Dialectical Behavior Therapy

“The Buddha’s message was simple but profound. Neither a life of self-indulgence nor one of self-mortification can bring happiness. Only a middle path, avoiding these two extremes, leads to peace of mind, wisdom and complete liberation from the dissatisfactions of life.” – Henepola Gunaratana, 2011

At Cornerstone of Recovery, we’re located in the foothills of the Great Smoky Mountains instead of in a monastery on one of those peaks, and you won’t find Buddhist monks meditating beneath the towering trees that line the river that runs alongside us.

You will, however, find that we employ a number of therapeutic tools taken from all mankind’s neverending search throughout history for ways to lessen pain, from Eastern philosophy to Western medicine, and one of those – Dialectical Behavior Therapy, or DBT – has roots in both in the way that it’s used at Cornerstone.

DBT is a cognitive behavioral treatment developed by Dr. Marsha Linehan. Clinically, “it emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness,” according to the Linehan Institute.  For addicts and alcoholics who come to Cornerstone seeking treatment for their diseases, it’s a method of restoring order to minds that have been chemically scrambled so thoroughly that for patients to describe how they feel is like asking them to grab a handful of smoke.

When all they feel are extremes – anger, depression, sorrow – how can they begin to effectively function in a world that requires a balance of emotions and a nuanced understanding of them to fully experience? DBT is one of the methods through which order is restored to chaotic minds through two basic concepts: acceptance and change.

“We want to accept who we are – our experiences, our addiction, our temperament – but we don’t want to get stuck in those things,” says Jaema Hayes, a licensed clinical social worker and one of Cornerstone’s residential therapists. “By the same token, we don’t want to become too geared toward change, so that we’re never happy with who we are. It’s about finding the Middle Path.”

DBT encourages acceptance through mindfulness techniques and distress tolerance coping mechanisms, and change through emotional regulation and greater interpersonal effectiveness. All of Cornerstone’s behavioral and processing therapeutic tools focus on the emotional states of patients, who come through the doors with no idea of what they feel or how to begin processing the emotions that come flooding back once the drugs and alcohol are removed; DBT, Hayes says, helps install something of an emotional barometer, so that patients can name their feelings and regulate their reaction to them.

Currently, all patients in Cornerstone’s Women’s Program receive DBT, and plans are being made to include it as part of the therapy for patients in all programs. While women are often perceived as having societal permission to be more emotional, male patients suffer from the same disconnect from their feelings as their female counterparts, and in some instances struggle more because of the masculine inclination toward stoic perseverance and internalized suffering.

“When people stuff their emotions, it leads to anger and depression,” Hayes says. “They never ask for help, or they get more emotionally reactive to receive the attention they so desperately crave.”

Through DBT, patients are taught how to first identify and name their emotions, even as they change – precursor emotions, Hayes adds, can be warning signs that greater emotional turmoil is on the horizon, which can be avoided if patients are attuned to those signs. One of the skills is S.T.O.P., in which clients are taught to “Stop” what they’re doing; “Take” a step back; “Observe”; and then “Proceed” mindfully. It’s a simple teaching tool that helps patients decide how to react, and they’re encouraged to put it into practice during interactions with peers and staff members in the larger treatment community.

That’s just one of the tools used in DBT, which is invaluable in providing emotional safeguards for those who will eventually return to the wider world beyond the confines of Cornerstone. Whereas addicts and alcoholics once used chemicals to anesthetize themselves from the discomfort emotions caused them, they leave treatment capable of overcoming that discomfort, so that while they may feel such emotions, they no longer have to react in a way that’s detrimental to life or recovery.

“Being mindful of what’s going on inside of you starts with observation of what’s going on inside of you,” Hayes says. “We encourage mindfulness in everything and urge them to be in the moment with everything they do. Even if they’re just brushing their teeth, they can be in the moment. That allows them to reel in their thoughts and judgments and focus on what’s going in in front of them. In that sense, DBT gives them skills they can use immediately.”

Alcohol & Drug Addiction Treatment Services

The Path To Recovery Starts At Cornerstone

Medical Detoxification can be a critical time in a patient’s journey toward recovery because the symptoms of withdrawal can be difficult to manage and potentially life-threatening. A team of certified, competent and caring professionals work together to ensure that we provide the best medical care for our patients. The Medical Director prescribes detox medications to keep the patient safe and reasonably comfortable.

