PTSD and Substance Abuse

What is PTSD?

The American Psychiatric Association defines Posttraumatic Stress Disorder (PTSD) as “a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault.” Other traumatic events can include mental illness, childhood trauma, child abuse, sexual assault, sexual abuse. Trauma experienced may be acute (a single occurrence), chronic (repeated and prolonged trauma such as domestic violence or abuse), or complex (repetitive, prolonged trauma involving ongoing abuse or abandonment within an interpersonal relationship with an uneven power dynamic). It is important that individuals who have experienced or been exposed to some type of traumatic event and/or substance abuse receive treatment for seeking safety therapy in order to increase the safety for themselves and for the people around them.

Someone diagnosed with PTSD continues to experience intense and disturbing thoughts and feelings related to the experience after it has ended. Someone may experience vivid flashbacks or nightmares related to the event and may experience a bodily response more closely linked to extreme stress or fear despite presently being out of danger. An individual may also experience feelings of anxiety, sadness, fear, depression, or disconnection from others.  Many times, when a person experiences something traumatic, the experience is locked away in the brain with strong emotional responses tied to the memories. Despite being safe in the current moment, the emotional response to a trigger or memory is so strong that the body responds as if they are still in immediate danger.

The PTSD symptoms someone may experience are pervasive and may make it difficult for a person to live fully and participate fully in their activities of daily life. Work, relationships, hobbies, and the daily tasks of life feel overwhelming and impossible to navigate. Typically, when someone experiences symptoms of PTSD, they also find a way to tolerate those symptoms, to make it through their day or night.

Each of us finds ways to cope with unpleasant feelings of emotions. Many people use safe coping skills like talking with a friend or therapist, taking a walk, engaging in a relaxing experience or using soothing self-talk. Many people also use unsafe coping skills when experiencing emotional discomfort. They may distance themselves from others, use alcohol or substances to numb their pain, engage in cutting behaviors, or use degrading and harsh self-talk. Our brain is always trying to find a way to cope or make sense of life. We are hardwired for survival, so when our emotion center takes the reigns and sends us into panic, fear, stress, or survival mode as a result of one or more traumatic events from the past, our brains will work overtime to keep us afloat. It is important to remember that regardless of whether our coping is safe or unsafe, we are engaged in a behavior in which we believe will make the pain or discomfort stop.

Typically, when we find a behavior that “fixes” the problem, we will continue to use it until it no longer works. We are creatures of habit. For some people, the behavior that brings the most reprieve from the discomfort is alcohol or substance use. Some research shows that at least 50% of individuals in inpatient treatment for substance abuse also suffer from PTSD (see Souza & Spades). While substance use may have origins elsewhere for some, for many, a history of trauma is involved in the desire to feel different. By their very nature, use of alcohol and other substances typically induces an alternate feeling or experience in the body.

SAMSA estimates that in 2016, 20.1 million people aged 12 or older had a substance use disorder related to use of alcohol or illicit drug abuse. While their findings do not specify how many of those individuals were also suffering from PTSD, it is important to recognize the high rates of substance abuse we’re seeing in the United States at this time and to know that this is not an issue limited to a select group of individuals. Research shows that in the veteran population, veterans stand as a high percentage of the individuals with a substance use disorder who also suffer from PTSD. The VA sites that more than 2 of 10 veterans with PTSD also have a substance use disorder and almost 1 of every 3 veterans seeking treatment for a substance abuse disorder also has PTSD.

Substance abuse does not discriminate on the basis of race, socioeconomic status, gender, or religious beliefs. The problem with substance dependence or alcohol abuse is that it becomes a common coping skill used to deal with anxiety, fear, loneliness, depression, sadness, and for many, is a behavioral reaction to just about any emotion one might experience.

Given the high rates of alcohol misuse and substance abuse, and the overwhelming symptoms experienced emotionally and physiologically, it is understandable that someone diagnosed with PTSD who is experiencing the symptoms or reliving the trauma might use a substance or alcohol to cope.

Treatment Modalities Commonly Used With Substance Abuse

Generally speaking, substance abuse treatment typically involves increasing internal motivation for change and then helping individuals increase coping skills to deal with triggers that previously led them to the substance abuse. It also involves a look at underlying issues that might be causing problematic symptoms someone might try to numb with the use of alcohol or a substance.

Motivational Interviewing (MI) is a therapeutic model that helps individuals resolve ambivalent feelings and insecurities to find the internal motivation they need to make changes in their behavior. It is a highly empathetic, short-term model that respects the challenges involved in making changes and helps individuals move through the emotional process of change required to increase motivation.

Cognitive-behavioral therapy (CBT) is a short-term, goal-focused modality with the goal of changing thought patterns and behaviors that are behind an individual’s challenges, thus changing the way an individual feels as a result.

Acceptance and Commitment Therapy (ACT) uses mindfulness and behavioral activation to increase psychological flexibility and the ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations.

Dialectical behavioral therapy (DBT) is a treatment modality that emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance.

Treatment Modalities Commonly Used for People With PTSD

Treatment for post-traumatic stress disorder and trauma typically involves some form of processing a trauma while also increasing coping skills to tolerate the strong emotion that comes along with the memory of it. It may involve desensitizing a memory or restructuring thoughts related to the trauma to be adaptive and supportive. This can be accomplished by various types of trauma focused therapy.

Exposure therapy involves the client coming into some form of contact with the traumatic memory. Exposure to the memory may be done in imaginal (remembering the event), interoceptive (remembering the emotion or physiological reactions during the event), or in vivo (returning back to a place or having direct contact with an object or place related to trauma). Each exposure is intended to decrease the intense emotional and physiological arousal state associated with the memory and increase the individual’s ability to desensitize their brain and body to triggering stimuli.

Cognitive therapy works by modifying negative assessments and memories of trauma with the intent to alter the behavior and/or thought patterns that have been problematic in the individual’s activities of daily living. Cognitive therapy uses some exposure to the trauma with the intent of identifying strong emotional responses and the restructuring of thoughts in the moment.

Relaxation training is used to manage physiological reactions which manifest as a result of ongoing exposure to the traumatic memory. Using techniques like mindfulness, grounding, yoga, and deep breathing, and relaxation training increases an individual’s ability to tolerate and be successful in more traditional therapies.

Eye Movement Desensitization and Reprocessing (EMDR) targets the unprocessed memories that connect negative emotions, sensations, and beliefs. By activating the brain’s information processing system, old memories can be digested with the idea that what is useful can be learned and what is no longer useful can be discarded. A clinician uses bilateral stimulation via eye movements, tapping, or sounds to activate both sides of the brain while processing the trauma.

Treatment for PTSD and Substance Abuse

There is good news. It is possible to heal from PTSD and to maintain a recovery free from substances if you are ready. Many people have braved the road to recovery for both PTSD and substance abuse and used different treatment options for addressing both.

Many practitioners recommend that an individual begins managing the substance use prior to beginning processing trauma, or to handle them both simultaneously. This may involve attending 12-Step meetings, admitting to a treatment facility, or attending an outpatient treatment program. The primary goal of obtaining sobriety initially or while also working to process trauma, is to increase coping skills. Therefore, when an individual begins to work through the trauma, they will have some coping skills other than the substance use to manage the overwhelming thoughts or emotions associated with the trauma that will likely emerge during the process. Without the addition of new, safe coping strategies, an individual is likely to return to problematic substance use to manage symptoms of trauma in the same way they had managed them initially.

Some modalities like Seeking Safety, target individuals who have a history of both trauma and substance abuse and help them when building and seeking safety coping skills that will help the healing process of both PTSD and substance abuse, simultaneously. In general, it is recommended that an individual has support as they begin to work towards sobriety and processes trauma. Support can entail a formal inpatient or outpatient treatment program, a therapeutic relationship, support groups, or sponsors/mentors. Though the processing and recovery are independent, increased support is encouraged through multiple channels when possible. Individuals might couple a treatment program with individual therapy or twelve-step programs with an individual therapist. Someone might join a PTSD support group for group treatment and admit to a treatment program. As with any major change one might make, individuals are encouraged to increase their safe support system in as many ways as are possible.

You Are Not Alone

Many times, individuals who are experiencing symptoms of PTSD and addiction to substance use feel very alone and isolated from others. The weight of it may feel unbearable, and the thought of working through it all may feel impossible. Know that you are not alone and you are not meant to bear this alone. You are not the first ,and you are not the last. There is hope and help for you. It is a brave thing to take the first step towards healing when you are unsure where the path will lead you. The path each person takes is different, and no two journeys are ever the same – there is room for everyone on this road to wellness. When we are ready and able to take that first step, we will learn that there are others walking this journey with us. When we look closer, we will notice that not only are they on their own journey towards wellness, but they are ALL cheering us on, every step of the way.

You had no control of the trauma that occurred in your life, but you have the ability to take control of the trauma you experienced, now. The first step might be telling a friend or loved one that you think you need help. It may be calling the VA for referrals. Your first step might be checking yourself into rehab, and at APEX Recovery, our trained clinical staff are able to help you not just achieve sobriety, but also overcome underlying traumatic experiences and issues. Whatever that first step is, take it. People all over the world will tell you that hope and healing is possible if you’re ready to engage and do the work. You are worth any amount of work it will take to achieve wellness. At APEX Recovery, we are ready to hear your story and help you write the rest of it in its best form. By contacting us today, you can invite our team to be a part of your healing journey.


Borderline Personality Disorder Dialectical Behavior Therapy

If you or someone you love one has recently been diagnosed with borderline personality disorder and/or a substance use disorder, it is common to feel uneasy, isolated, or overwhelmed. One of the best things that anyone can do after a recent diagnosis is to learn the facts about the mental health condition, as well as the available treatment options. Both borderline personality disorder and substance abuse can be treated through dialectical behavior therapy. Before beginning treatment, here are some things you need to know:

Borderline Personality Disorder


It is estimated that 1.6% of the adult U.S. population has Borderline Personality Disorder, a statistic that is representative of over four million people. However, that number may be as high as 5.9%. This may be due to the fact that over 40% of people with Borderline Personality Disorder have been previously misdiagnosed with more well-known or easily treated disorders, such as bipolar disorder or major depressive disorder. It’s also common for individuals to have other diagnoses in conjunction with BPD (such as substance abuse disorder). For example, a striking 20% of those diagnosed with Borderline Personality Disorder have been found to have a type of bipolar disorder, making treatment more complicated than treating one disease alone.

Additionally, 75% of people that are diagnosed with Borderline Personality Disorder are women. However, it has been hypothesized that men may be more equally affected by BPD, but are commonly misdiagnosed with depression or post-traumatic stress disorder (PTSD). These numbers may also be a reflection of the fact that women are typically more likely than men to seek treatment for personality disorders.


According to the National Institution of Mental Health, Borderline Personality Disorder (BPD) can be defined as, “A mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.” Overall, Borderline Personality Disorder is a condition that is characterized by difficulties in regulating emotion. Individuals may feel emotions (such as happiness, sadness, anger, regret) intensely and for extended periods of time. Additionally, it is very difficult for them to return to a stable baseline after an emotionally triggering event.


