The Original CBT Manual

by Steven Gledhill for FREEdom from MEdom Project 

FREEdom from MEdom Project (FFMP) is a unique opportunity to merge together the best of evidenced-based cognitive-behavioral therapy (CBT) approaches with faith-driven Christ-centered 12-Step power for a transformative new life experience. This online resource appreciates the scientific realities of how the brain functions. It recognizes that both excitatory and inhibitory biochemical activity are self-centered and therefore predisposed to untamed automatic thinking patterns that foster distortions (errors) and dysfunction from an irrational core belief of entitlement. This core belief of entitlement fuels an ongoing diagnosis of ill psychological health, with the prognosis being painful consequences that trigger more distortions and dysfunction. Add to that the spiritual reality of man’s selfish sin nature and you have… (?)   

The Bible, recognized by Judeo-Christian scholars and Evangelicals as the Word of God, should also be recognized as a vehicle for clinicians utilizing a cognitive-behavioral therapeutic (CBT) approach to spark behavioral change into rational recovery. The parallels between CBT principles and Scripture are profound and seemingly endless when studied in this context. As you read article after article throughout FFMP, you will discover these obvious parallels again and again. This is meant to be a reference particularly for Christian counselors to map out these relevant parallels to benefit clients seeking to make sense of faith-driven Bible-based principles for thinking and behaving differently, while also remaining clinically sound.

The following two paragraphs are taken from the Beck Institute for Cognitive-Behavioral Therapy:

Developed by Dr. Aaron T. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems. Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, 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.

Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally. When people are in distress, they often do not think clearly and their thoughts are distorted in some way. Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.

1st Century CBT

The primary focus of CBT is to change behavior from something unhealthy into something healthy. If the cognitive-behavioral emphasis is to change behavior then it goes without saying that there must be a change in how a person thinks; coming to believe that such behavioral change makes complete sense. CBT strategies involve targeting irrational beliefs (conclusions) that distort values and motivations according to what the irrational mind thinks and believes it wants.

CBT/REBT

Albert Ellis in the middle of the twentieth century hypothesized that we respond to events in our lives that activate beliefs from the way the events are interpreted; the beliefs give way to behaviors that result in consequential outcomes. His process of human thinking and emotion driving behavior is referred to as Rational Emotive Behavioral Therapy (REBT). Dr. Ellis suggested that A (Activating event) plus B (Belief about the event) equals C (Consequence from behavior fueled by irrational beliefs or conclusions drawn from the activating event).

The truth about how one interprets life experiences (activating events), drawing conclusions about experiences, is that beliefs are shaped by desire and expectations set up according to desire. We desire satisfaction and contentment. We desire to love and to be loved. We desire nourishment. Desire evolves into selfish ambition, lust, and jealousy—coveting the things that we want that we do not yet possess. The science of it is that there are chemicals in the brain that respond and react to desire while at the same time feed into human desire. The spiritual reality is that we have a selfish sin nature at the core of human desire that is unhealthy from the outset of our human existence.

Each one is tempted when he is drawn away by his own desires and enticed. Then, when desire has conceived, it gives birth to sin; and sin, when it is full-grown, brings forth death. James 1:14-15 (NKJV)

What is recognized today as revelation and fundamental to twenty-first century CBT therapists was not lost on the New Testament writers of the first century. Let’s break down this passage from James 1 from Dr. Ellis’ point of view.

Each one is tempted… This is the natural response to the (A) Activating event that evokes an interpretation of the occurrence (stimulus); it is the action that calls for a reaction; the cause that precipitates an effect. What is temptation? It is a natural interpretation that through the lens of selfish entitlement breeds expectation. The expectation enhances inherent desire, according to cognitive impulses from the interpretation of the event.

When he is drawn away by his own desires and enticed… Here lies the antecedent to one’s interpretation of the (A) Activating event. Inherent desire, from a core value of entitlement, is on its own wild and free. Untamed and stimulated, desire is off to the races wanting what it wants when it wants. Desire is motivated to dominate; getting its way. The Limbic System of the brain is where dopamine thrives for the purpose of pleasure, reward, and relief. Dopamine and serotonin levels can spike when stimulated. The brain’s thinking center—reasoning, judgment, emotion, memory, language—are also influenced and motivated by selfish intentions. The inhibitory process intended to protect us you could say is under the influence. As excitatory “GO” or “DRIVE” systems of the brain are in full acceleration mode, trending typically to override inhibitory “STOP” or “BRAKE” systems, we are “dragged away by desire and enticed”.

