Cognitive Behavioral Therapy and Mood Tracking in Addiction Treatment

Mood tracking or journaling is an important component of Cognitive Behavioral Therapy (CBT), the most common type of psychosocial therapy used in addiction treatment. CBT is not long-term psychotherapy intended to root out deep psychological problems; it focuses on short-term treatment to address the real-world needs of those who are seeking help for their addiction.

The results of using mood tracking in CBT can include:

  • Reduction of self-harming behaviors including drug use
  • Reduction of cravings
  • Resolving various types of stressors that were causing addiction behaviors
  • Improvements in self-care capabilities

CBT can be delivered in therapist-guided individual or group therapy sessions and complements medication-based therapy and other psychosocial interventions. Treatment usually lasts about six months or less, but at least certain elements can continue to be part of the longer-term comprehensive treatment plan.

Cognitive Behavioral Therapy is based on the idea that the human brain creates thoughts (cognition), which trigger feelings, which then trigger actions (behaviors). Addictive drugs tend to affect the amount or function of brain chemicals known as “neurotransmitters”. For most drugs of abuse, the payoff is that the drug user “feels better,” which may mean that anxiety eases, pain decreases, mood is improved, or the user escapes into a “high” which removes negative feelings.

When substances from outside of the normal neurochemical balance enter the user’s system over a period of time, chain reactions of neurochemical changes begin. New normal thresholds evolve, first causing the user to take higher and higher drug doses to offset the new threshold. This is called “tolerance”. Then, the brain may shut down or significantly decrease its generation of neurotransmitters, becoming dependent on the external source. At this point, the brain is “addicted”. When the substance is discontinued or decreased, the new chemical imbalance results in symptoms of drug withdrawal. Without effective alternate ways to deal with these symptoms, drug users tend to relapse.

Addictions of all types tend to cause the brain to produce inaccurate or abnormal thoughts. For example, the addict may think that normal quick glances from other people are intrusive, aggressive, and directed specifically at them. The abnormal thought generates feelings such as fear or anxiety. These feelings may then cause the person to behave differently, for example, yelling at the person or remaining isolated at home because they are uncomfortable elsewhere.

CBT focuses on this thought-feeling-behavior train, identifying triggers, pointing out the irrational thoughts and feelings, and providing skills that allow the drug user to cope more normally with these stressors and to avoid relapses.

CBT requires active participation from the person suffering with addiction. CBT is not “done to,” it is “done by.” Mood tracking or journaling is one way of encouraging the user’s participation and can help them see how clearly the thoughts, feelings, and behavior are related. This process can help the individual and their therapist identify thoughts and feelings that may be acting as triggers for harmful, addicted behaviors. Continuing to monitor and record these observations in detail provides a systematic way of following progress of treatment and can direct plan changes along the way.

Other factors such as tracking sleep amount and quality can also serve to identify specific coping skills that need to be developed and monitored. Mood tracking as a tool in various psychotherapy methods has been used for years. Before the development of digital software, observations may have been recorded and examined weekly or lees. Today’s digital software applications allow for easy data entry, more data points, and even reminders to chart. Entries can be made very frequently and automatically shared with therapists. Software may even encourage specific activities or interventions automatically. Frequent checking in can help to identify needs and successes associated with very small changes.

One great advantage of CBT is that it is effective not only in addiction, but also in some other psychiatric disorders. When certain psychiatric disorders are present along with substance abuse, these are called “co-occurring conditions.” According to the National Institutes of Health, nearly 38% of patients with substance abuse disorders also have other psychiatric conditions. Unfortunately, only about 9% of these people are treated for both conditions. Research has shown that individuals for whom substance abuse disorder and bipolar disorder are co-occurring conditions are more likely to be successful in reducing substance use and in maintaining abstinence when both the disorders are addressed with CBT as a component of the treatment plan. CBT plus caregiver education about bipolar disorder appears to significantly decrease medication nonadherence and mania symptoms and to increase global function in bipolar disorder, although it may not be effective for the treatment of depressive symptoms.

It makes sense that mood tracking or journaling can address therapy needs for both substance abuse and bipolar disorders. Mood tracking, especially on a frequent and user-friendly basis, can help to identify triggers and the user’s responses, empower the user to be actively involved in their own treatment, provide a systematic means of evaluating status on an on-going basis, and help to monitor responses to all elements of a comprehensive care plan.

This guest post was written by Dr Laurie Romig from

Dr. Laurie Romig is a board-certified emergency medicine and EMS medical direction physician. She has worked with, and overseen, thousands of EMTs, critical care nurses, paramedics, and physicians in her 25-year career. In her spare time, Dr.Romig works as a medical reviewer and writer for, a company that hopes to increase the public’s understanding of substance use disorders, while helping remove barriers to treatment.