Cognitive-Behavioral Therapy

IPHE 503
Introduction in Practice in Addictions
University of Calgary
Cognitive-Behavioral Therapy
By Shannon Webber

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Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy is an effective therapy used in treating many addictions.

The therapy draws from previous approaches of Cognitive Therapy and Behavioral Therapy. As

described by Kouimtsidis, Reynolds, Drummond, Davis, and Tarrier (2007) Cognitive-

Behavioral Therapy is the product of introducing the study of internal mental processes and

incorporating this element into behavioral theory following the scientific paradigm (p. 11). The

components that support Cognitive-Behavioral Therapys success include being consumer

driven, provides success to those with dual issues, has a structured process, and offers coping

skills and tools that can be applied to many different situations, addressing addiction and other

thought processing within the participants life. Researchers have outlined the effectiveness of

Cognitive-Behavioral Therapy (CBT), which has increased the need for more people to access

this approach. There has been attempts to fulfill this need by incorporating computer assisted

programs. The results of the application of CBT will be examined. Despite the successes of

CBT, there has been some changed needed and therefore, modifications have been made to CBT

in order to include a spiritual aspect, which the traditional approach doesnt incorporate. This

addition has been effective to better support those requiring the spiritual aspect. The adaptability

of Cognitive-Behavioral Therapy has been an important aspect of this program which can be

shaped to meet specific needs. Nevertheless, there is controversies and limitations with

modifying the CBT approach, which will be assessed.

What is Cognitive Behavioral Therapy?

Cognitive-Behavioral Therapy is a commonly offered treatment option for people in

recovery and has been one of the few evidence based approach. Recovery can be defined as

more than the absence of symptoms. Recovery is a profound personal process (Amering and

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Schmolke, 2009, pp. 14). CBT focusses on what the person having the addictions interpretation

is and the thought processes leading up to certain events or circumstances. Cognitive-Behavioral

Therapy has been proven to be successful. As described by Herie and Skinner (2014),

Cognitive-Behavioral Therapy is well-supported modality for addressing additive behaviors (p.

497). Caroll, Ball, Martino, Nich, Babuscio, Nuro, Gordon, Portnoy, and Rounsaville (2008)

agree and maintain that CBT has a strong level of empirical support across a range of

psychiatric disorders (p. 881). Cognitive-Behavioral therapy is not only successful for initial

recovery but has been successful in relapse programs as well. Weeks and Calvert (2006) suggest

that Cognitive-Behavioral relapse training program is prominent evidence-based treatment

techniques with demonstrated effectiveness (p. 3). Both the approaches require collaboration

between the person having an addiction and their practitioner, to explore their perceptions and

thought processing. As suggested by Herie and Skinner (2014), Because cognitive distortions

often shape how the person is involved in the addictive behavior, CBT works to expose and

contest these distortions so the person can develop a more balance perception and awareness (p.

497). The practitioner helps the person investigate the positive and negative effects of the

addiction and assists with exploring alternative behaviors while continuing to meet the needs of

the individual. Coping mechanisms to deal with triggers, building positive self-talk, and develop

better coping competencies are additional skills sets implemented. This approach is an action

orientated approach which require the person in recovery to be driving force. People can learn

how to recognize their automatic thought processing and explore why their viewing that in such

a way, discussing if this is fact-based. The practioner and person discover new ways to think and

then act. CBT is used in a structured format that is goal orientated, requiring additional time

allotment for the person in recovery to practice some of the strategies discussed in sessions. In

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applying CBT to substance recovery the practioner needs to be attentive to the willingness and

motivation of the person in recovery. A Canadian study by Ogborne, Wild, Braun, and Newton-

Taylor (1998) found high levels of support for cognitive, coping and relapse prevention

approaches, and lower support for medications (cited by Amodeo, Lundgren, Cohen, Rose, and

Chassler, 2011, p. 383) when the investment of the participants were exhibited in the CBT

recovery.

