What to do when Cognitive-Behavioral Therapy for Addictions isn't Working
Cognitive-Behavioral Therapy (CBT) is regularly described as evidence based or empirically supported. In fact, some researchers have described CBT as the gold standard of psychotherapy. Nonetheless, even the most experienced and skilled cognitive-behavioral therapists recognize that CBT doesn't always work with patients who suffer from addictions and mental health problems. In this workshop we describe and distinguish between CBT content and process, in order to contextualize common problems encountered when helping people who struggle with chemical and behavioral addictions. We consider structure, collaboration, case conceptualization, psychoeducation, and standardized techniques, with emphasis on potential challenges common to each of these processes.
We begin this workshop by emphasizing that Cognitive Behavioral Therapy (CBT) is a superordinate category that contains an assortment of “branded” therapy approaches (e.g., Rational Emotive Behavior Therapy, Acceptance and Commitment Therapy, Behavioral Activation, Cognitive Therapy, Exposure and Response Prevention, Mindfulness-Based Cognitive Therapy, etc.). These approaches have some obvious similarities and differences. Perhaps the most conspicuous similarity is that they focus on patients’ thoughts, feelings, and behaviors. They are typically structured, time-limited, and present-focused, providing structured techniques to facilitate desired patient outcomes. Differences mostly regard their various primary focal points (e.g., automatic thoughts, beliefs, schemas, acceptance, commitment, behavior change, compassion, emotion regulation, mindfulness, interpersonal processes).
While the efficacy of CBT for multiple disorders (e.g., depression, anxiety, addictions, PTSD, etc.) seems well established, there are still substantial misconceptions regarding CBT. Perhaps the most egregious is that CBT involves a superficial, formulaic, expedient process that is always effective for all disorders. In this workshop we emphasize that CBT is not superficial, formulaic, or expedient. Instead, CBT engages a complex process, involving complex content. To further complicate matters, CBT patients form a diverse group whose members vary in their responses to therapy and therapists. For example, some benefit from directive therapy, some from non-directive therapy; some require a high degree of structure, others prefer much less structure; some desire relaxed, friendly relationships with therapists, others prefer more formal, professional relationships with therapists.
During this 90-minute workshop we highlight the complexity of CBT for both chemical and behavioral addictions. In addition to distinguishing between therapy content (“What needs to be changed”) and process (“How change is facilitated”), we identify specific CBT components and how they might be optimized. Workshop participants will have opportunities to ask questions, observe and critique a CBT role-play demonstration, and discuss de-identified cases.
