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Cognitive Behavioral Therapy

Does Alcoholics Anonymous Work Because it's a Form of Cognitive Behavioral Therapy?

Does AA work because it's a form of CBT?

Most people think of AA as a spiritual process with its main emphasis on "giving it all up to God or a higher power." Implicit in this idea is a relinquishment of personal responsibility, free will, and self-determination. The truth is, however, that AA probably works because it shares many things with CBT such as thinking differently, acting differently, and actually taking personal responsibility for one's decisions.

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 behaviorally 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. Interestingly, this echoes the advice of Dr. Arnold Lazarus (who in 1958 was the first person to introduce the terms "behavior therapy" and "behavior therapist" into the professional literature) who often tells his clients to "do things differently and do different things."

Since it is a central tenet of CBT that thought and action can (and do) influence emotions and even brain chemistry, it is no surprise that changing what we think and how we act can have a powerful impact on how we feel, even to the extent of loosening the grip of powerful addictions.

Even the surrendering to a higher power aspect of AA is firmly rooted in a behavioral soil in that AA members frequently say "pray like everything depends on God, but act like everything depends on you," and "fake it ‘til you make it." Both of these bits of advice closely mirror the cornerstone of CBT, namely that how you act so shall you think and feel. For example, people who conquer fears, phobias, and even obsessive compulsive anxiety, do so by refusing to act afraid despite their fearful feelings and anxious thoughts. Over time, this leads to genuine shifts in thinking and feeling so that they come into alignment with the non-fearful behavior. Hence, people fake it (not being anxious or phobic) until they make it (getting over their fears).

What's more, working the steps further amplifies the corrective thinking and corrective action (i.e., CBT) components of AA because it encourages 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 a fearless inventory"), take 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 behavioral therapy groups.

Now this isn't to say that AA and CBT are synonymous or interchangeable, but that AA might owe its success to the parts of the program that are similar to CBT - one of the most empirically supported and evidence-based therapies in the psychological arsenal.

Remember, think well, act well, feel well, be well!

Lazarus, A. A. "New methods in psychotherapy: a case study". South African Medical Journal, 1958, 32, 660-664.

Copyright by Clifford N. Lazarus, Ph.D.

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