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The Cognitive-Behavioural approach

A common ‘brand’ of CBA is Aaron T. Beck’s Cognitive Therapy (CT) – a therapy which highlights the importance of a client’s negative automatic thoughts and the way they influence, in a real and abstract way, his or her perception of an event or experience, thus powerfully affecting his or her emotional, behavioural, and physiological responses to it. (Greenberger and Padesky, 1995.) Beck adapted his ‘cognitive model of depression’ (1979) to deal with ‘substance abuse’ (Beck et al., 1993) – a therapy which believed that addictive behaviour is a consequence of a combination of maladaptive core beliefs which elicit negative Automatic Thoughts which provoke and maintain painful or difficult emotional states e.g. “I am helpless”/ “I am trapped in this bad environment”/ “I feel depressed”/ or “I am unlovable”, etc with Addictive Beliefs, or a belief about drug use, which offers a way of coping with those painful or difficult emotional states.

The Addictive beliefs can be a) Pleasure oriented – “It will be fun to get legless”/”I’ll have an hour or so of pure unadulterated pleasure” b) Performance oriented – “I will function better and become a better writer”/”I will be more entertaining” and c) Relief oriented – “I need cocaine in order to function”/”I need a drink to get me out of bed in the mornings”. In addictive behaviour, incidentally, people very often move from the Pleasure oriented, through the Performance oriented, to the Relief oriented belief, by which time they are usually chronically dependent. Coupled with the above beliefs are the Permission Giving Beliefs and Thoughts, which tend to a) Justify the client’s use of the drug – “Nobody will know”, etc b) encourage Risk Taking – “It’s OK I can handle it”, etc., to c) provide Entitlement – I’ve worked hard so I deserve this drink”, etc.

This model, incidentally, does not deal with the root causes (the core beliefs), but deals with the symptoms (the negative automatic thoughts) and the Facilitating Beliefs (or permission giving beliefs) which instigate the cravings or urges which lead to relapse or continued use of the drug or chemical. These two areas, therefore, are where the counsellor concentrates his interventions after establishing a) the therapeutic relationship – maintaining a spirit of collaborative, building trust and rapport, etc; b) formulating the case – using the SPACES method alongside an assessment of the client’s core beliefs or schemas, conditional assumptions, automatic thoughts (especially drug related), and how they impact on emotions and behaviours.

BECK, A. T., RUSH, A. J., SHAW, B. F., & EMERY, G., (1979) Cognitive therapy of depression. New York: The Guilford Press.

BECK, A. T., WRIGHT, F. D., NEWMAN, C. F., LIESE, B. S., (1993). Cognitive Therapy of Substance Abuse. New York: The Guilford Press.

GREENBERGER, D., PADESKY, C. A., (1995). Mind Over Mood – Change how you feel by changing the way you think. New York: The Guilford Press.
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