If you or someone you love has been in addiction recovery for a while, the odds are pretty good that you’ve already heard of cognitive behavioral therapy (CBT). CBT is often deployed as a gold standard approach for the treatment of substance use disorder (SUD) (1, 2, 3, 4).
Despite the prevalence and promise of CBT in addiction recovery, many people remain unclear as to what, exactly, CBT is and how it can be used to support long-term sobriety in those dealing with substance dependency. This article examines the purposes, functions, and efficacy of CBT as a therapy of choice for many who are experiencing addiction.
What Is CBT?
Cognitive behavioral therapy (CBT) is a psychotherapeutic approach based on the idea that our thoughts and actions are inextricably intertwined. In other words, how we think strongly determines what we do, and in turn, what we do informs how we think.
Practitioners of CBT operate on the premise that addiction is both instigated and sustained by how we perceive, talk about, and respond to the world around us. It is an outcome of how we think not only about others but especially about ourselves. Thus, if you perceive yourself to be a helpless victim of your circumstances–of an abusive childhood, an indifferent spouse, a chronic illness, or a chronically overdrawn bank account–you may well also begin to see yourself entitled to that next binge or high. You may even begin to define yourself as powerless against alcohol or drugs, just as you once might have been powerless against an abusive parent or the generational poverty in which you were raised.
To be sure, CBT practitioners do not seek to minimize or delegitimize the traumas clients have experienced or the life challenges they may face in the present. Rather, the ultimate goal of CBT is to help clients learn to acknowledge and address those painful histories and present obstacles in healthier, more affirming, and more productive ways.
This commitment is driven by the recognition that if you see yourself only as a hapless victim of your circumstances, past and present, you will almost certainly never muster the hope and motivation you need to get–and stay–sober. CBT, in other words, is all about giving clients the tools they need to deal with unresolved trauma and to address present adversity, whether you are grieving the loss of a loved one, experiencing a health challenge, facing a financial crisis, or enduring other significant stressors in which anxieties are high and hope may seem to be fading.
Rejecting the Rose-Colored Glasses
Let’s face it: Life is tough. None of us gets through it unscathed. And CBT is by no means some Pollyanna approach that claims that happiness and sobriety can be won through repression and denial. Quite the opposite. No “hang in there” or “let a smile be your umbrella” cat posters here.
Rather, the bedrock of CBT is the acknowledgment of all that clients fear to acknowledge, the confrontation of all that clients have tried to escape by turning to drugs and alcohol. CBT doesn’t just require clients to confront their pain, shame, and fear. It also equips them with the tools they need to do so in ways that are healthy and healing.
Specifically, CBT approaches are designed to help clients develop better coping skills, improve their resilience, and enhance their sense of self-efficacy (8, 9, 10, 11, 12, 13). As clients gain new perspectives on their past histories and present challenges, the power of these circumstances to harm them wanes, even as the potential for clients to turn them to good grows.
For example, instead of defining a parent’s neglect as a token of some intrinsic unlovability, CBT teaches clients to challenge such false (and destructive) beliefs and to replace them with affirming but authentic thoughts. Thus, a client who had endured neglect as a child may learn through CBT to recognize that this experience was not, in fact, a sign of their unlovability, but of their own strength in surviving and enduring.
This may also be a conduit for healing family relationships, as clients learn to empathize with, or at least to better understand, the parent or relative who has hurt them. They may learn to perceive parental neglect not as an act of malice but as an act of weakness, the hurt inflicted by someone who has been hurt and is perhaps hurting still.
Such a shift in perspective instigates a shift in thought and language. Instead of narrating our life histories as a story of victimization and powerlessness, we can learn to define our pasts as a trajectory of strength, of triumph over adversity. And when you are embarking on the battle against addiction, there is perhaps no weapon more powerful than the ability to define yourself as a warrior, as a fighter strong enough to win any war, including the war with dependency (5, 6, 7).
The Power of Thought and Language
It’s estimated that the human brain processes, on average, around 70,000 thoughts per day, the vast majority of which we are often never even consciously aware of. Yet, even when we don’t really recognize or attend to the countless thoughts that flow through our minds every waking minute of every day, we’re still, nevertheless, profoundly impacted by them. Perception, after all, is reality. Our world lives up to the labels we assign it, even when we’re unaware of when (and how) we’re labeling our world, our relationships, and ourselves.
Such unconscious processes of thought and perception can have a profound and often devastating impact on addiction and recovery. You may not, for instance, realize how often you are undermining or criticizing yourself, how many times per day you’re tainting your hard work with self-doubt, or how frequently you’re projecting fear and anxiety into your vision of the future. When you’re doing your utmost to stay sober, those seeds of doubt, fear, and hopelessness are the very last thing you need.
Enter CBT. The principal mechanisms of CBT are designed to help clients learn to bring often unconscious thoughts to conscious awareness, where they can then be assessed, challenged, and, usually, reimagined or replaced with thoughts that are more accurate, more affirming, and more productive.
Clients engaged in CBT are tasked with keeping “thought journals” to help them track negative and harmful thoughts that arise the instant they occur. This can provide patients with the opportunity to challenge, reject, and replace those thoughts with ones that are healthier and more realistic. In addition, thought-tracking also helps patients better identify environments, interactions, and circumstances that are most likely to contribute to catastrophizing and self-critical thoughts.
For those who are in addiction recovery, the ability to recognize and remediate addiction triggers, as well as emotional and psychological triggers, can be highly effective in helping those in recovery resist the cognitive and behavioral reactions that can lead to relapse. For example, CBT helps patients learn to gain more conscious control over their emotions and the behavioral responses that follow. Because of this, it has been proven to significantly decrease depression and anxiety, both of which often play a leading role in the development and/or progression of addiction (9, 10, 11, 12, 13).
Importantly, CBT has also been shown to be quite effective in group settings (14, 15, 16). As such, it can be an especially beneficial tool for family counseling as a component of addiction recovery. After all, addiction is a disease that doesn’t just sicken the one experiencing the dependency. Addiction infects the entire family, which is the reason why family support and intervention are so critical to long-term sobriety. Family-focused CBT helps each family member learn to re-conceptualize both the family system and the impacts, both past and future, of the addiction on the family. It enables family members to work together to reimagine and redefine their own family role, their familial relationships, and their own identity as individuals and as a part of the family unit. Above all, it enables them to approach this project of reimagining not in relation to addiction, as before, but in relation to new and enduring sobriety.
How Bayshore Can Help
At Bayshore, our multidisciplinary team of mental health experts and addiction recovery specialists is expertly trained and highly experienced in cognitive behavioral therapy (CBT). Our mission is to provide comprehensive, customized, and evidence-based whole-person care to help our clients heal their bodies by transforming their minds, and by rejecting the painful and destructive thought patterns that have galvanized and exacerbated their addiction. As such, we are proud to offer individual, group, and family-based CBT to help our clients and the people they love learn to perceive–and then create–a healthier, happier, dependency-free future. Contact us today to discuss how our Bayshore family can help you or someone you love find hope, health, and healing at last.