Using and Adapting Cognitive-Behavioral Therapy

Not only can CBT be effective in relapse programs, it has been helpful with many

addiction recovery programs. As described by researchers, Cognitive-Behavioral Therapy is the

most used recovery approach for Internet Gaming Disorder. As described by Kiraly, Griffiths,

and Demetrovics (2005), the CBT approach posits that faulty cognitions are the sources of

maladaptive behaviors and psychological problems (p. 258). Researchers go on to explain that

CBT approach helps by developing to induce behavioral change through identifying these faulty

cognitions and replacing them with more healthy ones (Kiraly et al., 2005, p. 258). In another

study, CBT was used in assisting young adolescents with internet addictions. The researchers

suggest that multimodal, school-based group CBT is effective for adolescents with Internet

addiction, particularly in improving emotional state and regulation ability, and behavioral and

self-management style (Weinstein, A., Feder, L., Rosenberg, K., and Dannon, P, 2014, p. 99).

Research has been completed comparing CBT to other interventions, In general, these

comparisons have favoured the effectiveness of CBT (Somers, 2007, p. 38). Although

researchers indicate that some evidence of success isnt seen immediately during or after

recovery, indicating that often time is required to implement strategies learned though CBT.

According to Somers (2007), relatively little is known regarding the characteristics of

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individuals that would suggest a better (or worse) fit with CBT (p. 41). This recovery option

is helpful for many different people and is easily adaptable to meet the needs of people. Many

people suffering from mental illness may struggle with being in groups, initially abstaining from

drugs or alcohol, and may lack some social skills which will be barriers in participating in the

recovery process (Denning and Little, 2012). CBT has the ability to be facilitated in a group or

individually, which meets the needs of many people either requiring individual or group therapy

sessions.

The use of computer assisted CBT approach could allow for lower cost, more accessible,

and more standardization (Carroll et al., 2008). Researchers for the computer assisted program

reflected that it was user friendly, easily understood, and was intended to support a higher

engagement of the CBT programming (with the support of a practitioner who was included in the

recovery process). The results indicated that strong treatment involvement and homework

completion were completed with the use of this technology. This was indicated through lower

rates of engaging in drug use as investigated by urine testing results (Carroll, 2008). Although

the computer assisted CBT program was intended to be easily accessed and user friendly with

many pictorial supplements, there might be some populations that could not easily access the

program.

Another modification that was completed was CBT not including a spiritual aspect,

excluding some populations with this need. CBT was modified to better address a spiritual need

for participants, as it was felt that CBT was lacking in this aspect of recovery for some people.

The adaptation was successful and part of the benefits of the CBT recovery program is the ability

for it to be flexible. Hodge & Lietz (2014) point out, ...the fact that many studies have found

that most clients want therapists to incorporate their spiritual beliefs into the therapeutic

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enterprise (p. 200). In this adaptation the fundamentals of the CBT remain that same. Hodge

and Lietz (2014) outline that Spiritual beliefs and practices from clients spiritual belief systems

are used to convey the underlying therapeutic concepts that are hypothesized to promote health

and wellness (p. 201). The many benefits of including spiritual aspects into CBT treatment

included the success that other programs like AA have had, including this element, the sense of

motivation that the connection to the higher power provided, and the subsequent community

social system that was fostered when spirituality was present in treatment. However, modifying

CBT to include spirituality created some challenges with biases from practitioner and participant

which could impact sessions. As well, the authors acknowledged the risk with this modification

in a group setting could complicated with different spiritual views.

Limitations of CBT

Cognitive-Behavioral Therapy has been proven to be a very effective strategy for

someone in recovery. This recovery approach is inexpensive, structured, and accessible to many

populations. It is able to be modified and adapted to meet the specific needs of the individual.

However there is risk in adapting and there is limitations with needing a trained, qualified

practitioner to support people through the process. Often there is limited qualified practitioners

or insufficient resources for people to utilize and although the effectiveness of CBT has been

proven, many times this option is not being suggested. The use of technology is an attempt to

fulfill the higher rates of need for people, which has seen positive results. Although Cognitive-

Behavioral Therapy has been identified as an evidence based approach to treatment with some

success, there is significant evident that an individualized approach to treatment with a broad

inclusion of several treatment plans included is the most effective in continued recovery. There is

a need for individualized approach to specifically fulfill the specific needs of some populations.

