Psychotherapy has a long history that dates back before Sigmund Freud; however, most historians acknowledge that therapy owes its origins to Sigmund Freud who became the first person to regularly use a type of “talking cure” in the treatment of a known mental health disorder. As the field of psychology began to expand, other paradigms became popular, often as a result of dissatisfaction with Freudian psychology.
The paradigm of experimental psychology, which concentrated on empirical validation to test its principles, was fostered by the German psychologist Wilhelm Wundt in the latter part of the 19th century and early part of the 20th century. Both the psychological paradigms of behaviorism and cognitive theory grew out of the notions of experimental psychology. These two paradigms also fostered the development of techniques that were applied directly in psychotherapy and became increasingly popular due to the dissatisfaction with Freudian thought.
Cognitive psychology concentrated on people’s perceptions, beliefs, attitudes, etc., whereas behavioral psychology concentrated on the observable factors that were associated with learning and behavior. Clinicians eventually merged the principles of cognitive therapy and behavioral therapy, resulting in the popular school of Cognitive Behavioral Therapy (CBT).
What Is CBT?
CBT is not a specific type of therapy but rather describes an overall approach to treating individuals. As mentioned above, CBT combines the principles of cognitive therapy (cognitive psychology) and behavioral therapy (behavioral psychology). The result is a number of different types of therapies that focus on understanding how a person’s view of the world influences the way that person behaves.
A number of specific therapies are different types of Cognitive Behavioral Therapies, and they use the general principles combined in cognitive therapy and behavioral therapy. Some of these different types of CBT include:
- Rational Emotive Behavioral Therapy
- Dialectic Behavior Therapy
- Acceptance and Commitment Therapy
- Mindfulness-Based Cognitive Behavioral Therapy
- Specific types of CBT use to treat depression, anxiety and anxiety disorders, eating disorders, and substance abuse and other specific conditions
Even though there is a specific form of CBT that targets substance use disorders, several of the above specialized types of CBT, such as Rational Emotive Behavioral Therapy and Dialectic Behavior Therapy, have also been used to treat substance use disorders.
CBT for Substance Abuse and Addiction
CBT for the treatment of substance abuse specifically targets the individual’s belief system that is related to substance abuse and also targets specific behaviors that exacerbate the substance use disorder (addiction). CBT is a comprehensive but most often time-limited program that addresses the presenting issues that are problematic for the person.
In serious behavioral disorders, such as substance use disorders, the process typically follows an overall plan or program, but it is also individualized to fit the needs of the specific person in therapy. The overall plan presented would be adjusted in practice to fit the specific issues occurring with the person in treatment.
The general plan follows this course:
- Therapists begin by performing an intake interview with clients and learning the reason that clients want to become involved in therapy. During the intake, therapists will typically take a comprehensive life history that includes aspects of clients’ upbringing, education, vocation, physical and mental health history, relationships, and so forth. Therapists will also make sure to thoroughly outline the presenting problem that is the focus of the treatment.
- As part of the overall intake procedure, therapists will create a functional analysis of a client’s substance use to fully understand how the substance use disorder presents itself. This includes understanding the antecedents or predispositions that occur before the individual uses substances (environmental conditions, the individual’s thoughts, the individual’s emotional states, etc.); understanding how the person uses substances (what, where, when, etc.); and understanding the consequences associated with the person’s substance usage.
- As a part of understanding the whole picture, therapists will work with clients to identify beliefs and attitudes towards themselves, their environment (this includes other people, specific situations relevant to them, and so forth), and the future as it relates to them.
- Therapists will take special note of the beliefs of clients that are inconsistent or irrational (e.g., “I can never fail,” or “People must like me.”).
- The therapist and client work together to identify the client’s irrational belief system as relates to the above three factors and how these beliefs are tied into substance abuse.
- After a thorough understanding of the client’s situation, the therapist and client work together to alter unrealistic and irrational beliefs to more realistic beliefs that are more functional (cognitive restructuring).
- The client and therapist work together to practice functional skills, such as remaining abstinent, reducing stress, etc., in the form of practice sessions and homework.
- The therapist and client continue practicing and refining the client’s outlook and behavior.
- Follow up sessions occur as needed.
Is CBT Effective in the Treatment of Substance Use Disorders?
CBT has a large body of empirical evidence that supports its use for a number of different psychological disorders. It has a large foundation that attests to its effectiveness in treating substance abuse and substance use disorders. A large number of clinical texts refer to CBT as the preferred method of therapy in the treatment of substance use disorders. In addition, studies that include long-term follow-ups with the participants indicate that CBT helps individuals develop long-term coping skills to avoid future relapse. Thus, CBT when performed by professional, trained therapists is the first-line treatment for long-term success for individuals with substance use disorders.
CBT can be delivered in either an individual format or in a group format. Thus, it is a versatile type of therapeutic intervention that has been used to treat a number of psychological issues, including substance use disorders.
CBT is also commonly used in conjunction with medical interventions, such as antidepressant medications for people being treated for depression, anti-anxiety medications for individuals being treated for anxiety disorders, and medical treatments for other disorders, such as eating disorders, schizophrenia, and personality disorders. Likewise, CBT can also be used in conjunction with medications that are commonly used in the treatment of substance use disorders. This can include medications that are used during the detox process, such as Suboxone, or medications that are used for longer terms in the treatment of individuals with substance use disorders, such as naloxone to reduce cravings for opioids, Antabuse to assist with curbing alcohol abuse, and other medications.
The research indicates that when CBT and medications are used in combination, the combined effectiveness of using both outweighs the effectiveness of either used separately. However, CBT has the advantage of preparing individuals for long-term recovery, whereas medications are only effective when they are being actively used.
It’s Never Too Late to Get Help
CBT is a type of therapy that combines approaches from behavioral psychology and cognitive psychology. CBT specifically addresses how individuals perceive themselves and their relationship to the world. Viewpoints that are irrational are challenged and functionally changed through a combination of exercises in therapy sessions and homework in the real world.
CBT is effective in treating a number of different psychological issues, and it is often cited as being the preferred therapy in treating substance use disorders. However, CBT is not easy to implement and can only be effectively implemented by individuals who are trained and certified mental health professionals.