Cognitive Behavioral Therapy
Ralph Waldo Emerson once said, “If I have lost confidence in myself, I have the universe against me.” This is a concept that tends to come to the forefront in addiction therapy programs and mental illness treatment programs. These diseases tend to strip people of the ability to think clearly, make good decisions, feel confident about the future and make choices that support long-term health. The self becomes unknowable. While the consequences of these conditions can be serious, there are treatments that can help to restore confidence and clear thinking. Cognitive Behavioral Therapy is one such treatment.
Becoming a Detective
Traditional psychoanalysis requires the patient to be passive, listening to the therapist provide information on the causes and cures for the issue at hand. While this might be relaxing in some ways, and it might even be familiar to people who are accustomed to learning information through lectures, it’s not the sort of exchange that is provided in Cognitive Behavioral Therapy (CBT). Instead, CBT requires the patient to take an active role, coming up with theories, testing those theories and thinking of new ways to challenge old habits.
According to the Association for Behavioral and Cognitive Therapies, CBT is designed to help people determine what is supporting a poor behavior right now, and what will need to change in order for that behavior to stop. CBT is often called a “targeted therapy” for this reason. While prior trauma, childhood issues or other triggers may have had a role to play in the start of the behavior, the emphasis is on what is happening right now. The sessions move quickly, and attempt to bring results in a short period of time.
In order for the therapy to move quickly, the sessions are typically highly structured. Instead of spending time aimlessly talking about the week or examining a person’s reactions to old stimuli in a free-form manner, the sessions tend to follow a predictable format:
- The therapist and the patient review the last session’s work.
- The patient outlines challenges coming up in the next week.
- The two develop strategies to handle those challenges.
- The person is assigned homework based on those challenges.
- The session is over.
The sessions may take only 45 to 60 minutes, the Mayo Clinic reports, but the homework the person is assigned might take much longer to complete, and the homework forms a key role in the effectiveness of CBT. See Related: Dialectical Behavior Therapy.
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A New Way of Thinking
In CBT, patients are encouraged to think about and identify their hidden thoughts. These are internalized opinions that may have been formed years or even decades ago, and they tend to have a huge impact on the way a person behaves. For example, people might believe that they’re not as kind or charming as other people they know. They feel inadequate, almost all of the time. Feelings like this can lead people into depression or substance abuse, but the person might not even recognize that the thought drove the behavior. In CBT, the therapist might ask, “What did you think in the hour before you used drugs?” and those hidden thoughts might become clear. Then, the patient can work on that inner thought like a hypothesis. Instead of the firm thought (“I am not as smart as she is.”) the patient begins to shift to a less firm thought (“Is she smarter than I am? And is that the end of the world?”).
Homework sessions have a strong role to play in changing these thought patterns. For example, an article produced by the University of Houston states that some people with anxiety disorders develop attachments to objects, believing that those objects keep them safe. In CBT homework assignments, they might be encouraged to leave those objects at home, for an hour or a day, and then report what happened during the next session. They test the hypothesis that the object has magical powers, and they learn that instead they have a strength just waiting to come out. Over time, as they become accustomed to dealing with situations that once caused them fear, and they realize that those situations do not have the power to harm, they’re less likely to be crippled by their fear. They’re able to rejoin the world again.
In addition treatment programs, CBT can be used to help a person understand the causes for a relapse. It’s common for people to claim that relapses just happened, out of the blue, with no warning whatsoever. CBT encourages people to break apart a relapse, looking for clues that the lapse was beginning to come on and that resistance was beginning to fade. When the person begins to identify the triggers that seemed to precede the relapse, the team can come up with strategies that can help the person avoid those triggers in the future.
People who have numbed their minds with drugs and alcohol may have difficulty dealing with powerful emotions like grief, anger or loss. When these strong feelings begin to well up, they may have no idea how to deal with the rising tide, and they may be encouraged to go back into addiction just to keep the bad feelings away. CBT can help by teaching people mindfulness techniques. These strategies allow people to stop and live in the moment, recognizing that the pain they feel now is real but that it will dissipate with time. Some therapists provide lessons in meditation or muscle relaxation, encouraging their patients to use these techniques when deep emotions tend to overwhelm.
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CBT has been proven an effective treatment for people with mental illnesses such as depression. According to the National Alliance on Mental Illness, people who receive CBT do better in treatment than patients who do not receive CBT as part of their treatment programs. It seems that the therapy allows people to manage the symptoms of their depression, and avoid relapsing into negative behaviors that could make a flare-up of symptoms more likely. CBT has also been effective in treating other mental illnesses such as:
- Social phobias
- Personality disorders
- Eating disorders
- Psychotic disorders
People who have these mental illnesses in addition to a substance abuse issue have also benefitted from CBT. These Dual Diagnosis patients may learn how to control the symptoms of their mental illness, and how to avoid a relapse to drug use, all in the same sessions with a therapist. In a study published in the journal Addictive Behaviors, people who had post-traumatic stress disorder as well as a substance abuse problem improved with CBT in the three months after therapy began, although this study is quite small and more studies might need to be performed in order to make the link between CBT and healing more clear within this population.
Sometimes, CBT is combined with medication management, and this might be when the more significant results are obtained. People recovering from addictions to strong drugs like heroin or prescription drugs need to change the way they think and the way they react, but they might also be dealing with the chemical imbalances caused by years of drug use. They may be unable to change their thinking, due to these imbalances. Combining medications and therapy might be the best way to help these people improve. This approach was studied in the journal Focus, and researchers reported that 62 percent of people who were given medications as well as CBT did not relapse into heavy drinking, compared to 40 percent of people who were given CBT alone.
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It’s important to stress that there is no one way in which to provide CBT. In fact, the therapy is almost infinitely customizable, allowing therapists to change how often the sessions are provided, what is covered and what sort of homework is assigned. Therefore, the CBT sessions one person receives might not look anything like the CBT sessions another person receives, even if the two are receiving treatment for the exact same condition. The therapy is designed to be customized, putting the patient in control over how much of the treatment is delivered and how success is measured. For some people, this is the ultimate benefit of CBT, as it allows them to take control over their lives, and their addictions and/or mental illnesses may have robbed them of these choices many years ago.
If you find the concept of CBT appealing, and you’d like to learn more about how it could help you in your recovery from addiction and/or mental illness, please contact us at Michael’s House. Our professional staff is waiting to take your call right now.
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