Addiction Therapies Explained: CBT, DBT, Motivational Interviewing and EMDR

There are many options when it comes to addiction therapies. Each therapy offers a different approach to a very serious disease. How do these different types of therapies treat addiction and which type is best for you?

Components of Comprehensive Addiction Treatment

Research in addiction therapy has undergone immense changes since a boom in research that started in the 1970s. Several therapies have developed due to successful studies and others have evolved out of those studies in recent years. What governs whether or not an addiction therapy is effective in treatment? Researchers have identified key principles that they use in developing and assessing the effectiveness of newly developed therapies:

• Addiction is a disease that affects brain function and behavior.
• Treatment should be readily available and easily accessible.
• Treatment should address all facets of the patient’s needs, not only the addiction.
• Patient should remain in a treatment program for the entire length of the recommended treatment.
• Though individuals that enter treatment voluntary are often the most receptive, effective treatment should be just as effective in treating those who enter involuntarily.
• Treatment should involve the close monitoring of drug use, including medications prescribed.
• Individuals seeking treatment should also receive testing for infectious diseases such as HIV/AIDS and hepatitis as well as educational counseling on the risks and dangers of these illnesses.
• Treatment success rate will vary based on the individual.
• Medication and behavioral therapy are key components in many treatments.
• Medically assisted detoxification is the first of many stages of treatment.
• Dual disorder treatment must be addressed should there be an occurrence.
• Treatment plans must be closely monitored and changed based on patient needs.

Each of the following addiction treatments has been proven to be effective and follow the components listed above. Within these principles, there are usually about five key steps that all addiction treatment programs follow. First, the patient must remove the addiction through detoxification. Next, behavioral counseling is used to determine various aspects of causation. From here, therapists can prescribe medication should it be necessary as well as proceed with the appropriate method of addiction therapy. Long-term follow-ups are necessary to monitor patients for relapse as well.

Cognitive Behavioral Therapy (CBT)

It is quite common for individuals who have fallen into addiction to have arrived at it due to a pattern of dangerous, negative thinking. This thought pattern often leads individuals to seek treatment for depression, but it can also be passed over by the individual as normal behavior. The key to cognitive behavioral therapy (CBT) is changing the negative thought pattern that can affects the overall wellbeing of the individual. CBT encourages individuals to focus on the present while setting goals for improvement in the future. Those receiving CBT for addiction work to change the thoughts that lead them to pursue their addiction in the first place. By replacing their negative reflections on past events and focusing on the present and future, it is possible to change thought patterns over time. When used effectively, cognitive behavioral therapy can provide patients with the following benefits:

• Helps patients move away from the patterns of behavior and thoughts that have led them to addiction.
• Patients actively work with a therapist to help identify key instances in which a negative thought pattern occurs.
• CBT is able to be administered through individual or group therapy settings.
• Patients learn to develop strategies to deal with stress and negative situations that could potentially lead them to return to their previous thought patterns and habits.
• Skills learned are easily applied to everyday life.

Dialectical Behavioral Therapy (DBT)

Originally developed during the 1970s as a method of therapy for those suffering from severe suicidal thoughts, Dialectical behavioral therapy (DBT) was later adapted for those suffering from co-occurring disorders such as substance use disorder (SUD) and borderline personality disorder (BPD). Those that suffer from substance abuse often also suffer from depression and have a higher risk of suicide. Patients that pursue DBT will be assigned an individual therapist and that therapist will be personally responsible for the implementation of a comprehensive DBT treatment plan. The main method behind DBT treatment is the rejection of a mindset in which the patient should accept their current situation as unchangeable. The term dialectic actually means implies change achieved through persuasion and identification of oppositions that immerge as a result of therapeutic exploration. What does that mean? The patient pursues a change in the life by convincing themselves that for each reason for their behavior in the past, there exists a better and more fulfilling behavior. At its core, DBT is simply a more advanced and evolved form of CBT. CBT focuses heavily on the thought process, whereas DBT takes that one step further and incorporates an additional emphasis on how a person interacts on with others in certain environments and relationships. This helps patients identify certain catalysts for their behaviors in their relationships and environments. Dialectical behavioral therapy requires certain functions in order for treatment to be effective. The patient much first show a will or motivation to change their current behavior and situation. Once a motivation has been established, the therapy then shifts its focus to helping the patient begin to create new behaviors and build upon the motivations that they have developed. The therapist also helps the patient restructure their environment to be more conducive to new thought processes and behaviors. From here, the therapist evaluates progress and begins to build upon it.

