Behavior Therapy

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Recognize, Avoid and Cope

Cognitive behavior therapy is mostly used to treat depression, anxiety disorders, phobias, and other mental disorders, but it has also been shown to be valuable in treating alcoholism and drug addiction, especially as part of an overall program of recovery.
Cognitive-behavioral coping skills treatment is a short-term, focused therapeutic approach to helping drug-dependent people become abstinent by using the same learning processes the person used to develop alcohol and drug dependence initially.


What Is Cognitive Behavior Therapy?

Cognitive behavior therapy is based on the idea that feelings and behaviors are caused by a person's thoughts, not on outside stimuli like people, situations and events. People may not be able to change their circumstances, but they can change how they think about them and therefore change how they feel and behave, according to cognitive-behavior therapists.
In the treatment for alcohol and drug dependence, the goal of cognitive behavioral therapy is to teach the person to recognize situations in which they are most likely to drink or use drugs, avoid these circumstances if possible, and cope with other problems and behaviors which may lead to their substance abuse.


What Are Other Approaches to Cognitive Behavior Therapy?

According to the National Association of Cognitive-Behavioral Therapists, there are several approaches to cognitive-behavioral therapy, or CBT as it is called, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.

What Are the Components of Cognitive Behavior Therapy?

In its use to treat alcohol and drug-dependence individuals, cognitive behavior therapy has two main components: functional analysis and skills training.
Functional Analysis: Working together, the therapist and the patient try to identify the thoughts, feelings and circumstances of the patient before and after they drank or used drugs.

This helps the patient determine the risks that are likely to lead to a relapse.
Functional analysis can also give the person insight into why they drink or use drugs in the first place and identify situations in which the person has coping difficulties.

Skills Training: If someone is at the point where they need professional treatment for their alcohol or drug dependence, chances are they are using alcohol or drugs as their main means of coping with their problems. The goal of cognitive behavior therapy is to get the person to learn or relearn better coping skills.

The therapist tries to help the individual unlearn old habits and learn to develop healthier skills and habits. The main goal of cognitive behavior therapy is to educate the alcohol or drug-dependent person to change the way they think about their substance abuse and to learn new ways to cope with the situations and circumstances that led to their drinking or drugging episodes in the past.


How Long Does Cognitive Behavior Therapy Take?

Because cognitive behavior therapy is a structured, goal-oriented educational process focused on the immediate problems of the alcohol or drug-dependent patient, the process is usually short-term. Although other forms of therapy and psychoanalysis can take years, cognitive behavior therapy is usually completed in 12 to 16 sessions with the therapist.

How Effective Is Cognitive Behavior Therapy?

According to the National Institute on Drug Abuse, more than 24 randomized controlled trials have been conducted among users of tobacco, alcohol, cocaine, marijuana, opiates, and other types of substances, making cognitive-behavioral treatments one of the most frequently evaluated psychosocial approaches to treat substance use disorders.
In these studies, cognitive behavior therapy has been shown most effective when compared with having no other treatment at all. When compared with other treatment approaches, studies have had mixed results -- some show cognitive behavior therapy more effective while others show it to be of equal, but not greater, effectiveness than other treatments.

As with other treatments for alcoholism and drug abuse, including pharmaceutical treatments, cognitive behavior therapy works best when combined with other recovery efforts, such as participation in support groups.

In short, behavior cognitive therapy works well for some, but not for everyone, as is the case with all alcoholism and drug treatment approaches.

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Underlying Theory of Rational Emotive Behaviour Therapy

Rational emotive behaviour therapy ('REBT') views human beings as 'responsibly hedonistic' in the sense that they strive to remain alive and to achieve some degree of happiness. However, it also holds that humans are prone to adopting irrational beliefs and behaviours which stand in the way of their achieving their goals and purposes. Often, these irrational attitudes or philosophies take the form of extreme or dogmatic 'musts', 'shoulds', or 'oughts'; they contrast with rational and flexible desires, wishes, preferences and wants. The presence of extreme philosophies can make all the difference between healthy negative emotions (such as sadness or regret or concern) and unhealthy negative emotions (such as depression or guilt or anxiety).

For example, one person's philosophy after experiencing a loss might take the form: "It is unfortunate that this loss has occurred, although there is no actual reason why it should not have occurred. It is sad that it has happened, but it is not awful, and I can continue to function." Another's might take the form: "This absolutely should not have happened, and it is horrific that it did. These circumstances are now intolerable, and I cannot continue to function." The first person's response is apt to lead to sadness, while the second person may be well on their way to depression. Most importantly of all, REBT maintains that individuals have it within their power to change their beliefs and philosophies profoundly, and thereby to change radically their state of psychological health.

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Dialectical Behavioral Therapy

Marsha Linehan (1991) pioneered this treatment, based on the idea that psychosocial treatment of those with Borderline Personality Disorder was as important in controlling the condition as traditional psycho- and pharmacotherapy were. Concomitant with this belief was a hierarchical structure of treatment goals. Paramount among these was reducing parasuicidal (self-injuring) and life-threatening behaviors. Next came reducing behaviors that interfered the the therapy/treatment process, and finally reducing behaviors that reduced the client's quality of life. In 1991, Linehan published results of a study that seems to do remarkably well at achieving these goals.

