The term cognitive behavioral therapy (CBT) refers to a range of brief therapeutic interventions that are all based on the philosophy that patients can benefit from taking ownership of their choices and experiences in life.

CBT is recognized as one of the most evidence-based options in addiction treatment and recovery, and it has been proven to be equally effective in addressing a range of mental health disorders as well – disorders that include depression and anxiety. Usually implemented on a one-on-one basis, the length and duration of CBT sessions are usually finite and determined based on the specific goal of treatment. However, in some cases, CBT may be provided in a group setting.

In general, the goal of the many different cognitive behavioral therapies is often to identify the perspectives, behaviors, and/or thought patterns that may be making it more difficult for the patient to function or interact with others positively – and then to create a shift in those perspectives, behaviors, and/or thought processes to ones that are of benefit to the patient and his ability to function positively in the world. Learning to remove the shroud of negativity from one’s experience of self, others, and events can significantly improve the patient’s quality of life and relationships – and increase his ability to avoid relapse.

History of Cognitive Behavioral Therapies

The development of cognitive behavioral therapy began in the mid-1950s when Albert Ellis, PhD, developed Rational Emotive Therapy (RET) as an alternative to psychoanalysis. The philosophy of treatment was based on the idea that the quality of a person’s experience in life was based on her view of the world and not necessarily on the things that happened to her.

In the 1960s, utilizing the concepts put forth by Ellis in RET, Aaron Beck, MD, developed Cognitive Therapy at the same time that Maxie C. Maultsby, Jr., MD, developed Rational Behavior Therapy. These therapists enhanced the underlying philosophy of patient accountability by emphasizing the need for therapeutic homework, a focus on the attitudes of the patient, rational self-counseling, and other therapeutic techniques and strategies.

Over the years, cognitive behavioral therapy continued to evolve through the contributions of a number of therapists, theorists, and practitioners. In the 1980s, a book called Feeling Good by David Burns, MD, made CBT more popular among therapists and patients. Soon, CBT became well known as an effective tool for helping patients learn how to improve their mood and quality of life. A number of different types of cognitive therapies have been developed as a result of this body of work, each with its own benefits and unique characteristics.

Benefits of Cognitive Behavioral Therapies

In the treatment of substance abuse and addiction, cognitive behavioral therapies provide patients with a number of benefits including:

  • Increase in positive thinking and positive perspective
  • Decrease in self-destructive behaviors
  • Decrease in compulsive use of drugs and alcohol
  • Improvement in self-confidence and self-esteem
  • Enhancement of relationships with others
  • Increase in ability to communicate positively
  • Increase in ability to manage anxiety and/or fears

Characteristics of Cognitive Behavioral Therapies

Each type of cognitive behavioral therapy is different from the next, and details of how each session is conducted will also vary depending upon the therapist and the focus of treatment. In general, however, the National Association of Cognitive Behavioral Therapists (NACBT) says that cognitive behavioral therapies are all defined by the following:

  • Philosophy based on the Cognitive Model of Emotional Response (that is, that the person’s perspectives is responsible for his feelings and choices and not the situation or circumstance)
  • Philosophy based on the concept that a person’s reactions can be learned – and therefore can be unlearned
  • Focus on rational thinking and view of reality that is fact-based rather than based on emotion
  • A finite number of heavily structured therapy sessions determined by the treatment goal and agreed upon in advance
  • A relationship between the therapist and patient that is strong without being central to the therapy
  • A collaborative effort between the patient and therapist
  • Use of the Socratic Method (that is, the therapist uses questions to clarify the needs of the patient and encourages the patient to ask himself “tough questions”)
  • Use of clear directions to the patient, including directives to complete tasks outside of the therapy session

Disorders That Can Be Treated With CBT

Cognitive behavioral therapies have been proven to be effective in the treatment of:

  • Substance abuse and addiction, including alcoholism
  • Anxiety disorders, including phobias and obsessive-compulsive disorder
  • Self-harming behaviors, including suicide attempts
  • Mood disorders, including depression
  • Psychotic disorders
  • Schizophrenia
  • Personality disorders
  • Eating disorders
  • Sleep disorders

The CBT Session

There is a complex relationship that exists between thoughts, behaviors, and feelings. Often, the way people interpret the world around them and the people in it can significantly impact and alter individuals’ experiences. Those who assume that others are judging them or that the intentions of others is to harm them respond aggressively when it is unwarranted. These impulsive choices may inadvertently create a hostile situation where there otherwise would have been a simple, uneventful interaction, and these events contribute to the person’s decreased mood and inability to enjoy life.

