CBT vs. DBT vs. ACT for Addiction Treatment

Research shows that evidence-based psychotherapeutic behavioral approaches combined with support group attendance offer the best outcomes for treatment of addiction, mental illness, and self-destructive disorders.

A National Institute on Drug Abuse (NIDA) publication endorses behavioral therapies as effective approaches for addiction treatment. According to the NIDA, such therapies provide incentives for remaining abstinent, helps clients change attitudes and behavior linked to drug use, and teach skills to better manage stress and trigger situations.

Three well-respected behavioral models include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Acceptance Commitment Therapy (ACT), which use varying methods to identify and transform negative thoughts, emotions, and behaviors that may relate to addictive behavior. Scientific studies attest to the effectiveness of all three behavioral therapies. While similar, each has a slightly different focus.

Cognitive Behavioral Therapy (CBT)

The National Association of Cognitive-Behavioral Therapists explains CBT is a cognitive model of emotional response, meaning it involves conscious, intellectual activity. Founders of CBT believe, “our thoughts cause our feelings and behaviors, not external things, like people, situations, and events,” and we can learn to change how we think and respond.

Negative thoughts and feelings may stem from depression, anxiety disorders, traumatic experiences, chronic stress, or other factors, and may increase the risk of addiction.

Multiple studies support the link between addiction and chronic negative thinking. CBT helps clients identify how a personal pattern of negative thoughts, feelings, and actions fuels their addictive behavior.

Through CBT clients learn to recognize “hot thoughts” and other negative patterns, how to reframe those patterns, and how to shift to healthier responses.

Therapy sessions include exercises designed to help clients identify negative thoughts, how they interpret those thoughts, and how to challenge and reframe the thoughts. Clients may keep a thought journal, speak thoughts aloud, complete depression/anxiety inventories, practice imagery or relaxation skills, or practice other techniques.

CBT clients benefit by:

• Learning to change thoughts and responses even when the situation does not change.
• Identifying consequences of continuing substance abuse.
• Developing coping skills to manage cravings and identify trigger situations.
• Working with the therapist to set goals for each session.
• Practicing exercises and techniques between sessions.
• Accepting accountability for the therapeutic outcome.
• Experiencing a more structured vs. open-ended approach.
• Lowering their risk of relapse.
• Achieving positive results in a short time, lasting an average of 15 sessions.

Dialectical Behavioral Therapy (DBT)

DBT is a form of CBT but focuses more on helping clients learn to balance emotions, find inner peace, and strengthen interpersonal relationships. It also centers on the development of a trusting relationship between client and therapist. As the therapist validates the client’s feelings, it becomes easier for the client to make positive changes.

Dialectical means two opposites can both be true. DBT seeks to unite two situations that seem to conflict – acceptance and change, helping clients learn to accept past experiences and their current situation, while they learn to manifest the internal peace needed for healthy change.

Mindfulness is an important component of DBT. It is a technique that helps the client stay in the present moment by learning to notice when the mind is getting distracted and to guide the mind back to the present experience without judgment.

As clients practice mindfulness, they become more able to accept challenges with a peaceful, non-judgmental response, using coping skills to replace destructive behaviors.

DBT helps patients:

• Stay in the present moment without judgment.
• Develop tools to manage intense emotions and avoid negative responses.
• Improve relationships by learning to handle conflict.
• Learn coping skills to manage difficult situations or emotions.

Originally founded to treat people with suicidal behavior and borderline personality disorder, multiple studies found DBT is also effective in treating substance use disorder, eating disorder, anxiety disorder, and other mental health illnesses.

Acceptance Commitment Therapy (ACT)

Like DBT, ACT uses principles of mindfulness, encouraging clients to remain in the present moment while they release negative thoughts, feelings, and behaviors. ACT and DBT also share a similar emphasis on the relationship between client and therapist, encouraging an equal partnership as they work together toward recovery.

ACT differs from DBT in that its focus is to help clients identify personal strengths and how those strengths can help them maintain a positive state of mind, cope with challenges without using addictive substances, and make overall healthier choices.

There are also fundamental differences in how ACT and CBT view thoughts. CBT helps clients recognize and reframe negative thoughts, while ACT works to help clients accept negative thoughts as a part of life which they can learn to live with and develop a positive outlook.

ACT clients learn to:

• Practice mindfulness, visualization, stress reduction exercises.
• Reduce distress caused by negative thoughts, feelings, and behaviors.
• Distinguish between thoughts and behaviors.
• Reinterpret past negative or traumatic events.
• Be open to new ideas and behavioral change.
• Identify core values, and what is most important to them.
• Develop a deeper understanding of themselves.
• Accept challenging or painful experiences without using addictive substances.

Evidence-Based Practices For Addiction Treatment

CBT, DBT, and ACT are all evidence-based practices (EBPs), which means large scale clinical trials have concluded they work. An extensive amount of clinical data supports EBPs are safe and effective approaches to addiction treatment.

The National Institute on Drug Abuse agrees that evidence-based behavioral therapies are effective in the treatment of addiction, noting that each behavioral approach addresses, “certain aspects of drug addiction and its consequences for the individual, family, and society.”

At Midwest Recovery Centers, we believe the extended care treatment model provides a safe, transformative, client-centered, and cost-effective recovery process from alcohol and drug use.

After completion of inpatient treatment, we continue to provide support to program alumni and families through our aftercare and family programs.

We are guided by our dedication, integrity, and the belief that the disease of addiction is a treatable disease and the person suffering from it can recover. Our goal is to help our clients find a healthier, happier, and more fulfilling way of life.

Contact Midwest Recovery Centers today to start your recovery.

Reviewed and Assessed by
Taylor Brown, B.A.Com., MAADC II
Tim Coleman, M. of Ed.