Then, when desire has conceived… We are driven toward a (B) Belief about the (A) Activating event inspired by desire and the obsession to gratify it. Considering that our reasoning is impaired by selfish desire, we are prone to irrational beliefs that we justify in our self-centered thinking to make enough sense that we are willing to risk losing what we intellectually, emotionally, and spiritually hold dear, even sacred. Desire extends itself as far, as high, and as low as it takes to be gratified, inconsiderate of the cost to the things held most sacred. 

You have traveled far, even into the world of the dead, to find new gods to love. You grew weary in your search, but you never gave up. Desire gave you renewed strength, and you did not grow weary. Isaiah 57:9-10 (NLT)

It (human desire) gives birth to sin… S.I.N. is the Bible’s three-letter word for Self-Inflicted N-sanity, meaning that the harder we try to achieve satisfaction left to our own selfish devises, independent of God’s will and plan, settling for instant but fleeting gratification, the deeper we dig our way into the pit of dissatisfaction, decline, and destruction. It is here that our (B) Belief of entitlement is deeply rooted and firmly established. It is here that desire for satisfaction is translated into ambition and greed, lust and covetousness, jealousy and resentment, self-pity and shame, failure and fear. When we believe in the lies of unmet expectations we fall prey to the traps set in our minds about our livelihood, the world, and our place in it. As we buy into our Self-Inflicted N-sanity, we fall victim to moral sabotage caught in the deceitful web of irrational thinking and belief. Of course, by this time we have given in to these automatic thinking patterns and obsessions, then into compulsive (addictive) behaviors. The GO system of our brain remains in perpetual drive mode, the brakes don’t work very well, making it very difficult to STOP in time, and as previously stated, we are off to the races.

Sin, when it is full-grown… Most CBT/REBT models suggest that from the (A) Activating event to (B) Belief about the event, there is a time of thinking that is affected by the automatic processes within the brain that, when healthy, can lead to rational conclusions and healthy decisions. When unhealthy, this time of thinking is infected by the automatic processes within the brain leading to irrational conclusions—irrational beliefs—paving the way for irrational decisions resulting in unhealthy irrational behavior.

Ambivalence is being attracted to and desiring things equally that are opposite of each other—a conflict in the mind between good and evil, if you will. Ambivalence during this time of reasoning, when infected by irrational thinking, weakens the ability for sensible reason. Borne out of that irrational belief state is compulsive and addictive behavior. Common sensibility is replaced by Self Induced N-sanity, and behavior reflects this sick reality. Despite adverse consequences, the addictive behavior continues. 

Brings forth death… There is a plethora of (C) Consequences throughout this rational-emotive-behavioral cycle. Scripture here is identifying the negative outcomes of irrational reasoning and addictive behavior. Dissatisfaction, decline, and destruction result in the ultimate outcome: death.

Insanity is often described as doing the same thing over and over again expecting a different result. The different result would be finally achieving fulfilling satisfaction instead of ongoing and perpetuating empty dissatisfaction. The deception lies in the temporary gratification that arrives through addictive behavior. If there was not some temporary gain from the behavior, the behavior would extinguish. Of course there is gain realized in addictive behavior. You are angry so you yell at someone or hit something. The anger-stress hormone cortisol is released and the gain is, at the very least, relief (a form of gratification). But the gain is temporary. That someone you yelled at yells back at you with stinging words, or perhaps you broke your hand had you hit something. Now you are angry again, or worse, your spirit is crushed.

Stress, shame, resentment, and fear seem to fade away when thoughts and feelings are medicated. Yet, for some reason, our irrational-minded beliefs continue to fuel and drive addictive behavior until all of the setbacks are too much to recover from until we finally succumb to the ultimate dissatisfaction: death. Death can be physical death: to the body, and/or psychological death: to the mind (cognitive-rational), and/or behavioral (addiction)/social (relationships) death: to the heart (emotive); and/or spiritual death: to the soul (will).  

Stages of Change

The Stages of Change Model was originally developed in the late 1970’s and early 1980’s by James Prochaska and Carlo DiClemente at the University of Rhode Island when they were studying how smokers were able to give up their habits or addiction. This model has been applied to a broad range of behaviors including weight loss, injury prevention, and overcoming alcohol and drug problems among others. The idea here is that behavioral change does not happen in one step. Rather, we tend to progress through different stages on our way to successful change in recovery.

Assuming you are likely a clinician reading this, here is the in-a-nutshell recap of stages of change.