In CBT, patients are encouraged to:

  • Objectively interpret the intentions of others
  • Communicate needs and wants effectively
  • Create positive frameworks for their experiences
  • Identify potential stressors that can increase anxiety and decrease the ability to avoid impulsive reactions that may create ultimately create problems where there are none 

Types of CBT

A number of brief therapeutic interventions are classified as cognitive behavioral therapies, including:

  • Cognitive Therapy
  • Rational Emotive Behavior Therapy
  • Rational Living Therapy
  • Rational Behavior Therapy
  • Multimodal Therapy
  • Dialectical Behavior Therapy

Cognitive therapy sessions are focused on a specific treatment goal that is chosen at the beginning of treatment; the therapist and patient work together to achieve that treatment goal during a set number of therapy sessions that is determined at the same time that the treatment goal is identified. In most cases, the treatment goal is chosen based on a problem that the patient is currently facing, and therapy focuses on removing the power from that problem and increasing the patient’s abilities to manage her emotional responses and actions regarding that situation.

The main goal of rational emotive behavior therapy is to help patients let go of negative perspectives that inform their negative responses to situations in their lives and replace those with positive beliefs and choices that improve their lives. Based on ancient philosophic teachings and complex in nature, rational emotive behavior therapy is one of the earliest forms of cognitive behavioral therapy.

A combination of self-counseling and traditional therapy, therapists who practice rational living therapy attempt to persuade patients to make rational choices when strategizing how to deal with a perceived problem rather than emotion-based choices. Therapists lay out clear-cut directions for patients to follow, encouraging them to question the assumptions that usually inform their decision-making, and avoiding any formal diagnosis that may limit the patient’s sense of possibility and hope for change

The main focus of rational behavior therapy is to identify the underlying issue or problem that may be driving the negative views that trigger the undesired emotional or behavioral responses. The idea is that if the underlying issue is addressed, then the negative views and thought processes will be resolved, and the resulting feelings and behaviors will no longer be problematic.

Multimodal Therapy

Multimodal therapy helps the patient to address seven areas of their personality with the goal of improving the person’s ability to function in the world. These seven areas are defined by the acronym BASIC ID, according to the American Psychological Association (APA).

It stands for:

  • Behavior: actions and choices that cause the patient problems
  • Affect: emotions that may contribute to a negative experience
  • Sensation: negative perceptions that may not be correct
  • Imagery: poor self-image
  • Cognition: thoughts that are emotion-based rather than fact-based
  • Interpersonal factors: high-tension relationships
  • Drug/biological considerations: symptoms of medical or behavioral disorders

Therapists seek to provide patients with the tools to identify the difficulties they face in each of these areas and deal with them as needed.

Dialectical Behavior Therapy

Personal therapy sessions, group therapy sessions, long distance and/or phone consultations, yoga, and meditation – dialectical behavior therapy utilizes a range of therapeutic methods to empower patients to love themselves, accept others, be engaged and mindful in the moment, and recognize any negative thoughts and feelings they may have without judgment. Rather than shift their negative perspective, thoughts, or behaviors to ones that are positive, patients are instead encouraged to accept the “problematic” situations they face in their lives as normal and okay and move on from there.

Is CBT Right for You?

Cognitive behavioral therapies will be of benefit to almost anyone in treatment for addiction, but according to a study published in the Journal of Clinical Psychology, some personality characteristics and abilities may lend themselves to higher rates of success with CBT than others.

Thus, CBT may be a more effective choice for patients who:

  • Can objectively assess the inner thought processes that may be informing their choices
  • Would like to set and work toward a specific therapeutic goal
  • Are willing to be actively engaged in their therapy
  • Genuinely desire change
  • Are prepared to manage emotional discomfort
  • Are prepared to accept responsibility for the problems they experience
  • Are ready to try new ways of dealing with emotions, people, and situations
  • Have a positive and stable support system at home

Though many patients may not exhibit these qualities or define themselves in this way when they begin treatment, it is not uncommon to see these traits develop as the length of time in sobriety increases.

CBT: A Part of a Comprehensive Addiction Treatment Program

When used in conjunction with other traditional therapies, alternative therapies, holistic treatments, and mental health treatment and/or detox when necessary, cognitive behavioral therapies can be hugely beneficial to a patient’s ability to recover from drug and alcohol dependence and thrive in recovery. Different types may be more effective for patients than others.

The choice as to which type of CBT is right for you should be made together with a therapist who is familiar with your past in addiction and your goals for recovery.

Contact Orlando Recovery Center today to discuss your options in addiction treatment and therapy, and to take the first step toward a life without drugs and alcohol.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.