According to the Diagnostic and Statistical Manual (DSM-IV) diagnostic framework, the following are common signs and symptoms of Borderline Personality Disorder:

  • Separation anxiety
  • An intense and chronic fear of rejection. This may be evidenced by efforts to avoid real or imagined abandonment, such as rapidly initiating intimate relationships (either physically or emotionally). On the other hand, an individual may cut off communication or interactions with someone due to the anticipation or fear of being abandoned.
  • Interpersonal/relationship difficulties. People with Borderline Personality Disorder may long for intimacy with others, but struggle with navigating the emotions necessary to maintain healthy relationships. Individuals may frequently experience hostile, angry, or resentful feelings toward those they love, often without explanation. They may also become disproportionately angry in response to minor issues, or even alternate between idolizing and rejecting the people they love the most.
  • Identity struggles. Persons with BPD may frequently appear to modify or alter aspects of their identity, or have no sense of self at all. The frequent modifications often are a result of a desire to please others, in order to find love and acceptance. They may also have a low self-worth or a distorted self-image.
  • Impulsive behavior
  • Risky behavior
  • Self-Harm
  • Suicidal ideation or suicidal behaviors
  • Emotional instability, characterized by intense mood swings or extreme highs and lows. Many people with Borderline Personality Disorder have a “black and white” worldview, with viewpoints that frequently reflect people, places, things, and ideas as either “all good” or “all bad.”
  • Chronic and persistent feelings of boredom or emptiness. These feelings may relate to a person’s fear of abandonment or the lack of a clearly defined sense of self.
  • Inappropriate, intense or uncontrollable anger. This is typically followed by shame and guilt.
  • Dissociative feelings. This involves disconnecting from your thoughts or sense of identity, similar to an “out of body” experience, as well as stress-related paranoia. This may also lead to brief psychotic episodes.


As with any mental health disorder, it is often impossible to uncover the direct cause of a diagnosis. However, Borderline Personality Disorder is characterized by a few, specific risk factors.

Firstly, environmental, cultural, and social factors play a role. Many people with BPD have reported report traumatic life events, particularly during childhood. Some estimates suggest as many as 75% of those with Borderline Personality Disorder have a history of sexual abuse. Other examples of childhood trauma include: physical abuse, emotional abuse, neglect, witnessing violence in the home, abandonment, or poverty. Others have reported traumatic events throughout their lifespan and into adulthood, such as chronic disease, exposure to unstable relationships, hostile conflicts, violence, and other adverse experiences.

Secondly, family history is a viable risk factor in the development of Borderline Personality Disorder. Individuals who have a close family member (such as a parent or sibling) with the disorder may be at higher risk of developing it themselves. There is also some evidence that BPD is an intergenerational disease, and parents can pass down the condition to their children through environmental exposure, rather than genetics. For example, a caregiver’s instability may model harmful coping mechanisms to their children.

Thirdly, some symptoms of Borderline Personality Disorder may be rooted in neurology. Structural and functional changes in the brain, particularly the areas that control impulses and emotional regulation, may contribute to the development and severity of BPD. However, it is difficult to determine whether these neurological changes are risk factors for the disorder, or rather are caused by the disorder themselves.


Because individuals with Borderline Personality Disorder have difficulties regulating their emotions, this can lead to a variety of harmful consequences. These may include but are not limited to, impulsivity, poor self-image, tenuous or tumultuous relationships, intense responses to everyday stressors, and even dangerous behaviors such as self-harm or suicidal ideations. In fact, approximately 70% of people with Borderline Personality Disorder attempt suicide at least once. Furthermore, between 8 and 10 percent of those individuals will complete suicide. Overall, the suicide rate among individuals with BPD is over 50 times higher than the general population as a whole.

The consequences of Borderline Personality Disorder have to the potential to become much more severe when individuals do not seek adequate treatment after receiving a diagnosis. However, among those receiving seek appropriate treatment, the prognosis for BPD is very good. In fact, almost half of those who are diagnosed with Borderline Personality Disorder will not meet the criteria for a diagnosis just two years later. Additionally, after ten years, a striking 88 percent of individuals who were once diagnosed with BPD no longer meet criteria for a diagnosis.

Dialectical Behavior Therapy and Borderline Personality Disorder

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that is widely used to treat Borderline Personality Disorder. DBT is a modification of Cognitive Behavioral Therapy, combined from the basic principles of both behavioral and cognitive psychology. These theories contend that our thoughts and beliefs influence our all of our behaviors, emotions, and physiology. Dialectical Behavior Therapy is based on the perspective that some individuals develop pervasive problems in social functioning due to a lack of interpersonal and self-regulation skills. As a result, their potential to develop appropriate, adaptive behaviors is inhibited by both personal and environmental factors.

Using a variety of tools and assessments, Dialectical behavior therapy first targets a client’s immediate, life-threatening behaviors. The intervention then moves on to address problem behaviors that may intervene with the client’s ability to participate in therapy, as well as their overall quality of life. The end goal of DBT is to help people learn and use new skills and strategies to develop a “life worth living.”

Dialectical Behavior Therapy utilizes Individual Therapy, a Skills-Training Group, Coaching, and Consultation, in order to achieve the treatment targets through the various stages of intervention. After the client has expressed a commitment to therapy, they are able to begin with the first stage. The goal of Stage 1 is to achieve behavioral control. The goal of Stage 2 is for the client to learn skills that enable them to experience and process a full range of emotions, as well as reduce post-traumatic stress symptoms. Both the third and fourth stages of Dialectical behavior therapy focus on the development of self-respect and autonomy, as well as issues surrounding an individual’s own meaning and purpose. During Stage 3, the client is challenged to set life goals, and work toward living a life of healthy emotional regulation, being able to experience appropriate levels of happiness and unhappiness. Finally, in Stage 4, the overall goal of treatment is for the client to move from a sense of incompleteness or emptiness towards a spiritually fulfilling life.

Over 30 years of research have demonstrated the effectiveness of Dialectical Behavior Therapy (DBT) for people diagnosed with borderline personality disorder (BPD). DBT has been evaluated and found to be effective among individuals from diverse backgrounds in terms of age, gender, sexual orientation, and race/ethnicity, while being implemented within a wide variety of practice settings around the world. For example, Dr. Marsha Linehan (the founder of DBT) and her colleagues found that DBT resulted in significant improvements for chronically suicidal and self-injuring women who had been diagnosed with Borderline Personality Disorder (Linehan et al., 1991).

Borderline Personality Disorder and Substance Use Disorder

According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. Individuals who are experiencing a mental health condition such as Borderline Personality Disorder may turn to alcohol or other drugs as a form of self-medication, in order to mask the mental health symptoms they are experiencing. In actuality, alcohol and drug use worsens the symptoms of mental illnesses.

As a result, those with a mental disorder as well as a substance use disorder have a more severe clinical profile than those with just one diagnosis. Therefore, it is important to seek a treatment method that will be effective in addressing both conditions simultaneously.

Dialectical Behavior Therapy and Substance Abuse

Fortunately, Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) was developed for individuals with both substance use disorder and Borderline Personality Disorder. DBT-SUD is effective in treating substance use problems while simultaneously addressing other complex problems related to emotion dysregulation. The following addictions and mental health concerns associated with Borderline Personality Disorder and Substance Abuse can be addressed using DBT-SUD:

  • Alcohol
  • Tobacco or nicotine
  • Prescription pain medication
  • Opiates
  • Stimulants (e.g., methamphetamine, ecstasy)
  • Depressants
  • Antidepressants
  • Hallucinogens (e.g., LSD)
  • Illegal drug addiction (e.g., cocaine, heroin)
  • Recreational drug addiction (e.g., marijuana)
  • Eating disorders
  • Depression
  • Impulsivity
  • Anxiety
  • Post-traumatic stress disorder (PTSD)

Dialectical Behavior Therapy for Substance Use Disorders utilizes the same treatment strategies and protocols as standard DBT, while incorporating specific skills and targets relating to substance use behaviors. The four components of standard Dialectical behavior therapy (skills training, individual therapy, phone coaching and therapist consultations) are conducted with a particular emphasis on decreasing the abuse of different types of substances. This is accomplished through reducing painful withdrawal symptoms, regulating emotions, diminishing cravings and urges to use, avoiding tempting situations, increasing community support by developing relational skills, and encouraging recreational or vocational activities that support abstinence.

Overall, Dialectical behavior therapy has been proven to dramatically improve outcomes for clients who were suffering from co-occurring disorders, such as Borderline Personality Disorder and substance abuse. The implementation of behavioral skills such as effective mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation through DBT has helped countless individuals truly develop a “life worth living.”


What is Dialectical Behavior Therapy?

What is Dialectical Behavior Therapy? In short, Dialectical behavior therapy (DBT) is an evidence-based psychotherapy used to treat chronic or severe mental health issues. DBT utilizes the components of capability enhancement, generalization, motivational enhancement, and the structuring of the environment to help individuals achieve specific goals. The treatment targets of Dialectical Behavior Therapy are life-threatening behaviors, therapy interfering behaviors, quality of life behavior, and skills acquisition. The intervention is “dialectical” in the sense that it involves the integration of opposites. The primary dialectic synthesis within Dialectical behavior therapy is between the seemingly “opposite” strategies of acceptance and change. For example, DBT therapists focus their interventions as practitioners who accept clients as they are, while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills, components, strategies, and ideas that are taught in Dialectical behavior therapy are equally balanced in terms of acceptance and change.

The Development of Dialectical Behavior Therapy

In the late 1970s, Cognitive Behavior Therapy (CBT) had gained popularity as one of the most effective psychotherapies for a range of severe mental health issues. During that time, a researcher by the name Dr. Marsha Linehan took a particular interest in investigating whether or not CBT would prove helpful for women whose suicidal tendencies were activated in response to trauma and pain. Due to her training, Dr. Lineham was initially interested in treating discrete behaviors. However, through consultation with colleagues, she concluded that she was actually treating women who met the diagnostic criteria for Borderline Personality Disorder (BPD).

Dr. Lineman and her colleges quickly discovered major gaps in the effectiveness of Cognitive Behavioral Therapy among their target population of women with Borderline Personality Disorder. As a result, Dialectical Behavior Therapy was developed. The sets of strategies and the theories found in Cognitive Behavioral Therapy became the very foundation upon with Dialectical Behavior Therapy was built.

Who Can Benefit From Dialectical Behavior Therapy?

