Cognitive behavioral therapy in the treatment of addiction

What is psychotherapy? This is a therapeutic conversation, during which a professional psychotherapist or psychologist-psychotherapist helps the patient to understand and solve problems. Psychotherapy is the only method of treating mental disorders that considers a person as an indivisible whole, studies his essence and uses only an individual approach.

To choose a good psychotherapist, you need to pay attention to several important points:

• specialized medical or psychological education
• 3–5 years of work experience
• participation in educational events and conferences of the psychotherapeutic community

It is also important that the specialist answers the client’s questions as fully as possible, does not have a bad reputation on the Internet, and follows a moral and ethical code.

The goal of psychotherapy is to understand, bring to the surface and defeat what prevents a person from being happy. The psychotherapist does not make decisions for the person and does not impose his opinion on him, but helps him understand what the client really wants and how this can be achieved. Psychotherapy involves working on oneself, but when a person begins to get rid of the first uncertainty, anxiety and fears, it immediately becomes easier for him to move towards a new, fulfilling life.

There are a large number of methods, schools and directions in psychotherapy. Below we will talk about some popular techniques.

What is Cognitive Behavioral Therapy (CBT)

CBT is a complex psychotherapy based on human cognitive processes and behavior.

In practice, it has been used since the 60s of the last century. Its goal is to help a person work on negative thoughts and feelings in order to cope with mental problems.

In addition to addictions, CBT is used in the treatment of concomitant diseases:

• anxiety disorder;
• attention deficit disorder;
• bipolar disorder;
• obsessive-compulsive disorder;
• eating disorders;
• post-traumatic stress disorder.

Goals and methods of cognitive psychotherapy

The main goal of cognitive psychotherapy is to identify dysfunctional thoughts in the patient and their subsequent transformation. But, besides this, experts identify five goals of cognitive therapy:

• complete elimination of the symptoms of the disorder or reduction in the manifestations of the pathology;
• prevention of relapse after correction of mental state;
• improving patients’ perception of other types of therapy, including medications;
• resolution of a person’s psychological and social problems that may arise against the background of the disorder or immediately before its manifestation;
• elimination of the prerequisites that gave impetus to the development of the disorder.

During treatment, the therapist helps the patient understand the extent to which his thoughts influence his behavior, emotions, and physical condition. After a full course of cognitive therapy, a person can independently identify thoughts that negatively affect his psychological state. And most importantly, change dysfunctional beliefs into more rational thoughts.

The main methods of cognitive therapy include combating negative thinking, using alternative strategies for perceiving problem situations, re-experiencing events from the past, and imagination. Each of these methods is aimed at giving the patient the opportunity to relive and forget negative experiences, as well as acquire new learnings.

Cognitive psychotherapy is often complex. In addition to cognitive methods, psychotherapists in their work use various behavioral techniques that successfully complement each other.

What misconceptions does cognitive behavioral therapy work with?

• The addict thinks about approval from others, but not often about family problems and the interests of family members.
• He is hostile and distrustful of others and does not expect anything good from them. There's a catch waiting. In severe cases, persecution mania and phobias are observed.
• Blames not himself, but other people or circumstances. For example, “it was inconvenient to refuse drinking at a corporate party.”
• He thinks that it is easier to avoid life situations than to be responsible for the decisions made later. He is an outside observer and does not take any action to improve his life.
• Believes in the power of the past. Lives in regrets about himself and his behavior. Therefore, at the beginning of treatment, the patient is afraid of further social life: what if everything will be bad with her because he is a former drug addict?

Why is working with the body important?

A person experiences reality only through the body. When the connection between soul and body is broken, a person feels the world of his own experiences and illusions more realistically than the surrounding reality. As a result, the brightness and fullness of feelings and emotions is lost, nothing brings pleasure, and something is constantly missing in life. Some characterize this state as follows: “I live like a zombie,” “Like in a dream,” “Like frozen.”

