Is Alcoholics Anonymous a Form of Cognitive-Behavioural Therapy (CBT)?

By Steve K.

My reply to this question is that the philosophy and culture of Alcoholics Anonymous (AA) is replete with cognitive-behavioural interventions and effectively operates as a form of CBT and peer support system. AA and other 12 Step fellowships are also influenced by medical, philosophical, and spiritual ideas and principles.

The psychologist Clifford N Lazarus, Ph.D, considers AA to be a form of CBT as it encourages ‘thinking differently, acting differently, and taking personal responsibility for one’s decisions.’ He suggests.. “Indeed, if we look closely at AA, we see that despite its spiritual underpinnings and focus on working the 12 Steps, it is a very behaviourally oriented process. For example, one of the core recommendations that AA makes is to change people, places, and things. In other words, to change one’s routines, repertoires, and actions.” (1)

AA undoubtedly facilitates changes in thinking, feeling, and behaviour aimed at recovery from addiction and sober living. Albert Ellis, the founder of Rational Emotive Behaviour Therapy (REBT), an original type of CBT, used his ABC model (A= Activating Event, B= Belief System, C= consequence of A through B) to help identify how irrational beliefs about ourselves, others, and life lead to negative emotions and behaviour.. which for those prone to addiction can result in the harmful drinking of alcohol and/or using of other drugs.

Rational – How we think influences…

Emotive – How we feel, which influences…

Behaviour – How we want to act.

Therapy – Learning how to change our thinking to feel and behave in healthier ways.

The ‘Serenity Prayer’ used in AA encourages acceptance of things beyond our control, the courage to change things within our power (which is our attitudes, values, and behaviour), and to seek the wisdom to know the difference. REBT suggests that irrational beliefs and absolute demands lead to emotional suffering and behavioural dysfunction. Unconditional acceptance of ourselves, others, and life is often the antidote to these unhelpful beliefs and demands and the negative emotions and behaviour that stem from them. Acceptance does not mean that we can’t make efforts to change things within our influence and power, but that we are realistic about how things (ourselves, others, and life) are. The colloquial saying “It is what it is” reflects the wisdom of accepting reality rather than resisting it.

This portrait of acceptance of things beyond our control and focus upon things that we have the power to change, and how we consider life events, goes back to the early Greek and Roman Stoics. I’m reminded of the quote by the well-known Stoic philosopher Epictetus, 50 – 135 AD.. “Men are disturbed, not by things, but by the principles and notions which they form concerning things.”

Stoic philosophy, and in particular the Stoic philosophy of Epictetus and the Roman emperor Marcus Aurelius, strongly influenced Albert Ellis and his ABC model within REBT. AA uses a similar tool for self-reflection in Step 4 of its 12 Step program, which encourages its members to list people and events that trigger negative emotional and behavioural responses related to core human instincts (material, emotional, social, and sexual). Changing the self-centred, absolutist irrational beliefs that lead to negative emotions and behaviour is facilitated by AA’s spiritual principles and philosophy.

Albert Ellis believed that our egotistical irrational beliefs (IB’s) manifest in three forms… 1) “I must be successful,” 2) “Others must treat me well,” and 3) “Conditions under which I live must be agreeable to me.” (2) These must beliefs are a result of grandiosity according to Ellis, in other words, taking ourselves and our importance in the world too seriously.  The reality is that the world doesn’t revolve around those with grandiose thinking and beliefs (or anyone else), and they are setting themselves up for emotional pain and disappointment by viewing life in this way. Ellis advocated reframing our thoughts and beliefs with humbler and less absolutist desires and language, or in terms of CBT terminology, realistic/rational beliefs.

Like Albert Ellis, AA philosophy teaches that an ego-centric view of life creates mental and emotional suffering by suggesting that… “selfishness – self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity.” (3) The belief that grandiosity/egotism causes mental suffering is a core aspect of Buddhism and this ancient philosophical system of thought also influenced Ellis’s formulation of REBT. (4)

The CBT theorist David Burns suggests other types of cognitive distortions that often create negative emotions and dysfunctional behaviour based upon ‘all or nothing thinking’, ‘over generalisations/exaggerations’, ‘discounting the positive’/ ‘mental filtering’, ‘catastrophizing’, ‘minimization’, ‘jumping to conclusions’ and ‘mind reading’. (5)

Anyone who’s familiar with recovery fellowships and culture will be aware that these types of fear-based irrational thinking styles are very common among those who’ve suffered addiction (and human beings generally) and that 12 Step philosophy, literature, meetings, and sponsorship provide a healthy challenge and alternatives to this type of unhelpful thinking. AA meetings are full of positive psychology and cognitive reframing strategies e.g., viewing life’s difficulties as “an opportunity for growth”. This type of attitude is a classic example of Stoic philosophical thinking too.

Dr Clifford N Lazarus, Ph.D, the current world authority of Multimodal Therapy (MMT), also suggests that.. “working the 12 steps of AA amplifies the corrective thinking and corrective action (CBT) components of AA [meetings and culture] because [the Steps] encourage people to develop more self-awareness (“a searching and fearless moral inventory of ourselves”), face fears (“make amends”), engage in self-monitoring (“continue to take personal inventory”), take personal responsibility (“when we are wrong promptly admit it”), and change ones’ consciousness (“through prayer or meditation”).

In addition, the AA group process – including self-disclosure, mutual support, and observational learning – parallels many of the features found in cognitive-behavioural therapy groups.” (6)

In my experience, AA does encourage taking personal responsibility in relation to changing unhelpful attitudes and behaviour within a mutual help setting, regardless of encouraging belief in a ‘higher power’. For me, this ‘suggestion’ helps me relate to life in a less than egotistical way, realising that I am but a small part of a much greater interconnected whole. It’s not all about me and my wants and desires.

The AA group also encourages engaging with recovery activity and being responsible for our own efforts in this regard. The individual in 12 Step recovery is responsible for not taking the first drink or drug. They are also responsible for practicing the 12 Steps, for going to meetings, working with their sponsor, for carrying out service, and helping others to recover. These are all behavioural actions that facilitate personal change and help to maintain recovery from addiction.

The AA group without any doubt offers hope, wisdom, tools for living, and encourages pro-social behaviour through its promotion of virtue and service to others. These positive characteristics are also present within Stoic philosophy and CBT based mutual help groups such as SMART recovery.

In conclusion, I’m not suggesting that AA and CBT are synonymous, but that AA philosophy and culture bring about positive changes in thinking, feeling, and behaviour through comparable interventions and principles to those used within CBT. I’ve also indicated the Stoic influences upon AA and its focus upon acceptance and keeping things within the present day which are also common features of CBT.

References:

  1. Does AA work because it’s a form of CBT?’ By Clifford N Lazarus, Ph.D. Psychology Today, July 20th, 2010.
  2. ‘The Philosophical Foundations of Cognitive Behavioural Therapy: Stoicism, Buddhism, Taoism, and Existentialism.’ By Edward Murguia & Kim Diaz. Journal of Evidence-Based Psychotherapies, Vol. 15, No. 1, March 2015, 37-50.
  3. Alcoholics Anonymous, 3rd edition, p.62.
  4. ‘The Philosophical Foundations of Cognitive Behavioural Therapy: Stoicism, Buddhism, Taoism, and Existentialism.’ By Edward Murguia & Kim Diaz. Journal of Evidence-Based Psychotherapies, Vol. 15, No. 1, March 2015, 37-50.
  5. Ibid.
  6. ‘Does AA work because it’s a form of CBT?’ By Clifford N Lazarus, Ph.D. Psychology Today, July 20th, 2010.

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