In Precontemplation we are not yet acknowledging that there is a problem behavior that needs to be changed. In contemplation we are acknowledging that there is a problem but not yet ready or sure we are wanting or willing to make a change, though we might begin to make inquiries into what needs to change. In Preparation (Determination) we’re getting ready to change, wondering perhaps what changing will require—what will it take? In the Action stage we are changing behavior perhaps with the attitude of doing whatever it takes to change. In Maintenance it is just that: maintaining the behavioral change. And in Relapse we are returning to older behaviors, giving in to tempting triggers rejecting and abandoning the new changes.

Precontemplation & Contemplation

The Bible, the original CBT manual, takes its readers through the stages of change in recovery from sin, Self-Inflicted N-sanity. Even Jesus, Counselor, Prince of Peace, recognized those perhaps not ready to get well. He identified the ones lost in the pain of their mess and asked the question, “Do you want to be well?”

Crowds of sick people—blind, lame, or paralyzed—lay on the porches.  One of the men lying there had been sick for thirty-eight years. When Jesus saw him and knew he had been ill for a long time, he asked him, “Would you like to get well?”  “I can’t, sir,” the sick man said. John 5:4-7 (NLT)

We learn in the story that the man was paralyzed, obviously aware that he had a problem, but over the better part of four decades had become oblivious to it; it having been such a familiar reality in his life. According to the story, he had the opportunity weekly to be the first one placed in the pool of Bethesda for healing as the waters stirred. In 38 years there would be nearly 2000 chances for his healing. You would think that someone or group would have made it a point to get this man in the pool.

I do counseling work in a prison and have used this example of pre-contemplation and suggested that Jesus asking this man if he wanted to be well would be like asking the inmate, “Do you want to be set free?” It sounds silly but it is a legitimate question for the inmate who, while he treasures freedom, takes freedom for granted. He had the very thing he claims to hold sacred until he sacrificed his freedom for temporary gratification in a manner connected to prison. The inmates I work with do not like this truth because the truth really hurts. They do, however, appreciate it and want desperately their next shot at freedom. 

As one vacillates between the precontemplation and contemplation stages in recovery there is a tendency to take on a kind of victim disposition. A Scripture passage that depicts this “the world is out to get me”, or worse, “God has set out to punish me”, for my choices and behavior is from King David. David often times talked the talk while struggling to walk the walk. As King of Israel, David was wealthy and powerful enough to take on more than one wife and did so, contrary to the will of God. And he didn’t stop there. He had ongoing sexual relationships with the young servants of his multiple wives; all after he’d confessed and repented to God for his adultery with Bathsheba and conspirator role in the murder of her husband. Any chance David had issues with addictive thinking and behavior? Consequences of his choices and behavior rippled through his family for years. One son raped his half-sister. Another son arranged the murder of his brother that had raped his sister. Then the son who had his brother killed and then plotted to kill his father, the king, was killed by David’s security force. David became so depressed and despondent that he nearly lost his kingdom in the process of it all.

Look at David’s words in the midst of the aftermath after his addiction wrought tragic consequences:    

O Lord, don’t rebuke me in your anger or discipline me in your rage! Your arrows have struck deep, and your blows are crushing me. Because of your anger, my whole body is sick; my health is broken because of my sins. My guilt overwhelms me—it is a burden too heavy to bear. My wounds fester and stink because of my foolish sins. I am bent over and racked with pain. All day long I walk around filled with grief. A raging fever burns within me, and my health is broken. I am exhausted and completely crushed. My groans come from an anguished heart. 9 You know what I long for, Lord; you hear my every sigh. 10 My heart beats wildly, my strength fails, and I am going blind. 11 My loved ones and friends stay away, fearing my disease. Even my own family stands at a distance. Psalm 38:1-11 (NLT)

Prior to David’s relapse into his addictive chaos, he had come to his senses regarding his adultery with Bathsheba and the hit he’d put out on her husband. David had taken responsibility for his actions and had this moment of repentant prayer with God, seemingly determined and prepared to begin a commitment to a changed life. We cannot know, though, if David committed to recovery more than a minute or two into the action stage of change. What would active change into authentic recovery even look like for this king? Anyway, below is the confession at the time that David realized how low he had sunk into his addiction (Self-Inflicted N-sanity). Addiction to what… power… sex… love… wealth…? How about entitlement? Let’s go with that.

Contemplation and Preparation/Determination

Have mercy on me, O God, because of your unfailing love. Because of your great compassion, blot out the stain of my sins. Wash me clean from my guilt. Purify me from my sin. For I recognize my rebellion; it haunts me day and night. 