In order to “return” to the real world again, to fully experience it, you must first free your body. Muscle “armor” makes it very difficult not only to enjoy life, but even to breathe and walk. Imagine that they put two sheepskin coats on you and put on heavy felt boots with galoshes. And you live 24 hours a day, even sleep, in such clothing. Now take and throw off this burden, remaining in light summer clothes. It's better, right? But no external conditions have changed, only your body has gotten rid of heaviness. Therefore, body-oriented therapy, working with muscle tension and returning the body to its original, harmonious state, helps solve psychological problems.

Comment from a SELF center specialist:

A man came for a consultation, his name was Ivan, 32 years old, with a request about his relationship with his wife - there had been an affair. During the meeting, the man, describing his situation, lowered his head down, breathed shallowly and periodically clenched his jaw. I drew his attention to how his body behaved when he described his difficulty. It turned out that for several months now his right shoulder has been hurting, constantly, nothing helps, the pain radiates to the shoulder blade and spreads along the spine.

We began to explore this pain and its connection with what the man was experiencing and thinking.

– What word is associated with pain?

- Sharp, sharp, furious.

At the same time, Ivan began to clench and unclench his fists, his breathing became more “heavy.”

“What emotion is asking to be noticed?” – I asked. The man, restraining himself, replied that it was anger, rage, a desire to break something and hit someone.

Then I asked: “What are these emotions trying to protect, what feeling or image?” The man answered with tears in his eyes that this was powerlessness, despair and the inability to return to his previous relationship with his wife.

After these words and allowing himself to be with the feelings of sadness, powerlessness, anger, despair, he was surprised to notice that the muscles relaxed and the pain went away. The emotional tension created by this feeling affected the muscles, causing them to spasm, blocking natural movement. And they immediately relaxed as soon as the emotion was identified and lived.

What should be the outcome of cognitive behavioral therapy?

The patient begins to realize that many harmful actions are illogical. Negative emotions are irrational. He sees how negative feelings originate from lived experience or social environment. He no longer has to act based on his behavior patterns and use substances.

The addict understands why he feels or acts a certain way. He knows how these feelings and actions motivate the use of the object of addiction. This is precisely the mission of CBT, because in this way it is easier for a person to cope with addiction.

We help addicts discover thoughts about the desired substance (or action, if we are talking about games, for example) that arise “automatically.”

Such an “automatic” thought is impulsive and is often the result of misconceptions about oneself, uncertainty, and feelings of fear. Often people try to drown out this moral pain by drinking alcohol or drugs, gambling, etc.

Constantly revisiting painful memories will help reduce the pain they cause. After this, people can learn to behave in new ways so that the need for the object of dependence no longer arises.

Patients are freed from addiction with the help of:

• getting rid of misconceptions about yourself;
• self-help training to improve mood;
• teaching effective communication skills;
• instilling skills in managing triggers – situations that increase cravings for alcohol, etc.

When can cognitive psychotherapy help?

Cognitive psychotherapy is used in the correction of most mental and psychoemotional disorders. But most often this type of therapy is used to treat depression. A depressed person experiences an exaggerated sense of loss, which may be real or imaginary.

Depression is characterized by the presence of negative thoughts of several directions. First of all, the patient develops a negative image of himself; he considers himself a loser, an inferior person. At the same time, they are given a negative assessment of the world around them and passing events, as well as their own future. Experts call this the cognitive triad of depression. To overcome this psycho-emotional disorder, it is necessary to work in each of these directions, replacing dysfunctional thoughts with rational thinking.

In addition to treating unipolar depression and increased anxiety, this type of therapy is also used to eliminate obsessive-compulsive disorder, various phobias, eating disorders, migraines, anxiety and anger attacks, and other personality and behavioral disorders.

Cognitive methods can be part of complex therapy in the treatment of schizophrenia and bipolar affective disorder. The combination of psychotherapy with medication can eliminate hallucinations in patients with schizophrenia and mitigate other symptoms of this pathology. Researchers have proven its effectiveness in the correction of many somatic diseases.

During therapy, the therapist works to solve the problem; he does not change the patient's personality characteristics or shortcomings. From the very beginning, the patient and therapist must come to some kind of agreement, outline the range of problems on which they have to work. It is possible to eliminate the manifestations of the above-mentioned disorders with the help of experimental testing of disaptive thoughts.

