Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy that teaches people struggling with substance abuse or a substance use disorder (SUD) how to identify connections between how they feel, think, and act.
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What Is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a goal-oriented and problem-focused psychotherapy (talk therapy) where patients talk to a trained therapist in a confidential and safe environment. Multiple individual talk therapy sessions take place throughout the treatment process. 

CBT is a short-term treatment option for a variety of mental health disorders and other issues. However, in terms of drug addiction, it is especially effective in treating people with co-occurring disorders. This is when someone has both a substance use disorder (SUD) and mental health disorder (such as depression). 

This type of therapy teaches those struggling with substance abuse or a SUD 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. 

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What Conditions Does CBT Treatment?

CBT is used to treat many different mental health disorders and other issues, such as:

  • Mental Health Disorders — including depression (most common), bipolar disorders, anxiety disorders, panic disorder, and personality disorders. Those with obsessive-compulsive disorder (OCD) or posttraumatic stress disorder (PTSD) can also benefit from CBT. 
  • Substance Use Disorders (SUD) — a disorder that results in the inability to stop using an addictive substance, whether it be a prescription or illicit drug. An individual with a SUD is physically and mentally dependent on a substance. 
  • Alcohol Use Disorders (AUD) — a disorder that results in the uncontrollable need to drink alcohol in excessive amounts. An individual with an AUD is physically and mentally dependent on alcohol. 
  • Co-Occurring Disorders — this is when a person suffering from a SUD is also diagnosed with a behavioral or mental health disorder.
  • Eating Disorders — common types of eating disorders include anorexia nervosa, bulimia, and binge eating disorder.
  • Other Factors — those who struggle with ADHD, anger issues, marital conflicts, extreme loneliness, fears, and/or phobias may also benefit from CBT. 

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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15 Cognitive Distortions

There are 15 main “cognitive distortions” that can affect anyone during any stage of life. In short, 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 include:

  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 you have a direct impact on external forces, no matter how small the situation is.
  8. Fairness of fallacy is the obsessive concern about “fairness.” These individuals believe everything in life must be fair, which is not possible at all times.
  9. Change fallacy 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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How CBT Works: Two Types of Therapies

During CBT sessions, behavioral therapists create an open environment by asking patients questions about any current and past problems they are dealing with. Then they evaluate this information and provide insight to help each patient cope with their unique situation.

CBT utilizes two separate therapy techniques. This includes cognitive therapy, which means “to recognize” and behavior therapy, which refers to “behaviorism.” 

Cognitive Therapy

Cognitive therapy encourages people to form clear attitudes and expectations around their thoughts. In other words, the primary goal of cognitive therapy is to help people recognize and change dangerous or negative thought patterns. During these sessions, patients learn problem-solving and coping strategies, which allows them to develop more positive thinking patterns over time. 

Behavioral Therapy

The first part of behavioral therapy focuses on identifying any behavioral patterns that may be worsening an individual’s problems. For example, someone with a substance use disorder (SUD) may neglect work, relationships, and hobbies due to excessive drug-seeking. Then, the second part of treatment involves teaching patients how to effectively change these behaviors and replace them with healthier habits. 

Dialectical behavior therapy (DBT) is a common type of behavioral therapy, and involves developing new skills that help people manage difficult emotions. It also helps decrease conflicts in relationships, teaches people how to live in the present, and how to use coping skills to handle stress.

If you have a substance use disorder (SUD), behavior therapy teaches you ways to manage drug cravings. You’ll also learn skills that are helpful in preventing relapse during the recovery process. 

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. 

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Common Techniques of Cognitive Behavioral Therapy

CBT builds a set of skills that enables people to be aware of their emotions and thoughts. It also helps identify how certain situations, behaviors, and thoughts influence their emotions. After these factors are identified, therapists work with each patient to improve feelings by changing these harmful thoughts and behaviors.

There are many techniques used during cognitive behavioral therapy. Some of the most common CBT techniques include:

Cognitive Restructuring

Cognitive restructuring teaches people how to react differently to stressful situations by counteracting stress-generating thoughts and/or cognitive distortions (e.g., filtering and catastrophizing). Psychotherapists typically incorporate self-talk strategies, which teach patients how 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 lead to increased anxiety and may also worsen certain mental health conditions. Exposure therapy techniques help people carefully approach and overcome these fears. The primary technique of exposure therapy is facing and mastering each fear one-by-one until the patient is no longer afraid. 

Behavioral Assignments

Behavioral assignments are completed out-of-office (homework.) They are essential in helping patients establish self-management skills outside of therapy. These assignments usually include:

  • Monitoring emotions, thoughts, reactions, and stressors that trigger negative thoughts and/or behaviors (typically 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

Activity Scheduling

Depending on needs, activity scheduling may be an effective therapeutic tool for certain patients. Specific activities—such as meditation, journaling, daily walks, and/or working on a project—can help people develop positive behaviors and thought patterns. Practicing these activities regularly also teaches you how to create a healthy routine and stay organized. 

Problem-Solving

Problem-solving is another self-management skill patients may learn during CBT. In short, they will learn techniques that help improve decision making, take appropriate actions, and how to create alternative solutions when necessary. This technique also helps people learn how to take responsibility for their actions.

Successive Approximation

Successive approximation is a technique that is especially useful for people who have difficulties completing daily tasks. The inability to complete a task may be due to lack of knowledge or the task may be too difficult or overwhelming for the individual. This CBT technique helps people master easier tasks first and then teaches them how to complete more difficult tasks over time. 

Mindfulness, Breathing, and Relaxation Practices

Mindfulness techniques utilized in DBT may include meditation and yoga. Practicing mindfulness, such as meditation, helps people control negative and/or stressful thoughts by focusing on the present moment. DBT focuses on mindfulness skills used in Buddhism and Zen practices. Each session incorporates a Tibetan singing bowl.

In addition to these techniques, breathing training teaches patients how to control “fight-or-flight” responses in the body. Abdominal breathing and relaxation training is commonly used to treat people with anxiety disorders, especially generalized anxiety disorder (GAD) and panic disorder. 

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Is Cognitive Behavioral Therapy Effective?

Cognitive behavioral therapy is an effective treatment option for people struggling with a substance use disorder and co-occurring mental health disorder. In particular, if you have an anxiety disorder or depression, CBT is often recommended in combination with other treatment techniques. These may include inpatient treatment, outpatient treatment, and medication assisted therapy (MAT) for those with SUD, among others.   

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.

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How Much Does CBT Cost?

Most patients will typically meet with a psychotherapist for between five and 20 weekly or biweekly sessions. Each session takes between 30 and 60 minutes, with an average of 45 minutes per session.

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. And, if you need longer sessions, they may cost extra as well.


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Resources

“Cognitive Behavioural Therapy (CBT).” RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS, www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/cognitive-behavioural-therapy-(cbt).

“25 CBT Techniques and Worksheets for Cognitive Behavioral Therapy.” PositivePsychology.com, 6 Feb. 2020, positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/.

Lipchik, Gay L., et al. “Basic Principles and Techniques of Cognitive-Behavioral Therapies for Comorbid Psychiatric Symptoms Among Headache Patients.” Headache: The Journal of Head and Face Pain, vol. 46, no. s3, 2006, doi:10.1111/j.1526-4610.2006.00563.x.

Watkins, Katherine E., et al. “An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment.” Archives of General Psychiatry, vol. 68, no. 6, June 2011, p. 577., doi:10.1001/archgenpsychiatry.2011.53.

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Updated on: June 24, 2020
Author
Alyssa Hill
About
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Medically Reviewed: April 21, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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