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 888-902-8397.

Sources:

1. American Psychological Association. (2017, July). What is cognitive-behavioral therapy?
2. U.S. Department of Veteran Affairs. (n.d.). Understanding cognitive behavioral therapy for insomnia. (CBT-I).
3. U.S. Department of Veteran Affairs. (2022, March 23). Suicide and PTSD.
4. Koerner, K. (2018). Science in practice. In S. C. Hayes & S. G. Hofmann (Eds.), Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy (pp. 45–65). New Harbinger Publications.
5. Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(Suppl 2), S223.
6. National Institute on Drug Abuse. (2020, June 1). Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).
7. U.S. Department of Veteran Affairs. (2022, February 22). Cognitive behavioral therapy for chronic pain.
8. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
9. Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice, 13(1), 1–11.
10. Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258.