How Can We Apply CBT to Addiction Treatment?
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that has been applied to a variety of mental health disorders, including depression, anxiety, PTSD, and psychosis, among others. How can cognitive behavioral therapy help you?
About Cognitive Behavioral Therapy
CBT is a present-focused, action-oriented therapy that involves dealing with symptoms you’re struggling with right now. And, ultimately, how it relates to your past. CBT emphasizes the connection between thoughts, feelings, and behaviors. For example, if I feel depressed, it is often related to my thoughts of “I’m not good enough.” The behaviors associated with these thoughts and feelings are to isolate, avoid, or drink, etc..
Engaging in such behaviors often can make those thoughts and feelings better in the short term, but much worse in the long term, leading to cumulative stress. Cognitive behavioral therapy teaches different skills to better manage our thoughts and behaviors. One particular skill is the importance of gaining a greater awareness of our automatic thoughts so we can examine both the accuracy, as well as the helpfulness, of such thoughts.
Automatic Thoughts and Addiction
When it comes to substance use disorders and addiction, there can be a lot of automatic thoughts that might get in our way. Cognitive behavioral therapy can help you begin to change these painful automatic thoughts. Do any of these sound familiar to you?
- “I can’t handle this!”
- “This craving will never end.”
- “I need a hit to calm down.”
- “I’m worthless.”
- “Everything is a trigger.”
- “I can’t change it.”
There can be a wide range of thoughts like these, but all of them point to a smattering of automatic thoughts that may come up when faced with stressors, triggers, or cravings to use. These thoughts are closely connected to our feelings and, most of all, our behaviors.
Although it can be difficult to change a feeling, we can begin to examine the thought underlying the feeling, including those mentioned above. The two things we want to do when examining these thoughts are ask ourselves:
- Is this accurate (on a scale from 0-100%)?
- Is this helpful (on a scale from 0-100%)?
Our goal is not to get us to a utopian kind of thought, such as, “I will never have a craving.” Or, “I can do anything.” Instead, we aim for accuracy. This allows us to move the needle away from catastrophizing, and into more realism. So instead of the thoughts listed above, what about…
- “This is challenging. I’ve done hard things in the past and I can work on figuring out ways to handle this.”
- “I know that cravings generally last 20 minutes.”
- “I have to remember that although it may calm me down in the short term, it won’t in the long term.”
- “I may have done things I haven’t been proud of, but I have also done some pretty awesome things too.”
- “Although it may feel that everything is a trigger, there are safe places that I have also created for myself at various points in my life, and I can work on fostering those.”
- “It may be difficult, but I can take one step at a time towards change.”
Balance, Not Perfection
Again, we’re not looking for perfection. We’re just looking for a more balanced perspective on the situation. But we can’t move towards that balance if we don’t first break down the thought that’s actually underlying the stressor.
It’s not (at first) intuitive to think about our thoughts, but it’s possible with practice. I will say for me personally, I often recognize the feeling first and have to ask myself, “What’s my mind telling me that is making me feel this way?”