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Dialectical Behavior Therapy (DBT)

There are various types of addiction treatments available, and most are comprehensive, which means that they address many of the ways in which addiction impacts a person’s life. Treatment typically includes various types of therapy and programming, and one of these therapy types is dialectical behavior therapy (DBT).


What is Dialectical Behavior Therapy?

Dialectical behavior therapy is a type of therapy used to treat people with borderline personality disorder (BPD), both with and without a co-occurring substance use disorder (SUD).1 It draws from aspects of cognitive-behavioral therapy (CBT) but also incorporates techniques of mindfulness and dialectics, which is the reconciling of two opposing ideas—in this case, change and acceptance.1,2

Like most therapies used to treat mental disorders, DBT is an evidence-based therapy, meaning that it has been studied with published research that empirically supports it as efficacious and cost-effective.3,4 Treatment of BPD with DBT has 4 main goals, including:5

  • Reducing harmful and dangerous behaviors, including suicidal acts or self-harm.
  • Lessening behaviors that get in the way of therapy, such as calling the therapist too much or dropping out of treatment early.
  • Lessening behaviors that reduce quality of life, such as substance use and mental health disorder symptoms.
  • Improving behavioral skills that are learned in treatment, such as regulating emotions, practicing mindfulness, and practicing healthy behaviors.

The combination of Western behavioral therapy with Eastern mindfulness and acceptance therapies is one of the aspects that makes DBT a unique form of therapy.2 In addition, the way that the therapist works with the clients is different from traditional forms of therapy.

DBT therapists are typically more involved, staying in contact with clients between sessions, and reaching out if clients struggle to attend treatment.2 Therapists work on radical acceptance of each client where they are at, even as they help them strive towards improvement and reaching their goals.2


Find Out If Your Insurance Plan Covers Rehab

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What is Dialectical Behavior Therapy Used for?

DBT was developed in the early 1990s by psychologist Dr. Marsha Linehan.5,6 She initially created it to treat people with borderline personality disorder (BPD), particularly those who struggled with chronic suicidal thoughts and behaviors, especially those with multiple mental health and personality disorders.1,7

Since its creation, DBT has been expanded to treat a variety of mental and behavioral health disorders.1,2 Today, DBT can be used to treat:1-3,5,6

  • Antisocial, borderline, histrionic, and narcissistic personality disorders (cluster B personality disorders).
  • Anorexia.
  • Attention-deficit hyperactivity disorder (ADHD).
  • Behavioral disorders in adolescents.
  • Bulimia.
  • Binge eating disorder.
  • Depression, especially in older people.
  • Post-traumatic stress disorder (PTSD).
  • Self-harm.
  • Substance use disorders.

DBT for Substance Abuse

Dialectical behavior therapy for SUDs aims to address specific behaviors that reduce overall well-being.1 The goals of DBT for substance use include reducing substance use and prescription drug misuse, reducing withdrawal symptoms and discomfort associated with sobriety, decreasing cravings, minimizing triggers and chances to use substances, and developing social supports that encourage sobriety.1


How Does Dialectical Behavior Therapy Work?

DBT was developed for use in outpatient programs.6 Treatment incorporates various techniques used in several different types of sessions.1 DBT for BPD and drug addiction has a few main focuses over the course of treatment.1 This is accomplished by moving through four different stages in the program.2


Stages

DBT is broken into 4 stages.2,8

  • Stage 1 works to achieve stabilization by reducing dangerous behaviors that impede progress in therapy by replacing them with skills training. This includes working to reduce or stop substance use.
  • Stage 2 is known as the “quiet desperation” stage, where harmful behaviors are under control, but emotional pain is commonly prominent. This stage focuses on getting you to learn how to feel and express all emotions appropriately and can address trauma if present.
  • Stage 3 is aimed to manage issues in daily life and increase self-esteem.
  • Stage 4 works to strengthen skills learned during treatment and offer a sense of fulfillment and joy in your life.

The time it takes to go through these stages can vary depending on the individual.2,8


Dialectical Behavior Therapy Techniques

DBT includes several types of settings for sessions.

Individual counseling is designed to address motivations toward recovery and any problems that come up in treatment.1 The therapist is typically available for phone sessions between counseling appointments, in order to provide additional support during crisis situations and to encourage learning of healthy socialization behaviors.1,2 However, it can be difficult to maintain appropriate boundaries when using telephone counseling between sessions.2,6

Group sessions focus on exploring important skills that are helpful in maintaining sobriety and managing any mental health symptoms for people in mental health and addiction treatment centers.1,2 These groups aim to teach and practice new and helpful behavioral skills that can replace unhelpful ones.2 Homework is commonly given during group sessions, to strengthen new skills, including distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.2

  • Distress tolerance focuses on acceptance, meaning, and tolerating distressing situations or emotions.2,3 This is accomplished through learning coping skills like self-soothing in crisis situations and distraction techniques.2 This is especially important during addiction treatment.2
  • Emotion regulation incorporates skills to manage your ability to express emotions appropriately.2 This focuses on learning how to identify and explain the emotions you experience, change how you express them, feel less controlled by negative emotions, and handle troubling emotions more effectively.2,3 You’ll explore how your emotions can be triggered by external and internal situations, and feel less distressed by upsetting emotions.2 This specifically applies to addiction, since feelings can trigger substance use.
  • Mindfulness is one of the chief skills involved in DBT, involving acceptance and awareness of your emotions and thoughts.2,3 Mindfulness skills where you observe and describe your thoughts and feelings are part of weekly homework worksheets.2 Practicing mindfulness can help you ride out cravings to use.
  • Interpersonal effectiveness focuses on improving relationships by teaching conflict management skills and strengthening social and assertiveness skills.2,6 Learning how to interact with others in a healthy manner can help repair some of the damage that was done during active addiction, and can help you develop healthy, supportive, and sober relationships.2,3

Benefits of DBT for Addiction

DBT has some specific benefits for addiction treatment. It is primarily designed as a co-occurring disorder treatment program to treat BPD with co-occurring substance use disorder. As with all treatment than viewing relapse as a failure, DBT sees it as an opportunity to learn and progress in a different way to avoid relapse in the future.1

DBT applies some of the same principles as 12-step groups, focusing on acceptance and similar cognitive techniques.1 Focusing on sobriety in small, attainable goals, such as a month, a week, or even a day or an hour, makes it easier to maintain sobriety for someone who is struggling.1 This overlap encourages attendance in a supportive peer group outside of treatment. In addition, much like in 12-step groups, a DBT therapist will meet a client where they are at, working with clients outside of a treatment setting if needed, especially if they are at risk.1


Does Dialectical Behavior Therapy Work?

DBT can be an effective treatment for people with BPD with or without an SUD.1,3 Studies showed significant reductions in substance use, a greater likelihood of people staying in treatment, as well as improved management of BPD symptoms and impulse control.3,4 Studies have also shown that use of DBT can reduce suicide attempts and self-harming behaviors.1 As an addiction therapy for people without BPD or another co-occurring disorder, DBT may not be the most appropriate treatment, unless emotional dysregulation is a major underlying issue that has a significant impact on substance use, or in people who are often suicidal.1


Getting Started

You may be more likely to find a treatment center that uses DBT if they offer co-occurring disorder treatment, but contacting the facility is the best way to find out if they use DBT at their programs.


Dialectical Behavior Therapy FAQs

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