CBT as a core of psychotherapy in relapse prevention of addiction
The term „Cognitive Behavioral Therapy‟ came into usage around the early 1990‟s, initially used by behaviorists to describe behavior therapy with a cognitive flavor. In more recent years, „CBT‟ has evolved into a generic term to include the whole range of cognitively-oriented psychotherapies.
CBT is currently an integration of two originally separate theoretical approaches to understanding and treating psychological disorders:The Cognitive approach and the Behavioral approach. therapists typically design strategies to influence both cognitive and behavioral pathology
A two-way relationship between cognition and behavior. The cognitive factors serve as a template through which events are filtered and appraised. Faulty thinking processes will lead to problematic emotional and behavioral responses to what goes on in our life. Accordingly, changing the way a client thinks can change the way he feels and behaves. [Beck et al., 1993]The clinician can opt to intervene at either the cognitive or the behavioral level, using practical methods of interrupting the cycle and encouraging more adaptive responses.
Beck and his colleagues (1993) have identified three major levels of cognition that are relevant to the practice of CBT Consciousness is defined as a state in which rational decisions are made with full awareness. In contrast, automatic thoughts are the more autonomous, often private cognitions that flow rapidly in the stream of everyday thinking and may not be carefully assessed for accuracy or relevance. These cognitions are often riddled with errors in logic. [Little, 2007]
Core beliefs or Schemas, are the deepest level of cognition defined in CBT. A number of thoughts and beliefs are affected by an individual‟s substance abuse and addiction. Some common errant belief:“I‟m a failure.”, “I‟m different.”, “I‟m not strong enough to quit.”, “I‟m unlovable.” Because they play a major role in regulating self-worth and behavioral coping strategies, schemas are a frequent target of CBT interventions. It has been suggested that schema change may account for part of the relapse prevention effect of CBT.
The underlying assumption is that learning processes play an important role in the development and continuation of drug abuse and dependence.The several ways individuals may learn to use drugs include classical conditioning, operant conditioning and modeling.
These same learning processes can be used to help individuals reduce their drug use.CBT attempts to help patients recognize, avoid, and cope……... Recognize the situations in which they are most likely to use drugs. Avoid these situations when appropriate. Cope more effectively with a range of problems and problematic behaviors associated with substance abuse.
A type of psychotherapy (or "talk therapy") that is based on the theory that psychological symptoms are related to the interaction of thoughts, behaviors, and emotions. "CBT is used to teach, encourage, and support individuals about how to reduce / stop their harmful drug use. CBT provides skills that are valuable in assisting people in gaining initial abstinence from drugs (or in reducing their drug use). It also provides skills to help people sustain abstinence (relapse prevention) [UNODC, 2007b].
CBT has two critical components: Functional analysis Skills training
Functional analysis probes the situations surrounding the clients substance abuse. Provides important clues regarding the meaning of the behavior to the client, as well as possible motivators and barriers to change . Assess features in the clients emotional states and thoughts that are highly associated with substance abuse.
Identify the antecedents and consequences of substance abuse behavior, which serve as triggering and maintaining factors. Gain information about high-risk situations in which the person drank or used drugs. Later in treatment, functional analyses of episodes of drug use may identify those situations or states in which the individual still has difficulty coping Skills
A major component in CBT is the development of appropriate coping skills. The first few sessions focus on skills related to initial control of substance use (e.g., identification of high- risk situations, coping with thoughts about drug use). Once these basic skills are mastered, training is broadened to include a range of other problems with which the individual may have difficulty coping (e.g., social isolation, unemployment).
The skills to be taught are either specific to substance abuse, or apply to more general interpersonal and emotional areas (e.g., communication skills, coping with anger or depression). adequate practice of skills is essential, both during sessions and as homework.
Intrapersonal Skills Managing thoughts and Craving for use. Anger management. Negative thinking. Balanced lifestyle and positive addiction. Problem-solving. Planning for emergencies. Decision-making.
Drink/drug refusal. Intimate relationships: Enhancing social support network