Cognitive Behavioral Therapy
Table of Contents
Cognitive behavioral therapy (CBT) can help to actually undo some of the deep patterns, both mental and physical, associated with mental illness and addiction. Addiction and mental illness can cause the mind to take over a person’s actions. It’s a bit like being on autopilot: Instead of examining the internal message the brain might send, the person may just react automatically to every stimulus. These automatic reactions might be harmless, but they also might be incredibly harmful. Sometimes these automatic reactions lead to a relapse.
Cognitive behavioral therapy can help to turn off the autopilot function. Through therapy, the person learns to take control and deal with stimulus in a reasonable, measured and logical way. The methods the person can learn in Cognitive Behavioral Therapy can resonate throughout the rest of the person’s life.
Examining the Unconscious
Cognitive behavioral therapy began through the work of Alan T. Beck in the 1960s. According to the Beck Institute for Cognitive Behavioral Therapy, Dr. Beck noticed that his patients seemed to have two separate conversations during their sessions with him. One conversation took place between the patient and the therapist, while the other conversation was held between the patient and his or her mind. This unconscious conversation could be positive, but often the internal conversation consisted of negative thoughts about the person, the situation or the world. This internal conversation might never be shared, and the person might not even admit that it was happening, but it had a deep impact on how that person responded to a given situation.
A simplistic example might involve chocolate. If a person is shown a bar of chocolate, and the mind responds with, “Wow! A free gift!” the person might feel elated. If another person is shown the same bar of chocolate, but the mind responds with, “You can’t eat that because you’re fat,” that person might feel depressed. The chocolate bar doesn’t change. The presentation doesn’t change. Only the thoughts provided by the two minds differs. Cognitive behavioral therapy aims to change those thoughts.
Changing thoughts can lead to changing behaviors. A person who believes that the world is negative, hurtful or dangerous might always respond with fear. People with mental illnesses or addiction issues might respond to that fear with a return to the addiction or a return to the symptoms of mental illness. To return to the chocolate example, a person who believes that the chocolate is unattainable might compulsively exercise instead, or the person might sink into depression. Later, that person might not even realize that the chocolate was the trigger for those negative actions. After therapy, that person might be able to recognize the negative thought and replace it with a statement that is much more positive. No negative actions would follow, and the downward spiral might be stopped.
Therapists who employ cognitive behavioral techniques attempt to collaborate with their patients. As a prominent psychologist points out in an article in Psychology Today, this doesn’t mean that cognitive behavioral therapists can’t be caring and empathetic. This will always be an important part of the therapist’s personality. But, cognitive behavioral therapists do place a heavy emphasis on forming a partnership and working as a team. The patient is considered the expert on his/her experiences, and the patient drives the therapy to a large extent.
In order to facilitate this sort of ownership, the counselor might ask the patient to outline the goals of the therapy. The therapist might also ask for feedback with questions like:
- What thought just popped into your mind?
- How do you feel about today’s session?
- Is there anything we didn’t discuss that you’d like to bring up?
- How would you like to change your therapy plan?
- How much did I help you today?
- What would you like for me to do differently next time?
People who expect to attend a therapy session and passively receive information might be surprised to learn that they are expected to speak up, to set goals and to give feedback. For some people, this aspect of therapy can be incredibly helpful as it allows them to take ownership of their conditions and take charge of their own care.
Cognitive behavioral therapy also involves a significant amount of homework. Unlike other forms of therapy, in which the person might think about the lessons in therapy but isn’t expected to do much else when not in session, cognitive behavioral therapists often ask their patients to read books, complete surveys, keep journals or perform experiments when they’re not in a session. These homework sessions allow the therapy to continue, even when the person is not in the therapist’s office.
Because cognitive behavioral therapy is based on goals, and a significant amount of work happens outside the therapist’s office, the therapy might take place over a short duration. Unlike other psychotherapy methods that might stretch on for months or even for years, cognitive behavioral therapy is designed to move quickly and terminate in a short period of time. The person learns to be his/her own therapist, making formal therapy less necessary. The person might return for periodic touchup lessons on the items covered in therapy, but it’s unlikely that cognitive behavioral therapy will be provided for years at a stretch.
No Typical Sessions
Describing a cognitive behavioral therapy session is difficult, as most sessions are deeply tailored to the person’s goals for therapy. Often, however, therapy begins with a recap of the previous session and a discussion of the homework. Then, the patient outlines the challenges coming up in the next week, and the counselor and the patient discuss some methods the person can use to deal with those upcoming challenges.
For example, a woman in therapy for alcoholism might mention that she’s been invited to a party. She might state that she’s afraid to go because she knows she won’t have any fun or make any friends unless she has alcohol. Without a drink, she thinks she’s boring or dull. The therapist might stop the woman and ask her to challenge the idea that she’s boring when she’s not drunk. Is she boring at work? Is she boring now? If she realizes that her statement is false, she can move on to the next stage of therapy. She might be taught breathing exercises to use during the party, and she might be encouraged to go to the party for 10 minutes, to put her lessons to use. At her next therapy session, she and her therapist would discuss the party and the lessons she learned.
According to the National Association of Cognitive-Behavioral Therapists, the goal of the therapy is not to keep patients from feeling any emotions at all. The woman in the example above wouldn’t be encouraged to feel asleep or sedated during the party. Her feelings are valid. But, she might be encouraged to be calm and rational when dealing with her emotions. In other words, she is in control.
Who Does It Help?
Cognitive behavioral therapy can be used to treat almost any condition, but according to the website Psych Central, it’s most effective in treating conditions such as:
The therapy has been studied a number of times, and the results have been striking. For example, a study published in the Journal of Counseling and Clinical Psychology found that men who were given cognitive behavioral therapy for gambling held on to their lessons and the gains they made in therapy up to one year later. A similar study published in the Archives of General Psychiatry found that 25 percent of people with depression who were given cognitive behavioral therapy had a relapse of symptoms, compared to 80 percent of people who were not given the therapy. Other studies have demonstrated similar results in addictions.
Cognitive behavioral therapy isn’t a magic bullet, by any means, but it can result in meaningful change, especially if there is only one problem to be dealt with at one time. Multiple problems, all impacting a person at the same time, can make planning a session and developing homework more challenging, and the therapy might take longer to truly be effective. But these are issues therapists can work through in consultation with their patients, and these issues shouldn’t prevent people from getting the care they need.
Preparing for Therapy
The most important step patients need to take to prepare for cognitive behavioral therapy is to find a qualified therapist. If the person is using an inpatient program for addiction or mental illness, this step is relatively easy. In fact, the person might simply be introduced to a therapist as part of the program, and the therapy begins almost immediately. But there may be times when people need to find their own therapists in the communities they live in. Family doctors and caseworkers might be good sources for referrals, and sometimes, insurance plans keep a list of approved providers that can assist with this form of therapy.
Once the therapist is chosen, it might also be beneficial for patients to think about what they’d like to change with their therapy sessions. Asking these sorts of questions might make preparation easier:
- What is one thing I’d like to change about my life?
- Where would I like to be in a month?
- Where would I like to be in a year?
- What challenges do I face before I can reach these goals?
At Axis, we’ve used cognitive behavioral therapy techniques to help some of our residents deal with addiction and mental health issues. We tailor the approach to meet the needs of our residents as individuals, but we maintain a clear focus on the goals of treatment and we adhere to many of the fundamentals outlined above. For more information on our program, and how we integrate this form of therapy into the help we provide to our clients, please contact us.