What Is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) tackles negative thought and behavior patterns. 

It’s a short-term treatment option for addiction and various mental health disorders.

People struggling with an addiction often have negative behaviors or mental health disorders that feed into their addictions. 

CBT teaches them how to identify connections between how they feel, think, and act.

The goal is to positively impact a person’s recovery by increasing awareness of these factors.

What Conditions Does CBT Treat?

CBT is used to treat conditions like:

• Mental Health Disorders — CBT can treat a wide range of mental health disorders, including:
  • Depression
  • Bipolar disorders
  • Anxiety disorders
  • Panic disorder
  • Personality disorders
  • Obsessive-compulsive disorder (OCD) 
  • Post-traumatic stress disorder (PTSD)
• Substance Use Disorders (SUD) — This is the technical term for drug addiction. An individual with a SUD is physically and mentally dependent on a substance. This substance can be legal or illegal.
• Alcohol Use Disorders (AUD) — This is the technical term for alcoholism. A person with an AUD has an uncontrollable need to drink in excessive amounts. 
• Co-Occurring Disorders — This is when a person suffers from both mental illness and SUD. CBT is particularly good at treating co-occurring diagnoses.
• Eating Disorders — Examples here include anorexia nervosa, bulimia, and binge eating disorder.
• Other Factors — Some examples are ADHD, anger issues, marital conflicts, extreme loneliness, and various phobias. 

The basic principle of CBT is understanding the connection between how we feel, what we think, and how we behave. All of these factors influence your everyday decisions, actions, and overall well-being. 

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How CBT Works: Two Types of Therapies

During CBT sessions, therapists ask patients questions about any current and past problems they are dealing with. 

They evaluate this information and provide insight to help each patient cope with their unique situation.

CBT involves two separate techniques: cognitive therapy and behavior therapy. 

Cognitive Therapy

Cognitive therapy encourages people to form clear attitudes and expectations around their thoughts. 

In other words, it helps people recognize and change dangerous or harmful thought patterns. 

In CBT, patients learn problem-solving and coping strategies. These strategies allow them to develop more positive thought patterns over time. 

Behavioral Therapy

The first part of behavioral therapy focuses on identifying any patterns in behavior. These patterns may be worsening an individual’s problems. 

For example, someone with SUD may neglect work, relationships, and hobbies to use drugs instead. 

The second part involves teaching patients to change these behaviors, replacing them with healthier habits. 

Dialectical behavior therapy helps decrease conflicts in relationships, teaching people how to live in the present and cope with stress.

If you have a substance use disorder (SUD), behavior therapy teaches you ways to manage cravings. You’ll also learn skills to prevent relapse.

Many people who seek behavioral therapy also struggle with depression or anxiety. If this is the case, you may benefit from learning new breathing techniques. 

These techniques can help calm you down during stressful situations and also prevent anxiety attacks. 

15 Cognitive Distortions

Cognitive distortions refer to irrational thoughts that reinforce negative thinking patterns and behaviors. 

The goal of CBT is to identify these thoughts and come up with effective ways to handle them as they arise. 

These distortions are:

1. Filtering is when you ignore all of the positives and only focus on the negatives.
2. Black-and-white thinking means that your thoughts are either black or white, not gray. In other words, if you perform poorly in one area of your life, you may believe you are a failure in that area.
3. Jumping to conclusions means being sure of something without having any evidence.
4. Overgeneralization is when you take one small incident and use it as evidence for the “bigger picture.”
5. Catastrophizing is believing the worst-case scenario has happened or will happen in the future.
6. Control Fallacy is when you view yourself as a “powerless victim to fate.”
7. Personalization refers to feeling like everything people do is in reaction to you. It’s an example of egocentric thinking. 
8. Fallacy of Fairness is the obsessive concern about “fairness.” These individuals believe everything in life must be fair, which is not possible at all times.
9. Fallacy of Change is when someone believes his or her happiness depends on how other people are feeling.
10. Mislabeling is when you generalize one or two scenarios into a complete judgment. If you fail at one task, you may believe you are a failure in all areas of life.
11. Heaven’s Reward Fallacy is when someone believes self-denial and sacrifice will pay off.
12. Blaming is when someone blames others for what is going wrong or went wrong in the past.
13. Always having to be right and thinking it is unacceptable to be wrong.
14. The “shoulds” means believing you should have done something and things would have turned out differently.
15. Emotional Reasoning means acting on emotions rather than facts.