Today, Dialectical Behavior Therapy has since expanded to treat a wide variety of mental health concerns, including, but not limited to:

  • Borderline personality disorder, including those with co-occurring:
    • Suicidal and self-harming behavior
    • Substance use disorder
    • Posttraumatic stress disorder
    • High irritability
  • Cluster B personality disorders
  • Self-harming individuals with personality disorder
  • Attention deficit hyperactivity disorder (ADHD)
  • Posttraumatic stress disorder related to childhood sexual abuse
  • Major depression, including:
    • Treatment resistant major depression
    • Older adults with chronic depression and one or more personality disorders
  • Bipolar disorder
  • Transdiagnostic emotion dysregulation
  • Suicidal and self-harming adolescents
  • Pre-adolescent children with severe emotional and behavioral dysregulation
  • Binge eating disorder
  • Bulimia nervosa

The Cognitive-Behavioral Model

In order to truly understand Dialectical behavior therapy, it must be explored within the context of its theoretical framework. DBT is a form of cognitive behavioral treatment, which is based upon the combination of the basic principles from behavioral and cognitive psychology. The cognitive-behavioral model is based upon the assumption that our thoughts and beliefs influence our behavior, emotions, and physiology. In function, Dialectical behavior therapy is combined with cognitive and behavioral interventions. Both cognitive and behavior theories are founded on specific core concepts that serve as guiding principles.

Cognitive Theory

A major concept of cognitive theory is the development and function of one’s schema. A schema is our internalized representation of the world, or patterns of thought, action, and problem solving. It dictates the way that we organize thoughts, store information, process new information, and integrate the products of those operations (knowledge). It reflects necessary biases with which we view the world, based on both our direct and indirect learning. When we encounter a new situation, we either assimilate it to “fit” our existing schema, or we accommodate it, changing the schema. Although a flexible schema is desirable, all schemas tend to be somewhat rigid by nature.

Behavior Theory

The principles and assumptions of behavior theory include:

  • Behavior is what a person does, thinks, or feels that can be observed.
  • People are motivated to seek pleasure & avoid pain.
  • People behave based on their learning.
  • Behavior is amenable to change. Behavior concern must be defined in terms of measurable indicators.  
  • Intervention should focus on influencing reinforcements or punishments for client  behaviors.
  • Thoughts & feelings are behaviors subject to reinforcement principles.
  • The simplest explanations for behavior are preferred. Practitioners should avoid searching for ultimate causes of behavior.

Dialectical Behavior Therapy

Dialectical behavior therapy combines concepts from both cognitive and behavior theories. It may be appropriate for use as an intervention when an individual’s core difficulty is affective instability. From the perspective of DBT, some individuals develop pervasive problems in social functioning due to a lack of interpersonal and self-regulation skills. As a result, their potential to develop appropriate, adaptive behaviors is inhibited by both personal and environmental factors.

Behavior Chain Analysis

Overall, dialectical behavior therapy recognizes that certain internal and external stimuli have the potential to trigger problem behaviors through learned associations. In order to identify an individual’s cognitive, behavioral, affective, interpersonal, and environmental triggers, DBT utilizes an assessment strategy known as a behavior chain analysis. First, the client’s problem behavior is specified as clearly and concisely as possible. Then, the environmental conditions or cues that enhance or maintain the behavior are identified. Finally, the consequences of the behavior are considered. Another way to look at a behavior chain analysis is through the relationship sequence of A, B, and C.

A ——> B ——-> C

  • A stands for Antecedent. This refers to the various triggers or cues that precede a specific behavior. Antecedents can be social, physical, environmental, emotional, or cognitive.
  • B stands for Behavior. This refers to the actual problem behaviors that the individual is exhibiting.
  • C stands for Consequences. During this portion of the analysis, the potential consequences of each problem behavior are explored. These can be either positive or negative, and are drawn from past experiences or inferred as future possibilities.

Using the behavior chain analysis as an assessment tool, Dialectical behavior therapy first targets a client’s immediate, life-threatening behaviors, and then moves on to address problem behaviors that may intervene with the intervention itself and the client’s overall quality of life. The end goal of DBT is to help people learn and use new skills and strategies to develop a life that they experience as worth living.

The Components of DBT

Dialectical Behavior Therapy works to achieve these goals through a variety of components.

Individual Therapy

Individual sessions address the client’s specific maladaptive behaviors while strengthening and generalizing their coping skills. Each of the individual sessions are related to the themes of the skills-training group.

Skills-Training Group

In addition to individual therapy sessions, clients participate in group-oriented therapy sessions. The skills-training group explores four different modules. The first is mindfulness, which is based upon the awareness of self and context through mindful observation, as well as the ability to control one’s focus of attention on the present moment. The other three modules implement skills training in the areas of interpersonal effectiveness, emotional regulation, and distress tolerance.


An important component in Dialectical behavior therapy is coaching via telephone. Some client-practitioner contact is permitted between sessions for support and crisis intervention. The goal is to coach clients on how to use their DBT skills to effectively cope with difficult situations that arise in their everyday lives.

Therapist Consultation

This is a platform for the therapists who are offering Dialectical behavior therapy. The consultation team helps DBT therapists remain competent and stay motivated to work with disorders that are especially difficult to treat, such as substance abuse. The support helps ensure that the practitioners will be able to provide the best possible treatment to their clients.

Stages of Intervention

Dialectical behavior therapy incorporates five intervention stages. The first of these is referred to as a pre-commitment stage in which the model is explained and the client is oriented to its expectations. During this stage, it is required that the client commits to three things:

  1. Reducing self-harm behaviors
  2. Working on interpersonal difficulties
  3. Developing new skills

Once the client has made a commitment to DBT, the next four stages of intervention can begin.

Stage One

The goal of Stage 1 is for the client to move from feeling as if they are “out-of-control” to achieving behavioral control. The practitioner helps the client develop new behavior skills in order to reduce life-threatening behaviors, as well as any behaviors that may interfere with the client’s ability to consistently attend therapy. Quality-of-life issues and basic safety are addressed in this stage.

Stage Two

Stage 2 includes exposure to traumatic memories and the processing of past abuse. The goal of this stage is for the client to learn skills that enable them to experience and process a full range of emotions, as well as reduce post-traumatic stress symptoms. The client will progress towards moving from a state of quiet desperation to one of full emotional experiencing. This stage is particularly beneficial for those who have been diagnosed with PTSD.

Stage Three

Both the third and fourth stages of Dialectical behavior therapy focus on the development of self-respect and autonomy, as well as issues surrounding an individual’s own meaning and purpose. The client is challenged to set life goals, and work toward living a life of ordinary happiness and unhappiness.

Stage Four

In this stage, the overall goal of treatment is for the client to move from a sense of incompleteness or emptiness towards a spiritually fulfilling life. Clients are challenged to develop an ongoing capacity for experiences of joy, happiness, and freedom; as well as a sense of connectedness to something greater than themselves.

The Effectiveness of DBT

Like other interventions that are derivative of cognitive theory, Dialectical behavior therapy lends itself to empirical research methods. DBT has been extensively researched for individuals with a wide range of mental health conditions, who are receiving treatment in different practice settings across the globe. DBT has been evaluated and found to be effective among individuals from diverse backgrounds in terms of age, gender, sexual orientation, and race/ethnicity. Over and over again, Dialectical behavior therapy is an intervention which has been shown to be both well-established and efficacious.

  • In 1991, the very first randomized controlled trial (RCT) of DBT was published. Dr. Marsha Linehan (who is the founder of Dialectical behavior therapy) along with her colleagues, found that DBT resulted in significant improvements for chronically suicidal and self-injuring women with borderline personality disorder. These findings were significant, as this specific clinical population had previously been considered “untreatable” (Linehan et al., 1991).
  • In 2004, a controlled trial conducted in an inpatient setting found that those who received three months of DBT improved at a greater rate than those who received treatment as usual (Bohus et al. 2004).
  • In 2006, findings from another research study showed that Dialectical behavior therapy may be effective in reducing suicide attempts. This data showed that those who received DBT were half as likely to attempt suicide than those who did not. They had less psychiatric hospitalizations and were far less likely to drop out of treatment, compared to those who received other psychotherapy interventions (Linehan et al. 2006).
  • Overall, multiple controlled trials and independent studies found that one year of Dialectical behavior therapy decreased the instances of self-harming behaviors at a greater rate than alternative treatments. One such study reported that participants who received DBT had only .55 incidents of self-injurious behavior over one month, compared to 9.33 incidents among those who received other common treatments (SAMHSA National Registry of Evidence-based Programs and Practices).
  • Another review of the modality consisting of sixteen different randomized studies found that Dialectical behavior therapy had a moderate effect on reducing the participants’ suicidal behaviors (Kliem, Kroger, & Kosfelder, 2010).
  • A more recent meta-analysis of thirteen studies conducted among persons with eating disorders found that Dialectical behavior therapy was successful in addressing eating disorder behaviors (Bankoff, Karpel, Forbes, & Pantalone, 2012).

The APEX Difference

While Dialectical Behavior Therapy has proven to be useful among a wide variety of diverse individuals, there is truly no single intervention for treating any form of mental health condition. Because of this, the broad range of therapies available at Apex Recovery and the diversity of highly-qualified professionals make us able to provide highly flexible and personalized treatments to our patients.


What is Trauma Focused Therapy?

What is Trauma?

Every individual will experience trauma at some point in their lives. Unfortunately, most Americans have also been exposed to a form of severe trauma, either as a one-time event or a multiple, or even long-lasting repetitive traumatic events. Incidents of trauma can take the form of violence, child abuse, domestic violence, military combat, car accidents, natural disasters, life-threatening illness, fetal trauma, industrial accidents, mass shootings, terrorist attacks, prolonged neglect, or other events. The word “trauma” comes from the Greek term for penetration or wounding, an indication of how serious the effects of trauma can be. Trauma was generally not at all well-understood, or even seriously considered as a psychological injury, until Freud’s psychoanalysis in the late 1800s. Even so, conceptualizations of trauma have changed quite a bit over time, as have the methods and approaches for treating it.

The DSM-IV specifically defines trauma as:

“Direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior).”

The Impact of Trauma

Trauma, whether one-time, multiple, or long-lasting repetitive events, affects everyone differently. The impact of trauma can be subtle, hidden, or outright destructive. How an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors.  Usually the impact of trauma fades relatively soon, typically within one to three months. Most individuals will exhibit resilient responses or brief symptoms or consequences that fall outside of an official diagnosis. For others, trauma problems can persist for years and even decades. These lingering effects of trauma are usually diagnosed as Post-Traumatic Stress Disorder, or PTSD.

Trauma and Substance Abuse

Among those who seek treatment for substance abuse, a dual diagnosis PTSD and substance abuse disorder is surprisingly common. For most, the traumatic event or events occur first, and then the addiction develops. Substance abuse has been often viewed as “self-medication” to cope with the overwhelming pain that trauma has caused in an individual’s daily living. However, addiction can also lead to trauma, as individuals become more vulnerable while under the influence of substances. The rate of a diagnosable level of PTSD among those receiving substance abuse treatment is 12%-34%, and the rates are even higher among women (30%-59%). Most women with this dual diagnosis have experienced childhood physical or sexual abuse, and men have typically experienced war trauma or crime victimization. Various subgroups have higher rates of this dual diagnosis than others, such as combat veterans, victims of domestic violence, teenagers, prisoners, and the homeless. Overall, incidences of PTSD and substance abuse have consistently been found to co-occur, regardless of the nature of trauma or the type of substances that were abused.

