Important Differences Between Standard CBT and DBT

Cognitive-behavioral therapy (CBT) is a psychotherapy treatment commonly used for substance use disorder (SUD). Alongside medication-assisted therapy (MAT), CBT is a first-line SUD treatment in rehab centers in Boston and throughout the US.

Though many other psychotherapy approaches have been successfully used for treating SUD, CBT and its many subtypes (including cognitive processing therapy, cognitive therapy, and dialectical behavior therapy, to name a few) are currently the primary psychotherapy approaches used in most drug and alcohol rehabilitation programs.

These different CBT approaches have been successfully combined with MAT and other conventional and supplemental therapies and interventions to improve patient outcomes.

In the past few decades, dialectical behavior therapy (DBT), a subtype of CBT, has emerged as one of the more commonly used approaches in American substance rehab programs. While DBT is considered to be a type of CBT, it differs from standard CBT in several crucial areas. Below we’ll explore the main premises behind standard CBT and DBT as well as the situations these approaches tend to be used in, within the context of SUD treatment.

What Is Cognitive-Behavioral Therapy (CBT)?

People with mental health conditions like SUD often have various deep-seated negative thought patterns. These negative thought patterns can make it extremely difficult to control impulses, avoid relapse, or develop good recovery habits. Cognitive-behavioral therapy aims to help SUD patients control these negative thoughts through logic and reasoning1. CBT usually involves talking sessions, leading it to sometimes be inaccurately called “talk therapy”. In these sessions, therapists challenge the patient’s beliefs with questions intended to help them find reasons to reject or reframe harmful ideas,

CBT allows the patient to safely address long-held beliefs that could be making it difficult for them to maintain their recovery. Rather than being told what to think, someone undergoing CBT will be encouraged to explore and question their own thought processes.

To make this happen, therapists will often ask questions designed to stimulate critical thinking, much like the classic Socratic method2. The idea is that the patient will be able to arrive at their own logical reasons for discarding or recontextualizing harmful beliefs. Sessions can be done individually or in groups.

Key points about cognitive-behavioral therapy include the following:

• First-line psychotherapy treatment for SUD
• Is a general practice that includes several subtypes
• Uses logic and reasoning
• Challenges the patient’s worldview
• Focuses on thoughts, feelings, and behaviors

What Is Dialectical Behavior Therapy (CBT)?

Dialectical behavior therapy is a CBT-derived psychotherapy approach designed for patients with borderline personality disorder as well as those who have recently experienced severe trauma or emotional distress3. It has since been adapted for all kinds of situations where the patient is unable to regulate their emotions, something fairly common in people with SUD.

DBT diverges from standard CBT in that it does not attempt to directly challenge a patient’s beliefs. This is because challenges can be upsetting for people who are unable to manage their emotions, who may then resort to harming others or themselves.

The term “dialectical” in DBT refers to the idea of bringing together two seemingly contrary ideas: acceptance and change. In DBT, therapists validate a person’s experiences and ideas, including negative ones, to improve confidence and emotional stability. When this is achieved, the therapist can start nudging the patient towards changing negative ideas and behaviors. Shifting to standard CBT or some other psychotherapy approach can also be considered.

To help patients improve their emotional stability, therapists using DBT may employ a variety of techniques. This includes individual and group talks as well as coaching sessions intended to improve distress tolerance, emotional regulation, and confidence. Unlike standard CBT, which tends to use Western approaches like the Socratic method, DBT often uses Eastern-influenced concepts like mindfulness to achieve its goals.

Key ideas around dialectical behavior therapy include the following:

• Is a specialized practice
• A subtype of cognitive-behavioral therapy
• Aims to improve emotional regulation
• May use Eastern-influenced practices like mindfulness
• Can be used to prepare patients for standard CBT or other therapies

Which Kind of Therapy Do I Need?

Though standard CBT and DBT are widely used in SUD treatment, they are not necessarily appropriate in every case. SUD cases can be extremely complex and are rarely resolved with any single treatment, often needing a highly personalized approach to achieve good long-term outcomes. Only qualified mental health professionals can determine which therapies and interventions are appropriate for you

If you’re in the New England area, you can get in touch with our team at Boston Drug Treatment Centers to find programs with qualified specialists. We can help you find the therapies and interventions that will offer the best chance at a sustainable recovery.

Good luck, and be well!

Resources

1. Rothbaum, B. O., Meadows, E. A., Resick, P., & Foy, D. W. (2000). Cognitive-behavioral therapy. In E.B. Foa, T.M. Keane, & M.J. Friedman (Eds.), Effective Treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp 320-325). The Guilford Press.
2. Clark, G. I., & Egan, S. J. (2018). Clarifying the role of the Socratic method in CBT: a survey of expert opinion. International Journal of Cognitive Therapy, 11(2), 184-199.
3. Chapman, A.L. (2006) Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry (Edgmont), 3(6): 62-68.