woman sitting in therapy session

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy, or CBT, is among the most effective therapies in the world. It is based on the idea that many emotional stressors are rooted in thinking patterns. Changing these patterns leads to healing and relief.

CBT can be especially useful in treating addiction, and is a major part of Ria Health’s online coaching for alcohol use disorder.

What Makes CBT Different From Other Kinds of Therapy?

Cognitive behavioral therapy has worked successfully in more than 1,000 research studies.1 Unlike many other therapies that are fluid and may vary in focus, CBT is more structured. It can be flexible and adapted to your needs, but it remains focused on your long-term goals.

Traditionally, therapies may be centered on whatever comes up in the session, much like a conversation with a friend. While this provides a supportive environment, eventually many people may want to achieve more specific goals. This is where CBT comes in.

The therapy was developed by Aaron Beck in the 1960s, at the University of Pennsylvania. Beck began to notice that people’s thoughts impacted their feelings. How a person thinks, especially over time, influences feelings, behaviors, and further thoughts. Understanding this concept opened the door to address all kinds of stress, mental disorders, and even daily perceptions of life.

According to the Beck Institute, “Patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.”2 In this way, individuals can learn skills to become their own therapists.

Table of Contents

Ready for a change in your relationship with alcohol?
Schedule an appointment to speak with a Ria Health team member to get help.

How Does Cognitive Behavioral Therapy Work?

CBT focuses on distorted thinking. While some feelings come up seemingly without much thought, others are influenced by ongoing negative thoughts.

For example, if you often tell yourself that you’re worthless, then you’ll eventually begin to feel that way most of the time. This type of negative feeling is not unusual, but it is harmful. Since no one is actually worthless, this is not an accurate thought. And it’s certainly not a helpful one.

Ongoing negative thoughts can lead to anxiety problems, depression, and contribute to using alcohol and substances to manage emotions. For example, depending on alcohol or substances to cope can lead to feelings of shame or guilt. This ironically increases the urge to use. It can become a vicious cycle.

mental framework cognitive behavioral therapy

Replacing Negative Thought Patterns

Many believe that it’s a natural state for humans to prepare for the worst. Our brains may be wired to think this way, until we begin to question it. And while it is natural for many people, some do seem to have a stronger biological tendency than others. But even when this pattern is set in, it is possible to change it.

This tendency for humans to think negatively is referred to as automatic negative thoughts, or ANTs. CBT therapy helps you retrain your brain to think more productively, and create new, helpful patterns. This can stop the ANTs.

Here’s another example: If you frequently tell yourself that you’re not good at your job, you will begin to believe it. You may then feel discouraged and hopeless, and give up trying. This will likely make things worse, and you’ll use that as evidence to support your original view.

In CBT therapy, you will practice changing this common pattern. You may begin by looking for evidence that challenges your negative beliefs about yourself. For example, perhaps there are several things you do well at your job. Maybe there are areas where you simply need new training.

Or, maybe it is true that this particular position is not a good fit. You may be much more comfortable and successful in a different role. Not being good at this job may actually be a good thing, because it will encourage you to look for something better.

Reframing difficult situations like these, and challenging the unhelpful beliefs, makes a big difference over time. With CBT, you’ll practice changing your way of thinking, and see this modeled by others. Eventually, this will become your more typical way of thinking.

Examples of Thought Changing

Recognizing and changing negative thoughts takes some practice, but can make an ongoing difference. Here are a few more examples of changing specific thoughts:

Negative Thought: I never get anything done because I’m lazy.

Helpful Thought: I have been exhausted and resting a lot lately. Maybe I needed a break.

Negative Thought: Janice didn’t call me back because she’s mad about what I said at the party.

Helpful Thought: I’m not sure why Janice hasn’t called me back. Maybe she missed my message, or she’s working like she did last weekend.

Negative Thought: My spouse is mad at me again. I can never do anything right.

Helpful Thought: My spouse seems frustrated. We’ve both been stressed lately. Maybe we should talk about it.

How Effective is CBT?

CBT has been found helpful for a variety of mental health conditions. It can help with anxiety disorders, past trauma, mood issues, eating disorders, and all types of addictions—including alcohol. In some cases, it can lead to complete relief of symptoms.

CBT has consistently been found to work better than what’s called “treatment as usual,” or the typical type of therapy used. While cognitive therapy is very effective, many therapists aren’t trained in it, or don’t use it often.3 However, some newer forms of addiction therapy, including telemedicine programs like Ria Health, are now using CBT as part of their counseling support.

Learn more about addiction coaching with Ria Health.

What are Some Types of CBT?

There are many types of CBT therapy, as well as many therapies that combine CBT with other strategies. Many therapists combine thought exercises with relaxation techniques like mindfulness. The combination of these strategies can be particularly helpful, especially for those overcoming substance abuse.

Cognitive behavioral therapy is adaptable to the specific population or issue it’s addressing. For example, there are multiple trauma-focused therapies that use CBT. These include a popular children’s therapy,4 as well as cognitive processing therapy (CPT) for adults.

These therapies practice challenging distorted beliefs that relate to the trauma. Many people feel guilty or responsible for their traumas, even when they’re clearly not. Challenging these thoughts can lead to relief from post-traumatic stress and related symptoms.

Some negative thoughts have been present for years, beginning in early childhood. While these thoughts can be a little more difficult to challenge, they are also healable.

One of the advantages of CBT is that you learn the strategies for yourself. As you work with your therapist, the idea is that you will pick up all of the techniques to use on your own. This will lead to less need for alcohol or other coping mechanisms. In the Ria Health program, for example, our coaches frequently use CBT techniques to help members learn to cope with cravings and other challenges as they go through daily life.

Concerned you may be drinking too much?
Take our free alcohol use survey to find out where you stand

CBT for Alcohol Abuse

CBT can be particularly effective for treating alcoholism, or alcohol use disorder. By addressing the thoughts that surround your drinking patterns, you can begin to reframe any feelings of guilt and shame. Examining your thoughts, and their origins, can also help you recognize why and how you use alcohol.

Plus, CBT can address all kinds of problems with work, school, family, or your social life. By better understanding and reframing these issues, you’ll begin to make changes. This can help you establish new thought patterns and behaviors that lead to an overall healthier and happier life.

CBT has also shown strong results as part of app-based therapy, and other online, technology-based approaches to treatment. In two studies of this method, both found that heavy days of drinking decreased significantly.5

Ria Health is one online, app-based treatment program that makes extensive use of CBT techniques. Our members get weekly meetings with recovery coaches, who help them identify and challenge negative thought patterns connected with their alcohol use. This, combined with other elements like anti-craving medications and app-based tools, helps members reduce their drinking by an average of 75 percent in the first year.6

Ready for a change?

Ria Health offers online coaching, along with medication and digital tools, to help you change your relationship with alcohol.


Is My Drinking Normal?

Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol.