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Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

Over time, our life experiences form the basis for a well-organized and relatively stable set of beliefs and expectations. These may include beliefs about ourselves and the world around us. These beliefs and expectations operate to influence our behavior. This happens without our full knowledge and awareness of them. In fact, these beliefs are powerful enough to distort how we perceive ourselves and other people.

brain with gearsOne instance of this powerful effect is the self-fulfilling prophecy. The self-fulfilling prophesy suggests that whatever I expect will happen; will actually happen, just as I expected. This is because my expectation (anticipation) of what will happen causes me to behave in a particular way. Subsequently, I behave in a way that causes certain things to happen in response to my behavior. An example will make this much more understandable. Suppose I attend a party and expect no one will like me. I will probably be anxious because of my expectation. Since I don't expect people will like me, I don't smile at anyone. I stand off by myself. In the event someone does come over to talk to me, I am so nervous that I chatter endlessly. I'm not even listening to what they are saying. Because of my anxious, unpleasant behavior, people at the party avoid me. I may also misinterpret the interactions I have, because I expect people will dislike me. So suppose a woman has been talking to me at the party and then excuses herself. I will immediately assume she departed because she didn't like me. Because of my expectation, I will not search for any other reason for her sudden departure. Thus, I won't notice that someone had just joined the party and waved to her. She simply stepped away to greet them. Upon her return, I look away because I am embarrassed that she doesn't like me. When she sees me look away, she logically assumes I no longer wish to talk to her. So, she walks away. Notice that my expectation "people will dislike me" caused me to behave in a manner that actually created what I expected.

The self-fulfilling prophesy can serve to maintain someone's addiction. This is particularly true if they do not believe that recovery is possible. If I expect that I will fail, this expectation forms a self-fulfilling prophecy. I will not put forth any effort to recover. What's the point? My lack of effort dooms any feeble recovery attempt I make. This further solidifies my inaccurate beliefs and expectations. Therefore, when strong cravings arise, I won't make any effort to cope with them. I might think to myself, "I can't stop anyway, what's the point in fighting it?"

Cognitive-behavioral therapists help people to identify unhelpful beliefs. Next, the therapist encourages people to evaluate the accuracy and helpfulness of their beliefs. Additionally, the therapist guides participants to test the accuracy of their beliefs in the real world (outside the therapy office). These real world "experiments" help people to update their faulty beliefs. For example, suppose someone believes that there's no sense fighting cravings because the cravings never stop. The therapist will ask them to conduct an experiment to see if this notion is true. They will discover it is not. Cravings subside.

Beliefs and expectations also dictate the way we will interpret a particular event. Our interpretation of an event determines how we feel about it. Although beliefs and expectations heavily influence our feelings, most people are not usually aware of these beliefs. Nonetheless, we are usually aware of our feelings. Usually, this lack of awareness is not a problem. This is particularly true for happy well-adjusted people. It really isn't necessary for me to become aware of the beliefs that cause the good feelings I usually have!

What about the person who frequently has negative feelings and doesn't cope with these feelings very well? This person is at greater risk for becoming dependent on addictive substances and activities in order to feel better. Indeed, people often use addictive substances or activities for this very purpose. In these cases, it's important to become aware of these beliefs. Without this awareness, these inaccurate beliefs cannot be updated and corrected. With an accurate perception of the world, and a positive outlook, negative feelings diminish. When negative feelings subside, so does the reliance on an addictive form of relief.

In a similar manner, most people believe that external events, and other people, "cause" their feelings. This is a problematic belief. It leads to feelings of helplessness and the false conclusion that we can do nothing to feel better. Such a belief strengthens the reliance on addictive substances (or activities) as a means of relief from unpleasant feelings. Cognitive therapy teaches people to realize we cause our own feelings, not other people. It is what we think and believe about things that causes our feelings. By changing our thoughts and beliefs, our feelings will change accordingly. Let's use a simple example to illustrate this important concept. Suppose someone has just stepped on my foot. One thought I might have (particularly if I believe that people are out to get me) is the foot-stepper did this on purpose. "I can't believe that idiot just stepped on my foot, how dare he!" These thoughts naturally lead to feelings of anger. Conversely, I could instead think (particularly if I believe most people are kind) the foot-stepper's action was clumsy and accidental. "Whoops, that guy sure is clumsy." This thought might lead to feelings of compassion. Notice the exact same event, caused two opposite feelings; just by the way I think about it. Thus, the situation did not "cause" my feelings. My own thoughts did.


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