Purify me from my sins, and I will be clean; wash me, and I will be whiter than snow. Oh, give me back my joy again; you have broken me—now let me rejoice. Don’t keep looking at my sins. Remove the stain of my guilt. 10 Create in me a clean heart, O God.     Renew a loyal spirit within me. 11 Do not banish me from your presence, and don’t take your Holy Spirit from me. 12 Restore to me the joy of your salvation, and make me willing to obey you.

17 The sacrifice you desire is a broken spirit. You will not reject a broken and repentant heart, O God. from Psalm 51 (NLT)

There appears to be a clear difference between David’s Psalm 38 plea for mercy and his Psalm 51 desire for change. In Psalm 38, David feels like a victim of the consequences of his shameful behavior, expecting to be punished by a vengeful God. In Psalm 51, David talks to God as his Higher Power, understanding that he deserves to experience the full consequential weight of his action, but expectant of God’s forgiveness because of His gracious compassionate mercy. In Psalm 38, David seems to vacillate between precontemplation and contemplation in terms of his readiness for real substantive change. In Psalm 51, David is still in a contemplative place and appears to be trending toward preparation for recovery. There is determination in his words anticipating reconciliation and salvation, where in his Psalm 38 confession, the tenor of his words is self-pity in failure, rejection, and defeat.

While David was described as a man after God’s own heart, perhaps because his repentance was authentic from a relationship with his God of love, peace, and joy; his recovery experience was a bit schizophrenic. It was on the one hand victorious, even glorious; and on the other hand it was tragic, as David lamented in the desperate cycle of contemplation to preparation, and maybe action stages of change now and then, but free falling into relapse to the point that he almost lost everything after he seemingly lost everything once before.

It should be noted that David’s desperate plea in Psalm 38, chronologically was written a number of years after his beautiful prayer of repentance in Psalm 51. Toward the end of David’s life, he said the things that are reassuring about where he was in his recovery journey while, at the same time, curious.

“The Lord is my rock, my fortress, and my savior; my God is my rock, in whom I find protection. He is my shield, the power that saves me, and my place of safety. He is my refuge, my savior, the one who saves me from violence. I called on the Lord, who is worthy of praise, and he saved me from my enemies.“The waves of death overwhelmed me; floods of destruction swept over me. The grave wrapped its ropes around me; death laid a trap in my path. But in my distress I cried out to the Lord; yes, I cried to my God for help. He heard me from his sanctuary; my cry reached his ears. 2 Samuel 22:2-7

He led me to a place of safety; he rescued me because he delights in me. The Lord rewarded me for doing right; he restored me because of my innocence. For I have kept the ways of the Lord; I have not turned from my God to follow evil. I have followed all his regulations; I have never abandoned his decrees. I am blameless before God; I have kept myself from sin. The Lord rewarded me for doing right. He has seen my innocence. 2 Samuel 22:20-25

What is curious is that David would appear to a recovery clinician to be in denial about his behavior and the consequences of it. Or, I suppose you might say that he had overcome his shame in recovery and set free from it; and that God when He looks at the life of David, sees a man whose slate is wiped clean, declared innocent through repentance. It is clear looking back at his life that David was a pawn in his ambivalence between what he wanted in the moment and what was good and right and truly satisfying.

Ambivalence/Cognitive Dissonance: Resistant or Motivating?

When I want and am motivation for more than one thing equally, and those things I desire are opposite of each other—meaning to gain the one things means to lose the other—I am experiencing ambivalence. My ambivalence presents cognitive dissonance (means internal conflict or disagreement), which means that I am experiencing conflict between continuing in my problem behavior and embracing, or at least considering, healthier behavior choices in recovery. This inner conflict in my thinking can be resistant to recovery or motivation for recovery, or both. If I am in a precontemplative stage of change (not in recovery), cognitive dissonance can create a conflict in my thinking about my negative behavior when I had no conflict about using in the worst of my addiction. It could be that something severe enough to really catch my attention has motivated me to contemplate that I might have a problem requiring behavioral change to solve it. But if I am contemplating change, determined and preparing for change, or acting on change, cognitive dissonance can argue against rational sensibilities that had proven effective for awhile. 

Once again, there is some 2000 year old literature that speaks to this condition from a man named Paul. Apostle Paul understood the problem of ambivalence for the person who wants to do the right thing while also craving to do the opposite. Paul describes the problem of ambivalence as conflict between two natures; that which is flesh and that which is spiritual.

