CBT and the 12 Steps Have a Lot in Common - Page 2

By Alexis Stein, Hunter R. Slaton 04/19/13

It turns out that cognitive-behavioral therapy and the 12 Steps share plenty of DNA. A therapist and a sober Fix staffer compare and contrast, one step at a time.

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Spot the difference! Art: Danny Jock

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Step 7. Humbly asked Him to remove our shortcomings.

HS: The first time I did this step, my sponsor just told to me pray regularly to have my “character defects” removed. The second time, though, my sponsor (a new one) told me to pick one thing from my “small” list and one from my “large,” and to focus and pray about these items regularly, and also try to take action on them “in the real world.”

AS: A common CBT practice is to have a client create a dysfunctional thought record, which consists of writing about a situation and the emotions it precipitated. Then the client takes note of his automatic thoughts about the situation and the evidence that supports those thoughts; notes the evidence that challenges those automatic thoughts; and finally arrives at a new, alternative and more balanced thought. Praying about one’s character defects could have a similar effect, and repetition of an exercise like this should only increase its positive results.

Similar to a 10th Step, many CBT clients write daily thought records, or mood logs.

Step 8. Made a list of all persons we had harmed, and became willing to make amends to them all.

HS: Back to the pen and yellow legal pad: I made a list of all the people I’d hurt or offended over the years, whether directly because of drinking- and using-related behavior or otherwise, and listed the particulars of each case. I “became willing,” again, by just praying and thinking about making amends to these people.

AS: Identifying problematic behavior would be among the first things a client and therapist would discuss in CBT. This would include identifying damaged relationships. Volition is a necessity when it comes to therapy, as success will be limited if the client is unwilling.

Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

HS: With my sponsor I went through the list I’d made in Step Eight, and started getting in touch with a handful of people at a time, telling them I wanted to meet up and talk to them about something. The first one I did was an old boss of mine. I met him at a coffee shop and laid out how my behavior had been lacking, and asked if there was anything I could do to make it right. He said that wasn’t necessary, and everything went fine. Other amends I made followed roughly the same script. I felt good when I finished each one, like I had straightened up something in my past that had gotten out of whack.

AS: CBT focuses on curbing problematic behavior in future situations, but that doesn’t mean there’s no room for addressing past consequences. In fact, doing so can bring validation and support of a client’s new, rational way of thinking. An addict doing the 12 Steps, like a client in CBT, might imagine that trying to make amends would result in hateful words or drama, but instead it is usually a validating and liberating experience. 

Step 10. Continued to take personal inventory, and when we were wrong, promptly admitted it.

HS: My sponsor recommended that at the end of each day I write briefly about what happened that day, including anything I didn’t feel great about, as well as stuff I did well—and, if I needed to say to someone, “Hey, I’m sorry for X thing,” doing it right away.

AS: Many CBT clients do daily thought records, or mood logs. Daily “homework” in CBT helps the therapist gain insight into the client’s motivation to change, coping abilities and areas of dysfunction. For the client, it creates and maintains awareness of their thought and behavior patterns, and it puts the work done in session into practice in daily life.

Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

HS: Even though I am an atheist, I pray on a regular basis. (I’m not much one for meditation.) When pray, I think, “God, help me to stay sober today, help me to stay calm, and help me to be generous toward my fellows.” If something in particular is going on in my life that I’m having trouble with—work, say, or a relationship—I’ll often add that into my prayer. I think of prayer as a tuning fork for my mind, that will hopefully direct my attention toward what I want to work on or get better at on any particular day.

AS: Spirituality is not part of CBT, but mindfulness is—and prayer and meditation can lead to the sort of mindfulness that is one of the ultimate goals of CBT. Meditation also can be central to CBT, especially when dealing with generalized anxiety disorder. Relaxation techniques—including more guided imagery (“happy place”), breathing exercises and progressive muscle relaxation—are used to reduce anxiety.

Step 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

HS: My sponsor told me to practice the 12th Step it by taking new guys through the Steps, and participating in AA meetings, by talking to newcomers and doing service. When I guide sponsees through the Steps, I feel like it really reinforces my own “stepwork.”

AS: CBT generally is a short-term therapy, focusing on specific life issues. While CBT clients do not, in turn, become therapists by virtue of their experience, many continue to have therapeutic maintenance sessions to continue addressing target behaviors. As with the 12 Steps, the hope is that, after completing CBT, one will possess the tools to cope with any related situations and address similar target behaviors that may arise in the future.

Alexis Stein, LCSW, is a psychotherapist with years of experience in the field of addiction. She specializes in individual, couples and group therapy in her Manhattan private practice. Hunter Slaton is The Fix's Rehab Review editor.

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Alexis Stein, LCSW, is a psychotherapist with years of experience in the field of addiction. She specializes in individual, couples and group therapy in her Manhattan private practice. Find Alexis on LinkedIn.

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Hunter Slaton is the esports managing editor for Blizzard Entertainment. You can find hunter on Linkedin or follow him on Twitter.