As a result, those with PTSD and substance abuse have a more severe clinical profile than those with just one of those disorders. Not only are they seeking treatment for their substance abuse, but they are facing recovery while also dealing with the lingering effects of intense trauma. Furthermore, those with PTSD and substance abuse disorder are particularly vulnerable to repeated traumas, far more so than those with substance abuse or PTSD alone. Typically, there are also a wide variety of life problems that may present themselves as complicating factors in successful treatment. These may include, but are not limited to, other diagnoses and disorders, interpersonal and medical problems, child maltreatment and neglect, homelessness, HIV risk, custody battles, financial hardships, job insecurity, and domestic violence. Due to these issues, those with a dual diagnosis are at risk of falling into a “downward spiral.” Researchers describe this as one triggering event after another, burying the individual deeper and deeper into substance abuse and PTSD. For example, the increased vulnerability to new trauma can lead to increased substance abuse, and vice versa. In a nutshell, PTSD symptoms can be common triggers of substance abuse, which in turn can intensify PTSD symptoms.

However, even those who are exhibit responses to trauma that are outside of a PTSD diagnosis may choose to turn to substance abuse as a coping mechanism. Experiencing trauma early in life increases a person’s susceptibility for drug addiction in adulthood. A person is also more susceptible to drug addiction if they experience any trauma whatsoever, whether early in life or later. Furthermore, an individual may have been struggling with addiction before the traumatic event took place. Psychological trauma and substance abuse can occur in any person, regardless of their age, gender, religion, socioeconomic status, sexual orientation, or any other factor. It is important that individuals who are struggling receive treatment that is designed to address both trauma and addiction. A treatment plan that is tailored to the individual and utilized daily, or at least with regular frequency, is key to recovery.

What is Trauma Focused Cognitive Behavioral Therapy?

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is a treatment model that was designed to assist both individuals and families in overcoming the negative effects of a traumatic experience. This evidence-based method has been proven effective for treatment after multiple traumas or a single traumatic event, and therapists trained in TF-CBT are frequently able to help those experiencing the emotional effects of trauma to address and resolve these effects.

General Cognitive Behavioral Therapy (CBT) offers effective methods for treating trauma-related disorders and promoting healing, but TF-CBT offers expanded methods, incorporates techniques from family therapy, and uses an extremely trauma-sensitive approach. TF-CBT is also relatively short-term for most clients.

How it Works

Trauma Therapy is administered in three distinct phases, which includes eight components that are recognized as the acronym P.R.A.C.T.I.C.E.

Phase One: Stabilization

In phase one, the therapist will walk the clients through the TF-CBT approach, educate patients about trauma, and help them develop the skills they will need to promote meaningful healing and development. This phase includes the PRACTICE components of P through C.

P – Psycho-education: This phase starts off therapy by learning about trauma. The patients receive information on trauma and the most common reactions to traumatic experiences, as well at PTSD. The goal is to ensure patients that their reactions are understandable, and to validate their feelings.

R – Relaxation Skills: The second component is relaxation and self-care skills. These are intended to help reverse the physiological arousal effects of the trauma they have suffered.

A – Affective Regulation Skills: Similar to the relaxation skills component, the affective regulation skills component is intended to help the patients learn helpful strategies for identifying, modulating, and regulating any upsetting affective states that may arise, especially those that are a result of the trauma experience.

C – Cognitive Processing Skills: The intent of this component is to help the client build the necessary coping skills to manage their stress and achieve meaningful healing from their trauma. Cognitive processing skills help recognize the connections between thoughts, feelings, and behaviors and replace harmful or unhelpful thoughts with more accurate or more helpful ones.

Phase Two: Trauma Narrative

In this phase, the therapist will walk the client through creating a trauma narrative.

T – Trauma Narration and Processing: The trauma narrative is the telling of the story of their traumatic experience or experiences. They are often quite difficult to begin, as the emotions engendered by the original trauma can come flooding back as the sufferer recalls the details of the event(s), but it will get easier as the process goes on. Most clients find it helpful to begin by focusing on the concrete facts (the who, what, when, and where of the experience). Next, they can add the thoughts and feelings that arose during the experience. Once they are comfortable listing or describing their thoughts and feelings during the experience, they can move on to the most difficult or disturbing moments of their trauma. This will be difficult, but it is necessary to put together a comprehensive narrative of the trauma.

Phase Three: Integration / Consolidation

The aim of phase three is to consolidate the lessons learned, continue to build skills and improve connections, and prepare for future success. This phase includes the final PRACTICE components of I, C, and E.

I – In Vivo Mastery of Trauma Reminders: Trauma reminders are stimuli that individuals may experience in their daily lives that can trigger intense, painful, and often debilitating memories of the trauma suffered. It is also possible for these reminders to skip the memories entirely and send the client straight into the physiological arousal that thinking about the trauma could provoke (i.e. unexplained hyperventilation, heart palpitations, etc). The in vivo mastery component involves helping individuals overcome their avoidance of generalized reminders and work towards mastering more specific reminders. The therapist will develop a hierarchy of reminders and work with the client to gradually master feared stimuli and triggers, working from least feared to most feared. This component may actually start in the stabilization phase, and then reach completion toward the end of the PRACTICE components.

C – Conjoint Sessions: This component was originally designed for children who are receiving Trauma Focused Cognitive Behavioral Therapy. Its intention is to provide key opportunities for the therapist to help families reconnect and plan for continued healing and growth. It is in these sessions that the child can share their trauma narrative with their parents, and work together on improving their communication both about the trauma and in general. These sessions may also help families address healthy boundaries and behaviors, as well as develop a family safety plan for potential future crises.

E – Enhancing Safety: This component involves recollecting all of the positive skills and insights gained through therapy and applying it to the future. It is imperative that both individuals and families create plans to deal with the stressors and trauma reminders that will arise in the future.

How APEX Difference

While Trauma-Focused Cognitive Behavioral Therapy has proven to be useful among a wide variety of diverse individuals and families, there is truly no single formula for treating a dual diagnosis of substance abuse and trauma-related disorders. Because of this, the broad range of therapies available at Apex and the diversity of highly-qualified professionals make us able to provide highly flexible and personalized treatments to our dually diagnosed patients.

Using a trauma focused treatment approach, the clinically trained staff at Apex Recovery Rehab understand the impact of trauma and the resulting behaviors.  With judgment-free empathy and responses, the Apex staff understands the ramifications of trauma and can help you implement the necessary tools to increase your wellbeing and deliver truly effective holistic care.  We will help you rebuild a sense of control and develop personal empowerment in a setting that promotes and emphasizes psychological, physical and emotional safety.

More often than not, people struggling with an addiction have some type of co-occurring mental health diagnosis or other trauma related disorder. Not only does APEX Recovery addiction treatment team specialize in all aspects of drug and alcohol dependency, we also treat co-occurring disorders and help patients learn how to manage the often debilitating effects of traumatic experiences.

Here at APEX, we believe that thorough assessment and treatment of co-occurring disorders is a critical piece in maximizing the chance of success in treatment. Fortunately, trauma focused, dual diagnosis therapy now brings these patients the best of both worlds – treatment for both trauma and substance abuse.


Seeking Safety Coping Skills

Seeking Safety Coping Skills 

The primary goal of Seeking Safety therapy is to increase safe coping skills an individual may use to reduce the dangerous behavior related to symptoms of Post Traumatic Stress Disorder (PTSD) and Substance Abuse. All skills provided in the Seeking Safety model are applicable to someone who has experienced trauma and/or Substance Abuse. In general, the coping skills presented as part of the Seeking Safety Model can be used across a wide variety of concerns including depression, anxiety, mania, psychosis, panic attacks, grief, etc. The skills presented are categorized as cognitive, behavioral, interpersonal, or case management.

When considering building coping skills it is important to think of these skills as tools one might keep in a tool belt. As a good craftsman would have all the tools he might need in close proximity as he works on a particular project, so it is important to have many coping skills available and ready for use. Even without having experienced a traumatic event or substance abuse problem, everyone should have some coping skills in their back pocket to help manage the sadness, stress, and pressures that arise as a part of everyday life. You probably already use some coping skills without actually calling them “coping skills. “ These might be things like calling a trusted friend after a stressful day, taking several deep breaths as you wait for the doctor to come back with your test results, or meeting with a therapist during a crisis.  Many people also use coping skills that are unsafe. Unsafe coping skills might include having more drinks than you should after a stressful day, using a substance to feel more comfortable in a social setting, cutting yourself to numb emotional pain, or acting on impulse.

Seeking Safety is a trauma focused therapy modality and as such, focuses on the premise that many of the ways an individual responds to something is based on a pattern of behavior that has at some point been helpful for us. It is important to recognize that we all have developed a pattern of using particular safe or unsafe coping skills as a result of trying to manage overwhelming feelings or emotional pain. Some of us have been lucky enough to have stumbled onto coping tools that help us manage overwhelming emotion safely and effectively while others of were not as fortunate.

We may have observed unsafe behavior in our environment and assumed that it was just the way to deal with life. Regardless of what coping you were using, remember that your brain was trying to keep you safe from the overwhelming pain being experienced. At some point, each person must decide what is working and what is no longer working to manage our emotional pain, stress, sadness, fear, etc.

Some warning signs that your current coping skills are no longer working for you:

  • You feel unable to engage in meaningful relationships.
  • It becomes challenging to get out of bed in the morning and show up for life.
  • You have difficulty with completing your work or schoolwork with the integrity and quality that you once had.
  • Trusted friends or family members regularly provide feedback that you don’t seem well or okay.
  • You find it difficult to sleep at night.
  • You are struggling with your finances because you are spending more money than you have on alcohol or other substances.

When you determine that your current methods of coping are no longer working, it becomes time to try something new. Seeking safety offers new and safe coping skills.

Grounding Techniques

Seeking safety presents three categories of grounding skills that an individual can learn and utilize to ground oneself. These include mental grounding, physical grounding, and soothing grounding. Individuals are encouraged to learn and practice each type of grounding but will likely gravitate towards one type of grounding which they find most effective.  It is important to note that while grounding, we do not assign positive or negative values – things aren’t pretty, ugly, good, or bad, they simply are.

Mental Grounding

Mental grounding uses one’s ability to focus on something external. It may be focusing on the external environment or engaging our brain in an activity in which our full attention is required (eg. the color of the walls, the textures in a painting, the variety of flowers outside, reading letters backwards, or naming all the sports teams you can think of).

To practice mental grounding, try the following exercise:

Take a moment and look at the space that you are in. Name all the colors you can see from where you are seated. Now, start at the number 100, and count down by 5’s. Finally, name all the cities you can think of.  

Physical Grounding

Physical grounding uses one’s ability to focus on the sensation of something external using our sense of smell, touch, taste, sight, or hearing.

To practice physical grounding, try the following exercise:

Touch an object around you and describe it – is it cold, warm, smooth, rough, small, or large? Next, press your palms together firmly and hold for 5 seconds. Now, release your palms and notice the difference in sensation of your hands.

Soothing Grounding

Soothing grounding uses the positive associations one already experiences internally and brings our focus to them. It may be identifying favorite things, calm places, and soothing experiences.

