DBT

“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.”