If you or a loved one has been diagnosed with substance use disorder, cognitive behavioral therapy, or CBT, maybe one treatment option that you have been offered. This type of therapy is often recommended either alone or in combination with other treatments, such as medications, residential treatment, or outpatient treatment. Before you decide on a treatment method that is best for you or your loved one, it is important to understand what CBT is, how it works, its advantages, and its limitations so that you can make the best choice.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is sometimes referred to as talk therapy. CBT has its roots in Dr. Sigmund Freud’s psychoanalysis techniques in the early 1900s, but the form that is most familiar today began to take shape in the 1950s and 1960s. Talk therapy centers on allowing a patient to identify the beliefs that lead to the behaviors that he or she wishes to change and developing coping mechanisms to help him or her change those thoughts to ones that bring more productive behaviors.

Identification of the beliefs and thoughts behind the behavior is the foundation of the therapy. Aaron Beck was one of the first to use cognitive therapy in a form that is familiar today. Beck’s work focused on identifying what he considered to be illogical thought patterns that are self-defeating in people with anxiety or depression. The therapy focused on helping people change the underlying beliefs that lead to unwanted behaviors. This is still the basis for cognitive behavioral therapy today.

What Is Involved in CBT Today?

Over the years, CBT has developed into a form that is one of the most widely used therapies for a number of mental health issues. CBT has been used effectively for anxiety, phobias, depression, and substance use disorder. It has been used in a wide range of ages from youngsters to older adults and for people from many different backgrounds.

The treatment can involve individual counseling sessions, group therapy and interventions, family therapy, and counseling, and it can occur with or without the use of medication. The process begins with an initial consultation where the goals, resources, and challenges of the person are identified. This consultation leads to the development of a strategy that will be used to encourage steps toward the desired behavioral changes. The therapy occurs in a stepwise process until the person can build the skills that he or she needs to manage the behavior on his or her own.

What Are the Steps Involved in Cognitive Behavioral Therapy?

The first step is the assessment. Typically, this is the only thing that is accomplished during the first few sessions of therapy. However, cognitive behavioral therapy steps cannot be thought of as having a definitive beginning and end. The therapy is more like a gradual transition from one part of the process to the next, and the evaluation process is an ongoing theme that carries throughout the course of therapy. During the assessment phase, the therapist will identify the social and environmental factors, emotional factors, financial factors, and physical factors that may influence what represents an effective course for the individual.

During this early phase, the therapist will focus on identifying high-risk situations that may lead to engagement in substance use behaviors. The therapist will try to understand whether a substance is used to enhance positive social activities or if it is used to cope when situations become difficult. Identification is a highly individualized process that is adjusted to meet the needs and situations of the individual.

Once the strengths and challenges have been identified, the process moves to identify coping and motivational strategies that can be used in high-risk situations for substance use to occur. This can involve rehearsing behaviors and identifying thoughts that may stand in the way of avoiding substance use. Examples of these thoughts include, “I will use it just once more and then give it up,” “One more won’t hurt me,” or “Why even try?” Through identifying these thoughts, strategies can be developed to help turn them into something more positive that is more likely to lead to the ability to resist substance use.

CBT involves restructuring the thought processes and developing skills that can be used outside of the treatment setting. In some cases, a system of rewards may be used when the person successfully avoids substance use. Avoiding exposure to the instruments and implements of substance use is almost always a part of the treatment process. This may mean restructuring daily routines, changing environments, and learning to build skills.

Group sessions are often used to help a person feel as if he or she is not alone. Hearing the experiences of others can sometimes help a person to have hope and to understand how to use the coping mechanisms learned in individual sessions. The social support of the group can be a powerful instrument by building a system of support among those who have been there and who still are going through similar circumstances.

How Long Does Cognitive Behavioral Therapy Take?

A therapist has many techniques at his or her disposal to help change behaviors and thoughts surrounding substance use. The question that almost everyone wonders is how long the process will take. The problem is that there is no easy answer to this question. People come to CBT with different strengths and challenges to overcome.