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Common Techniques of Cognitive Behavioral Therapy

There are many techniques used during cognitive behavioral therapy. 

Some of the most common techniques include:

Cognitive Restructuring

Cognitive restructuring teaches people how to counter cognitive distortions. 

Psychotherapists typically incorporate self-talk strategies. These teach patients to identify irrational statements and replace them with realistic, positive statements. 

Exposure Therapy

In most cases, fear makes people avoid uncomfortable situations. However, avoiding these situations can increase anxiety and worsen certain mental health conditions. 

Exposure therapy techniques help people carefully approach and overcome these fears. 

This is done via the patient facing and mastering each fear one-by-one until they are no longer afraid. 

Behavioral Assignments

Behavioral assignments are completed out-of-office on the patient’s own time. 

Sort of like homework assignments, they teach patients valuable self-management skills for outside of therapy 

These assignments usually include:

• Monitoring negative thoughts and emotions and things that trigger them. Observations are recorded in a journal.
• Practicing relaxation techniques, cognitive restructuring techniques, and problem-solving skills learned during CBT sessions
• Incorporating and tracking lifestyle changes, such as healthy eating and exercise routines

Problem-Solving

This involves learning techniques to improve decision-making and find alternative solutions when needed. 

Patients also learn how to take responsibility for their actions.

Successive Approximation

Successive approximation is especially useful for people who have difficulties completing daily tasks. 

There are various reasons an individual may find it hard to complete a task. They may not know how to do it or find the task overwhelming.

This technique has people do small portions of the task. 

For example, someone who is anxious about writing an essay may start by simply listing out some ideas to talk about. 

Then, they may organize those ideas into an outline, and so on. 

Small steps like these help to build confidence and avoid frustration.

Activity Scheduling

Depending on needs, activity scheduling may be an effective therapeutic tool for certain patients. 

Specific activities can help people develop positive behaviors and thought patterns. 

Examples of these include:

• Meditation 
• Journaling 
• Daily walks
• Hobbies or projects

Practicing these activities regularly also teaches you how to create a healthy routine and stay organized. 

Mindfulness, Breathing, and Relaxation Practices

Mindfulness techniques utilized in DBT may include meditation and yoga. 

Practicing mindfulness helps people control negative or stressful thoughts by focusing on the present moment. 

Breathing training teaches patients how to control “fight-or-flight” responses in the body. 

Abdominal breathing and relaxation training is used to treat people with anxiety disorders and panic disorders. 

Skills for Managing Triggers

CBT techniques can also be practiced outside the therapist’s office. Patients can perform many CBT exercises alone, from home, or in a group setting.

Addiction support groups such as the Self-Management and Recovery Training (SMART) also include CBT practices in their self-help exercises to encourage continued sobriety and recovery.

Recognize

Identify which situations and circumstances lead you toward drug or alcohol use.

Avoid

Remove yourself from triggering situations whenever possible.

Cope

Use CBT techniques to address and deal with emotions and thoughts that lead to substance abuse.

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Is Cognitive Behavioral Therapy Effective?

CBT is an effective treatment option for people struggling with SUD and co-occurring mental health disorders. 

For anxiety or depression, CBT is often recommended in combination with other treatment techniques.^{3, 4}

These include inpatient and outpatient treatment, along with medication-assisted therapy (MAT) for those with SUD.     

CBT is the most effective psychological treatment option for moderate and severe depression. It is also useful if you are also struggling with a substance use disorder (SUD) and co-occurring depression.

How Much Does CBT Cost?

Patients meet with a psychotherapist for between five and 20 weekly or biweekly sessions.

One CBT session is about 45 minutes, and the cost per session depends on the type of therapist (pre-licensed vs. licensed CBT therapists). 

On average, each session costs between $140 and $290. The first appointment is typically more expensive. Longer sessions may cost more.

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