DBT vs CBT in Addiction Treatment

Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) are two forms of evidence-based therapies that are often used in addiction treatment.

The two types of therapies are sometimes used together, separately or not at all. They don’t work in opposition, and neither is better than the other. The therapy someone participates in often depends on their individual treatment needs and where they are being treated.

We’re going to dig into each therapy, talk about the difference and how the most suitable therapy is chosen for you or your loved one at Asana Lodge.

What Is CBT in Addiction Treatment?

Cognitive Behavioural Therapy is a type of talking therapy used in addiction treatment to explore the relationship between thoughts, feelings and how they impact negative behaviours.

By becoming more familiar with how your thoughts and feelings impact what you are doing, you can begin to make positive changes. The focus of CBT for addiction treatment is around identifying triggers that may cause your addiction and reviewing unhelpful beliefs you have about yourself or others and things that contribute to addictive behaviours.

You can then begin to challenge these views and work on strategies to navigate triggers, honing coping and relapse-prevention skills.

CBT is a goals-based approach. You work with the therapist to set goals, which motivates you to progress and reach the next target. CBT is about more than positive thinking; you learn practical skills and practise between sessions, such as journaling, to keep you engaged.

What Is DBT in Addiction Treatment

Dialectical Behaviour Therapy is a talking therapy that is built upon CBT methods but adapted and used more for people who struggle with experiencing intense emotions that interrupt attempts to think your way out of negative patterns.

The central idea of DBT is “dialectical”, meaning that two opposite things can both be true. For example, people undergoing DBT are often told to accept themselves but also know that they need to change.

Four core elements make up DBT:

• Mindfulness – The practice of bringing yourself into the moment to better understand how you are feeling right now and describe it.

• Distress tolerance – Learning how to tolerate urges, feelings, and crises that before would have led you to substance abuse.

• Emotion regulation – Learning how to recognise emotions accurately and manage them more effectively.

• Interpersonal effectiveness – Learning skills to help in relationships, such as creating healthy boundaries, speaking up for yourself and improving communication.

DBT for addiction treatment can be useful, helping in situations such as helping someone manage intense emotions during an argument that before would have caused them to use substances afterwards. A full DBT programme is more structured, with therapy, skills training and additional support, whereas there are DBT-informed sessions that may teach selected techniques.

The Key Differences Between DBT vs CBT

Though the approaches are similar, there are some key differences.

• Focus: CBT has more focus on getting you to identify negative thoughts and behaviours. DBT is about balancing this desire to change with accepting who you are and validating that emotions are not all bad and don’t require immediate change.
• Skills: Both involve working on coping strategies. DBT brings a more structured approach with the 4 core skills. CBT approaches can be more flexible, varying with the structure of sessions and the goals of the individual.
• Format: CBT sessions may be individual or group-based in some cases. DBT combines individual therapy with skills learning in groups, between-session coaching over the phone and contact with a therapist.

There is often a misleading belief that CBT is concerned with thoughts whilst DBT deals with feelings. Actually, there is plenty of overlap as both approaches address emotions, behaviour and how they interact.

What Does the Evidence Say?

NICE recognises that CBT can be an effective therapeutic approach in treating alcohol addiction, but any psychological intervention needs to be tailored to the individual. It should form part of a broader plan that may include detox, and whether CBT is right depends on many factors like the substance used, severity and co-occurring conditions.

They also recommend that CBT should not be offered routinely for those needing support for cannabis, stimulant misuse or opioid maintenance treatment. However, CBT should be considered when these forms of substances are present alongside co-occurring mental health conditions like depression and anxiety.

A study of 29 patients with alcohol and other substance use disorders found that DBT skills training in emotional regulation resulted in significantly lower impulsivity levels.

How Is the Most Suitable Therapy Chosen?

You will take part in the therapies that Asana Lodge believe will be most effective for you. To decide this, you’ll undergo a thorough assessment before treatment, considering a range of factors including your substance use, recovery goals, how well you regulate emotions, mental health, previous treatment attempts and personal preferences.

DBT may be considered if you do experience intense emotions and related behaviours, like impulsivity, which could affect long-term recovery. There is no symptoms checklist used, the assessment is designed to see more than symptoms but look at the person as a whole and right the path through treatment that suits them.

These therapies can be specialised, so those providing them need to have the expertise to deliver what is needed, have access to appropriate services and be sure of a client’s commitment to skills practice.

Treatment providers may combine elements from the different approaches to meet individual needs, but doing this and using selected DBT techniques does not mean you are completing a full DBT programme.

How Therapy Fits Into a Wider Recovery Plan?

Therapy is a large part of an effective residential addiction treatment programme but is just one element. It should sit alongside a medical assessment, medically assisted detox and social support to provide a comprehensive treatment approach.

A detox is not always necessary, but therapy is not a replacement. Before you can deal with the underlying psychological issues behind your addiction, you may need to end your physical dependence with a medically managed withdrawal.

Support from Asana Lodge can continue after rehab with a personalised aftercare plan to ease the transition back into normal life. To boost recovery efforts, you should continue to practice skills you learn in therapy and engage in relapse prevention planning so that you are more prepared if you feel a slipup occurring.

Discover a Treatment Approach Tailored to You

If you are worried about your substance use, you’re not alone.

Contact Asana Lodge today for a confidential chat about your needs, and we can tell you about our treatment options. We have no set addiction treatment programmes, whether you take part in CBT or DBT, an individual assessment will inform how we decide which approach will work best for you.

Start your recovery journey today by calling 01908489421.