Cognitive Distortions
What is the difference between a thought being uncomfortable and being untrue?
Uncomfortable thoughts can still be true. CBT challenges accuracy, not just discomfort.
What is the first step before changing a thought?
Notice it.
What is a trigger?
Anything that increases risk of use (emotion, person, place, thought).
What part of the brain is more active during high emotional stress: logical thinking or survival mode?
Survival Mode
You think: “If I’m stressed, I deserve to use.” What distortion might this be?
Emotional reasoning or justification.
How is labeling different from all-or-nothing thinking?
Labeling attacks identity (“I’m a loser”), all-or-nothing focuses on situations (“This is a total failure”).
What question could you ask to test the accuracy of a thought?
“What evidence do I have?”
Name the 3 parts of the CBT triangle.
Thoughts, feelings, behaviors.
Why does deep breathing work physiologically?
It activates the parasympathetic nervous system.
You feel anxious walking into a social event sober. What is the CBT move?
Notice thought → challenge it → use coping skill → approach anyway.
Why is mind reading especially risky in recovery?
It can increase shame, isolation, and avoidance — which are relapse risks.
Rewrite: “I relapsed, so there’s no point in trying.”
Possible: “I slipped, but that doesn’t erase progress.”
Why is identifying early warning signs important?
It allows intervention before the behavior happens.
Name one reason cravings peak and fall like waves.
They are driven by temporary brain chemistry changes.
You feel a craving and think, “This will never stop.” What skill applies?
Urge surfing + challenging permanence thinking.
Give an example of a “recovery-themed” thinking trap.
“If I have cravings, I must not be serious about recovery.”
What makes a replacement thought effective?
It is realistic, balanced, and believable.
What is a “seemingly small decision” in relapse prevention?
A choice that seems minor but moves you closer to risk.
Why does sleep deprivation increase relapse risk?
It lowers impulse control and increases emotional reactivity.
Explain how shame can fuel relapse and how CBT interrupts that cycle.
Shame → negative thoughts → avoidance → use. CBT challenges the thoughts and builds coping instead.
Why do thinking traps feel so convincing even when they’re distorted?
They’re fast, emotional, and often based on past experiences.
Why is “positive thinking” not the same as CBT?
CBT focuses on realistic thinking, not pretending everything is great.
Explain how avoidance can increase relapse risk.
Avoidance increases anxiety and makes triggers stronger over time.
Why is emotion suppression different from emotion regulation?
Suppression pushes feelings away; regulation manages them safely.
You think “I don’t need coping skills. I just need stronger willpower.” What is the CBT response?
Willpower is unreliable under stress
Skills reduce emotional intensity
Behavior change requires planning, not just motivation