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Cognitive-Behavioral Therapy

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

In the 1950s, Albert Ellis, Ph.D., developed Rational Emotive Behavioral Therapy (REBT; Ellis, 1962). Ellis recognized that our beliefs influence our interpretations of events. Our unique interpretations of events subsequently give rise to our feelings and behaviors. The idea that beliefs affect feelings is over 2000 years old. An early statement of this concept was made by Epictetus (c. 60-138 CE): "Men are disturbed not by things but by their views of them."

woman thinkingMany people incorrectly believe events cause their reactions. Our beliefs cause our thoughts and feelings, not the event itself. Let's return to a previous example to illustrate this point. Suppose you are walking through a crowd of people and someone steps on your foot. If you believe the person did this intentionally, you will likely feel angry, perhaps even hostile. You might push the foot-stepper, or call him a nasty name. On the other hand, if you believe, the foot-stepper is merely clumsy you will feel quite differently. Notice the exact same event "caused" two completely different sets of thoughts and feelings. The only thing that changed was the belief about that event.

Ellis was particularly interested in beliefs that represented irrational absolutes. "Everyone must like me in order for me to be happy." "Life should always be fair." Ellis created a series of exercises and techniques to assist people to identify and change beliefs that Ellis termed irrational, or unhelpful. For instance, using REBT someone might recognize an irrational belief such as, "I must have a drink in order to relax" or "I can't tolerate this craving." A person might challenge these beliefs to evaluate whether they are true and accurate. If a belief is false, a therapist assists a person to reframe the belief so that it is more rationale and accurate. "I might like a drink but there are many ways for me to relax. I can also go for a run or play with my kids." "This craving is annoying and uncomfortable but it will soon pass."

Around the same time that Ellis was perfecting his method of REBT, Aaron Beck, M.D., was developing Cognitive Therapy (CT; Beck, 1975). CT initially focused on identifying fleeting, inaccurate, "distorted" thoughts. These are also known as cognitive distortions. A common type of cognitive distortion is called black or white thinking. People with this type of distortion tend to see things as either-or (but not both, or neither). You can imagine how this might cause some difficulty. "Either my wife loves me, or she hates me." This rather extreme belief would cause this man to frequently misinterpret his wife's behavior. Suppose this man's wife forgot they had a date for dinner. Rather than being understood as a momentary lapse, or an inconsiderate gesture, it would become proof-positive his wife doesn't love him.

Both Ellis and Beck addressed thoughts and beliefs. They each devised ways to help people to change beliefs and thoughts into more helpful and accurate ways of perceiving the world. Ellis focused more on global, all-encompassing irrational beliefs. His goal was to change these into new, more rational beliefs. Beck focused more on moment-to-moment distorted thoughts. His goal was to change these distorted patterns of thought into more realistic and logical patterns. Overtime, psychologists blended these two because they were so similar. Nowadays, we simply call this type of therapy Cognitive-Behavioral Therapy (CBT)

Since the original formulation by Beck and Ellis, researchers continued to study CBT and further refine it. Psychologists also developed many effective hybrids such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT). Ongoing and continuous research established CBT as an evidence-based practice for a variety of common disorders (anxiety, depression, addiction). CBT is perhaps one of the most well studied types of psychotherapy. This is partially due to the fact it is easily studied. This is because it can be accurately and simply described ("manualized"). There is debate about whether CBT is the most effective form of psychotherapy, or simply one of the most studied. As these debates continue, it is safe to conclude that CBT is a highly effective therapy for addiction.

CBT strengthens the motivation to abstain from addictive substances or activities. It teaches participants successful cognitive and behavioral coping strategies. Compared to other forms of psychotherapy CBT is a short-term therapy. The typical CBT treatment lasts about three months, but shorter treatment can also be helpful. Several different teams of researchers have developed brief, computer-based CBT interventions for addiction and other disorders.