Cognitive Behaviour Therapy for Addiction (AQA A Level Psychology): Revision Note

Cognitive behaviour therapy to treat addiction

• Cognitive behaviour therapy (CBT) aims to change the faulty ways of thinking that lead people to use drugs or engage in behavioural addictions as maladaptive ways of coping

  • There are two indispensable elements to a CBT programme:

    • cognitive restructuring, which identifies and tackles the cognitive distortions that underlie addictions

    • skills training, which helps the client develop coping behaviours to avoid the high-risk situations that usually trigger addiction-related behaviour

• CBT starts with functional analysis, in which the client and therapist together identify the high-risk situations in which the client is likely to gamble or use a drug

  • The client and therapist together identify high-risk situations that increase the likelihood that the client will engage in the addictive behaviour

  • The therapist reflects on what the client is thinking before, during and after such a situation, and the quality of the client-therapist relationship is critical

    • It should be warm, collaborative and responsive, but not cosy, because the therapist must challenge the client's distorted cognitions and not merely accept them

• CBT is used to develop coping skills, strategies and the strength necessary to deal with addiction-related cues or triggers, including:

  • Drug-refusal skills – therapy equipping individuals with specific strategies so that they can deal with the physical temptation and the social pressures to take drugs

  • Cognitive restructuring – this tackles the biases that operate below the client's level of awareness, addressing faulty beliefs about probability, randomness, control, gains and losses, which are confronted and challenged by the therapist

  • Relapse prevention training – a more long-term technique of preventing a return to addictive behaviour by supporting the individual’s new thought patterns and focusing on giving them control over their addiction

• CBT is a 'broad-spectrum' treatment because it focuses on wider aspects of the client's life that are related to their addiction

  • Assertiveness training helps the client confront interpersonal conflicts in a controlled and rational way instead of using avoidance, manipulation or aggression

  • Anger management can help some clients cope with situations that make them angry enough to resort to drinking

  • Social skills training helps clients learn how to refuse alcohol with minimum fuss in ways that avoid embarrassment, such as making appropriate eye contact and being firm in refusing an offer of a drink

Research which investigates cognitive behaviour therapy

• Cowlishaw et al. (2012) reviewed 11 studies comparing CBT for gambling addiction with control conditions, and found that CBT had medium to very large beneficial effects in reducing gambling behaviour for periods of up to three months after treatment

  • However, after nine to 12 months there were no significant differences in outcome between the CBT and control groups

• Petry et al. (2006) recruited pathological gamblers through media advertising and randomly allocated them to a control group attending Gamblers Anonymous meetings, or to GA meetings plus an eight-session individual CBT programme

  • Treatment clients were gambling significantly less than controls up to 12 months later, and as allocation was random with no differences at the start, this is strong evidence that CBT is effective for gambling addiction

  • CBT delivered face-to-face was more effective than CBT delivered by workbook, suggesting some therapeutic benefit in the client-therapist relationship

Evaluation of cognitive behaviour therapy

Strengths

• CBT is especially effective at preventing relapse, which matters because most people's experience of addiction is one of chronic relapse

  • Relapse is treated as an opportunity for further cognitive restructuring rather than as failure, and may be seen as an inevitable part of the addicted person's life, acceptable as long as their psychosocial functioning improves

• CBT uses a wide variety of techniques, some of which can be combined with other treatments such as drug therapies, and delivery has expanded in recent years to include online and telephone-supported formats

  • This means treatment can be tailored to individual needs, making it more likely to suit the particular addiction and circumstances of each client

Limitations

• Cuijpers et al. (2008) indicate that drop-out rates in CBT treatment groups can be up to five times greater than for other forms of therapy, which may be because CBT is a demanding therapy

  • Even when the most high-risk users continue in treatment, they take it less seriously, completing fewer homework assignments and attending fewer sessions

• The flexibility of CBT makes it difficult to establish which components actually work, as there is no standard treatment to evaluate

  • Two clients described as receiving 'CBT' may have had very different programmes, so studies comparing CBT with control conditions are not comparing a single consistent intervention

Issues & Debates

• CBT is based on the idea that individuals have control over their thoughts and behaviours, supporting the free will side of the determinism vs free will debate

  • This contrasts with deterministic models (e.g. biological or learning theories) that suggest addiction is outside of conscious control

• CBT offers a more holistic approach by addressing both cognitive and behavioural aspects of addiction

  • This contrasts with biological therapies, which are reductionist and focus only on brain chemistry or genetics