Types of Behavioral Therapy
Behavioral therapy, a commonly used evidenced-based practice in addictions treatment, was initially pioneered by Dr. Aaron Beck and Ivan Pavlov through a variety of experiments which were informed by an understanding of classical conditioning and automatic thoughts. Classical conditioning, founded by Pavlov, is a concept that resulted from the infamous experiment, “Pavlov’s Dogs”, which helped establish the behavioral connection between stimulus and reward. By conditioning the dogs to salivate (respond) after ringing a bell during feeding time, the behaviorist identified how learned responses are formed from unconditioned stimuli. Another form of learning, called operant conditioning, helps understand the developed connection between behavior and consequence, also known as positive and negative reinforcement and is similar to types of aversion therapy. Although addiction is not typically an intended outcome in substance use, conditioning as a concept aids in the development of addiction. That said, it can also be used to help gain an understanding of one’s behavioral learning style and work towards recovery from the addiction.
In addiction, substance use becomes the conditioned response to multiple stimuli including uncomfortable emotions, a phase of life issues, conflict, and various other unpleasant situations. The development of a conditioned response is best described as: When I drink I feel good; I have a bad day so I drink to feel good again; therefore when I have a bad day, I am triggered to drink. Behavioral conditioning is important in understanding how addiction forms in each individual, which includes identifying triggers: what makes you want to use or drink. In treating addiction, behavioral therapy helps by changing the conditioned response to the stimuli through the development of healthier coping skills and possibly changing exposure to the stimuli. There are multiple types of behavioral therapy approaches that help address learned responses and conditioning such as cognitive behavioral therapy, systematic desensitization, aversion therapy, and flooding.
Behavioral therapy is used to manage mental health symptoms and to treat addiction by changing behaviors which subsequently changes how you feel and think. This includes finding more positive and healthier activities to engage in, developing and utilizing your support system, and learning a more self-compassionate and positive language and automatic thoughts. At APEX Recovery, behavioral therapy approaches are utilized daily through behavior activation exercises, group therapy activities such as CBT, and recommended self-care interventions.
Cognitive behavior therapy (CBT) is a treatment intervention used to target unhealthy and irrational thoughts, behaviors, and feelings. Destructive behavioral patterns, such as substance abuse, have been linked to unhealthy thoughts and feelings about oneself, others, and the future. An example of this might be, “If I make a mistake at work and get a write-up, I believe I am a horrible person and should know better, I feel anger and shame, so I drink alcohol”. This example shows how unhealthy thoughts towards oneself result in uncomfortable emotions and subsequent unhealthy and destructive behavior patterns. By using CBT, you can identify cognitive distortions and extreme thinking patterns that can cause self-loathing and destructive behaviors, including substance use. Through changing the response or reward to stimuli to be healthier and constructive, you will able to build confidence, increase self-esteem and decrease the use of habits that help perpetuate substance use.
Other forms of behavioral therapy, such as systematic desensitization and flooding, address fears and phobias which can often include anxiety and panic. Systematic desensitization is a form of exposure therapy that helps target irrational fears through gradual exposure. As with other forms of behavior therapy, systematic desensitization uses classical conditioning to counter-condition the response to fear or fearful situations. This form of therapy helps with social anxieties, panic, phobias, and other forms of anxiety disorders by helping the client develop relaxation and grounding skills through progressive muscle relaxation, deep breathing, and meditation and then gradually exposing the client to the stimuli. For example, if a client experiences anxiety about going swimming, the client would identify a small goal related to the task, such as putting on a swimsuit and engage their relaxation exercise during the task to help the mind associate the task to relaxation and safety as opposed to anxiety and fear. In this form of therapy, setting small goals for yourself is important and can be used as a way to mark progress and continued efforts.
In rehab programs, anxieties and fears are often co-occurring and can be a trigger for continued substance use. Some fears can include managing responsibilities of adulthood, parenting, social interactions, making new friends, etc., and can develop at a young age through traumatic experiences, unhealthy relationships, etc., making it difficult to build a healthy lifestyle for yourself. The innate purpose of fears and anxieties is to be a motivator and influencer in preparedness and precaution. However, if not addressed appropriately, they can be isolating and place limits or boundaries on a person that seem immovable and, in some cases, can become dangerous in addiction. In these cases, substance use can be seen as a way to cope with the isolating mental and physical strain that arise from those fears and anxieties. By using systematic desensitization, a client can gain the abilities to self-soothe when signs of anxiety begin the emerge. The use of classical conditioning in exposure therapy focuses mainly on pairing the conditioned stimuli to a healthier response, similar to Flooding.
