Cognitive Behavioral Therapy (CBT) for Veterans with an Addiction

Cognitive behavioral therapy, or CBT, is an evidence-based
therapy used in many different populations and age groups for the treatment of various
disorders. CBT can be effective for many of the issues that Veterans commonly
experience, including post-traumatic stress disorder (PTSD), substance use disorders,
and sleep disorders.^{1, 2, 3} Read more to learn about:

• What CBT is and why it is used.
• How CBT works.
• How the VA and veterans’ benefit programs cover
  CBT services.

What Is Cognitive Behavioral Therapy?

CBT is an intervention used for many mental health issues,
including anxiety, depression, substance use disorders, and eating disorders.¹
CBT focuses on changing unhelpful thinking patterns and helping the
individual develop healthier ones.

The model has certain underlying principles that explain
this focus more in-depth.¹ The core principles of CBT are:¹

• Mental health issues are based on faulty
  thinking patterns to a large degree.
• Patterns of unhelpful learned behaviors create
  mental health issues and other problems.
• People can learn new coping skills through CBT
  that reduce negative symptoms and help them function in more effective
  ways.

CBT is a relatively new form of treatment for mental
health disorders. For decades, mental health treatment focused on
psychoanalysis, and eventually, leaders in the field of psychology noted that
the approach was not particularly effective.⁴

In the 1960s, a new movement towards evidence-based
practices emerged, where psychologists began to study which treatments worked
the best for specific problems and developed protocols.⁴

The focus in psychology moved from trying to understand
unconscious impulses and motives to working on improving problems in the here
and now to offer symptom improvement.⁴

Essentially, CBT helps people understand that it is not so
much what happens to them, but rather how they view the events that really
matter.⁵

CBT Uses & Addiction Treatment

CBT has been shown to be effective in the treatment of
many mental health
disorders, including substance use disorders.⁵

When a person has a substance use disorder, CBT can be
helpful to aid the person learn to think in new ways that help them avoid
substance use.⁶ For example, CBT can teach a person to develop new
strategies for managing stress that don’t involve using substances. A person
can learn other coping skills, such as self-monitoring for early warning signs
of relapse or avoiding situations likely to trigger cravings.⁶

For veterans, CBT can be used not only for addiction treatment
but also for PTSD, chronic pain, depression, and other issues.^3,5,6,7
For example, in treating chronic pain, the therapist can work with a veteran to
reshape their thinking about pain in ways that will reduce the impact pain has
on their life. CBT has been shown to helpful for Veterans in terms of:⁷

• Decreasing the intensity of pain.
• Managing cycles of more intense pain.
• Increasing the person’s involvement in positive activities.
• Improving overall quality of life.
• Managing worries about pain.

Likewise, sleep disorders can be helped by specific CBT
interventions.² A CBT therapist can help Veterans struggling to
sleep well find ways to relax and can help them develop practical habits (sleep
hygiene) to encourage better rest, such as keeping a room dark and avoiding
caffeine.²

If the Veteran has built up fears and anxiety around
sleeping due to a pattern of insomnia, a CBT therapist can work with them on
cognitive restructuring to reduce that anxiety.^2(middle)

If a Veteran has PTSD,
CBT can help them to manage the traumatic memories and associated behaviors, as
well as reduce the risk of suicide.³

How Does Cognitive Behavioral Therapy Work?

CBT works to alter a person’s thinking patterns. One of
the important goals of CBT is to realize that distorted thinking leads to
problems and learn to reevaluate thinking in a realistic way. CBT can help a
person gain a better understanding of other people’s motivations and behaviors.
It focuses on problem-solving and gaining confidence in one’s ability.¹

In addition to changing thinking, CBT also focuses on
changing behaviors.One key component is to learn how to face one’s
fears and stop avoiding them.¹ CBT also uses role-playing to
practice engaging in new behaviors. Furthermore, CBT can teach you ways to calm
and relax your mind and body.¹

CBT is never a one-size-fits-all approach, and usually, a
therapist or psychologist will not necessarily use all these CBT strategies. More
often, the provider will collaborate with the person to understand the
different aspects of the primary problem(s) and come up with a treatment plan
to address them.¹

CBT is meant to help patients develop the tools they’ll
need to manage stressful situations on their own; this means that patients may
not have to be in therapy for years or a lifetime.¹ CBT emphasizes
teaching coping skills to enable people to learn to solve their own problems,
change their thinking patterns, and manage their emotions.¹

Someone with an
anxiety disorder, for example, will often avoid situations that lead to anxiety
and build up the situation or object to be scarier or more dangerous than it
really is.

For instance, if they have an intense fear of open spaces,
their thinking about the real danger of open spaces has become distorted and
faulty over time. A therapist skilled in CBT can work with the person to lessen
their anxiety by helping them correct their distorted thoughts around open
spaces and managing their anxious responses in the moment to help reduce their
overall fear.⁵ As the person repeatedly adjusts their thoughts with
the help of their therapist, they may eventually be able to do the same on
their own.

Likewise, someone with
depression may see their situation as hopeless and themselves as worthless.⁵
A therapist will help their patient see these negative thoughts as less
absolute and automatic by working with them to determine whether there is
evidence for these thoughts.⁵

The therapist will help the person test their thoughts and
engage in experiments to see how realistic the thoughts are. ⁵ Over
time, the person is less likely to automatically assume they are worthless, or
that the situation is hopeless.⁵

CBT Statistics & Success Rates

There is no treatment that works universally for everyone
in all settings. However, the effectiveness of CBT has been demonstrated in
multiple studies over the years to be more effective than many other types of
treatment for anxiety and some types of substance use disorders, such as marijuana
use.⁸ There is mixed evidence that CBT is superior to other
treatments for depression.⁸

Specifically for insomnia, research has shown that CBT is
just as effective as sleep medication, and over time, it may have a more
lasting effect.⁹

For Veterans, CBT has been demonstrated to be an effective
intervention for PTSD.¹⁰ CBT is noted to be one of the first-line
treatments for PTSD in Veterans.¹⁰

Is CBT Covered by the VA or Veteran Benefits?

Veterans Affairs discusses CBT in several settings, including for chronic pain, insomnia, and PTSD. Counselors and therapists at the VA should be equipped to provide CBT. If a Veteran believes they need addiction treatment and CBT, and that their VA facility cannot provide it, the VA can find a community care partner, including American Addiction Centers (AAC) facilities.

To learn more about the Veteran-specific programming offered at AAC for addiction treatment and co-occurring disorder treatment, call .