The CBT process is not set in stone and sometimes changes, and adaptations need to be made along the road as new information is discovered. Sometimes, situations change that may affect the course of treatment. In addition, many times a therapist will discover that one technique works better than others. Therefore, cognitive behavioral therapy develops according to many different factors along the way.

One of the strengths of this type of therapy is that it has the ability to adapt to the individual and to things that may change or come up during the course of therapy. One of the disadvantages is that it is difficult to determine exactly how long therapy will take because it is such a highly individualized process. The adaptive component of talk therapy is one of the reasons why it has demonstrated such success in a wide variety of populations and mental health challenges.

Another component of cognitive behavioral therapy is that sometimes there are situations that need to be addressed, such as family difficulties, unemployment, a lack of social networks, difficulties with the legal system, and other mental health or physical challenges that may be present. The therapy does not occur in a vacuum, and the therapist will try to identify all of the needs of the individual and get him or her to the appropriate help to manage these other situations. This is another advantage of CBT. It seeks to treat the whole person rather than only the substance use disorder in isolation.

How Well Does CBT Work?

Cognitive behavioral therapy has proven to be highly effective in treating substance use disorder. When used in this context, strategies are developed to help a person avoid relapse and to address a whole range of problems that a person may have. The focus of the therapy is on building skills. As with any new skill, learning and applying take time and practice. However, a patient does not walk alone and has a whole network of people to help along the way.

CBT is an addiction therapy that focuses on getting better at recognizing cravings early, identifying situations that might put a person at risk, and developing strategies for avoiding or coping with these situations when they occur. Just as with any new skill, these must be practiced over time until the skills become strong enough for a person to use them without assistance. The focus is on the positive aspects and successes throughout the course of therapy. Setbacks are considered a natural part of the process and are not punished or viewed in a negative light. Instead, they are seen as opportunities to make improvements and to do better the next time.

The process of CBT is focused on giving a person the skills that he or she can use throughout the rest of his or her life. The therapy will not end until the person is successfully self-monitoring and coping with instances that could lead to relapse. This is why cognitive behavioral addiction therapy is considered one of the more long-lasting therapies that helps build skills that will last a lifetime. If a relapse does occur after treatment has been discontinued, it is always possible for you to go back and pick up where you left off. It is a chance to evaluate what happened and develop strategies to do better the next time.

Things to Remember

If you are considering CBT, one of the most important things to remember is that this is a marathon, not a sprint. It is a journey filled with triumphs and challenges along the way. The best part is that you do not have to walk this journey alone because one of the steps along the process is building a support network that can help encourage you and guide you along the way.

Cognitive behavioral therapy is about focusing on the positive and helping develop strategies for coping with the negative. It focuses on building up a person, including his or her self-esteem and self-confidence. It is not isolated or only focused on substance use behaviors. Instead, CBT focuses on helping you visualize your future in a positive way through all aspects of life.

Many people find this type of therapy to be a positive and rewarding experience. It gives them a chance to explore parts of themselves that they never knew existed. It helps them dig deep inside and discover strengths that they never knew they had. Because CBT focuses on the whole person rather than just a part, the therapy often leads to unexpected growth and new discoveries about yourself. Many of the techniques can also be applied to other areas of life. Once you learn coping mechanisms for avoiding substance use, the same techniques can be applied to losing weight, starting an exercise program, building relationships, and learning new skills or hobbies. In these ways, cognitive behavioral therapy can provide many opportunities for self-discovery.

The goal of CBT is to give you the skills that you need to cope with your target behaviors, but it also has an effect on making positive changes in your whole person. It is about building on the strengths and minimizing the weaknesses. No one said that the journey will be easy, and there will certainly be challenges along the way; however, in the end, many say that cognitive behavioral therapy was all worth it. Sometimes, your greatest challenges in life can end up being your greatest triumphs in the end.

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