Cognitive-Behavioral Therapy
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.In the 1950s, Albert Ellis, Ph.D., developed Rational Emotive Behavioral Therapy (REBT; Ellis, 1962). Ellis recognized that our beliefs influence our interpretations of events. Our unique interpretations of events subsequently give rise to our feelings and behaviors. The idea that beliefs affect feelings is over 2000 years old. An early statement of this concept was made by Epictetus (c. 60-138 CE): "Men are disturbed not by things but by their views of them."
Many people incorrectly believe events cause their reactions. Our beliefs cause our thoughts and feelings, not the event itself. Let's return to a previous example to illustrate this point. Suppose you are walking through a crowd of people and someone steps on your foot. If you believe the person did this intentionally, you will likely feel angry, perhaps even hostile. You might push the foot-stepper, or call him a nasty name. On the other hand, if you believe, the foot-stepper is merely clumsy you will feel quite differently. Notice the exact same event "caused" two completely different sets of thoughts and feelings. The only thing that changed was the belief about that event.
Ellis was particularly interested in beliefs that represented irrational absolutes. "Everyone must like me in order for me to be happy." "Life should always be fair." Ellis created a series of exercises and techniques to assist people to identify and change beliefs that Ellis termed irrational, or unhelpful. For instance, using REBT someone might recognize an irrational belief such as, "I must have a drink in order to relax" or "I can't tolerate this craving." A person might challenge these beliefs to evaluate whether they are true and accurate. If a belief is false, a therapist assists a person to reframe the belief so that it is more rationale and accurate. "I might like a drink but there are many ways for me to relax. I can also go for a run or play with my kids." "This craving is annoying and uncomfortable but it will soon pass."
Around the same time that Ellis was perfecting his method of REBT, Aaron Beck, M.D., was developing Cognitive Therapy (CT; Beck, 1975). CT initially focused on identifying fleeting, inaccurate, "distorted" thoughts. These are also known as cognitive distortions. A common type of cognitive distortion is called black or white thinking. People with this type of distortion tend to see things as either-or (but not both, or neither). You can imagine how this might cause some difficulty. "Either my wife loves me, or she hates me." This rather extreme belief would cause this man to frequently misinterpret his wife's behavior. Suppose this man's wife forgot they had a date for dinner. Rather than being understood as a momentary lapse, or an inconsiderate gesture, it would become proof-positive his wife doesn't love him.
Both Ellis and Beck addressed thoughts and beliefs. They each devised ways to help people to change beliefs and thoughts into more helpful and accurate ways of perceiving the world. Ellis focused more on global, all-encompassing irrational beliefs. His goal was to change these into new, more rational beliefs. Beck focused more on moment-to-moment distorted thoughts. His goal was to change these distorted patterns of thought into more realistic and logical patterns. Overtime, psychologists blended these two because they were so similar. Nowadays, we simply call this type of therapy Cognitive-Behavioral Therapy (CBT)
Since the original formulation by Beck and Ellis, researchers continued to study CBT and further refine it. Psychologists also developed many effective hybrids such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT). Ongoing and continuous research established CBT as an evidence-based practice for a variety of common disorders (anxiety, depression, addiction). CBT is perhaps one of the most well studied types of psychotherapy. This is partially due to the fact it is easily studied. This is because it can be accurately and simply described ("manualized"). There is debate about whether CBT is the most effective form of psychotherapy, or simply one of the most studied. As these debates continue, it is safe to conclude that CBT is a highly effective therapy for addiction.
CBT strengthens the motivation to abstain from addictive substances or activities. It teaches participants successful cognitive and behavioral coping strategies. Compared to other forms of psychotherapy CBT is a short-term therapy. The typical CBT treatment lasts about three months, but shorter treatment can also be helpful. Several different teams of researchers have developed brief, computer-based CBT interventions for addiction and other disorders.
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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What Causes Addiction?
- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
- Biological Causes of Addiction
- Disease Model of Addiction and Recovery Implications
- Evolutionary Model of Addiction and Recovery Implications
- Psychological Causes of Addiction
- Learning Theory of Addiction and Recovery Implications:
- Social Learning Theory of Addiction and Recovery Implications
- Cognitive (Expectancy) Theory of Addiction and Recovery Implications
- Educational Model of Addiction and Recovery Implications
- Developmental Model of Addiction and Recovery Implications
- Sociological Causes of Addiction and the Temperance Model
- General Systems Theory of Addiction and Recovery Implications
- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
- The Diagnostic Criteria of Substance-Induced Disorders
- Alcohol-Related Disorders
- Caffeine-Use Disorders
- Cannabis-Related Disorders (Marijuana)
- Hallucinogen-Related Disorders
- Inhalant-Related Disorders
- Opioid-Related Disorders (Heroin, Oxycontin®, Vicodin® and other pain medications)
- Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders
- Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)
- Tobacco-Related Disorders
- Other Substance-Related Diagnosis and Unspecified Other Substance-Related Disorder
- Activity Addictions (Behavioral Addictions)
- Gambling Disorder (Addiction)
- Sexual Addiction and Pornography Addiction
- Other Activity (or Behavioral) Addictions: Internet Gaming Disorder (Addiction)
- Other Activity (or Behavioral) Addictions: Food Addiction
- Addiction and Other Psychological Disorders
- Addiction and Eating Disorders
- Addiction and Personality Disorders
- Addiction with Depression, Anxiety, and Compulsive Disorders
- Summary of the Diagnostic Process
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- What The Pros Know: The Practical Recovery Model
- Social Approaches Addictions Recovery
- A Cultural Approach to Addictions Treatment: Harm Reduction
- Family Approaches to Addictions Treatment: CRAFT, Intervention And Al-Anon
- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
- LifeRing Secular Recovery
- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
- 12-Step Support Groups: Part III
- Expanding Addiction Treatment Choices in the United States
- Developing a Personal Action Plan for Addiction Recovery: Part I
- Developing a Personal Action Plan for Addiction Recovery: Part II
- References
- Resources
- Frequentlly Asked Questions about Addiction
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What is Addiction?
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Questions and Answers
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Tests
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Book & Media Reviews
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Self-Help Groups
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Links
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Videos
- Technology Addiction
- Why People Can Become Addicted to Opioids
- The Swiss Cheese Model of Drug Addiction
- The 7 Skills for Addiction-Free Living: Alternatives to Substance Abuse
- Teen Drug Use: 2014 Monitoring The Future Survey Results
- Sex and Gender Differences of Importance to Addiction Science
- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
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39 more
- Women and Addiction: Why Gender Matters
- Designed to Drink? The Genetics of Alcoholism
- Gaming disorder: questions and answers
- ADHD & Risk of Adult Drug Use
- Energy Drink Sparking More ER Visits
- Why are Drugs So Hard To Quit
- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
- Teen Substance Use
- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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