To practice soothing grounding, try the following exercise:

Think of your favorite color. Now think about your favorite animal. Finally, think about your favorite season. Now, think of your favorite upbeat song and try to sing a few bars of the song.

Self-Help Groups and Importance of a Safe Community

One of the key elements of Seeking Safety is the connection of community resources. These may be connecting to a specialty physician, finding a support group, locating a 12-Step or other substance treatment-focused group, locating supportive housing or identifying an individual therapist.

Self-Help Groups

Self-help groups are what many individuals think of when they consider the road to substance abuse recovery.  The biggest benefit of a self-help group is the community available as you work through your recovery. Self-help groups offer a safe space to be vulnerable and connect with others who can provide empathy as well as new insight as you share and listen to the stories and ways others have learned how to cope. Many people in self-help groups report being able to connect with “someone who gets it” for the first time in their lives. Shame is heavy when one is considering recovery and finding a safe place with others you trust is invaluable in this journey. Most self-help groups are not facilitated by a professional and may compliment individual therapy.

Twelve Step meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) are available almost everywhere and offer a safe environment to work through recovery from an addiction. They offer a set of principles that members work through with the support of a community and/or sponsor to support long-term sobriety. These meetings are free of charge and offer a connection to others struggling with an addiction with the intention of moving towards sobriety. Meetings are typically facilitated by a non-professional and may be closed or open to the public. For more information about AA, visit their website.

SMART Recovery is another community-based self-help group with the intention of achieving sobriety and abstinence from substances. SMART is based on a cognitive-behavioral psychotherapy called Rational Emotive Behavioral Therapy with the underlying belief that managing the beliefs and emotions that lead one to drink or use a substance will empower you to quit and then abstain from use.  Meetings are facilitated by individuals that have been trained in SMART Recovery and may be professionals or community members. For more information about SMART Recovery, visit their website

Many community organizations host Twelve Step or SMART Recovery meetings or may facilitate other recovery-based meetings. Some Buddhist Temples may host a Recovery Sangha while Protestant Churches may host Celebrate Recovery.  A quick search online for “substance abuse self-help groups” will likely reveal numerous resources.

In addition to substance-based recovery self-help groups, some people may also consider self-help groups to address other specific concerns. Many people find it helpful to connect with others dealing with depression, anxiety, PTSD, ADD/ADHD or other mental-health related diagnoses. Others may find it helpful to attend a grief support group to increase support after a loss or a cancer/cancer survivor support group to connect with others experiencing a similar health problem. Survivors of domestic violence or sexual assault may find a support group beneficial as they recover from traumatic events. Many local hospitals or clinics offer FREE support groups that may increase insight and coping skills also supportive of long-term sobriety.

Safe Communities

A safe community is a haven as you work through your recovery. It provides new insight, feedback, and hope along the way of this journey towards healing. Each of us belongs to a family of some kind. Each of also has the ability to create or join a community of our choice that can become a second family to us. It is a safe space of like-minded people who meet with the intention of providing support to one another in recovery. A safe community offers space to ask questions and get a variety of responses. It supports the joyful and challenging days of life and celebrates and mourns with us. A safe community also provides us with numerous people we can count on when we need it most. When that one person isn’t available, there will be others who are equally committed to supporting you and the direction you intend to travel.  

A safe community can be found in self-help groups but can be anywhere you feel accepted and that your sobriety is supported. It may be a group of hunting buddies. Maybe your safe community is the mom-friends you meet at the park. Your safe community could be the depression support group you attend or the coffee enthusiast group you met at a Meet Up. They may be the entrepreneur mentoring group you joined or your weekly church Bible study. Whatever that safe community is, invest and engage in it. It is as important to find this safe community, as it is to be an active part in it. Show up again, and again, and again. Get to know the individuals in it, and allow them to know you.

Utilizing Safe Supportive Individuals

Why Do I Need Support?

We ALL need support. As humans, we are not meant to exist alone and isolated from one another. Vulnerability and accountability are imperative to recovery. We can’t heal and grow without being honest about what has already happened, what has kept us from moving forward and being honest about our hopes for the future. We also can’t begin to trust that the world is safe and good, without experiencing safe and good relationships with others. Vulnerability is the enemy of shame. When we are willing to show up as ourselves, we invite others to do the same and are likely to find that we are not alone. We find that someone else understands and that someone else is also imperfect. We find that people like us and choose us despite all of our imperfections. We begin to believe that we are enough. This belief that we are worthy of love… that we are enough, is the fuel we need to move forward towards change.

Who is a Safe Supportive Individual?

A safe supportive person can look like many things to different people. To some, this may be a trusted friend who will ask how you’re doing, and ask again when you answer “I’m fine.” It may look like a parent who sets boundaries in the relationship while reminding you that they love you and that your wellbeing is at the forefront of their intention. To others, this may be a therapist. An AA Sponsor. A priest or Rabbi, or Minister. These individuals are people you trust to have your best intention in mind and do not want you to continue making unsafe choices for yourself. They will be available to talk you through a craving or a flashback. They will remind you about how good you felt when you were sober and will encourage you to make it through another day, hour, or minute. A safe supportive individual will not judge you if you slip. They will ask what happened and continue to encourage you to pick up where you left off on your journey to sobriety. They will remind you that they are here and that you and your choices are important.

It can be scary to invite someone in. Most people experience some anxiety when they are identifying support people. It is normal to wonder if those people or groups will be there when we need them and if they will judge us when we slip. Support people are human, just like we are human. They will slip, like we will slip. The difference is that they will continue to show up for us and will ask us to continue showing up for ourselves.  This is how we know that they are safe and that the relationship is important to invest in and hold on to.

Our trained clinicians at APEX Recovery want to be a safe supportive person for you.  Our staff will provide you the support necessary to implement Seeking Safety safe coping skills, and began to live a life congruent with your goals.  Contact us today.


What is Seeking Safety?

The Dual Diagnosis

Trauma is an epidemic, with most Americans at some point in their lives surviving one or more incidents – violence, child abuse, domestic violence, military combat, rape, car accidents, natural disasters, life-threatening illness, and industrial accidents. For most people, the impact of trauma fades relatively soon, typically within one to three months. But for others, trauma problems can persist for years and even decades. This type of lingering trauma is typically diagnosed as Post-Traumatic Stress Disorder, or PTSD. Among those who seek treatment for substance abuse, a dual diagnosis PTSD and substance abuse disorder is surprisingly common. For most, the traumatic event or events occur first, and then the addiction develops. Substance abuse has been often viewed as “self-medication” to cope with the overwhelming pain that trauma has caused in an individual’s daily living.

However, addiction can also lead to trauma, as individuals become more vulnerable while under the influence of substances. The rate of a diagnosable level of PTSD among those receiving substance abuse treatment is 12%-34%, and the rates are even higher among women (30%-59%). Most women with this dual diagnosis have experienced childhood physical or sexual abuse, and men have typically experienced war trauma or crime victimization. Various subgroups have higher rates of this dual diagnosis than others, such as combat veterans, victims of domestic violence, teenagers, prisoners, and the homeless. Overall, incidences of PTSD and substance abuse have consistently been found to co-occur, regardless of the nature of trauma or the type of substances that were abused.

As a result, those with PTSD and substance abuse have a more severe clinical profile than those with just one of those disorders. Not only are they seeking treatment for their substance abuse, but they are facing recovery while also dealing with the lingering effects of intense trauma. Furthermore, those with PTSD and substance abuse disorder are particularly vulnerable to repeated traumas, far more so than those with substance abuse or PTSD alone. Typically, there are also a wide variety of life problems that may present themselves as complicating factors in successful treatment. These may include, but are not limited to, other diagnoses and disorders, interpersonal and medical problems, child maltreatment and neglect, homelessness, HIV risk, custody battles, financial hardships, job insecurity, and domestic violence. Due to these issues, those with a dual diagnosis are at risk of falling into a “downward spiral.” Researchers describe this as one triggering event after another, burying the individual deeper and deeper into substance abuse and PTSD. For example, the increased vulnerability to new trauma can lead to increased substance abuse, and vice versa. In a nutshell, PTSD symptoms can be common triggers of substance abuse, which in turn can intensify PTSD symptoms.

The Presenting Problem

Because of the possibility of this “downward spiral,” many clinicians have chosen to avoid trauma therapy in their modalities for substance abuse treatment, arguing that it may be too distressing a topic to discuss in the midst of recovery. While there is some validity among these concerns, becoming abstinent does not resolve PTSD and, in some cases, may even cause the symptoms to worsen if they are not addressed. On the other hand, traditional trauma based interventions involve delving into a detailed narrative of the traumatic events, which can leave a client who is struggling with substance abuse more vulnerable as well.

However, it is important for clinicians to recognize that trauma and substance abuse are intrinsically intertwined. Research has shown that an integrated model of treating both PTSD and substance abuse disorder at the same time is recommended as more likely to produce successful results. Unfortunately, clinical programs have historically been known to treat PTSD or substance abuse, but rarely both. As a result, the majority of patients with PTSD and substance abuse never receive trauma-focused therapy, and many patients who are in addiction recovery are never even assessed for PTSD. Treatments that are usually effective for treating each diagnosis individually may not be advisable when the two disorders occur together, hence the need for an integrated modality.

The Treatment

Currently, there is only one evidence-based model that is endorsed by professionals for treating the dual diagnosis of substance abuse and PTSD. This model used to address both addiction and trauma together is known as Seeking Safety. Seeking Safety is an evidence-based therapy model that can be used in group or individual counseling, and can be conducted with the broadest range of clients – including the highly complex, chronic, and multiply burdened clients who often cycle in and out of treatment. It was specifically developed to help survivors with trauma and substance abuse disorder in a way that does not ask them to delve into emotionally distressing trauma narratives. This significantly minimizes the risk of instigating the “downward spiral” that other forms of trauma-based therapies often present. Thus, “safety” is a deep concept with varied layers of meaning throughout the modality: the safety of the client as they do the work, helping clients envision what safety would look and feel like in their lives, and helping them learn specific new ways of coping.

How it Works

Seeking Safety stays in the present, teaching a broad array of safe coping skills that patients may never have learned if they grew up in dysfunctional families or may have lost along the way as their addiction and trauma spiraled downward. All of the Seeking Safety coping skills apply to both trauma and addiction at the same time – providing integrated treatment that can help boost motivation and guide clients to see the connections between their trauma and addiction issues. Seeking Safety provides various options for recovery, in keeping with current research and understanding about substance abuse. It can be done as part of an abstinence-based approach (with clients giving up all substances of abuse), harm reduction (decreasing use, perhaps with an ultimate goal of abstinence), or controlled use (decreasing use to a safe level).

Helping to meet the both patient’s trauma and substance abuse needs at the same time and in safe fashion can build hope in new ways.

The 25 Seeking Safety Topics

There are 25 topics that clients are exposed to during therapy, each a safe coping skill. Each topic is independent of the others so they can be used in any order and for as long or short as the client’s time in treatment. The topics address cognitive, behavioral, and interpersonal skills, plus there is a focus on engaging clients in community resources.

