THERAPEUTIC MODALITIES
A DYNAMIC APPROACH
RT Wellness clinicians and staff incorporate a dynamic approach to substance use disorder and mental health recovery. As an outpatient treatment center offering various programs to meet the unique needs of clients, we find tremendous clinical and human value in the use of diverse therapeutic modalities across each of our programs.
Learn more about the main evidence-based modalities we use here at RT Wellness in the sections below.
RELAPSE PREVENTION (RP)
All treatments for substance use disorder (SUD), in a way, are intended to prevent relapse. The treatment called Relapse Prevention (RP), however, refers to a specific intervention.
Relapse Prevention is a skills-based, cognitive-behavioral approach that requires patients and their clinicians to identify situations that place the person at greater risk for relapse – both internal experiences (e.g., positive thoughts related to substance use or negative thoughts related to sobriety that arise without effort, called “automatic thoughts”) and external cues (e.g., people that the person associates with substance use).
Then, the patient and clinician work to develop strategies, including cognitive (related to thinking) and behavioral (related to action), to address those specific high-risk situations. With more effective coping, the patient develops increased confidence to handle challenging situations without alcohol and other drugs (i.e., increased self-efficacy).
In Relapse Prevention (RP), the clinician and patient work first to assess potential situations that might lead to drinking or using other drugs. These situations include, for example, social pressures and emotional states that could lead to thoughts about using substances, and ultimately to cravings and urges to use.
These potentially risky situations are known as “triggers.” Patients and clinicians also aim to identify lifestyle factors that affect the likelihood of encountering these triggers (e.g., health behaviors like eating and sleeping, as well as one’s group of friends).
Relapse Prevention Strategies Include:
Building awareness around the potential negative consequences of encountering high-risk situations and thoughts that associate substance use with good outcomes (i.e., it challenges positive expectancies surrounding substance use)
Helping the patient to develop and expand their repertoire of coping skills that address specific high-risk situations for relapse (often called “triggers”), whether those situations lead to drug use-related thoughts, feelings, or bodily sensations
Skills range from techniques to communicate with others when in a risky situation (e.g., how to confidently and comfortably say “no” to a drink if it is offered, called “assertive drink and drug refusal”), to “urge surfing,” a technique to help individuals cope with the intense longings to consume the substance that occurs during cravings
Planning for “emergencies.” That is, unexpected situations where the patient finds themselves suddenly struggling to abstain from drinking or using other drugs
Assessing and reinforcing the patient’s confidence in his/her ability to abstain from substance use, even in the face of challenging situations (e.g., self-efficacy)
Finding alternative ways of thinking about positive thoughts related to substance use, and negative thoughts related to abstinence, sometimes called “cognitive restructuring.” This activity includes discussing the thinking “traps” (sometimes called cognitive distortions, or unhelpful thinking styles) that can develop after years of drinking and using other drugs. See visuals below for examples of how this work might look
Source(s): Recovery Research Institute
COGNITIVE BEHAVIORAL THERAPY (CBT)
Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.
It is important to emphasize that advances in CBT have been made on the basis of both research and clinical practice. Indeed, CBT is an approach for which there is ample scientific evidence that the methods that have been developed actually produce change. In this manner, CBT differs from many other forms of psychological treatment.
CBT is based on several core principles, including:
Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
Psychological problems are based, in part, on learned patterns of unhelpful behavior.
People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
CBT treatment usually involves efforts to change thinking patterns. These strategies might include:
Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
Gaining a better understanding of the behavior and motivation of others.
Using problem-solving skills to cope with difficult situations.
Learning to develop a greater sense of confidence in one’s own abilities.
CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include:
Facing one’s fears instead of avoiding them.
Using role playing to prepare for potentially problematic interactions with others.
Learning to calm one’s mind and relax one’s body.
Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy.
CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.
CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.
Source(s): APA Div. 12 (Society of Clinical Psychology)
DIALETICAL BEHAVIORAL THERAPY (DBT)
Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT) but it’s specially adapted for people who experience emotions very intensely.
“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors. The main goal of therapists who use DBT is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.
Individual DBT therapy sessions have the following goals:
To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
To limit behaviors that get in the way of productive therapy.
To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
To help you learn new skills to replace unhelpful behaviors.
Other DBT skills aim to help enhance your capabilities in day-to-day life, including but not limited to the following:
Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
Emotion regulation: This means understanding, being more aware of and having more control over your emotions.
Not all DBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy.
Source(s): Mayo Clinic
TRAUMA-INFORMED GROUP THERAPY
Trauma-informed group therapy offers a holistic, strengths-based approach to group therapy that aims to create welcoming, engaging environments for both service recipients and staff.
As a therapeutic modality, trauma-informed care acknowledges the need to understand a patient's life experiences in order to deliver effective care and has the potential to improve patient engagement, treatment adherence, health outcomes, and provider and staff wellness. Furthermore, this modality is based on the understanding that trauma can have a significant impact on physical, emotional, and mental health, and that other service systems can sometimes retraumatize people.
Joining a group of strangers may sound intimidating at first, but group therapy provides benefits that individual therapy may not. Our experienced, compassionate clinicians guide groups toward greater education, awareness, and commitment to the principles and practices of recovery from substance use disorder and co-occurring mental health disorders.
Groups can act as a support network and a sounding board. Other members of the group often help you come up with specific ideas for improving a difficult situation or life challenge, and hold you accountable along the way.
Regularly talking and listening to others also helps you put your own problems in perspective. Many people experience mental health difficulties, but few speak openly about them to people they don't know well. Oftentimes, you may feel like you are the only one struggling — but you're not. It can be a relief to hear others discuss what they're going through, and realize you're not alone.
Diversity is another important benefit of group therapy. People have different personalities and backgrounds, and they look at situations in different ways. By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns.
Source(s): SAMHSA, APA
Some of the benefits of art therapy for individuals in recovery from substance use disorder and co-occurring mental disorders include the following:
Serves as a method of self-expression
Allows for health emotional release
Provides stress management
Helps you adjust during your recovery process
Decreases any denial of addiction you may be experiencing
Increases your motivation to change
Provides a safe outlet for painful emotions
Lessens the shame of addiction
Serves as a break from intensive talk therapy modalities
Allows the subconscious to express itself creatively
Gives an alternative way to describe and communicate feelings
Serves as something tangible to discuss with the therapist and your peers in a group setting
EVIDENCE-BASED ARTS THERAPY
Arts therapy harnesses the power of creative self-expression and nonverbal communication and insight. An increasing body of scientific research shows significant benefits of art therapy in the treatment of mood disorders, trauma, and substance use disorder and related co-occurring disorders.
Art Therapy is used to improve cognitive and sensory-motor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, and reduce and resolve conflicts and distress.
Through integrative methods, art therapy engages the mind, body, and spirit in ways that are distinct from verbal articulation alone. Kinesthetic, sensory, perceptual, and symbolic opportunities invite alternative modes of receptive and expressive communication. Visual and symbolic expression gives voice to experience, and empowers individual and communal transformation.