CBT and DBT: A Tale of Two Therapies

In addiction treatment, there are countless forms of evidence-based, scientifically sound therapies to treat the symptoms and underlying causes of this substance use disorder. From individual psychotherapy to experiential therapies like equine and ropes courses, those participating in professional addiction treatment will be exposed to several different therapies. Two of the most commonly utilized therapies are CBT and DBT, both of which help individuals focus on modifying their behaviors and emotions. 

What is CBT?

Cognitive behavioral therapy, or CBT, is a therapy that focuses on improving a person’s mental well-being by helping him or her change distorted patterns of thinking and behavior.

First developed in the 1960s by Aaron T. Beck, CBT came to be after Beck himself began thinking of ways to help his patients who were living with depression. He noticed certain patterns of negative thinking among these patients and began using a specific approach to address and disrupt these patterns.

Since Beck’s discovery, CBT has become one of the leading forms of mental health care in the world. It is used in the treatment of clients from toddlerhood to adulthood and has helped treat such issues as depression, substance use disorder, anxiety, and posttraumatic stress disorder (PTSD).

The goal of cognitive behavioral therapy is to help individuals break their negative or distorted patterns of thinking and replace them with positive ones. Within cognitive behavioral therapy sessions, individuals work to achieve several other goals, including:

• Foster motivation for abstinence
• Develop coping skills
• Change reinforcers or habits that perpetuate the problem
• Learn to manage painful emotions
• Improve interpersonal relationships and social supports

The majority of cognitive behavioral therapy sessions last for about one hour and can be conducted in both individual and group therapy settings.

Studies suggest that those who participate in cognitive behavioral therapy sessions retain the changes they have made through those sessions, meaning that people do not need to continue CBT for long periods of time. On average, a person participates in 12 CBT sessions.

Since CBT is focused on modifying negative behaviors, a great deal of time is spent on identifying those behaviors and developing ways to neutralize them. Patients often work through several distortions in their efforts toward positive transformation. Some of the distortions that are identified and addressed include behaviors related to:

• Catastrophizing
• Blaming others
• Making unfair comparisons
• Focusing on the past
• Discounting positives
• Overgeneralizing

CBT can provide individuals with several tools to help them manage their distortions, along with other emotionally distressing elements in their lives. These include:

• Recognizing distorted thinking patterns
• Achieve a stronger understanding of the behaviors of others
• Applying problem-solving skills in challenging situations
• Improving upon self-confidence

When applied correctly, the elements of CBT can help individuals to not only change their distorted behaviors, thoughts, and emotions, but also help them develop lifestyles that support strong mental health.

What is DBT?

Dialectical behavior therapy, more commonly referred to as DBT, is a specific form of cognitive behavioral therapy. Originally developed in the 1980s by Marsha Linehan, a psychology researcher looking to treat people struggling with borderline personality disorder, dialectical behavior therapy continues to be one of the top treatments for bipolar today. It is also a leader in the treatment of other mental health illnesses and diseases like substance use disorder, self-harm, and eating disorders.

At first glance, DBT might seem the same as cognitive behavioral therapy. While there are fundamental similarities between the two, what differentiates DBT is the implementation of additional skills not present in CBT. These skills are what help individuals learn how to manage their emotions, reduce stress, and control destructive behaviors. These skills include:

• Mindfulness is a practice that has been used by people throughout the world for thousands of years, if not longer. Mindfulness is designed to help individuals become present in the moment and aware of something, such as their current emotions. Through mindfulness comes acceptance, which brings the peace and clarity needed to get through a difficult challenge, such as a panic attack or a cravings to use drugs.
• Interpersonal effectiveness. Communication is vital, and dialectical behavior therapy helps individuals improve upon it. Through interpersonal effectiveness training, individuals can learn how to speak up and ask for what they need and learn how to say “no.” This empowers individuals to build self-confidence and healthier relationships with others.
• Emotional regulation. Managing one’s emotions can be difficult, especially if a mental illness or a disease like substance use disorder has developed. Emotional regulation in dialectical behavior therapy shows individuals how to modify their emotional responses, properly label their emotions, and take healthy action against negative emotions.
• Distress tolerance. Distress tolerance helps individuals build a tolerance against distress. This can be done through acceptance of distressing events, developing healthy ways to soothe oneself, and taking steps to improve the situation.

Similar to CBT, DBT sessions is provided in both individual and group settings and can run for a number of weeks at a time. Depending on the needs of the individual, he or she may stay enrolled in DBT sessions for up to one year.

Differences Between CBT and DBT

There are many small differences between CBT and DBT, but the ones to keep in mind are acceptance and validation.

In dialectical behavior therapy, the individual will work with his or her therapist to accept his or her emotions and see them as being real (as opposed to distorted like they would be in CBT). When individuals accept their emotions, they often feel empowered to continue, eventually changing their behaviors.

Also, therapists in DBT spend more time validating the individual’s feelings and emotions, whereas, in CBT, therapists focus on the negative feelings and emotions to modify them.

Get Help at JourneyPure in Clarksville

If you are ready to put an end to your substance abuse once and for all, reach out to JourneyPure in Clarksville to learn more about how we can help you.