How does a cognitive behavioral therapist work with an addict?
Let’s take two examples here, one being pornography and one being gambling. How would we desensitize someone to these sort of stimuli? Let’s take the pornography first: let’s say every time a person sees pornography, there’s a sort of a “light bulb” that goes on inside and they fantasize about a woman or doing certain other things which brings them into a further involvement with the pornography. What we would do in the course of treatment is exactly sort of what we’ve talked about, but we would bring the images in and, in a slow, progressive, predetermined sort of set of stages where there may be a very obscure piece of pornography, it may be a pornography of a very mild type, and as we noted your arousal or your stimulation from the pornography, we would ask you to go through a relaxation technique. So, we would start to teach you that this does not cause that, that this stimuli need not cause that internal experience. Over time, we would bring it closer and closer, in a literal sense, that when you’re in the presence of it, when the therapist isn’t in the room, or something, that it won’t automatically bring about an internal experience as it has become when you’re quote-unquote “addicted”. In a similar way, let’s say it’s gambling, let’s say every time you drive by the casino or walk into a casino, you see the “object of desire”, so-to-speak, you fantasize about winning a lot of money, your arousal goes up, you start getting excited, and things like that–that’s part of the addiction, that’s that “feeling” stuff that we were talking about earlier. So what we would do in a clinical session, is sort of, it would start with probably just talking about slot machines in a casino, and then ultimately we would be bringing in pictures of a slot machine in a casino, but as we noted, as a professional, that your arousal was going up as your stimulation, where that “trigger” was activated, we would go through a pre-rehearsed relaxation technique, so we would start to disassociate that high arousal with that trigger or that stimulation. And over the course of many, many sessions, we would eventually sort of even walk with you into a casino, in-hand, and if you would start to get aroused, we would ask you to go through the relaxation thing, and eventually be able to even touch a slot machine and not have that automatic, addictive-like response.