So I say, let the Holy Spirit guide your lives. Then you won’t be doing what your sinful nature craves. The sinful nature wants to do evil, which is just the opposite of what the Spirit wants. And the Spirit gives us desires that are the opposite of what the sinful nature desires. These two forces are constantly fighting each other, so you are not free to carry out your good intentions. Galatians 5:16-17 (NLT)

The trouble is with me, for I am all too human, a slave to sin. I don’t really understand myself, for I want to do what is right, but I don’t do it. Instead, I do what I hate. But if I know that what I am doing is wrong, this shows that I agree that the law is good. So I am not the one doing wrong; it is sin living in me that does it.

And I know that nothing good lives in me, that is, in my sinful nature. I want to do what is right, but I can’t. I want to do what is good, but I don’t. I don’t want to do what is wrong, but I do it anyway. But if I do what I don’t want to do, I am not really the one doing wrong; it is sin living in me that does it.

I have discovered this principle of life—that when I want to do what is right, I inevitably do what is wrong. I love God’s law with all my heart. But there is another power within me that is at war with my mind. This power makes me a slave to the sin that is still within me. Oh, what a miserable person I am! Who will free me from this life that is dominated by sin and death? Romans 7:14-24 (NLT)

Ambivalence—cognitive dissonance—can be resistant to addiction, and motivation to advance to the next stage of recovery, or it can be resistant to effective recovery. Which would you say is true in the context of this passage from Romans 7? In this case, the writer is indicating that his ambivalence is resistant to recovery. We can recognize this since he is in recovery wanting to surrender his will over to his higher power for recovery. It is what he wants to do. But then he encounters resistance in the form of triggers to relapse, something that he does not want to do. He has indicated that he is a slave to the addiction that compels him and that when he lapses back into his mess he is miserable in his mess. Why would he give in to his triggers if he does not want to be an addict, which he recognizes he is? Because the deception of the temporary gains, that instant gratification, which appears in the moment to be worth it. Even aware of the risk of loss, which can be most severe, it seemingly is worth the risk. From an action stage of change there are temptations that can trigger addictive thinking into relapse behavior when a person’s recovery becomes undisciplined with divided loyalties.

Ambivalence in Scripture is described as being double-minded. No matter how much we genuinely love God committed to a surrendered relationship with Jesus Christ, even empowered by His Spirit as we work steps, we remain in our selfishness. While free from the eternal consequences of sin, having been justified by faith, we can become comfortable until we’re complacent. Then we get lazy and are again dragged away by selfish human desire and enticed into behaving like we did in our addiction. That is how our loyalties become divided. That is when we take our will back, deceiving ourselves that we are in control—recovered perhaps, surrendering to our selfish desires instead of surrendering all (body, mind, heart, and soul) to the perfect plan of our Higher Power, Jesus Christ.

But don’t just listen to God’s word. You must do what it says. Otherwise, you are only fooling yourselves. For if you listen to the word and don’t obey, it is like glancing at your face in a mirror You see yourself, walk away, and forget what you look like… If you need wisdom, ask our generous God, and he will give it to you. He will not rebuke you for asking. But when you ask him, be sure that your faith is in God alone. Do not waver, for a person with divided loyalty is as unsettled as a wave of the sea that is blown and tossed by the wind. Such people should not expect to receive anything from the Lord. Their loyalty is divided between God and the world, and they are unstable in everything they do. James 1:22-24, 5-8 (NLT)

Do not merely listen to the word, and so deceive yourselves. Do what it says. Anyone who listens to the word but does not do what it says is like someone who looks at his face in a mirror and, after looking at himself, goes away and immediately forgets what he looks like… If any of you lacks wisdom, you should ask God, who gives generously to all without finding fault, and it will be given to you. But when you ask, you must believe and not doubt, because the one who doubts is like a wave of the sea, blown and tossed by the wind. That person should not expect to receive anything from the Lord. Such a person is double-minded and unstable in all they do. James 1:22-24, 5-8 (NIV)

Action Stage of Change

The Bible is direct when it comes to its cognitive-behavioral focus and emphasis about recovery. The writer of James purposefully stated the need to resolve ambivalence by doing the work of recovery laid out in Scripture. There is a distinct relationship between deciding (determining/preparing) to live out recovery God’s way, and acting on that decision. When in doubt, DO! Do what the Word of God says.