  1. Introduction/Case Management: Introduction to the treatment, getting to know the patient, and assessment of case management needs.
  2. Safety: Patients explore what safety means to them, and are provided with a list of over 80 “Safe Coping Skills”
  3. PTSD – Taking Back Your Power: Clients are provided information regarding “What is PTSD?”; “The Link between PTSD and Substance Abuse”; “Using Compassion to Take Back Your Power”; and “Long-Term PTSD Problems.”
  4. Detaching From Emotional Pain (Grounding): Three types of grounding are presented, along with an experiential exercise to help clients detach from emotional pain.
  5. When Substances Control You: Eight handouts are provided regarding various substance abuse topics.
  6. Asking for Help: Encourages patients to become aware of their needs and learn how to seek assistance.
  7. Taking Good Care of Yourself: Tips for Self-Care and a commitment to improvement and immediate action.
  8. Compassion: Patients are taught that a loving perspective towards oneself can produce lasting change.
  9. Red and Green Flags: A safety plan is developed to identify signs of both danger and safety.
  10. Honesty: Exploring the role of honesty and dishonesty in the journey to recovery.
  11. Recovery Thinking: The power of rethinking is demonstrated through various exercises.
  12. Integrating the Split Self: Patients are trained to notice splits as a defense mechanism and strive for self integration.
  13. Commitment: Creative strategies for keep commitments are described.
  14. Creating Meaning: Meanings that are harmful versus those that bring healing are discussed.
  15. Community Resources: A lengthy list of national non-profit resources is offered to aid patients’ recovery. Also, guidelines are offered to help patients take a consumer approach in evaluating treatments.
  16. Setting Boundaries in Relationships: Ways to set healthy boundaries are explored, and domestic violence information is provided.
  17. Discovery: Discovery is offered as a tool to reduce the cognitive rigidity common to PTSD and substance abuse.
  18. Getting Others to Support Your Recovery: Patients are encouraged to identify which people in their lives are supportive, neutral, or destructive toward their recovery.
  19. Coping with Triggers: A simple three-step model is offered to actively fight triggers of PTSD and substance abuse.
  20. Respecting Your Time: Balancing structure versus spontaneity, work versus play, and time alone versus in relationships are addressed.
  21. Healthy Relationships: Healthy and unhealthy relationship beliefs are contrasted. Patients are guided to notice how PTSD and substance abuse can lead to unhealthy relationships.
  22. Self-Nurturing: Safe self-nurturing is distinguished from unsafe self-nurturing.
  23. Healing from Anger: Guidelines for working with both constructive and destructive types of anger are offered.
  24. Life Choices: As part of termination, patients are invited to play a game as a way to review the material covered in the treatment.  Patients pull from a box slips of paper that list challenging life events (e.g., “You find out your partner is having an affair”).  They respond with how they would cope, using game rules that focus on constructive coping.
  25. Termination: Patients express their feelings about the ending of treatment, discuss what they liked and disliked about it, and finalize aftercare plans.

Benefits of this Approach

The concept of safety is designed to protect the clinician as well as the client. By helping clients move toward safety, clinicians are protecting themselves from treatment that could move too fast without a solid foundation. Increased substance use and harm to self or others are of particular concern with this vulnerable population. Thus, seeking safety is both the clients’ and clinicians’ goal. Over many years, feedback on the model indicates that its structured approach and compassionate tone make it practical and user-friendly for both the clinician and client.

The approach has been successfully implemented with a wide range of populations including both males and females; adolescents; military and veterans; homeless people; survivors of domestic violence; criminal justice and racially/ethnically diverse populations; clients with cognitive or reading impairments (including mild traumatic brain injury); those who are seriously and persistently mentally ill; individuals with behavioral addictions such as pathological gambling; active substance users; and clients in all levels of care (outpatient, residential, inpatient, community care, and private practice).

Seeking Safety is one of the lowest-cost trauma models available as only the book is needed to conduct it. No degree or licensure is required to conduct Seeking Safety. It has been used successfully in peer-led format, by case managers, and by domestic violence advocates.

Seeking Safety was developed over a ten-year period beginning in the early 1990’s under a grant from the National Institute on Drug Abuse. Clinical experience and research studies informed revisions of the manual, resulting in the final published version in 2002. Altogether, more than 20 studies have been conducted including pilots, controlled trials, multisite trials, and dissemination studies. While most studies on PTSD exclude people with complex problems, Seeking Safety research has been conducted with such populations.
It is currently classified as the only model for co-occurring PTSD and substance abuse disorder “strongly supported by research” and the only one that has evidenced significant improvements on both disorders by the end of treatment.

Our Mission at APEX Recovery

Overall, our mission at Apex Recovery Rehab is to use this research and other treatments to provide the best possible evidence – based individual recovery in the world. We are committed to treating every person and family in recovery with dignity, respect, love, personal care and attention. We choose to follow the best scientific, medical, holistic and smart ways to deal with one’s addiction and offer a comfortable setting and memorable experience to last a lifetime for every client and their family. We achieve our mission by having very strong convictions, a set of beliefs and solid core values, family-centered, comprehensive, individualized, treatment that takes place in a safe, substance-free environment.

Types of Behavioral TherapyBlog

Types of Behavioral Therapy

Behavioral therapy, a commonly used evidenced-based practice in addictions treatment, was initially pioneered by Dr. Aaron Beck and Ivan Pavlov through a variety of experiments which were informed by an understanding of classical conditioning and automatic thoughts. Classical conditioning, founded by Pavlov, is a concept that resulted from the infamous experiment, “Pavlov’s Dogs”, which helped establish the behavioral connection between stimulus and reward. By conditioning the dogs to salivate (respond) after ringing a bell during feeding time, the behaviorist identified how learned responses are formed from unconditioned stimuli. Another form of learning, called operant conditioning, helps understand the developed connection between behavior and consequence, also known as positive and negative reinforcement and is similar to types of aversion therapy. Although addiction is not typically an intended outcome in substance use, conditioning as a concept aids in the development of addiction. That said, it can also be used to help gain an understanding of one’s behavioral learning style and work towards recovery from the addiction. 

In addiction, substance use becomes the conditioned response to multiple stimuli including uncomfortable emotions, a phase of life issues, conflict, and various other unpleasant situations. The development of a conditioned response is best described as: When I drink I feel good; I have a bad day so I drink to feel good again; therefore when I have a bad day, I am triggered to drink. Behavioral conditioning is important in understanding how addiction forms in each individual, which includes identifying triggers: what makes you want to use or drink. In treating addiction, behavioral therapy helps by changing the conditioned response to the stimuli through the development of healthier coping skills and possibly changing exposure to the stimuli. There are multiple types of behavioral therapy approaches that help address learned responses and conditioning such as cognitive behavioral therapy, systematic desensitization, aversion therapy, and flooding. 

Behavioral therapy is used to manage mental health symptoms and to treat addiction by changing behaviors which subsequently changes how you feel and think. This includes finding more positive and healthier activities to engage in, developing and utilizing your support system, and learning a more self-compassionate and positive language and automatic thoughts. At APEX Recovery, behavioral therapy approaches are utilized daily through behavior activation exercises, group therapy activities such as CBT, and recommended self-care interventions.

Cognitive behavior therapy (CBT) is a treatment intervention used to target unhealthy and irrational thoughts, behaviors, and feelings. Destructive behavioral patterns, such as substance abuse, have been linked to unhealthy thoughts and feelings about oneself, others, and the future. An example of this might be, “If I make a mistake at work and get a write-up, I believe I am a horrible person and should know better, I feel anger and shame, so I drink alcohol”. This example shows how unhealthy thoughts towards oneself result in uncomfortable emotions and subsequent unhealthy and destructive behavior patterns. By using CBT, you can identify cognitive distortions and extreme thinking patterns that can cause self-loathing and destructive behaviors, including substance use. Through changing the response or reward to stimuli to be healthier and constructive, you will able to build confidence, increase self-esteem and decrease the use of habits that help perpetuate substance use. 

Other forms of behavioral therapy, such as systematic desensitization and flooding, address fears and phobias which can often include anxiety and panic. Systematic desensitization is a form of exposure therapy that helps target irrational fears through gradual exposure. As with other forms of behavior therapy, systematic desensitization uses classical conditioning to counter-condition the response to fear or fearful situations. This form of therapy helps with social anxieties, panic, phobias, and other forms of anxiety disorders by helping the client develop relaxation and grounding skills through progressive muscle relaxation, deep breathing, and meditation and then gradually exposing the client to the stimuli. For example, if a client experiences anxiety about going swimming, the client would identify a small goal related to the task, such as putting on a swimsuit and engage their relaxation exercise during the task to help the mind associate the task to relaxation and safety as opposed to anxiety and fear. In this form of therapy, setting small goals for yourself is important and can be used as a way to mark progress and continued efforts.

In rehab programs, anxieties and fears are often co-occurring and can be a trigger for continued substance use. Some fears can include managing responsibilities of adulthood, parenting, social interactions, making new friends, etc., and can develop at a young age through traumatic experiences, unhealthy relationships, etc., making it difficult to build a healthy lifestyle for yourself. The innate purpose of fears and anxieties is to be a motivator and influencer in preparedness and precaution. However, if not addressed appropriately, they can be isolating and place limits or boundaries on a person that seem immovable and, in some cases, can become dangerous in addiction. In these cases, substance use can be seen as a way to cope with the isolating mental and physical strain that arise from those fears and anxieties. By using systematic desensitization, a client can gain the abilities to self-soothe when signs of anxiety begin the emerge. The use of classical conditioning in exposure therapy focuses mainly on pairing the conditioned stimuli to a healthier response, similar to Flooding.

Another efficient form of behavioral therapy, called “flooding”, can also be as effective and is known to be helpful for symptoms congruent with Post-Traumatic Stress Disorder. In this technique, the exposure is more immersive and less gradual. When using flooding in behavior therapy, the client learns grounding and relaxation techniques to help manage the anxiety and fear. There is also a component of cognitive therapy associated with flooding that is used to address cognitive distortions and irrational thought patterns; the CBT portion also helps process any trauma or unsettling experiences related to their anxiety. As a result, when the flooding experience occurs, the client is able to think more rationally and use grounding techniques to overcome the fear.

For example, a person who is triggered to drink alcohol due to social anxiety may be asked to attend a party, sober and alone, for a small and specified period of time. In this example, the individual is immersed in their feared experience, in a controlled environment, and is encouraged to apply their grounding techniques in the situation with the new knowledge they have gained. This subsequently re-conditions the brain to develop a more corrective experience. For clients who have a history of trauma and other fears that result in impairment or lifestyle disturbances, flooding can be very effective. As with any therapy, the coping skills learned and the knowledge gained during the course of therapy can be applied towards their recovery. By addressing the identified fears and traumas the individual will learn how to respond and react in situations and not feel that their fears and anxieties are hindering their progress towards recovery. It is of the utmost importance that these areas are addressed while completing recovery treatment in an effort to decrease the chance of relapse when encountering stimuli that were significant triggers for substance use initially. Through developing healthy coping skills to effectively manage such triggers, recovery is more attainable.