Another efficient form of behavioral therapy, called “flooding”, can also be as effective and is known to be helpful for symptoms congruent with Post-Traumatic Stress Disorder. In this technique, the exposure is more immersive and less gradual. When using flooding in behavior therapy, the client learns grounding and relaxation techniques to help manage the anxiety and fear. There is also a component of cognitive therapy associated with flooding that is used to address cognitive distortions and irrational thought patterns; the CBT portion also helps process any trauma or unsettling experiences related to their anxiety. As a result, when the flooding experience occurs, the client is able to think more rationally and use grounding techniques to overcome the fear.
For example, a person who is triggered to drink alcohol due to social anxiety may be asked to attend a party, sober and alone, for a small and specified period of time. In this example, the individual is immersed in their feared experience, in a controlled environment, and is encouraged to apply their grounding techniques in the situation with the new knowledge they have gained. This subsequently re-conditions the brain to develop a more corrective experience. For clients who have a history of trauma and other fears that result in impairment or lifestyle disturbances, flooding can be very effective. As with any therapy, the coping skills learned and the knowledge gained during the course of therapy can be applied towards their recovery. By addressing the identified fears and traumas the individual will learn how to respond and react in situations and not feel that their fears and anxieties are hindering their progress towards recovery. It is of the utmost importance that these areas are addressed while completing recovery treatment in an effort to decrease the chance of relapse when encountering stimuli that were significant triggers for substance use initially. Through developing healthy coping skills to effectively manage such triggers, recovery is more attainable.
Lastly, an alternative behavior therapy approach that utilizes conditioning, called aversion therapy, has been proven effective in treating addiction through reinforcement and mild aversion techniques. Aversion therapy is a form of behavior therapy that uses conditioning to break certain behavioral habits. Different from systematic desensitization and flooding, instead of the client pairing the stimulus to a relaxation response, the stimulus is paired to something of discomfort in an effort to associate the behavior with an unpleasant response and therefore cease the behavior. This is sometimes used in substance use treatment in many different ways. For example, as a way to help a loved one abstain from substance use, a family member may decline continued support of the loved one. Another example would be the use of Antabuse for someone with a drinking problem, which is a medication that causes a person to experience symptoms of a severe and highly unpleasant physical sickness when alcohol is consumed. In substance use treatment, aversion therapy is used as a way to help the client abstain from substance use by associating continued substance use with something of mental or physical discomfort. That can include loss of financial support, declining health, and loss of familial support.
In reality, recovery is challenging as it includes having to change behaviors, mindsets, and the overall lifestyle. It can also be difficult to obtain abstinence due to the quick and seemingly painless relief that substance use provides in the moment. However, the natural progression of substance abuse can often result in broken relationships, unprocessed trauma or emotions, health issues, and more hurt and anguish. For some, the inevitable damage substance abuse causes can be used as a form of aversion therapy to cease continued use and possibly seek treatment towards recovery. Just having the knowledge of the impairment that continued substance abuse has can reinforce continued abstinence. In many ways, aversion therapy is used at our facility by building the discrepancy between the want to use and the motivation to maintain sobriety. Recovery is a challenging feat which requires hard work and an understanding that cravings will occasionally re-emerge due to association and habit. It is the use of behavioral therapy approaches like aversion therapy that help break these patterns during the process of recovery.
Behavior therapy has been used for many years in a wide variety of therapeutic settings due to its universal techniques. Empirically based research studies have repeatedly shown it to be effective in targeting problems related to emotional regulation as well as unhealthy thoughts and behavioral patterns. In addiction it is common to see distorted patterns of thinking, irrational and unrealistic thought processes and abnormal behavioral patterns. By using behavioral therapy approaches in substance use treatment, the client is given the chance to not only achieve recovery but maintain their abstinence from substance use as well.
At APEX Recovery, relapse prevention is imperative to recovery and is addressed upon the start of treatment. It is therapeutic modalities such as CBT, exposure therapy, systematic desensitization, and flooding that help the client develop the tools and necessary coping skills towards relapse prevention. Clients are also taught how to continue implementing those interventions after treatment, as it is common to continue experiencing triggers, cravings, and other things that may prompt the want to drink or use. In substance use, there are always precipitating factors that exacerbate use and drive addiction and sometimes it can seem too overwhelming to deal with those factors. By addressing those precipitating factors, re-conditioning the mind and body to react in healthier ways, implementing new coping skills, and maintaining the motivation towards abstinence, recovery is possible.
Call APEX Recovery today to begin the process of working with our trained therapeutic staff using behavioral therapy techniques and the cognitive therapy approach to move towards living a life free from drug and alcohol abuse.