Therefore, I urge you, brothers and sisters, in view of God’s mercy, to offer your bodies as a living sacrifice, holy and pleasing to God—this is your true and proper worship. Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will. Romans 12:1-2 (NLV) 

Here is where our plan of action begins in recovery as we progress into the action stage of change. The behavioral change is in offering the specific members of our body into our action stage of recovery. ‘Offer’ is an action verb that is all about doing. It is about what we do. It’s about what we do with our eyes. What are we looking at and looking for? Will I surrender my eyes as a sacrificial act of worship unto God in my recovery? (Wow, that just spoke to me as I wrote it just now.) Will I surrender my ears and what I listen to unto God in my recovery? Will I surrender my arms and hands, legs and feet—what I actively pursue—unto God in my recovery? Will I surrender my physical brain as a sacrificial act of worship unto God in my recovery? Only then, acting according to His plan of surrender for me, will I willfully act on my decision to no longer conform to the obsessive and addictive patterns of the place and time in which I live. Only then will I experience the transformative power of a new life experience as God of all gods renews my mind, changing how I think; from irrational to rational—confused to sensible. When we read “Be transformed by the renewing of your mind”, ‘Be’ is a passive verb since it is about change. Except that this change God does in me as I act out change in what I do behaviorally. In the action stage of change through recovery God’s way I can have assurance in the midst of my doubt. I can have confidence that the way I think and process in my daily experience is new and right and good.

This assurance from Romans 12:1-2 is the cognitive-behavioral pay-off. It involves me changing my behavior and it involves God changing how I think. This transformation suggests that God has the power to rearrange the automatic thinking mechanisms in my brain as I offer myself to Him each and every moment of each and every day. It sounds impossible to make that kind of commitment, right? That is why Paul wrote that it’s about being a living sacrifice. So the question that Jesus asked the paralytic still stands: “Do you want to be made well?” Or I suppose the question could be asked, how much or how badly do you want to be made well? What is it worth to you? What is it worth to me?

Rational Thinking and Belief

When an (A) Activating event occurs, my (B) Belief about the event is through a renewed lens. As my behavior in active recovery reflects my transformed belief system, founded no longer in lies and irrational expectations, but in the truth of God’s word revealed spiritually to my mind. Then (C) Consequences will trend toward positive outcomes and blessing. This is huge! Of course, there will be struggles along the way. There will be heartbreak and pain. There will be disappointment, failures, and loss that will be a challenge to productive healthy recovery. But if I stay focused with my daily emphasis on maintaining (the next change stage in recovery) my disciplined daily walk on the journey, the most likely scenario for my life in recovery is the promise of blessing in my life. I now possess the God-given tools to do this recovery thing the right way.

Maintenance Stage of Change

Essential to maintaining disciplined recovery is a disciplined healthy thought-life. To experience confidence in the midst of doubt is to bring even my thoughts into submission to win the argument against spiritual Christ-centered intentions. Situations, circumstances, and people will challenge my faith in God to restore my unmanageable life to sanity. It will be tempting along the way to seek remedies in the midst of working to solve problems; remedies to ease anxiety and stress, anger and resentment, injury, discouragement, and fear. Central to continuing to rationally challenge thoughts of doubt that seek to justify relapse is to daily surrender my mind sacrificially as unto the Lord, Jesus Christ, the rational authority in my life.

We are human, but we don’t wage war as humans do. We use God’s mighty weapons, not worldly weapons, to knock down the strongholds of human reasoning and to destroy false arguments. We destroy every proud obstacle that keeps people from knowing God. We capture their rebellious thoughts and teach them to obey Christ. 2 Corinthians 10:3-5 (NLT)

What powerful words to rationally challenge the human reasoning that appeals to my prideful thinking. Add to that that I live amongst people in my family, my community, and throughout society that are set before me who will spew their sick irrational justifications into the mix and I am in jeopardy every day of my life. So again, to minimize and not be overrun by the ambivalent cognitive dissonance that is natural to my selfish mind, I must go to my Higher Power throughout each day and call on Him to receive my thoughts and to help me to bring each thought into obedience. It is in this discipline that I can and will maintain recovery cognitively and behaviorally.

Relapse Stage of Change

Relapse is a stage of change. Something occurs in the life of the recovering addict that evokes ambivalence about how to respond to the occurrence. There is once again internal disagreement about how to manage conflict within the automatic thinking process. We can forget that we are still selfish during what feels so good and right in recovery. We are praying daily, perhaps attending recovery meetings or fellowship gatherings on a consistent basis that promote recovery principles, avoiding high-risk situations and associations that could jeopardize our health.