Lastly, an alternative behavior therapy approach that utilizes conditioning, called aversion therapy, has been proven effective in treating addiction through reinforcement and mild aversion techniques. Aversion therapy is a form of behavior therapy that uses conditioning to break certain behavioral habits. Different from systematic desensitization and flooding, instead of the client pairing the stimulus to a relaxation response, the stimulus is paired to something of discomfort in an effort to associate the behavior with an unpleasant response and therefore cease the behavior. This is sometimes used in substance use treatment in many different ways. For example, as a way to help a loved one abstain from substance use, a family member may decline continued support of the loved one. Another example would be the use of Antabuse for someone with a drinking problem, which is a medication that causes a person to experience symptoms of a severe and highly unpleasant physical sickness when alcohol is consumed. In substance use treatment, aversion therapy is used as a way to help the client abstain from substance use by associating continued substance use with something of mental or physical discomfort. That can include loss of financial support, declining health, and loss of familial support. 

In reality, recovery is challenging as it includes having to change behaviors, mindsets, and the overall lifestyle. It can also be difficult to obtain abstinence due to the quick and seemingly painless relief that substance use provides in the moment. However, the natural progression of substance abuse can often result in broken relationships, unprocessed trauma or emotions, health issues, and more hurt and anguish. For some, the inevitable damage substance abuse causes can be used as a form of aversion therapy to cease continued use and possibly seek treatment towards recovery. Just having the knowledge of the impairment that continued substance abuse has can reinforce continued abstinence. In many ways, aversion therapy is used at our facility by building the discrepancy between the want to use and the motivation to maintain sobriety. Recovery is a challenging feat which requires hard work and an understanding that cravings will occasionally re-emerge due to association and habit. It is the use of behavioral therapy approaches like aversion therapy that help break these patterns during the process of recovery.

Behavior therapy has been used for many years in a wide variety of therapeutic settings due to its universal techniques. Empirically based research studies have repeatedly shown it to be effective in targeting problems related to emotional regulation as well as unhealthy thoughts and behavioral patterns. In addiction it is common to see distorted patterns of thinking, irrational and unrealistic thought processes and abnormal behavioral patterns. By using behavioral therapy approaches in substance use treatment, the client is given the chance to not only achieve recovery but maintain their abstinence from substance use as well.

At APEX Recovery, relapse prevention is imperative to recovery and is addressed upon the start of treatment. It is therapeutic modalities such as CBT, exposure therapy, systematic desensitization, and flooding that help the client develop the tools and necessary coping skills towards relapse prevention. Clients are also taught how to continue implementing those interventions after treatment, as it is common to continue experiencing triggers, cravings, and other things that may prompt the want to drink or use. In substance use, there are always precipitating factors that exacerbate use and drive addiction and sometimes it can seem too overwhelming to deal with those factors. By addressing those precipitating factors, re-conditioning the mind and body to react in healthier ways, implementing new coping skills, and maintaining the motivation towards abstinence, recovery is possible.

Call APEX Recovery today to begin the process of working with our trained therapeutic staff using behavioral therapy techniques and the cognitive therapy approach to move towards living a life free from drug and alcohol abuse.


Cognitive Behavioral Therapy vs Psychotherapy

With so many different types of treatment for behavioral issues, choosing a therapist may feel like a difficult or even overwhelming task. Cognitive behavioral therapy and psychotherapy are behavioral treatment routes that many patients choose to take. Before selecting a therapist or treatment plan, it’s important to have a thorough understanding of each therapy as well as how they differ.

Defining the two therapeutic approaches and exploring their similarities and differences will help you understand the essence of each therapy and decide which will be the most helpful for your unique needs. Cognitive behavioral therapy is a type of psychotherapy. To define one, we must define the other. Keep reading to find out more about cognitive behavioral therapy and psychotherapy so you can make an informed choice about your treatment.

What is Psychotherapy?

Psychotherapy, sometimes referred to as talk therapy, consists of treatment methods that help people with a wide range of mental illnesses and emotional problems. Psychotherapy works to minimize or eliminate adverse behavioral symptoms allowing a person to heal psychologically and function better in all aspects of their life.

A variety of mental difficulties can be mended through psychotherapy including addiction, social phobias, childhood trauma, death of a loved one, insomnia, depression, and anxiety disorder. Psychotherapy can be administered through a variety of programs, each of which will work differently, depending on the individual and their specific cognitive issues. In addition, psychotherapy is often used in conjunction with other types of therapies or medications.

Psychotherapy may be short-term, consisting of just a few treatment sessions and dealing with immediate emotional issues. Conversely, it may be long-term, tackling more complex issues over the course of several months or years. The patient and therapist will work together to determine the length of treatment and specific goals for psychotherapy.

Types of Psychotherapy

Psychotherapy covers a wide range of cognitive treatment methods. As some patients respond better to certain types of treatment, psychotherapists will take a variety of factors into account in order to determine the best therapy program for each individual. The most effective type of psychotherapy will depend on a patient’s specific condition, unique circumstances, and personal preference. In addition to cognitive behavioral therapy, the following types of psychotherapy may be used to treat various mental conditions:

  • Interpersonal therapy
  • Dialectical behavior therapy
  • Eye movement desensitization and reprocessing therapy
  • Mentalization-based therapy
  • Psychodynamic psychotherapy
  • Supportive psychotherapy

Interpersonal Therapy

Interpersonal therapy focuses on a person’s relationships with others and aims to improve their interpersonal skills. During an interpersonal therapy session, a psychotherapist will help individuals assess their interactions with others and take note of negative patterns and behaviors such as social isolation or aggression. This will help the patient to strategize how to cultivate positive interactions with other people.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) was first developed to treat chronically suicidal patients with borderline personality disorder. This type of psychotherapy has developed over time and is currently used to treat people with a number of mental illnesses. However, most individuals treated with DBT have been previously diagnosed with borderline personality disorder.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is a type of psychotherapy most commonly used to treat post-traumatic stress disorder (PTSD). EMDR has been shown to reduce anxiety and emotional distress resulting from trauma.

Mentalization-Based Therapy

Mentalization-based therapy (MBT) is a form of psychotherapy that can result in long-term improvement among those with borderline personality disorder. MBT engages a skill called mentalizing in which people learn to separate their own automatic thoughts and feelings from those around them.  

Psychodynamic Psychotherapy

Psychodynamic psychotherapy is a clinical treatment method based on psychoanalytic principles. These theories are used to achieve self-actualization through a deepened insight into emotional conflicts causing cognitive difficulties.

Supportive Psychotherapy

The goal of supportive psychotherapy is to improve unfavorable mental symptoms and improve self-esteem and social skills. During a supportive psychotherapy session, a patient’s relationships will be examined as well as social patterns and emotional responses to various scenarios.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a newer form of psychotherapeutic practice. Although CBT cannot solve deeper issues and emotional trauma for some patients, it is considered to be an effective remedy for a long list of mental health conditions. This type of psychotherapy is generally short-term with a set number of sessions.

CBT combines theory and techniques behind both cognitive and behavioral therapies. The approach was created by examining the relationship between a person’s negative thoughts, fears, behaviors, and physical responses to various experiences. Cognitive behavioral therapy has shown to be effective in treating several different cognitive disorders including depression, anxiety, substance abuse, eating disorders, and severe mental illnesses.

Advances in cognitive behavioral therapy are based on extensive research and clinical practice. The approach has been backed by scientific evidence showing that it produces quantifiable changes in patients. Research shows that cognitive behavioral therapy leads to a significant improvement of mental wellness and overall quality of life in most patients. In fact, in many clinical studies, CBT has shown to be equally or sometimes more effective as medication and other forms of psychotherapy.

Types of Cognitive Behavioral Therapy

During cognitive behavioral therapy sessions, therapists work closely with their patients to figure out the best action plan for treatment for feelings such as depressive symptoms. This type of psychotherapy may consist of a few different approaches including exposure therapy, exposure and response prevention, and mindfulness-based stress reduction instead of relying on medications such as antidepressants.

Exposure Therapy

Exposure therapy is a type of CBT that is traditionally used to treat obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and certain phobias. During exposure therapy treatment, therapists will help their patients identify anxiety triggers and teach them how to avoid obsessive or anxious behaviors. Patients will then be exposed to their triggers and learn to confront them in a safe, controlled environment.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a type of exposure therapy in which a therapist helps patients confront their fears and learn to resist their compulsion to escape. ERP is often used to combat symptoms of OCD.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) is also known as mindfulness-based cognitive therapy and is a CBT method that uses highly-researched mindfulness techniques with consistent practice to accomplish certain behavioral outcomes.

Core Principles and Common Practices of Cognitive Behavioral Therapy

CBT is based on a number of core principles and common practices. Each cognitive behavioral therapy treatment program will be unique and will not use all of these strategies and principles. The therapist and patient will work collaboratively to gain an understanding of the psychological problem and develop an appropriate treatment plan.

CBT is based on several core principles including:

  1. The belief that psychological problems are based, in part, on unuseful thinking.
  2. Those who suffer from psychological issues can develop tools to cope which will relieve their symptoms and allow them to live more effective lives.
  3. CBT treatment usually involves efforts to change thinking patterns.

Common CBT practices include:

  • Learning how to recognize distorted thinking and reevaluate it logically
  • Developing a better understanding of the behavior of others
  • Using problem-solving skills for coping in difficult scenarios
  • Developing a sense of confidence
  • Facing fears instead of avoiding them
  • Learning to calm the mind and relax the body

In cognitive behavioral therapy, patients essentially learn to be their own therapist. By participating in exercises, developing tools, and learning coping skills, individuals are able to change their thinking patterns and prevent problematic feelings and behaviors for the long-term without extensive therapy.

Choosing the Best Type of Therapy for Your Needs

The effectiveness of different types of psychotherapy will depend mostly on patients finding a therapist they are comfortable working with as well as their willingness to put in the time and effort to make significant behavioral changes. The relationship between patient and therapist is the most important factor in successful therapy, so it’s a good idea to contact more than one psychologist before committing to a treatment plan.

If you’re ready to begin a psychological treatment plan, remember that the practice of psychotherapy encompasses a wide variety of therapy methods, including cognitive behavioral therapy and other forms of talk therapy.

The term psychotherapy refers any type of therapy related to the mind (psyche) that works to achieve mental wellness. Some forms of psychotherapy will involve extensive therapy sessions over the course of several months or years with the goal of working out deeper, underlying psychological issues or traumas. Conversely, cognitive behavioral therapy is a form of psychotherapy that is short-term and used with intent to correct and prevent future behavioral problems.

Choosing the right type of therapy approach can be difficult. While some types of psychotherapy work well in conjunction with one another, some forms work best on their own. Ultimately, this will depend on an individual’s specific situation, current condition, and treatment preference. It’s important to remember that patients have a say in the route they take for psychological therapy.

At APEX Recovery, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery.  Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes. Call APEX today.


Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy (CBT) is a short-term psychotherapy approach. The intent of CBT is to help people refrain from undesirable behaviors by changing their thought patterns.

