Ask an Expert: What's Cognitive Therapy Got To Do With Addiction?

By Rita Milios 12/30/14
Today's question is on how cognitive therapy is relevant to addiction treatment.
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What can you say about cognitive therapy?  Hard to see how it is supposed to help with drug addiction.

Rita Milios: Cognitive Therapy, and Cognitive Behavioral Therapy (CBT) is based on the idea that what we think (cognition), what we feel (emotion) and what we do (behavior) are intrinsically linked together. Faulty thinking, often based on deeply held but erroneous subconscious beliefs, may cause us to believe that we are less adequate, less loveable or less capable than we really are. Some people attempt to deny or dampen these uncomfortable feelings though the use of addictive substances.

Along with limiting or refraining from the use of addictive substances, it is a good idea to address the underlying uncomfortable emotions that often are at the root of substance abuse. Cognitive errors are often so ingrained in a person’s thinking style that they are unaware that they have “stinkin’ thinkin.” CBT helps bring conscious awareness to cognitive distortions, such as “I am incapable of having a positive future because of my past,” or “No one will love me as I am.”

CBT (most often used because behaviors as well as ideas must be addressed), focuses on helping a client discover and challenge Irrational Beliefs that hold them back from reaching their goals. In the 1950’s, Albert Ellis, PhD., created an ABC method to demonstrate this. Ellis said that it is not the activating event (A) itself that causes negative emotions and behaviors/consequences. Rather, it is that a person’s unrealistic interpretation of the event feeds a deeply held irrational belief system (B) that leads to painful consequences (C). For instance, Stan experiences an Activating Event, A, in that he made a mistake at work. Stan’s Irrational Belief, B, is that he must always do well or he is worthless. The Consequence, C, is that Stan feels depressed and down on himself (and he is more likely to self-medicate with a substance if he happens to be a substance user).

CBT is a great tool for re-programming thinking errors. Common irrational thinking errors that can be re-programmed with cognitive behavioral therapy or CBT include, but are not limited to: selective attention (for instance, the tendency to see the negative in one’s self and ignore the positive), magnification (“making a mountain out of a molehill” when viewing one’s own mistakes), and overgeneralization (one misstep and you believe “It always goes wrong” or "I’ll never get it right.”)

For more on subconsciously-programmed erroneous beliefs, see the author’s Fix article, “Oh, Grow Up!”

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Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training." RitaMilios.linktoexpert.com  Full Bio.

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