Then, BANG! We are hit with something unexpected that drops us to our knees; though, not necessarily to pray. We get knocked down. We need relief as soon as possible. Or, BANG! We are hit with an unexpected temptation that appeals to every impulse we have to “act out”. It could be a relationship, an event, a place, a smell, a dream… anything nostalgic that brings us face to face again with thought and feeling triggers that can and likely will challenge the rational sensibilities of recovery. Remember the passage from Romans 7 that says, “I do the things I don’t want to do and don’t do the things I want to do.” As we lose discipline in our recovery in the face of “justifiable” relapse triggers, what were obvious sensibilities regarding the principles to live by become less palpable. We can become less conflicted about “using” behavior. In weighing our ambivalence, we adopt the belief again that whatever we risk losing for instant gratification is worth it.

But afterward Jesus found him in the Temple and told him, “Now you are well; so stop sinning, or something even worse may happen to you.” John 5:14 (NLT)  

Remember the story of the lame man who had been paralyzed nearly 40 years until he was healed by Jesus? Well, Jesus saw the man again. The man was walking around in the temple courtyard. This was an area that men went seeking out women, perhaps for hire. The healed man likely had not been intimate with a woman all that time. For all we know the man may have contracted a sexually transmitted disease that rendered him paralyzed. Whether or not that was the case, the healed man was engaging in undisciplined behavior; maybe returning to the very behavior that was his undoing in the past. He was starving for “relationship”. This is a strong case for the Bible identifying the matter of relapse.

Relapse Prevention

The CBT strategy for relapse prevention emphasizes, of course, cognitive awareness of high-risk situations that can trigger thoughts that rationalize using, that feeds cravings and fuels urges to use, and that trigger beliefs to justify using as a sensible acceptable option for managing the situation at hand. This could also involve a 4th, 5th, 6th, and 7th step in the process of being aware and alert to formidable obstacles along the recovery path. CBT considers the full spectrum of circumstances that precipitate relapse and seeks to keep the consequences of addictive behavior in the cognitive forefront to hopefully allow people in recovery to avoid the kind of dissonance that can sabotage the miracle of sobriety and avoid the destructive outcomes connected to relapse.

A wise person thinks a lot about death (destructive outcomes), while a fool thinks only about having a good time. Ecclesiastes 7:4 (NLT)   

For by the grace given me I say to every one of you: Do not think of yourself more highly than you ought, but rather think of yourself with sober judgment, in accordance with the faith God has portioned to each of you. Romans 12:3 (NIV – modified) 

There is so much Scripture that goes right to the heart of our relapse triggers that can prove to be effective intervention for the body, mind, heart, and soul. Below is a list of stressors that can trigger cognitive dissonance that given the opportunity to steer us in the wrong direction can be harmful to the best of our recovery. 

Anxiety and Stress –

Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. Philippians 4:4-7 (NIV)

Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you. 1 Peter 5:6-7 (NLT)

Always be full of joy in the Lord. I say it again—rejoice! Let everyone see that you are considerate in all you do. Remember, the Lord is coming soon. Don’t worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done. Then you will experience God’s peace, which exceeds anything we can understand. His peace will guard your hearts and minds as you live in Christ Jesus. Philippians 4:4-7 (NLT)

Don’t fret or worry. Instead of worrying, pray. Let petitions and praises shape your worries into prayers, letting God know your concerns. Before you know it, a sense of God’s wholeness, everything coming together for good, will come and settle you down. It’s wonderful what happens when Christ displaces worry at the center of your life. Philippians 4:6-7 (The Message)

Anger and Resentment –

 And “don’t sin by letting anger control you.” Don’t let the sun go down while you are still angry, for anger gives a foothold to the devil. Ephesians 4:26-27 (NLT)

Surely resentment destroys the fool, and jealousy kills the simple. Job 5:2 (NLT)

Let some one else praise you, not your own mouth—a stranger, not your own lips. A stone is heavy and sand is weighty, but the resentment caused by a fool is even heavier. Anger is cruel, and wrath is like a flood, but jealousy is even more dangerous. An open rebuke is better than hidden love! Proverbs 27:2-6 (NLT) 

An angry person starts fights; a hot-tempered person commits all kinds of sin (Self-Induced N-sanity). Proverbs 29:22 (NLT)

People with understanding control their anger; a hot temper shows great foolishness. Proverbs 14:29 (NLT)   

Pride –

Those who belong to Christ Jesus have nailed the passions and desires of their sinful nature to his cross and crucified them there. Since we are living by the Spirit, let us follow the Spirit’s leading in every part of our lives. Let us not become conceited, or provoke one another, or be jealous of one another. Galatians 5:24-26 (NLT)

Sin whispers to the wicked, deep within their hearts. They have no fear of God at all. In their blind conceit, they cannot see how wicked they really are. Psalm 36:1-2 (NLT)

Don’t be selfish; don’t try to impress others. Be humble, thinking of others as better than yourselves. Don’t look out only for your own interests, but take an interest in others, too. Philippians 2:3-4 (NLT)

Pride ends in humiliation, while humility brings honor. Proverbs 29:23 (NLT)

Jealousy – 

If you are wise and understand God’s ways, prove it by living an honorable life, doing good works with the humility that comes from wisdom. But if you are bitterly jealous and there is selfish ambition in your heart, don’t cover up the truth with boasting and lying. For jealousy and selfishness are not God’s kind of wisdom. Such things are earthly, unspiritual, and demonic. For wherever there is jealousy and selfish ambition, there you will find disorder and evil of every kind. James 3:13-16 (NLT)

Anger is cruel, and wrath is like a flood, but jealousy is even more dangerous. Proverbs 27:4 (NLT)

A peaceful heart leads to a healthy body; jealousy is like cancer in the bones. Proverbs 14:30 (NLT)

“I can see that you are full of bitter jealousy and are held captive by sin.” Acts 8:23 (NLT)

Guilt and Shame –

Even if we feel guilty, God is greater than our feelings, and he knows everything. Dear friends, if we don’t feel guilty, we can come to God with bold confidence. And we will receive from him whatever we ask because we obey him and do the things that please him. 1 John 3:20-22 (NLT)

Finally, I confessed all my sins to you and stopped trying to hide my guilt. I said to myself, “I will confess my rebellion to the LORD.” And you forgave me! All my guilt is gone. Psalm 32:5 (NLT)

“Fear not; you will no longer live in shame. Don’t be afraid; there is no more disgrace for you. You will no longer remember the shame of your youth.” Psalm 54:4 (NLT)

“Have I tried to hide my sins like other people do, concealing my guilt in my heart? Job 31:33 (NLT)

Those who look to him for help will be radiant with joy; no shadow of shame will darken their faces. Psalm 34:5 (NLT)

For the kind of sorrow God wants us to experience leads us away from sin and results in salvation. There’s no regret for that kind of sorrow. But worldly sorrow, which lacks repentance, results in spiritual death. 2 Corinthians 7:10 (NLT)

Suffering –

In his kindness God called you to share in his eternal glory by means of Christ Jesus. So after you have suffered a little while, he will restore, support, and strengthen you, and he will place you on a firm foundation. 1 Peter 5:10 (NLT)

Doubt –

I cried out, “I am slipping!” but your unfailing love, O Lord, supported me.  When doubts filled my mind, your comfort gave me renewed hope and cheer. Psalm 94:18-19 (NLT)

Then Jesus said to the disciples, “Have faith in God. I tell you the truth, you can say to this mountain, ‘May you be lifted up and thrown into the sea,’ and it will happen. But you must really believe it will happen and have no doubt in your heart. I tell you, you can pray for anything, and if you believe that you’ve received it, it will be yours. Mark 11:22-24 (NLT)

 Now all glory to God, who is able, through his mighty power at work within us, to accomplish infinitely more than we might ask or think. Ephesians 3:20 (NLT)

Fear –

And as we live in God, our love grows more perfect. So we will not be afraid on the day of judgment, but we can face him with confidence because we live like Jesus here in this world. Such love has no fear, because perfect love expels all fear. If we are afraid, it is for fear of punishment, and this shows that we have not fully experienced his perfect love. 1 John 4:17-18 (NLT)

Then Jesus got into the boat and started across the lake with his disciples. Suddenly, a fierce storm struck the lake, with waves breaking into the boat. But Jesus was sleeping. The disciples went and woke him up, shouting, “Lord, save us! We’re going to drown!” Jesus responded, “Why are you afraid? You have so little faith!” Then he got up and rebuked the wind and waves, and suddenly there was a great calm. The disciples were amazed. “Who is this man?” they asked. “Even the winds and waves obey him!” Matthew 8:23-27 (NLT)

Fatigue –

Then Jesus said, “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest. Take my yoke upon you. Let me teach you, because I am humble and gentle at heart, and you will find rest for your souls. Matthew 11:28-29 (NLT)

I would like to encourage clinicians to leave a comment below concerning the relevance this Biblical approach to cognitive-behavioral therapy might have to your practice. This is the result of several years of researching what the writers of the Bible had to say about the cognitive-behavioral approach to change in recovery from MEdom—my addiction to me. God is so great. He is loving, gracious, and kind. And He has given us a way out by letting us in on all of it. Praise God!

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