The idea behind this approach is that thought patterns and the way we process life events have a great influence on our behaviors and feelings. Cognitive behavioral therapy is an effective talk therapy approach that aims to teach coping skills and strategies for dealing with a variety of obstacles throughout life.

One of the major components behind the theory of CBT is that distorted thinking can lead to anxiety, depression, and problematic behaviors while thinking logically with a positive outlook can help people respond to life events more effectively. Research has shown that cognitive behavioral therapy is a powerful and useful technique for treating depression, anxiety, and panic and disorders, as well as addiction and other dysfunctional behaviors.  

On a fundamental level, cognitive behavioral therapy works. Successful application of CBT will consist of structured, collaborative therapy sessions between a counselor and patient. Sessions will involve clearly identifying the problem, goal setting, thorough and frequent communication, “homework” assignments, and feedback as well as the teaching of tools to help achieve behavioral changes and personal growth.   

History of Cognitive Behavioral Therapy

The practice of mindfulness dates back thousands of years to early Buddhism and Hinduism. Modern cognitive behavioral therapy is a relatively new psychotherapy method that was created in the 1960s for the treatment of depression. The Association for Behavioral Cognitive Therapies was founded in 1966 for CBT professionals and researchers. The 1979 book Cognitive Therapy and the Emotional Disorders by Aaron T. Beck was one of the first to explore cognitive behavioral therapy as a form of psychotherapy and was groundbreaking for its time. Today, CBT is modeled to treat a variety of behavioral disorders including anxiety, insomnia, social phobia, anger, addiction, and schizophrenia as well as panic, post-traumatic stress, bipolar, borderline personality, and eating disorders.  

How Effective is Cognitive Behavioral Therapy?

Research shows cognitive behavioral therapy can be more effective at treating behavioral problems than some medications and other forms of psychotherapy. It can be used to treat almost any dysfunctional behavior issue in which cognition plays a major role.

In clinical studies, CBT is known to be the most effective form of talk therapy. Unlike medication, cognitive behavioral therapy yields minimal side effects. After undergoing short-term CBT treatment sessions, many patients exhibit significant signs of improvement. Even when they discontinue therapy, most patients continue to improve because they are able to leverage the tools they learned in CBT and adjust their thinking styles and behaviors for the long-term.

In order for cognitive behavioral therapy to be truly effective, patients must commit to doing their “homework” between sessions with their cbt therapists. This means they use the skills they learned during therapy and apply them to real-life scenarios before their next visit. The process will also involve confronting various anxieties and fears, which can be difficult to do. With dedication, CBT is very effective in treating most behavioral problems.

However, cognitive behavioral therapy is not suited for every individual, and some will benefit from the treatment more than others. The therapy may not be effective for those with deeply-rooted mental health problems stemming from childhood or severe trauma. In these cases, longer-term psychotherapy can be more effective in treating behavioral issues.

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy focuses on changing certain thoughts and behaviors that prevent positive results. The psychotherapy technique can assist with working out numerous emotional, medical, and social problems. CBT is short-term and involves one-on-one treatment sessions. The therapy sessions are goal-oriented and intended to eliminate cognitive issues and prevent relapse of various behavioral disorders.

CBT is a one-on-one, short-term form of psychotherapy therapy that lasts anywhere from one to twenty sessions. It is problem-specific, goal-oriented, designed to achieve remission and prevent relapse of specific mental disorders.

Other forms of psychotherapy work by exploring a person’s past to gain insight into their emotions and behaviors. Conversely, CBT focuses on present beliefs and feelings. During cognitive behavioral therapy sessions, patients will develop skills to help them recognize problematic thinking, modify their thought patterns, and behave in more productive ways. Eventually, they will develop the tools to be able to act desirably in their ongoing life.

Cognitive behavioral therapy is based on the following core principles:

  1. Psychological behavioral issues are partially based on insufficient ways of thinking.
  2. Some psychological problems are a result of learned patterns of faulty behaviors.
  3. Individuals who suffer from psychological behavioral issues can learn better ways to cope in therapy which will relieve their symptoms and allow them to live less strained or destructive lives.

Cognitive misinterpretations can lead to adverse behaviors. When someone goes through a stressful experience, certain thoughts will automatically arise, leading to unfavorable emotions. Some individuals draw incorrect or illogical conclusions about the meaning of certain events and experiences based on this automatic thought process. When this occurs, they may fret, overreact, or shut down completely.

This flawed thinking will lead to negative behaviors unless interrupted or corrected through psychotherapy. For example, a person with social phobia is similar to social anxiety disorder, and a person may have feelings of fear attending a birthday party because they perceive that they will suffer from ridicule or trauma by being around groups of people. This fear may be triggered by an early childhood experience and can cause a person with social phobia to feel severe anxiety, experience sleep deprivation, and avoid a number of social scenarios. A cognitive behavioral therapist can help their patients realize how distorted thoughts directly affect moods and ignite fears and teach them how to change these thinking patterns. During CBT sessions, the patient and therapist will work together to develop a plan to overcome negative thoughts and irrational fears.

Common practices in cognitive behavioral therapy include:

  • Identifying problem areas
  • Practicing awareness of automatic thought patterns
  • Diminishing negative thinking
  • Learning to distinguish between rational and irrational emotions
  • Challenging underlying assumptions
  • Learning to view situations from various perspectives
  • Identifying what is realistic and what is illogical fear
  • Learning to stop catastrophizing
  • Testing perceptions against reality
  • Examining the validity of certain thoughts
  • Modifying distorted beliefs
  • Improving awareness of moods
  • Avoiding “all or nothing” thinking
  • Keeping a cognitive behavioral journal
  • Slowly increasing exposure to feared scenarios

During cognitive behavioral therapy, the therapist and patient will discuss different techniques and develop goals and practices that will be used throughout treatment as well as after CBT is completed. In order to see sufficient results with CBT, patients must be an active participant in their treatment.

How Cognitive Behavioral Therapy Modernizes Mindfulness

Cognitive behavioral therapy is typically very systematic and structured with frequent practice. This is part of what makes the treatment effective. For example, a person undergoing CBT to treat depression may be asked to write down their thoughts each time an upsetting event occurs. They will then work with their behavioral therapist to test how accurate and productive those thoughts are. Frequent and repeated practice is an essential piece of successful cognitive behavioral therapy.

CBT does not teach those with behavioral disorders what they didn’t already know. Instead, it works by reminding them of what they need to do. Cognitive behavioral therapy focuses less on conveying new information and more on building new habits. This form of psychotherapy helps patients by repeatedly exhibiting where flawed thinking can lead them astray and offers them better alternatives for moving forward.

What Happens During a Cognitive Behavioral Therapy Session?

Since cognitive behavioral therapy is a form of psychotherapy, early treatment will be similar to those in any initial therapy session. CBT Sessions will begin with a discussion of the patient’s background, expectations, and a general overview of the therapy. During the subsequent sessions, the patient will discuss their fears, struggles, and emotional setbacks. The therapist will work with them to develop the most effective responses to these emotional dilemmas.

CBT patients will prepare for behavior therapy sessions by thinking of emotional hurdles they’d like to overcome or stressful situations they fear. After presenting these items to the therapist, the two will work together to create an action plan. The goal of the plan will be to identify problematic thoughts and reactions and use strategies to change the adverse behaviors in between therapy sessions. Cognitive behavioral therapy action plans are sometimes referred to as “homework”.  

With relatively few therapy sessions and active application of goals and strategies, CBT has shown to be effective at reducing symptoms of behavioral problems. Cognitive behavioral homework may include keeping a journal of moods throughout the week, relaxation techniques, assigned reading, or seeking out opportunities to apply the refined approach to feared scenarios.

Cognitive behavioral therapy works by eliminating behavioral symptoms as soon as possible. This usually occurs within a few weeks or months of starting treatment. It’s important to keep in mind that results from CBT will depend on the number and severity of a person’s cognitive issues, but the approach is typically used for shorter periods of time than other forms of intensive psychotherapy.

Types of Cognitive Behavioral Therapy

Cognitive behavioral therapists work with their patients to determine the best course of action for treatment. CBT may consist of a variety of techniques including exposure therapy, mindfulness-based stress reduction, and exposure and response prevention.

Exposure Therapy

Exposure therapy works by encouraging patients to gradually face feared situations and repeat the process on a regular basis.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) is a cognitive behavioral therapy program that utilizes tested mindfulness techniques with consistent practice to achieve certain behavioral outcomes.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a form of exposure therapy that has patients confront their fears and resist their escape response. ERP is commonly used to combat obsessive-compulsive disorder (OCD).  

Cognitive behavioral therapy is an effective form of psychotherapy. Negative, distorted thoughts and emotions can lead to problematic behaviors and a dysfunctional lifestyle. CBT helps individuals recognize disordered thinking, understand cognitive distortions, modify their outlook, and practice facing situations with the right tools to help them cope.

At APEX, cognitive behavioral therapy is used as part of our approach to integrative treatment. Through CBT, we are able to help patients adjust their thinking and behavioral patterns and help them overcome addiction, mental illness, and depression. Our cognitive behavioral therapists work closely with patients to improve their outlook, behaviors, and general lifestyle. APEX administers cognitive behavioral therapy to combat a variety of conditions including addiction, depression, anxiety, and phobia. It’s a very hands-on approach that allows our cognitive behavioral therapists to work closely with each patient to improve his or her behavior and thought patterns through thought and behavior therapy.

For more information on cognitive behavioral therapy or other rehab programs we offer, contact us at APEX Recovery Center today! 


Dr. Matthew Bruhin Honored with Citizen of Courage Award

On April 10th, 2018 Dr. Matthew Bruhin was honored as a recipient of San Diego’s Citizen of Courage Award for 2018. The award was presented for to Dr. Bruhin for his work in saving a man’s life from certain suicide, when he encountered a man preparing to jump off Coronado Bridge in November of 2017. The man who was saved was a military veteran, a father, and hardworking native San Diegan. During the intervention, Dr. Bruhin and his wife were able to convince the man that they had resources to help house him. Get him clean and sober, and to move forward with his life in a better way. Finally, after intense negotiation, Juan chose to put his trust in the strangers and stepped back off the ledge and onto the bridge.  

Dr. Bruhin, a CEO of APEX Recovery and a licensed therapist, took him to treatment where he received a scholarship for three months. He was able to be treated for his depression and drug addiction. In addition, Dr. Bruhin’s wife, the City of Coronado, and many kind anonymous strangers donated money, clothing and well wishes to Juan. After discharge from APEX, Juan received help from the VA and received housing services. He remains sober to this day and maintains the experience not only saved his life but helped him enrich the lives of others. Dr. Bruhin received the award with his family, his business partner and co-founder of APEX Recovery, Fred Bowen, and nominator Dr. Ken Druck, a bestselling author and expert in the field. The highlight of the event was during Dr. Bruhin’s acceptance speech when he openly stated that the true man of courage was Juan, for trusting strangers to help him in the darkest of moments. The packed crowd then gave Juan a standing ovation for over two minutes. The story is nothing short of a miracle.