“…there is nothing either good or bad, but thinking makes it so.”
This familiar quote from William Shakespeare’s play Hamlet can be applied to cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) in that both forms of psychotherapy encourage patients to examine and change their thinking as well as problematic behaviors. Some of the concepts in both CBT and DBT can be traced back to the concept from Stoic philosophy that although people cannot control events in their lives, they can control—or learn to control—their reaction to those events.
CBT was developed in the 1960s from previous behavioral therapies and the concept that a person’s emotions and behaviors are influenced by their thoughts and perceptions. DBT was developed in the 1980s and can be thought of as a specific type of CBT.
What Is CBT?
According to Pinelands, CBT is “the most common therapeutic modality used for substance ause disorders and mental health disorders. The goal is for patients to understand negative thoughts and feelings that influence behaviors, and change these distorted thinking patterns and emotional responses into positive thought processes that can bring forth healthy behaviors.”
In CBT, an individual attends weekly therapy sessions and has “homework” between sessions. Patients first learn to recognize their unhealthy thinking patterns, frequently referred to as cognitive distortions. Examples of these unhealthy thinking patterns include:
- Dichotomous (black-and-white) thinking, such as, “If I’m not perfect, I’m a failure.”
- Catastrophizing is assuming the worst will happen.
- Overgeneralization takes a single negative event and sees it as a never-ending pattern.
- Fortune-telling is assuming that events will turn out bad.
- Discounting the positive is the idea that positive experiences don’t count, aren’t real or were a one-time occurrence.
Next, patients use thought records to analyze their thinking, such as:
- The event
- Emotional and physical responses to the event
- Unhealthy thoughts and behaviors that occurred as an initial reaction
- Healthier, alternative thoughts and behaviors
- Current feelings
As patients become more accustomed to identifying their automatic, negative responses, they learn to use various thought-stopping techniques, which can be as simple as saying “stop” when they find themselves dwelling on negative thinking. Through CBT, patients gain a better understanding of the connection between thoughts, feelings and behaviors and learn to change their behavior and improve their mood by changing their thinking.
What Is DBT?
DBT was developed in the 1980s by psychologist Marsha Linehan to treat patients with “borderline personality disorder and suicidal thoughts.” DBT grew out of CBT and, according to ] Pinelands Recovery, is a “more specific type of CBT that helps patients identify and cope with negative emotions.” Part of the premise of DBT is that some people have stronger emotional responses to events than the average person and that it takes them longer to recover from these responses.
In DBT, patients attend group therapy sessions in addition to their individual counseling sessions. DBT emphasizes the ways in which patients interact with other people in varying environments and relationships. Group sessions give patients a safe place to practice new behaviors and ways of thinking. DBT teaches people four primary strategies for identifying and coping with negative emotions as well as the triggers that can lead to relapse in addiction recovery: mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.
- Mindfulness: This refers to a person’s ability to be conscious in the present moment, which can help with controlling emotions and impulses. Deep breathing, progressive relaxation and meditation are examples of techniques used for developing mindfulness.
- Distress tolerance: Patients learn to accept negative emotions rather than fight against these emotions. In accepting rather than fighting the emotion, individuals learn to accept reality (which is not the same as liking the situation). Patients learn techniques to help them more readily tolerate the painful emotions that they are experiencing. These techniques include distracting themselves with positive behavior, noticing physical sensations in their bodies that result from the emotion, or being aware of their thoughts.
- Interpersonal effectiveness: This core part of DBT gives individuals the tools they need to treat other people and themselves with respect, thus fostering healthy relationships.
- Emotional regulation: This technique helps people learn to recognize and name their emotions as they experience them and think about them objectively rather than labeling them bad or good or acting on them.
Which Treatment Is Right for Me?
Both CBT and DBT are successfully used in treating mental health issues and substance use disorders. Both help individuals gain self-awareness, better understand the connection between their thoughts, feelings and behaviors, and examine their thoughts and stop automatic negative thinking.
CBT is widely used to treat anxiety and depression. DBT can be very helpful for people who have difficulty discussing or controlling their emotions, who are impulsive or engage in risky behaviors, or who are in unstable relationships. DBT is also effective for people who have experienced trauma or who have tendencies toward self-harm or suicidal thoughts.
Deciding which treatment modality is best for you is best done working with a therapist knowledgeable in both. However, either option can bring about healing from addiction and mental health issues and result in a happier, more rewarding life.
Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are both forms of talk therapy used effectively to treat substance use disorders and mental health issues. Both therapeutic modalities help patients gain self-awareness and understanding of the interplay between thoughts, emotions, and behaviors. Both are based on the concept that although you cannot always control the events in your life, you can learn to control your reactions to these events. Pinelands Recovery Center of Medford in New Jersey offers both CBT and DBT to its patients. If you are struggling with addiction or are concerned that someone close to you could be, call Pinelands Recovery at (877) 557-5372 to learn more. Let us help you prepare for a happy, healthy life after rehab.