Cognitive Behavioral Therapy Helps Reduce Impulsivity So You Can Gain Control of Your Actions
Thinking before we act is something most of us are able to do. After all, rational thought over impulse and decision-making over instinct are what differentiate us humans from other animals. Unfortunately, some people have a hard time resisting certain impulses or behaviors, even destructive or unhealthy ones.
Are you prone to angry outbursts? Do you have problematic spending or find it difficult to resist junk food or fattening desserts? You are not alone. A significant number of people in the U.S. suffer from something called impulsivity, or impulsiveness. Impulsivity is associated with substance abuse and addiction disorders, including sex addiction, as well as risk-taking behaviors and attention-deficit issues. It is an underlying mechanism in impulse control disorders (ICD), and many obsessive-compulsive disorders (OCD) as well. Studies show that people with higher levels of impulsivity are more likely to do things like start fights, drive recklessly or shoplift.
Whether your impulsivity is a mild annoyance or severe enough to cause harm or disruption in your life, cognitive behavioral therapy, or CBT, can help you gain control over your impulses and actions.
How Cognitive Behavioral Therapy (CBT) Works
Cognitive behavioral therapy is actually a term for a category of active interventional therapies that are research-based, goal-oriented, practical approaches to helping clients identify and manage the negative and self-defeating thoughts that drive addiction and other harmful or unhealthy behaviors. Some examples of CBT include motivational interviewing (MI) and dialectical behavioral therapy (DBT).
“I use CBT to help clients define cognitive distortions that outline their biased ways of thinking about themselves and the world around them,” says Timothy L. Hook, LMSW, CSAT- candidate, a primary therapist at The Ranch. “Their cognitive distortions have led to the unmanageability in their lives and can lead to relapse if they are not able to recognize them. They may have irrational thoughts and beliefs that underlie problematic emotional states such as impulsivity, anxiety and low self-esteem that lead to behaviors that cause conflicts with their values.”
Each type of CBT teaches alternative ways of thinking and self-regulating responses to negative thoughts and emotions — the triggers for impulsive actions. The basis of CBT is psycho-education and cognitive restructuring where negative thought patterns are identified and unlearned, then replaced with healthier thought patterns, resulting in greater self-control over behavior. CBT works particularly well in helping a person resolve a specific issue, such as controlling angry outbursts or a substance addiction.
“When CBT allows a client to become aware of their cognitive distortions, they can shift their thinking to more rational or realistic thoughts and the more rational thinking facilitates positive experiences in their life,” explains Hook.
CBT is a hands-on and collaborative approach, where the therapist engages the client in analyzing and may ask them to take notes — recording thoughts and listing positive phrases among other written exercises — to help them recognize problematic thought patterns and areas where they need better coping skills. Exercises for clients include self-assessing symptoms that occur right before a problematic behavior, recognizing thought distortions, developing stress-reduction techniques, interrupting or preventing damaging behavior and practicing positive coping skills. CBT clients are typically asked to do homework as well, to practice alternative thinking and coping skills on their own.
The goal is to alter an individual’s thought process so they no longer lose control, but can choose to react differently to people and situations. Research suggests that CBT can bring about real change that lasts long after the client has completed therapy.
Here are some of the impulsivity associated disorders and behaviors that can be managed through CBT.
Addiction and Alcoholism. In CBT, negative thinking is viewed as an obstacle to self-change. The most common type of negative thinking is an all-or-nothing thought process, such as, “I must do this perfectly, or it will be a failure.” This distorted and destructive thought pattern is common among people with substance use disorders, contributing to their powerlessness over their addiction. They may think, “I already had one drink so I may as well drink the entire bottle.” These cognitive tendencies may be deeply ingrained and often drive addictive behavior.
How CBT Can Help: CBT helps people with addiction recognize and replace all-or-nothing thinking with a more moderate perspective. During CBT group sessions in addiction treatment, clients focus intensively on their substance abuse as a maladaptive response to negative thoughts and difficult emotions. They develop alternative behaviors and coping skills as part of an integrated treatment plan that includes other therapies and also addresses any co-occurring disorders.
