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Cognitive Behavioral Therapy as part of the recovery process
Today I want to talk about cognitive behavioral therapy (CBT) and how it is utilized in conjunction with other therapies in the recovery process, including the 12 Steps. Philosophically and at our core as an organization, New Directions for Women is drenched in the 12 Steps of Alcoholics Anonymous. Our women attend multiple 12 Step meetings on and off campus which provide them with an opportunity to talk and listen. Consequently, it works in union with cognitive behavioral therapy. While each patient is different, studies have shown that CBT has been successful in the treatment of addiction with a positive response rate, especially from women. The therapy focuses on the relationships that each patient has between her feelings, thoughts and behaviors.
Studies have shown that women are also very experiential in nature. Before they can get into a cognitive therapy group they have to identify their feelings through an experience. Our facilities, as well as many others, provide experiential therapy with activities such as rock wall climbing, ropes courses, kayaking and equine therapy, all of which provide opportunities for women to experience feelings that can be identified and correlated to specific situations or circumstances in their lifetime.
For example, a woman might be traumatized through some form of abuse (be it sexual, physical, or verbal in nature) at some point in her life (whether young, middle aged, or later in life). Through the experience of rock wall climbing or kayaking, the activity brings up for her the emotion of fear and suddenly the patient identifies when that traumatic event occurred, and she finds herself experiencing the same feeling through this experience. During CBT, patients are asked to identify their feelings and how they might impact their lives negatively. This process allows the patients to find out how their thinking patterns correlate to destructive behavior. By identifying this they can process this feeling. However, it is important that first, they identify the feeling that was associated with the traumatic event.
Through Step work patients can get through the process of the 4th, 5th, and 8th Steps of harms created and amends that need to be made. As they work through their Steps with a sponsor and perhaps as part of their continued treatment process, they will eventually come to a place where they need to develop a personal inventory (this occurs during the 4th Step.) If they have been able (through the use of experiential activities and CBT) to identify “people, institutions or principles with whom [they] were angry … in most cases it was found that our self esteem, our pocketbooks, our ambitions, our personal relationships (including sex) were hurt or threatened” (Big Book, page 64). So once this thorough inventory is completed, we move into sharing this step with another trusted human being, which is known as the 5th Step. In the Big Book on page 73 it states, “We must be entirely honest with somebody if we expect to live long or happily in this world.” After completing the 5th Step, the Big Book of Alcoholics Anonymous directs us to, “…find a place where we can be quiet for an hour, carefully reviewing what we have done.” This is the beginning of the 6th Step which ends with a suggested prayer. Upon completion of this prayer we have completed the 7th Step and at this point the Big Book suggests we get into more action and would have us look at steps 8 and 9. In following the steps as outlined in the Big Book of Alcoholics Anonymous, the list of people that we created for our 4th Step that had harmed us becomes the list of people, institutions or philosophies that we now need to make amends to. This step work coincides perfectly with CBT as it too is very structured and goal oriented.
CBT is a very structured and goal oriented process that focuses on the substance use disorder patient in the short term. One of the goals of CBT is to change how the patients perceive their addiction and to assist them with finding healthy ways to cope rather than using drugs or alcohol. Patients are taught new ways to react to their unwanted reactions through the use of CBT, and for those utilizing 12 Steps, that too supports this change. Most importantly, this type of psychotherapy permits the patient and therapist to work together towards recovery. Cognitive behavioral therapy centers on what problems the patient has and what needs to be addressed while allowing the patient to set goals with her therapist.
The patients are expected to do homework outside of their sessions which is a necessity in the therapy process because it encourages them to put into practice the techniques that were provided by the therapist. The treatment has much flexibility and allows for individualization which can be adapted to various formats including inpatient, outpatient group and individual settings.
Another study that was conducted showed that the use of CBT changes the rate of brain activity in patients which suggests improvement in brain function. However, CBT has been most successful when used in conjunction with other recovery efforts. A Harvard study which sampled substance use disorders in women showed that satisfaction with CBT was high, and a greater number of CBT sessions were associated with greater improvement on drug use. In 2009, it was found that female based recovery groups, “more frequently endorsed feeling safe, embracing all aspects of one's self, having their needs met, feeling intimacy, empathy, and honesty. In addition, group cohesion and support allowed women to focus on gender-relevant topics supporting their recovery. These advantages of single-gender group therapy can increase treatment satisfaction and improve treatment outcomes. Together, these studies have proven that gender based recovery groups with women are advantageous to the recovery process.
We must remember that it is important for a gender separate program to provide services that give women the tools that they need in a way that can be utilized over a lifetime as addiction is a chronic disease. We have found great success in making the core and foundation of our recovery curriculum 12-Step work, CBT and experiential work. We must also keep in mind that women are relationship-oriented and through the combination of these treatments, women going through programs will leave having the tools that they need to support them in their lifelong journey of recovery.
[1]Greenfield SF, Cummings AM, Kuper LE, Wigderson SB, Koro-Ljungberg M (2013). A qualitative analysis of women's experiences in single-gender versus mixed-gender substance abuse group therapy. SUBSTANCE USE & MISUSE, 48(9).
