CBT and DBT – Decoding the Treatment Alphabet


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What Are CBT and DBT?

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are branches of psychotherapy that rely heavily on mindfulness and trusting relationships with therapists. Both forms of talk therapy have shown to be highly effective for treating mental health conditions such as substance abuse disorders. They provide goal-oriented skills that revolve around the interaction between your thoughts, feelings, and behaviors and the concept that changing one can influence the others. DBT is a more specific subset of CBT, but both involve a combination of group and individual therapy. Whichever strategy is right for you, these treatment models can be transformative and lead to a life of health and sobriety.

Cognitive Behavioral Therapy

One primary focus of CBT is the focus on cognitions (thinking patterns) as a trigger for maladaptive or harmful behaviors. Self-defeating thoughts such as “I’m not good enough” can lead to feelings of low self-worth or hopelessness. These thoughts can create the idea that you are not worthy or capable of recovery and may result in continued substance abuse or other self-harm behaviors. Your CBT therapist will help you identify your negative cognitions so you can challenge them by teaching you to substitute a positive thought such as “I am worthy” for a negative one. This simple change can boost your mood and decrease the urge to use unhealthy coping mechanisms.

It also promotes mindfulness and staying in the present moment rather than dwelling on past behaviors that you might perceive as personal failures. Feelings of guilt can be one of the main barriers to recovery. They can lead to a desire to punish yourself and not strive for a happier, healthier life. Not only can grounding yourself in the present moment help alleviate feelings of guilt, but it can also help you pause and rationalize your negative cognitions before turning to substance abuse or self-harm.  Mindful practices have been shown to reduce stress and managing stress is essential for recovery.

Sometimes, CBT focuses on behaviors rather than cognitions. Changing your thoughts and actions can improve your mood and decrease the likelihood of using maladaptive coping strategies. This model recognizes that changing your feelings is difficult and advocates mindful acceptance and acknowledgment of them with the knowledge they will pass. Changing your behaviors in response to emotion will ultimately be much more productive than changing your feelings directly. Engaging in a healthier behavior such as meditation, exercise, or art can result in an elevated mood from the release of endorphins and positive cognitions such as “I can do it.” You will also learn a variety of other healthy coping mechanisms.

This form of therapy can help you find a mindful, healthy approach towards life. Recovering from your substance use disorder is in reach with this technique.

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy has many similarities with CBT. It also provides skills to help people who struggle to regulate their emotions. It was created by Dr. Marsha Linehan in the 1970’s to treat people with Borderline Personality Disorder (BPD). DBT has also proven effective for treating other conditions such as alcoholism, bulimia, suicidal depression, bipolar disorders, and drug abuse.

Module Goal
Mindfulness To live in the moment.
Interpersonal Improve relationships with others and learning to get your needs met.
Distress Tolerance Develop and practice healthy ways to deal with stress.
Emotion Regulation Balance day to day emotional regulation.

One of the main principles of this model is the dialect, simply an idea that two things that seem like opposites can be true at the same time. For example, in a treatment center, you may be working towards changing your drug and alcohol abuse behaviors, and there is space in your life to improve. These truths could include the fact that you are doing well, and it is still possible to slip up. The dialectic of doing well and accepting the possibility of a slip can reduce feelings of guilt when you are struggling. If you struggle it is easier to acknowledge a slip-up without feeling like you aren’t worthy of recovery and should just give up. This way, it is easier to think about moving forward and prevent a slip from becoming a relapse.

Another essential aspect of dialectical behavioral therapy is making specific, attainable goals. Committing to a lifetime of abstinence may feel overwhelming and not even worth trying, so DBT techniques allow you to choose a particular time frame during which you will commit to abstaining from drug abuse and alcohol abuse. At the end of this time, you will set a new goal, so you can achieve long-term abstinence one step at a time. You will apply this method of goal setting to many areas of your life to discover what truly makes you happy and find reasons that life is worth living. Working towards recovery can help you put an end to self-sabotaging behaviors and find joy in life.

Because dialectical behavioral therapy was developed for people who struggle with emotion regulation, it uses a distress tolerance skills-based therapeutic model that offers specific skills such as self-soothing, mindfulness, distraction techniques, alternative behaviors, and challenging disordered thoughts.

DBT techniques are also very relationship-oriented, as people who struggle to regulate their emotions may struggle with interpersonal relationships but also may benefit from the support of others. This model will help you practice coping ahead for social scenarios by participating in practice scenarios and making plans for how you might handle a specific incident. Forming a trusting relationship with your DBT therapist is also essential to the relationship-oriented treatment modality and the therapy’s overall effectiveness.

How Do I Pick A Type Of Therapy?

Different methods will work better for different people, so how can you choose between CBT vs. DBT? The best way to figure it out is to consult with a mental health professional who can evaluate your needs. They will probably ask questions such as:

  • Do you have a co-occurring mental illness with your substance use disorder?
  • If you do have a dual diagnosis, is it a mood disorder, anxiety disorder, depressive disorder, or personality disorder?
  • Do you struggle to regulate your emotions?
  • Do you struggle with interpersonal relationships?
  • Do you regularly engage in severe self-harm behaviors, suicidal attempts, or homicidal behaviors?

These questions can help your provider determine which method will work best for you. However, everyone is different, so you may need to try both and see what works.

Which Type Of Therapy Is Best For Me?

Although both methods are highly effective and can work for different people in different ways, in general, the default will be cognitive behavioral therapy. DBT may be best for you if you have been diagnosed with a borderline personality disorder or another disorder in which your emotions dramatically swing between poles and become difficult to manage. DBT techniques also may be best for you if you are suicidal, homicidal, or frequently engage in severe self-harming behaviors.

Both of these evidence-based treatment methods can help you recover from addiction. Substance use disorders can lead to interpersonal difficulties, financial struggles, and severe health consequences, so it is vital to seek help at a treatment center as soon as possible. An addiction treatment center will be effective at any stage to help you in recovery. Seek help now and discover a healthy, sober life worth living

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