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Dialectical vs Cognitive Behavioural Therapy

Dialectical vs Cognitive Behavioural Therapy
Written by Seth Fletcher on February 1, 2020
Last update: March 9, 2023


Effective Addiction Treatments For Many

In 2017, it was estimated that 20.7 million Americans needed treatment for substance use disorders. Addiction recovery requires an approach uniquely tailored to each individual, so no two recoveries will be the same. Often, recovery will utilize a combination of individual therapy sessions and group programs. Understanding the root causes, instigators, and symptoms are key to long-term sustained recovery. This allows the individual in recovery to address the root issue rather than trying to escape their problem by using drugs or alcohol. While several different approaches may be used throughout recovery, two of the most common are Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT).

Cognitive Behavioural Therapy (CBT) is a short-term, goal-oriented approach where the strategy is to change the pattern of thinking, thereby changing the way an individual feels. This hopefully results in changes to the individual’s behaviour. Dialectical Behavioural Therapy (DBT) is a form of CBT where it addresses the emotional response to stimulation.

Cognitive Behavioural Therapy (CBT)

CBT is a practical hands-on approach to problem-solving. It is often used in the short-term to address certain challenges an addict may be facing at the moment. Its goal is to reveal patterns of thinking and behaviour that create difficulties. The mind is a powerful tool, and when these patterns come to light it can often reveal the thoughts, triggers, and instances that not only instigated an addiction but may also cause relapse. CBT can be considered a combination of psychotherapy and behavioural therapy. Psychotherapy highlights the personal meaning we place on things and how thinking patterns colour our outlook on life. Behavioural therapy examines the relationship between our thoughts, our behaviours, and our problems.

This theory suggests that it is not the events that trigger drug, alcohol, or substance abuse, but the meanings given to those events. Negative thoughts can colour an individual’s perceptions and cause them to do things they should not, or interpret the circumstances incorrectly. Once the light is shed on the reality of a situation rather than the perception of the situation, the outcome becomes more easily identified. Once possible outcomes are identified, individuals can then start to make action plans to cope rather than abusing drugs or alcohol as a means of escape. Negative things happen – we live in a world full of hardships and problems. However, it is amazing what having the right outlook on life can do.

Dialectical Behavioural Therapy (DBT)

DBT is a form of CBT. It was first developed by Marsha M. Linehan as a form of therapy to address borderline personality disorder (BPD). The main difference between CBT and DBT is that DBT examines one’s emotions in a given situation, whereas CBT examines the meanings given to a situation. DBT theory suggests that some may attain higher emotional states faster than others, and take much longer to return to normal. DBT also examines how individuals interact in social situations: DBT therapists will often use group sessions as an important part of recovery.

In these group sessions, people gain skills in four main categories:

Mindfulness: As part of the mindfulness module, participants learn ‘what’ skills and ‘how’ skills. They learn how to observe, describe, and participate in order to learn ‘what do I do’ to practice core mindfulness. They then learn ‘how I practice mindfulness skills’ through learning how to be non-judgemental.

Interpersonal Effectiveness: This module allows participants to practice changing something and learning how to resist change in a safe environment. They learn strategies for how to maximize their chances of achieving their goals without damaging the relationships around them.

Distress Tolerance: The majority of mental health treatment focuses on changing the events or circumstances that cause stress. Rarely do they address accepting, find meaning for, or dealing with stress. In this module, participants learn behaviours that are focused on tolerating crisis and finding meaning in the moment.

Emotion Regulation: In this module, participants learn several skills including:

  • Properly identifying and labeling emotions
  • Identifying obstacles
  • Reducing vulnerability
  • Increasing positive emotional events
  • Increasing mindfulness to current emotions
  • Taking the opposite action and saying ‘no’
  • Applying distress tolerance techniques

Final Thoughts

Recovery is a journey, and addicts may use both CBT and DBT techniques as part of their treatment plan. By stepping out of the problem and objectively examining them, those in recovery are better able to work through problems towards a realistic outcome. In utilizing some of these techniques, some addicts may discover that their emotions play a significant role in managing their problems. As a result, the techniques of DBT may be used. CBT and DBT are just two of the many addiction treatment options available. The ultimate goal of any treatment is long-term sobriety. No matter what recovery journey an addict follows, recovery is always possible.

Certified Addiction Counsellor

Seth brings many years of professional experience working the front lines of addiction in both the government and privatized sectors.

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