBT, you can get rid of the word never in your vocabulary. Therefore, you can replace the thought, “I will never have a lasting relationship,” with “I need to consider what I require in a relationship so I can find someone who is compatible.”

A Review of the Several CBT Techniques

Not all CBT will use all of these strategies, but some of the popular CBT techniques include:

• SMART goals. SMART is an acronym that stands for Specific, Measurable, Achievable, Realistic, and Time-Limited.
• Guided discovery and questioning allow the patient to question certain assumptions and take on a different viewpoint when needed.
• Journaling allows the user to write down negative beliefs and replace the beliefs with positive thoughts or affirmations.
• Self-talk is used to replace critical things a patient tells themself with more constructive and compassionate self-talk.
• The cognitive restructuring allows the patients to look at cognitive distortions, such as black-and-white thinking, catastrophizing, or jumping to conclusions. This form of thinking can lead to behavioral difficulties.
• The technique called thought recording allows a patient to see evidence supporting or opposing a negative belief. The evidence is used to create a more realistic thought process.
• Positive activities reward an activity that improves a patient’s mood. Examples include buying a small treat for yourself or eating a picnic lunch in the park.
• Situation exposure involves writing a list of things that upset the patient so they can recognize these events and gradually alleviate their feelings of negativity.
• Systematic desensitization is similar to situation exposure. To practice this method, the patient learns relaxation methods to cope with difficult moods.

Teaching the Patient to ‘Be Their Own Therapist’

What’s also very constructive about CBT is that the psychologist and patient work together in a collaborative fashion to develop an understanding of the problem and a treatment strategy.

Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.

Since the ultimate goal of therapy is for the patient to thrive independently, the natures of these tools and activities help sustain ‘long-term recovery’ on their own.  This facet of CBT is one of its strengths and why many consider it ‘the gold standard.’