What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is one of the most common treatments used by rehab facilities within the United States. For example, in the 2011 Survey of Substance Abuse Treatment Services, 91 percent of facilities that responded admitted that they used CBT in order to help their clients. People who know about this treatment may not be surprised to learn that its use is so common. In fact, they might be surprised that some facilities don’t use this treatment, since it has such a proven ability to help people to improve.

Short and Focused

In a traditional therapy arrangement, a client agrees to spend a lengthy amount of time in treatment, delving into the past in order to understand the present. While this kind of in-depth analysis can certainly be helpful for people with specific kinds of illnesses and issues, it’s not the right approach for all people who are struggling with their lives. Some people might even resist the idea of entering treatment altogether, if they thought they’d have to spend decades working on their problems. CBT might be perfect for clients like this, as it’s a therapy that’s intended to move quickly and bring about big changes within a short period of time.

CBT practitioners focus on the issues the client is dealing with right now, in the exact moment in which the person enters the treatment room. The past may be important, but it’s the person’s reactions that take place in the present that’s the focus of the therapy. By changing the way the person reacts, and perhaps the way the person thinks, the therapy hopes to change the way the person feels.

The National Association of Cognitive Behavioral Therapists reports that the average number of CBT sessions given to a client is 16. Some clients may need more, while some may need less, but it’s clear that this isn’t a therapy that lasts for years. Instead, it’s a therapy that’s designed to help people move past a very real obstacle in the present, and get on with their lives in no time at all.

Typical Structure

In a CBT session, therapists attempt to help clients see that they can amend their reactions to outside stimulus, even if they can’t amend that stimulus at all. It sounds like a very complicated concept, but in essence, it’s quite simple. For example, some people may resist the idea of going to an office when they’re sober as they may:

• Believe that everyone is watching them
• Feel convinced that they’ll make a mistake
• Seem stiff and awkward
• Move slowly and make mistakes

All of these outcomes may become a reality, but they could just as easily never come to fruition. A therapist can help clients to really examine their thoughts pertaining to work and change those thoughts. Is it likely that the poor outcomes will become truth, or is it remotely possible that something else could happen? Is it worth experimenting in order to see how likely that poor outcome might be?

Therapists who use CBT tend to ask a lot of questions, instead of making a lot of proclamations. They’re interested in what the client wants to change and what the client thinks, not what the therapy community thinks is true and what the experts say should change. By asking pertinent questions and supporting learning, CBT therapists hope to bring about the changes clients want in their own lives.

Some CBT therapists also incorporate meditation and body awareness into their therapies. Some people who enter CBT are very out of touch with the messages their bodies would like to deliver, and they remain trapped in a cycle of destruction as a result. By learning how to meditate, clients may learn how to calm their minds without using drugs or other substances, and by focusing on body awareness, they can learn how to spot symptoms of distress from the subconscious, long before they rise to the level of consciousness. When these symptoms are spotted early, it’s easier to control them without relying on quick fixes like drugs and alcohol.

CBT is sometimes provided in private sessions between a counselor and a client, but the treatments are also effective when they’re provided in group settings. The therapist might remain firmly in charge, but all the participants in the group might have their own contributions to make to the healing process, and the group may also provide people with the opportunity to practice their newfound skills. In some cases, this can be more effective than therapy provided on a solitary basis.

Common Targets for CBT

As mentioned, this therapy is commonly provided to people who have addictions. The treatment can help people to understand why they might lean on drugs and alcohol in order to soothe their minds, and the therapy can help people learn how to control their minds without relying on any substances at all. The therapy can, in short, help people to take control, and it’s a valuable part of any addiction program as a result. But the therapy can be even more meaningful to people who have mental illnesses as well as addiction.

For many people, a mental disorder starts them down an addictive path, as they lean on addictive substances in order to keep their mental distress under control. For people like this, real healing can’t take place until both the mental illness and the addiction are addressed. CBT can do just that.

Since CBT sessions are customized based on the needs of clients in care, therapists can tweak the sessions in any way that might seem beneficial. For clients who have addictions to sleeping medications, for example, the therapy might incorporate new methods clients can use in order to prepare for bed, along with techniques they can use when their minds become fixated on the idea that sleep will never come. According to a study on the effectiveness of CBT in people with sleep difficulties, as quoted by the National Alliance on Mental Illness, people who get this therapy tend to do better than people who don’t get the therapy. For some, it can make a real difference.

CBT can also be useful in the fight against depression, as the treatment can help people to shut out an inner negative voice that tells them they’ll never succeed and never improve. The treatment can also help people to focus on their strengths and their talents, rather than on their failings and limitations, and this can also help distress to ease. In a study of the effectiveness of CBT in people with depression, published in the Journal of Consulting and Clinical Psychology, researchers found that depression levels in people who got the treatment went from moderate at the beginning of therapy to non-existent at the end, and these benefits were maintained when treatment was over. If these people were medicating their depression with substances, the therapy might have helped them to break that link.

People with anxiety disorders seem to be especially helped by CBT. In fact, some CBT practitioners use a specific type of modified CBT in order to help their clients. Here, clients are slowly but surely reintroduced to the items that provoke their anxiety, all while the therapist remains on hand to ensure that nothing negative happens.

People with phobias of crowds, for example, might be asked to:

• Look at pictures of crowds
• Watch videos of crowds
• Stand across the street from a crowd
• Stand on the edge of a crowd
• Walk through a crowd
• Stand in the middle of a crowd

This gradual exposure can reduce the amount of anxiety the person feels, and it can allow people to do things their fears have kept them away from for decades. In a study of CBT for people with anxiety, in the Journal of Consulting and Clinical Psychology, researchers found that only 8 percent of people given this treatment still had signs of anxiety when the treatment was over, compared to 83 percent of people who were given another kind of therapy. Again, if people had been sedating their anxiety with drugs and alcohol, this therapy could break that link.

Finding a Fit

Just because CBT is a helpful intervention for some people doesn’t mean that it will work for everyone, or that it might be the only treatment used in a fight against a mental illness and/or an addiction. For example, in a study in the journal Addiction, researchers found that stimulant users were likely to drop out of their CBT sessions, even though they could be helped by those sessions. Here, researchers had to provide prizes in order to encourage people to complete their therapy sessions. A little creative thinking like this might be needed, in order to ensure that people get the benefits of this therapy.

At The Orchid, we provide CBT for our clients, but we also believe in providing individualized therapies for all of our clients. We sometimes find that some clients don’t benefit from this therapy, or that another approach might work a little better for them. When this happens, we adjust our treatment programs accordingly, in order to help our clients find the healing deep inside them. For us, personalized care is key to success. If you’d like to find out more about our work, and how it might help you, please call.