Motivational Interviewing (MI)

Many different types of addiction therapies revolve around a change in mentality. This is also the case for motivational interviewing (MI), however, the application is slightly different than CBT and DBT. MI is driven by the thought that individuals suffering from addiction understand, a least partially, the consequences of their addiction. It is the job of the therapist to identify the level of readiness in the patient for a behavioral change. This readiness is often determined by helping the patient identify their own fear of change and lack of motivation. The methodology of MI is based on seven key points:

1. Patient and therapist must see their relationship as a partnership in which both parties are working toward finding a solution.
2. Motivation must come from the patient and can’t be driven by outside sources.
3. After evaluation, the counselor leads the client to identifying the conflicting ideas that are preventing their motivation to quit.
4. The counselor must allow the patient to strive for a resolution of conflicting ideas.
5. MI treats the readiness to change, not as an unalterable trait, but as something that fluctuates as a result of interactions.
6. Persuasion should not be used to resolve these conflicting ideas.
7. While observing, the counselor gathers and evaluates information from the client.

While CBT and DBT are often used for co-occurring disorders, MI may not be enough by itself. Individuals seeking motivational interviewing therapy must be able to focus on evaluating the pros and cons of their addiction. Those suffering from severe mental illness alongside addiction may lack the mental clarity to do so. MI can be used following a successful treatment of a mental disorder.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) developed during the 1980s after a key discovery showed the potential of using eye movement to lessen the intensity of disturbing thoughts. For several years following the discovery, researchers focused on how to effectively utilize eye movement in the treatment of trauma victims. EMDR is now used in the treatment of various disorders ranging from addiction to PTSD. What exactly is EMDR? Patients move their eyes rapidly from side to side while simultaneously recalling a traumatic experience together with the counselor. The basis for this idea is that by the conclusion of the therapy sessions, the patient will have desensitized themselves from both the rapid movement of the eyes and the traumatic experience they are recalling. By having the individual move their eyes, the counselor is creating a physical stimulus with which to identify. This stimulus can also come in the form of pulsating lights, tapping of the knees, or other various physical motions that can be used to the same effect. Traumatic experiences such as the death of a loved one, rape, child abuse, or domestic violence are often the catalyst for addiction. Individuals become unable to cope with their traumatic experience normally and reach for other methods such as substance abuse and other addictive behaviors. How is EMDR implemented? A comprehensive EMDR treatment plan includes eight phases:

1. Treatment Planning: The therapists takes an account of any history of traumatic events that may have occurred in the patient’s past.
2. Preparation of Treatment Plan: The therapist and patient work together to develop coping methods to help manage the challenges that will arise from visiting these traumatic events.
3. Assessment of Trauma: The patient creates a single image that represents the traumatic event that they are focusing on. Negative thoughts are explored and then, the patient is instructed to replace the negative thoughts with positive ones. Throughout the process, the therapist helps the patient numerically rate the distress of recalling these events, often using a scale between 0 to 10.
4. Desensitization through Physical Stimulus: As described about, the therapist walks the patient through the exploration of the traumatic event, while introducing a physical stimulus such as rapid side to side eye movement or tapping on the knees. This process is completed in sets of 30 seconds until the patient is able to recall the memory without distress.
5. Installation of Positive Visualization: The process in step 4 is repeated while the patient focuses on the positive visualization explored in step 3. After the patient has arrived at the conclusion that the positive visual is true, the therapist moves to the next step.
6. Identifying Negative Physical Sensations (Body Scan): In addition to negative thoughts, trauma often presents itself in negative physical sensations in various parts of the body. This can include tightness in the chest or stiffness or weakness of the limbs. While exploring the positive visualization, the patient scans their body to identify any sensations that could be a result of recalling the trauma. Once it is possible to recall without any physical distress, the patient and therapist can move on.
7. Repetition and Closure: It may take several sessions before the patient is able to recall the traumatic event without feeling distressed. Once this occurs, the sessions can move on to helping the patient deal with emotions and habits that have developed as a result of the traumatic experience.
8. Reevaluation: Progress will be measured of the course of several treatment sessions and over time the patient will have developed methods to deal with the negative emotions when they occur at home.

Because EMDR can be used to treat co-occurring disorders, it is frequently used to treat addiction that occurs as a result of a traumatic event. In these situations, the addiction is implemented as a coping mechanism. EMDR treats both the addiction and the underlying cause.

Finding an Addiction Therapy That’s Right for You

Though there are many different types of addiction therapies available, not every plan was discussed here. Every person is different and because of this, there is no one-size-fits-all approach to therapy. Each therapy offers a different approach to dealing with addiction and there is bound to be one that can help you or your loved one. If you have tried to overcome your addiction and failed, it wasn’t your fault. There is a way for you to overcome your addiction, you just have to find the right path.