The Theory

Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
How it works
Dialectical Behavioral Therapy (DBT) consists of two parts:
Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:

Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
(Linehan, 1991)
DBT targets behaviors in a descending hierarchy:
decreasing high-risk suicidal behaviors
decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
decreasing behaviors that interfere with/reduce quality of life
decreasing and dealing with post-traumatic stress responses
enhancing respect for self
acquisition of the behavioral skills taught in group
additional goals set by patient
Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

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Cognitive-Behavioral Therapy (CBT)
(Rational Emotive Therapy, Rational Behavior Therapy, Rational Living Therapy, Dialectic Behavior Therapy, Schema Focused Therapy)

En Español (Spanish Version)

Definition
Cognitive-behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings, and actions with a mental health professional. CBT focuses on how the way you think affects how you feel and how you act.

For example, a situation may be perceived in a positive way by one person, enhancing his/her well-being, but may be perceived in a negative way by another person, contributing to feelings of sadness or anxiety. Your therapist helps you identify negative thoughts and evaluate how realistic these thoughts are. Then, he or she teaches you to “unlearn” negative thought patterns and “learn” new, helpful ones.

CBT is a problem-solving approach. You cannot control other people or situations, but you can control the way you perceive and react. CBT teaches you the skills to change your thinking and manage your reactions to stressful people and situations.

Reasons for Procedure
Cognitive-behavioral therapy is used to treat many health concerns. These include:

Depression and mood swings
Anxiety disorders, including social anxiety, extreme shyness, and extreme worry
Difficulty managing stress
Panic disorders
Phobias
Posttraumatic stress disorder (PTSD)
Childhood depressive and anxiety disorders
Obsessive-compulsive disorder (OCD)
Eating disorders, including anorexia nervosa, bulimia nervosa, and obesity
Insomnia and other sleep problems
Substance abuse, codependency, or enabling
Schizophrenia
Chronic pain
Difficulty with relationships
Low self-esteem
Poor coping skills
Uncontrolled anger or passive aggression
Risk Factors for Complications During the Procedure
CBT may not be appropriate for people with certain conditions:

Psychotic or bipolar disorders that are not controlled by medication
Lack of stable living arrangements
Unstable health problems
What to Expect
Prior to Procedure –
There is no specific preparation for CBT. You may be asked to fill out a questionnaire about your feelings.

Description of the Procedure –
You may receive CBT in one-on-one therapy sessions or in a group format.

CBT can be divided into two parts: functional analysis and skills training.

In functional analysis, you and your therapist identify stressful situations. You also determine the thoughts that lead to or worsen these situations. These thoughts are then analyzed to see if they are realistic and appropriate. For example, your therapist may point out negative thought patterns, such as “I can’t handle this” or “people are laughing at me.”

Next, through skills training, your therapist guides you to reduce unhealthy ways of thinking, and to learn healthier ways. Instead of thinking “I can’t handle this,” you will learn to draw on your strengths: “I’ve handled difficult situations before, so I can handle this one.”

You’ll also learn to ask more questions about yourself before making a conclusion. For example, “Could those people be laughing at something other than me?” The goal is to replace irrational responses with appropriate and rational ones.

Skills training takes a lot of practice, which is often given as “homework.” You might practice deep-breathing exercises or role-play how to act in certain social situations. A person dealing with substance abuse might practice ways to decline an alcoholic drink.

Homework is vital to the success of CBT. You must practice new, rational responses until they replace your previous, unhealthy responses. Homework also allows you to try new skills and give feedback to your therapist on which work best for you.

After Procedure –
You may be given homework to do between sessions. You’ll need to practice the strategies you and your therapist have discussed.

How Long Will It Take –
The length of an individual session is usually 60 minutes. Group sessions may last for 90 minutes. Treatment sessions may occur one to two times per week for 12-16 weeks. This is a general guideline, depending on your situation, treatment may be longer or shorter.

Keep in mind it may take several tries to unlearn poor habits and to learn healthier ones.

Possible Complications –
There are no known complications to CBT.

Average Hospital Stay –
CBT is usually done on an outpatient basis. This may be in a therapist’s office or in a community health center.

Post-Therapy Care –
Some therapists advise that you return for a check-up about 3, 6, and 12 months after therapy has ended. In addition, you may call your therapist whenever the need arises.

Outcome
The goal of CBT is to change your thought process to allow healthful and realistic responses to difficult situations. Many patients notice an improvement in their symptoms within 3-4 weeks of beginning CBT and doing their “homework.”

Call Your Doctor If Any of the Following Occurs
If the thoughts, feelings, or other difficulties that led you to seek therapy are returning or worsening, call your doctor. If you have thoughts of hurting yourself or others, call your doctor or 911 immediately.