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Although as suggested by researchers, individualized application of CBT was viewed as more

flexible than the group format (Amodeo, et al., 2011). However, there is limitations for the

application for CBT. As indicated by Amodeo et al. (2011), client limitations in the areas of

motivation, cognitive ability and psychiatric stability (p. 387) were highlighted as important

aspects that can limit the use of CBT. Not only are there limitations for the person in recovery

for CBT to be effective, there is limited trained practitioners, considering the high turnover of

qualified staff, and lack of funding for high quality certified people, there is inadequate access.

Thus, the introduction use of computer assisted CBT.

Reflection

In the researching process and learning about Cognitive- Behavioral Therapy, I have been

able to recognize the significance of this recovery approach. I chose this topic because I knew

very little of this therapy option and have been mostly educated on the Alcoholics Anonymous

approach. The ability to deconstruct and reconstruct thought processing is an important element

in recovery and would be critical in maintaining a healthy life. The philosophies of collaborating

with people and developing coping skills and tools is incredibly valuable for sustained sobriety.

I have a much better understanding of this recovery approach. I think there needs to be more

research to fully understand the impacts that this approach and higher accessibility to support

people with using Cognitive-Behavioral Therapy through their recovery process. Recovery is

more than the absent of engaging in unhealthy activities, its about learning how we view

situations, understanding our negative thought processes, and dealing with situations in a

healthier manner. This takes a lot of time and work, which really supports the multi-dimension

approach to recovery. CBT can be one effective element in that recovery process. I have learned

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through taking this course that there are many recovery options and that the recovery approach

should be highly individualized and personally driven.

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References

Amering, M. & Schmolke, M. (2009). Recovery in Mental Health: Reshaping scientific and

clinical responsibilities. Hoboken, NJ: Wiley.

Caroll, K., Ball, S., Martino, S., Nich, C., Babuscio, T., Nuro, K., Gordon, M., Portnoy, G., &

Rounsaville, B. (2006). Computer-assisted delivery of cognitive-behavioral therapy for

addiction: a randomized trial of cbt4cbt. American Journal of Psychiatry. (165)7, 881-

888.

Caroll, K., Kiluk, B., Nich, C., Babuscio, T., Brewer, J., Potenza, M., Ball, S., Martino, S.,

Rounsaville, B., & Lejuez, C. (2011). Cognitive function and treatment response in a

randomized clinical trial of computer-based training in cognitive-behavioral therapy,

substance use & misuse, Informa Healthcare. 26-34. doi:

10.3109/10826084.2011.521069

Dimidjian, S., Arch, J., Schneider, R., Desormeau, P., Felder, J., & Segal, Z. (2016). Considering

meta-analysis, meaning, and metaphor: a systematic review and critical examination of

"third wave" cognitive and behavioral therapies. Elsevier Ltd. (47), 886-905.

Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment:

review and recommendations for public policy. Health Policy, 97, 93-104. doi:

10.1016/j.healthpol.2010.05.013

Herie, M., & Skinner, W. J. (Eds.) (2014). Fundamentals of addiction: A practical guide for

counsellors. Toronto, Canada: Centre for Addictions and Mental Health (CAMH).

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Hodge, D., & Lietz, C. (2014). Using spiritually modified cognitive-behavioral therapy in

substance dependency treatment: therapist and clients perception of the presumed

benefits and limitations. Health and Social Work. (39)4, 200-210. doi:

10.1093/hsw/hlu022

Kouimtsidis, C., Reynolds, M., Drummond, C., Davis, P., Tarrier, N. (2007). Cognitive-

behavioral therapy in the treatment of addiction. John Wiley & Sons Ltd. West Sussex,

England.

The American Institute for Cognitive Therapy retrieved March 11, 2017 from

http://www.cognitivetherapynyc.com/What-Is-Cognitive-Therapy.aspx

Weinstein, A., Feder, L., Rosenberg, K., & Dannon, P. (2014). Internet addiction disorder:

overview and controversies. Behavior Addictions. 99-117. doi: org/10.1016/B978-0-12-

407724-9.00005-7

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