Today, the majority of substance rehab centers in Dallas employ two mainstream treatment approaches: medication-assisted therapy (MAT) and psychotherapy. Of the two, psychotherapy sees much wider use for more cases and throughout the entire recovery phase.
Several psychotherapy types are used to treat substance use disorder (SUD), a mental illness that covers conditions previously described as “addiction”, “substance abuse”, or “dependence”. Of these specific therapies, cognitive-behavioral therapy (CBT) is, by far, the most used in substance rehab programs throughout America. Another commonly employed approach is dialectical-behavioral therapy (DBT), a subtype of CBT.
These are not the only two psychotherapy approaches that could be used for treating a substance use disorder. But given that CBT is almost universally used by accredited psychiatrists and rehab centers, there has been some confusion about what it is and how DBT is supposedly a better alternative.
What is cognitive-behavioral therapy?
The main premise of CBT is that negative thought patterns and emotions, such as drug and alcohol cravings, can be controlled by logic and reason. To help this happen, a therapist will help the patient talk about their problems so that they can better frame them positively or less destructively. This practice also gives CBT its alternate name, “talk therapy”.
There are several types of CBT, employing very specific approaches. To name a few, these include cognitive processing Therapy (CPT), cognitive therapy (CT), rational-emotive behavior therapy (REBT), self-instructional training, stress inoculation training, and, of course, dialectical-behaviorial Therapy (DBT).
What is dialectical-behavioral therapy?
Dialectical-behavioral therapy works on the same premise as other types of CBT. The word “dialectical” in the name refers to the bringing together of apparent opposites in therapy — acceptance and change. Therapists seek to reassure and validate the patient’s experiences (acceptance) and use the built-up confidence as a way to modify negative behaviors (change).
DBT was developed for people with borderline personality disorder, suicidal individuals and other people undergoing severe distress. It has been used with success on patients with difficult-to-treat conditions like substance use disorder. It’s also been found useful for individuals with co-occurring mental health disorders, as often happens when someone has SUD.
Where is CBT effective?
Cognitive-behavioral therapy is generally effective for most mild or moderate mental health disorders, including SUD. It’s useful for treating a host of other conditions linked to SUD, including obsessive-compulsive disorder, post-traumatic stress disorder, sleeping issues, and others.
Notably, it’s also been shown to be effective at treating depression, which is something most people undergoing drug rehab will experience at some point. There are also proven benefits for alleviating anxiety symptoms, which are often linked to drug-taking behavior and relapses.
Where is DBT effective?
DBT is not generally used as a first approach for most substance use disorders. However, it can be effective for treatment-resistant cases, such as for individuals with co-occurring mental health disorders, or those that are at risk of harming themselves and others. Patients who are not receptive to other CBT approaches may benefit from it, as well.
Main differences in basic CBT and DBT approaches
While dialectical-behavioral therapy is a type of cognitive-behavioral therapy, it differs from basic CBT in a few crucial areas.
1.) Socratic method vs. mindfulness
CBT generally employs the Socratic method, which is where questions are asked to help the patient question faulty ideas and arrive at logical answers. For instance, individuals who feel that they are failures can be made, through the guidance of a therapist, to realize ways that they are, in fact, successful.
DBT, on the other hand, uses mindfulness and meditation techniques to allow a person to accept perceived failures, rather than have a negative attitude towards them. Later, the individual can be helped to make realizations about how they can create positive changes in their life, even as they accept the supposed bad things in it.
2.) Different emphasis on change and acceptance
Most CBT approaches focus on helping the patient change harmful behaviors by applying active thinking and logic, with the hopes of modifying harmful behavior like compulsive substance misuse.
In contrast, DBT focuses on accepting these behaviors. While there may be later attempts to ultimately change them, the immediate focus is on helping the individual accept these, with a goal of immediately stabilizing their mental condition.
3.) Different approach to regulating emotions
Logic is the primary tool for most CBT approaches. Issues get talked out and the patient may have breakthroughs that ultimately help them to move away from self-destructive tendencies.
While this also happens in DBT (which, again, is a form of CBT), there is far more of an emphasis on regulating one’s emotions. Mindfulness and meditation practices are common tools for this approach. The main idea is to help calm a patient’s emotions, possibly intending to have them transition to regular CBT or other psychotherapy approaches.
Which approach is right for me?
Whether they’re in rehab or are receiving continuing care for an SUD, recovering individuals must work with mental health professionals to find the specific therapies that work for them. CBT(DBT included) is not effective in all cases and the attending clinicians may have to recommend a different psychotherapy approach altogether.
It’s also important to avoid self-treatment unless you have already consulted with a psychiatrist. Even seemingly innocuous talk therapy can be harmful when implemented in the wrong way. Working with your therapist and periodically reassessing the effectiveness of the approach and switching strategies as needed can be key to a sustainable long-term recovery from SUD.
Good luck, and be well!