While receiving detoxification medications, patients also attend psychoeducational groups and experiential activities. However, detox patients are also given sufficient opportunity to relax and allow their bodies to begin the healing process. Patients on a detox protocol are monitored 24 hours a day and the typical length of detoxification is 3 to 5 days and may be longer depending on the severity of the patient’s withdrawal symptoms.

This unit is designed to support our patients as they enter treatment and begin to invest in their community of peers. An extensive battery of assessments is performed to identify the patient’s bio-psycho-social-spiritual strengths, needs, and barriers to recovery (such as chronic pain, dual diagnosis, trauma, or other co-occurring disorders). This comprehensive assessment process provides our medical and clinical teams with much of the information they need to build a treatment plan that is individualized for each patient.

Our NON-NARCOTIC PAIN MANAGEMENT PROGRAM offers solutions that eliminate and or reduce the dependence on medications to treat pain and improve treatment outcomes. We are able to reduce pain and improve the recovery process. We offer sound information and teach skills that the patient can use to improve coping, relaxation, mindfulness, nutrition, and much more. Some of the modalities we use are Reiki, Rubenfeld Synergy, Acupressure, Mindful Stretching, and Addiction Free Pain Management Education.

We believe healing occurs through direct experience. Experiential activities amplify the traditional therapeutic
modalities that are part of our milieu. Fitness, Meditation, Relaxation Therapy, Yoga, Spirituality Groups, Ropes Course, Mindfulness, Art Therapy, Drumming Circles, and community outings are some components of experiential healing at Cornerstone. Patients who participate in experiential therapies report reductions

Family Therapy is an integral part of all of the clinical programs at Cornerstone. Early on in the treatment process, we conduct a Family Questionnaire which allows family members and close personal friends to have input that impacts the patients treatment plan. When appropriate, there are Family Therapy sessions throughout the treatment process. These sessions are designed to work through relationship issues, enhance communication, educate the family about the disease of addiction and provide them with emotional support while their loved one is in treatment. Through this support, the family will gain knowledge about the treatment process and how they may be unknowingly supporting the addiction through co-dependent and enabling behaviors.

Family members will learn about how to engage in personal growth and change through various 12 step programs, so that the family can heal together trough the recovery process. Cornerstone requires that each patient complete Family Fundamentals, an intensive three-day family program designed to provide intensive education, group therapy, family therapy, 12 step meeting experience, and an opportunity to repair the damage caused by active addiction. Family members are strongly encouraged to attend the Family Fundamentals program along with the patient. Cornerstone also has a weekly family education group for family members and an ongoing support group for parents of young adults who are struggling with addiction or who have recently entered recovery

The Continuous Care Program upholds Cornerstone of Recovery’s treatment philosophy that chemical dependency is a chronic incurable disease that requires the consistent and continued attention of each patient for a lifetime. Recent scientific studies of the disease process have determined that full remission from active addiction does not occur until an individual has experienced at least 18 months of continuous sobriety, long after most intensive treatment programs have concluded.

In response to this knowledge, the Continuous Care Program provides services for a period of at least 18 months following treatment, to ensure that each patient has the opportunity for professional support throughout the early stages of their recovery. During this time, patients are encouraged to practice the skills and tools they learned and developed in treatment as they find their way back
into their home, work, and social environments. They are able to talk with Recovery Coaches and therapeutically
process the ups and downs they experience in sobriety. Active participation in the Continuous Care Program is vital in establishing a lifelong, solid recovery plan.

The Support Living Facility (SLF) provides a safe environment for patients to continue to learn and practice self-management and interpersonal relationship skills while solidifying their recovery program. It can take several months for individuals to become comfortable enough in their recovery to successfully move away from the environment where they got sober. The SLF Program allows men and women to experience some of the freedoms they will experience after treatment while they are supported by thier peers, staff, and a sober environment. Staff monitors the community through regular contact, group therapy, spirituality groups, relapse prevention groups, drug screens, and random checks of the living quarters. Eventually, the patient is allowed to retrieve their cell phone, to leave the premises, operate a vehicle and obtain employment. The minimum length of stay is 2 months (while the individual concurrently is in the IOP Program). Patients often choose to stay in SLF longer while they continue to build their recovery network and become more comfortable with the life changes they’ve made.Typical length of stay varies from 2 to 6 months, depending on the patient’s clinical needs.


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