Differences Between Cognitive-Behavioral Therapy and Dialectical Behavior Therapy

Treatment centers for substance use disorders may offer cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). While the names sound similar, these two methods have many differences. According to the National Institute on Drug Abuse (NIDA), CBT stands as an evidence-based effective treatment for substance use disorders. DBT, designed to treat people with borderline personality disorder, now helps treat people who need intensive help coping with mental health issues in recovery.

What is Cognitive-Behavioral Therapy?

Research conducted by the Psychiatric Clinics of North America found that CBT decreased the risk of relapse and improved post-treatment quality of life for people in substance use recovery. CBT helps people change problem behaviors by understanding and changing the thoughts that produce them. The therapy explores the relationship between a person’s thoughts, feelings, and behaviors. The idea is, if people can learn to cope with their negative thoughts and feelings better, they can change their problem behaviors. CBT is based on these ideas:

• Feelings, thoughts, and behaviors all impact each other.
• Negative thoughts often fall into cognitive distortions or “thinking traps.”
• When people recognize these illogical thoughts, they can change them.
• When the thought changes, the emotional and behavioral responses change, too.
• Long-term behavior changes come from consistent work on changing thinking.

For example, the cognitive distortion “mind-reading” happens when a person feels like they know another person thinks negative things about them or judges them, often based on a gut feeling. The thinking trap harms the person because they may experience distressed or angry feelings toward the person or themselves. In CBT, the person would explore the thought, identify that “mind-reading” is a thinking trap, and consider whether it has any evidence or support. By reframing these thoughts, people can avoid some of the distressing feelings and problem behaviors.

What is Dialectical Behavior Therapy?

While DBT was designed for people with borderline personality disorder, it now finds a place in substance use disorder treatment. Research from the Journal of Addiction Science and Clinical Practice found that DBT adapts well to substance use disorder treatment and improves outcomes, especially for those with a mental health diagnosis. While CBT works on changing thoughts, DBT focuses on decreasing emotional and mental distress and improving emotional self-regulation. DBT has four core principles or core skills:

• Mindfulness: DBT teaches people to practice mindfulness, focusing on the here and now to avoid fixating on thoughts of the past or present. People also learn to accept and release emotions without letting them cause distress.
• Interpersonal Effectiveness: People learn skills to interact with others in a healthy, assertive way to get their needs met. Because people with borderline personality disorder and people with substance use disorders may struggle with things like setting boundaries, these interpersonal skills have value.
• Distress Tolerance: To improve a person’s tolerance for and reactions to distress, DBT teaches tools for managing distressing situations. People learn new techniques, including distracting, self-soothing in safe ways, accepting life situations with mindfulness, and other tools.
• Emotional Regulation: People with dual diagnoses may have difficulties with emotional regulation, which can also pose an issue for people in recovery. DBT teaches methods to handle emotions better, including:
  • Labeling emotions and identifying them
  • Using mindfulness techniques to distance from the emotion
  • Making use of their distress tolerance lessons
  • Recognizing the difference between emotions and reality

Which One Is Right for You?

When a person enters a recovery program like Lakehouse Recovery Center, they receive an assessment that helps determine what treatments might work best for them. People with a substance use disorder, especially those with a dual diagnosis, can benefit from both types of treatment, and both can be used.

Almost every treatment facility will use CBT techniques, as the therapy has strong research-based evidence behind it in treating substance use disorders. Used as a broad term, CBT covers almost every practice that uses thought awareness to change emotional and behavioral responses. CBT works in group and individual treatments, and people can do a lot of the work on their own during the time between sessions and then discuss with their therapist at the next meeting. Practice is the key to spotting thinking traps reliably and changing them.

DBT follows a more clearly outlined path, although researchers from the Journal of Addiction Science and Clinical Practice have laid out guidelines for adapting standard DBT to substance use disorders. DBT works well for people with moderate to severe mental health issues who benefit from learning distress tolerance and other emotional management skills. However, the skills taught in DBT benefit almost anyone, and many concepts from this model of treatment can appear in group or individual therapy sessions.

In the end, the choice of which therapy to use falls to the person and the therapist. The treatment program’s assessment will help guide the course of therapy to help the person in recovery.

Cognitive-behavioral therapy and dialectical behavior therapy can both be used to treat substance use disorders. CBT focuses on the relationship between thoughts, feelings, and behavior. It helps people identify illogical or unhelpful thoughts and reframe them to change behavior. DBT focuses on providing tools to improve mindful awareness, increase distress tolerance, and help with emotional regulation. Both find a place in substance use treatment but may be used with different people depending on the situation. Some people with higher levels of emotional distress may benefit more from DBT, while others may find CBT more beneficial. At Lakehouse Recovery Center, therapists can provide both CBT and DBT treatment methods. These are used in individual and group sessions, and many people learn tools taken from both types of therapy. We use evidence-based treatments to give people the best chance of a strong recovery. If you have questions or need help, call (877) 762-3707. We have a therapy program to help you.