Reducing addiction: Cognitive behavioural therapy

• CBT 

  CBT aims to identify faulty thinking patterns 

  that are irrational and potentially maladaptive. 

  Replacing these with healthy and rational thoughts instead.

  By having conversations (or even arguments) with patients, the psychiatrist will begin to break down the patient’s irrational beliefs. For example, by discussing the likelihood of an event/belief happening they can reduce the anxiety associated with a negative thought
• What does CBT involve?

  The Sessions

  Meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. 

  Each session will last between 30 and 60 minutes.
• CBT for addiction 

  So how can we apply it here?

  CBT for addiction aims to change the faulty thinking to leads people to maladaptive ways of coping such as using drugs or engaging in certain behaviours. 

  In gambling specifically this takes the form of 2 main steps:

  • Functional analysis: Identify and tackle cognitive distortions and replace them with more adaptive ways of thinking

  Skills training: Help the client developing coping behaviours to avoid high risk situations which can trigger addictive behaviour
• Functional analysis

  Client and therapist work together to identify the high-risk situations in which the client is likely to partake in their addiction. The therapist then reflects on what the client’s thoughts are before, during and after such situations

  Functional analysis isn’t just a one-off, it is on-going and can help the client:

  • Identify the triggers or reasons for their addiction to start
  • Work out the circumstances in which they have problems with coping and what skills training they may need
• Skills training 

  Cognitive restructuring

  ALL CBT programmes include an element of cognitive restructuring to tackle the client’s biases. 

  In gambling addiction, training addresses the client’s faulty beliefs about probability, randomness, control, gains and losses. 

  These are confronted and challenged by the therapist and may involve the therapist giving the client information about the nature of chance
• Skills training 

  Specific skills

  CBT is a “broad-spectrum” treatment because it focuses on wider aspects of the client’s life that are related to his/her addiction. 

  Functional analysis may reveal that the client lacks specific skills that will allow him/her to cope with situations that trigger alcohol abuse for example.
• Social skills

  Most clients can also benefit from developing skills that allow them to cope with anxiety in social situations i.e. where others are drinking

  Social skills training (SST) helps clients to learn how to refuse alcohol for example with minimum fuss in ways that avoid embarrassment 

  Whatever skills that need training are identified, explained and modelled by the therapist which the client will then imitate in a role play scenario. Skills training in CBT is highly directive allowing the client to practice with a therapist before using the skills in real life high-risk scenarios
• AO3 - Evaluation 

  (-) Short vs long term gains

  However, the pattern revealed by most CBT research shows short term benefit but little long term impact

  Cowlishaw et al (2012) reviewed 11 studied comparing CBT for gambling addiction with controls. This showed that CBT had medium to very large benefit in the 3 months after treatment but at 9-12 months there were no significant differences between the CBT and control groups. Therefore there is no definitive understanding of the efficacy of CBT
• AO3 - Evaluation 

  (-) Lack of treatment adherence 

  Cuijpers et al.’s (2008) research indicates that drop-out rates for CBT treatment groups can be up to 5x greater than other forms of therapy.