Explosive Anger. You have heard of anger management programs for people who have uncontrolled anger or aggression. These programs usually involve CBT to help people who have something called intermittent explosive disorder, or IED, an impulse control disorder. People with IED can suddenly “explode” into an angry tirade or tantrum despite a lack of apparent provocation. Others may view these outbursts as unwarranted or disproportionate to the situation, but the outburst is usually precipitated by a sense of growing tension or turmoil within the individual, triggered by negative thoughts about something or someone.
Someone with anger issues may be highly reactive and their thinking tends to be overly dramatic. To them, a frustrating situation or relatively small problem feels disastrous or catastrophic and they over-respond. Their dramatic thought process may be characterized by viewing someone else as always being wrong or never getting things right, making them feel they’re justified in their anger as they go on the attack.
How CBT Can Help: CBT helps people with anger problems review their reactions to people and situations and restructure their thoughts about them. For example, instead of allowing themselves to think, “You have ruined everything, this is a disaster!” they can retrain themselves to think “Everyone makes mistakes. This is unfortunate, but it is not the end of the world.” They can also learn to interrupt the tension buildup that precedes their outbursts, using some de-stressing strategies to defuse their anger. In short, CBT can provide an attitude adjustment so people can respond to things more reasonably. Instead of making demands or confronting someone in anger, they learn to make requests or state a problem in neutral terms and work with others to find an agreeable solution.
Food Issues and Eating Disorders. People who have impulsivity around food may be unable to resist binge eating or they have disordered thoughts about food that manifest as anorexia nervosa, bulimia or an unspecified eating disorder (e.g. night bingeing or chronic fasting/dieting). There are usually underlying issues that contribute to eating disorders and food issues. A person with disordered eating uses food, or their severe restriction of it, as a coping tool or control mechanism for dealing with chaos or difficult feelings rather than as simple nourishment. They need to manage their impulsivity and unlearn their habit of treating food as a “drug” or coping mechanism.
How CBT Can Help: CBT can help people with disordered eating analyze what they are feeling when they have the impulse to binge eat, purge or starve themselves. Keeping written records of eating activity and feelings around meal times usually forms the basis of treatment. The records help clients observe and change how they relate to food and approach eating. CBT might help a client, for example, learn to eat only at designated meal times and at a specific place, and to eat more slowly and enjoy their food. It might also help them identify issues around grocery shopping or food preparation. CBT sessions also teach clients healthy tools to cope with the feelings that come up. For example, a client who eats at the first sign of stress might learn to ask themselves, “What am I feeling? Why am I stressed?” and then manage the stress with constructive problem-solving strategies, replacing stress-eating with a soothing activity like taking a warm bath, going for a walk or doing something creative. CBT sessions might be augmented by nutritional and body image counseling, as well as trauma-focused therapy to address underlying issues.
Practice makes perfect. CBT impulse control techniques can also be applied to helping a person gain control over compulsive shopping or gambling, and compulsive hair pulling (trichotillomania) or skin picking (excoriation), among other behaviors.
“With some CBT clients, I have had to use a behavior chain to outline their behaviors sequentially to find the cognitive distortion that is driving the impulsive or otherwise problematic behaviors,” says Hook. “Once the client is able to deconstruct their behaviors, we can usually find the thoughts that are behind them. After their thoughts are identified, we can work to understand if the thought is true or a distortion used to facilitate the impulsivity and, thus, unmanageability in the client’s life. Once the distortion has been identified, we can look at other skills that might help, which we might draw from DBT, 12-step programs, or experiential work for a family of origin problem.”
A person’s success with CBT treatment is highly dependent on their motivation — they must commit to doing the in-session and homework exercises consistently in order to retrain their brains to a new way of thinking and acting, just as they would train their bodies to establish a new muscle memory for sports and fitness. People who commit to practicing the CBT exercises for cognitive restructuring are able to use new positive coping skills in triggering situations and moments of crisis. With practice, clients resist turning to the negative thoughts that once triggered substance abuse, angry outbursts or other impulsive behaviors, instead relying on positive self-control strategies.
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