Basic techniques of cognitive behavioral therapy in the treatment of addiction

CBT specialists use special exercises (techniques) to make it easier for the patient to overcome addiction. Below are examples of such techniques.

Fixation of thoughts

Patients think about when they have negative thoughts and look for objective evidence. This evidence can be either confirmatory or disconfirming. The goal is to help a person think more balancedly and less categorically by critically evaluating what they are thinking about.

Example of a negative thought : “My boss doesn’t value me. I need a drink to feel better."

This thought transforms into the following : “Everyone makes mistakes. I will learn from my own mistakes, and my boss will be grateful to me. I don't need alcohol to feel better."

Experiments on behavior

The essence of these exercises is the contrast between negative and positive thoughts. The patient sees which of these thoughts are more effective in changing behavior. Some people benefit from a loyal attitude towards themselves, while others change for the better thanks to self-criticism.

Example: “If I berate myself after playing online poker, I will play less” or “If I talk to myself gently after playing online poker, I will play less.”

Figurative representation

This exercise involves the person thinking about memories that cause strong negative feelings in him. He pays attention to everything he sees and hears while thinking, to every emotion, thought or impulse that arises at that moment. By frequently revisiting painful memories, the addict can, over time, reduce the anxiety caused by them.

For example , he focuses on a painful childhood memory. He remembers every detail, including emotions. With repeated exposure, the memories cause him less and less pain, reducing the need to self-medicate with drugs or alcohol.

List of enjoyable activities

The essence of this technique is to compile a weekly list of exciting and healthy activities so that a person diversifies his everyday life. Tasks should be easy to complete and, of course, evoke positive emotions. This will help reduce the number of spontaneously arising negative thoughts, and therefore avoid the need for an object of dependence.

Example: a person is tired at work. To relax, instead of drinking, he relaxes for 15 minutes every day. He uses this time to find and listen to a new song by a contemporary musician.

The most popular cognitive psychotherapy techniques

Treatment of mental disorders using cognitive psychotherapy is not just a way to combat a specific disease. This approach to therapy gives the patient a special perspective on everything that happens in his life. Thus, it is possible to prevent the development of relapses and other mental disorders. A person trained in the basics of cognitive psychotherapy is able to systematically monitor his own negative emotions and transform them into rational thoughts. This method is especially effective in combating panic attacks.

All techniques used in cognitive psychotherapy can be divided into two large groups:

• techniques aimed at identifying automatic thoughts of a negative nature. The main way to achieve this goal is to interview the patient, but the therapist can also use role-playing techniques. After the automatic thought is found by the patient, the therapist must check it with behavioral factors, as well as logical analysis. In some cases, the identified beliefs turn out to be a mythologem, but most often such thoughts nevertheless take place in reality, although they are not realized by the patient. The therapist must identify the relationship between the automatic thought and the traumatic situation and pathological emotional reactions;
• techniques that allow you to identify the unreasonableness of an automatic thought and cognitively reconstruct it. A person will be able to abandon a maladaptive thought only if he is completely sure of its “wrongness.” First of all, the validity of such thinking can be verified by its consequences. This technique is called decatastrophizing or “what if.” The patient imagines the consequences of the situation that frightens him, and understands that in fact nothing terrible will happen. You can push a person to check irrational thoughts with real actions. If the patient suffers from depression, believing that he is not capable of anything, then he can be given small tasks. Their successful implementation will restore a person’s faith in his own strength. The psychotherapist can also invite the patient to compare his situation with another case from his practice. By feeling sorry for a patient with similar problems, the patient automatically feels sorry for himself. As a result, the negative attitude towards oneself changes into pity and sympathy. A similar result can be achieved using the catharsis method, when the therapist encourages the patient to speak out and cry. In addition, there are a large number of other methods that allow you to change cognitive attitudes.

Throughout the course of therapy, the patient receives homework. He must track automatic thoughts and record his feelings in a special notebook. A psychotherapist may recommend reading certain literature and listening to recordings of psychotherapy sessions.

Most often, psychotherapy is individual, but group work can also be used. In the latter case, not the relationships between its individual members are examined, but the rationality of their thinking and behavior is assessed.