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When you are exploring therapy options for your mental health, and particularly to treat a substance use disorder (SUD), it does not take long to realize there are many different approaches to psychotherapy. Two approaches that are widely used include CBT (cognitive behavioral therapy) and DBT (dialectical behavior therapy).

CBT and DBT are both evidence-based, meaning they are grounded on scientific evidence that prove they can successfully treat a range of conditions from depression and anxiety to PTSD and substance use disorder, and most behavioral health professionals with adequate training can provide these approaches competently.

According to NAMI (the National Alliance on Mental Illness), 20% of adults in the United States will grapple with some form of mental health issue in any given year, and up to 10% will suffer from substance use disorder. Given the prevalence of these conditions, therapies like CBT and DBT are a vital component of the recovery toolbox.

But how do CBT and DBT differ? Before we compare them, here is an introduction to both forms of psychotherapy.

What is CBT?

Cognitive behavioral therapy is a skills-based therapy. Sessions can be delivered one-to-one or in a group setting. With CBT, the client works closely with a therapist to investigate how their thoughts, feelings, and behaviors are all interrelated, and there is a heavy emphasis on logic and reasoning.

One way is by examining the correlation between feelings and the actions that follow those feelings. The client learns to identify the triggers that lead to negative behaviors and learns healthier coping mechanisms to replace these responses so they can avoid destructive and self-defeating behavior.

CBT can be used to treat:

  • Alcohol use disorder
  • Anxiety
  • Depression
  • Insomnia and other sleep issues
  • Panic disorders
  • Phobias
  • PTSD
  • Substance use disorder

CBT encourages looking at things more objectively, and ultimately how thoughts and feelings do not have to drive behavior.

What is DBT?

Dialectical behavioral therapy, or DBT, is a specific form of CBT. Rather than focusing on trying to think or talk one’s way out of painful issues, DBT focuses on changing the behavioral patterns.

Initially developed by University of Washington psychologist Marsha Linehan to treat patients with borderline personality disorder (BPD), DBT later was applied effectively to treat a range of mental health conditions.

Through DBT, a client learns to acknowledge pain or discomfort in social situations or the environment while still finding ways to feel mentally and emotionally safe. DBT encourages an alternative way of coping instead of engaging in negative and destructive behaviors.

As well as treating BPD, DBT can also be effective for treating the following:

  • Alcohol use disorder (AUD)
  • Chronic suicidal ideation
  • Self-harm
  • Substance use disorder (SUD)
  • Trauma from sexual assault

It’s worth noting that there are four modules to DBT:

  1. Mindfulness. With mindfulness, the client learns to stay fully focused in the present moment.
  2. Interpersonal effectiveness. Interpersonal effectiveness helps the client to work more effectively within the context of their interpersonal relationships.
  3. Distress tolerance. When life becomes stressful or uncomfortable, distress tolerance equips them with the skills to cope.
  4. Emotion regulation. With emotion regulation, they move toward understanding the purpose of their emotions and healthy responses rather than being driven by those emotions.

What is the difference between CBT and DBT?

Your healthcare provider can best determine whether CBT or DBT would make the best fit in a therapeutic setting. Some people find exploring both forms of therapy beneficial, while others require only CBT or only DBT; all mental health conditions and all addictions are different, and they should be treated as such.

If, for example, you are being treated for a substance use disorder, you may discover that it is an underlying diagnosis of PTSD that is triggering the substance use. In this case, CBT could help you to change the way you think and behave. On the other hand, if you are struggling with a personality disorder and battling instinctive emotion-driven responses, DBT can be highly beneficial.

With CBT, your focus is on the interrelated nature of your feelings, thoughts, and behaviors. DBT touches on these elements but puts far more stock on mindfulness, regulating emotions, and the acceptance of pain.

CBT also is proven effective for treating depression and is more likely to send depression into remission than any other form of therapy; CBT also works well for treating anxiety disorder, panic disorder, PTSD, and sleep disorders. While DBT was initially created to treat the symptoms of BPD, it also works well for treating self-harm and the survivors of sexual trauma.

In terms of the philosophies underpinning CBT and DBT, there are some key differences. CBT is grounded on logic and reasoning. This helps you deal with the symptoms of depression and anxiety more objectively and less emotionally. DBT, by contrast, draws heavily on the mindfulness skills from Zen and Buddhism. Acceptance rather than change underpins dialectical behavior therapy.

What Comes Next

If you are struggling with a substance use disorder (SUD) or alcohol use disorder (AUD), Landmark Recovery’s treatment programs utilize both CBT and DBT, according to your needs.

Our dual-diagnosis treatment programs for addiction help you to address your substance use issue at the same time as your mental health condition. Both CBT and DBT can be invaluable components of therapy.

If you are ready to commit to recovery, speak with a recovery specialist at Landmark 24/7 at 888-448-0302.

About the Author

Michelle Dubey - LCSW, LISW, CCTS

Michelle has been with Landmark Recovery since the beginning in 2016, and she has been in her role as Chief Clinical Officer since 2019. As CCO, Michelle is responsible for development and oversight of Landmark’s clinical programming, as well as quality assurance and compliance. She is a Licensed Clinical Social Worker with active licenses in Arizona, Kentucky, Ohio, and Virginia, and is a Certified Clinical Trauma Specialist. Michelle received her Master’s degree in Social Work from the Kent School of Social Work at University of Louisville and brings more than 13 years of experience working with individuals and families healing from substance use and other co-occurring disorders.

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