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Dialectical Behavior Therapy (DBT) was developed by an American psychologist named Dr. Marsha Linehan. Her goal was to create a therapy for women who experienced chronic suicidal behavior.
Therapists later started to see that it also could help people with substance use problems. DBT uses elements from cognitive behavioral therapy (CBT) and social learning theory and adds the Zen practices of mindfulness and acceptance.
What sets DBT apart from other therapies is its focus on validation. The basic premise is that your feelings are what they are for good reason. Therefore they are valid. At the same time, DBT holds that any behavior that doesn’t serve you like self-harm and substance use must change even when the feelings leading to it are valid.
These two opposite concepts are held together to be true in DBT. The word “dialectical” refers to the coexistence of these two seemingly contradictory beliefs.
How DBT Addresses Addiction
We know that DBT is an effective treatment for addiction in people with borderline personality disorder. There is now also promising evidence showing that it may work in addicted people who don’t have this condition. Many substance use treatment centers already use DBT as part of their treatment curriculum. These are some of the treatment goals of DBT programs:
- Identifying triggers mindfully: DBT trains you to notice yourself without judging yourself. This is called a nonjudgmental stance. You can use this stance to start to become aware of your emotional states and how they affect you.
- Distraction: Once you identify that you’re feeling triggered then you learn to be purposeful about where you direct your attention. There are a host of DBT strategies for distracting and focusing your attention somewhere that will better serve you.
- Tolerating distress: You gradually learn you have the power to experience emotional states without having to change them. This is a crucial skill for people who are recovering from addiction.
- Understanding that feelings aren’t forever: You learn about the passing nature of feelings. You may start by noticing this in emotional states that are easier to tolerate and gradually work your way up in difficulty as you feel able.
- Improved interpersonal skills: DBT interpersonal effectiveness skills can help you grow supportive relationships, request the help you need and resist peer pressure.
What Is Dialectical Behavior Therapy (DBT)?
Classic DBT has a specific format where participants take part in both individual and group therapy. Individual and group sessions may have specific structures and use tools like diary cards and chain analysis exercises.
The skills training portion of DBT is sometimes isolated for people with addictions because it’s delivered in a group format. Group therapy is the treatment delivery style that is known to be one of the most effective when treating addiction.
Dialectical behavior therapy teaches four major categories of skills: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.
Mindfulness is the core DBT skill that is foundational for mastering other skills. You learn how to stay in the moment without judging the moment or yourself. You learn to observe yourself and your thoughts while training yourself to come back to the present moment when your thoughts wander away.
Distress tolerance builds on mindfulness and teaches you strategies to tolerate distress once you have learned to pause and identify the distressing feeling without judging it. The emotional regulation module teaches you practical strategies to help you modify how you react in a crisis.
The interpersonal effectiveness training sessions help you learn skills that better enable you to say no when you need to, make better requests and give feedback in ways that promote healthy connections and boundaries with others.
DBT Strategies for Recovery
These are some of the strategies you may encounter in a DBT-based program:
Dialectical Abstinence
Dialectical abstinence refers to the stance the therapist takes in guiding your recovery. It involves balancing complete commitment to abstinence and acceptance that relapse is a possibility.
Therapists are very clear that a relapse won’t end treatment. They ensure their patients understand that if relapse happens then it’s a solvable problem and not a character flaw. A relapse doesn’t mean failure.
Behavioral Chain Analysis
This is an exercise you perform if you relapse or have a close call. You complete the exercise by writing a step-by-step account of what led to your relapse. The purpose of the exercise is to learn how to see a relapse coming and to learn where you might be able to head it off next time you’re in a similar situation.
Telephone Consultation
Your DBT therapist may allow for telephone consultations to help coach you in applying your skills. The goal would be to coach you to prevent substance use. Your therapist may set boundaries on telephone consultation if you have recently used substances.
Skills Training
Skills training takes place in a group format. It’s like a classroom setting. One or two therapists teach you the core dialectical behavior therapy skills. To learn all the DBT skills, you can usually expect several weeks of classes depending on how many times a week you attend sessions.
Many drug and alcohol treatment programs incorporate just this portion into their program because the group format makes it easy to integrate into other programs.
Benefits of DBT for Addiction Treatment
We’ve known for a long time that DBT is effective at helping people with personality disorders stop using drugs. We’re also beginning to realize that people without personality disorders can also benefit.
On top of being effective, DBT is also well-liked. DBT-based addiction programs have shown a lower dropout rate than standard programs so far.
The skills you learn in DBT can be applied to many aspects of life and not just in recovering from substance use. This is part of why DBT is compatible with the recovery model. It focuses on making your whole life better and not just how to remove drugs from your life.
DBT skills can teach you how to find more meaning in life and how to improve relationships with people who are close to you. They can also help you better manage stress overall by helping you be more centered.
DBT in Different Settings
You might find that different treatment settings adapt dialectical behavior therapy to fit their program. You will find some of the most common adaptations below:
Overnight Treatment Centers
Inpatient centers and residential drug treatment centers sometimes adapt DBT to make it work in their setting. They might do more frequent group skills training sessions over a shorter time period. Instead of a telephone consultation, you might find a staff person to coach you.
Intensive Outpatient Programs
In an intensive outpatient setting, you might find that they only use the skills training portion of DBT. The schedule for groups is likely to be more intensive than a standard outpatient setting, with several sessions a week.
Standard Outpatient
The traditional outpatient DBT setting was the original format that Dr. Linehan developed. In this format, you can expect to attend skills training groups once or twice a week over several weeks.
Alongside skills training, you will likely meet with an individual therapist regularly to review how applying the skills in your daily life is working for you. In a classical DBT program structure, your treatment team participates in a consultation group to help them support each other and stay true to the principles of DBT.
Cost Effectiveness of DBT
DBT can reduce the costs associated with untreated substance use for more people by retaining more people in therapy. It may also help people become more productive members of society because it helps them with every aspect of their lives, not just addiction.
Working with a DBT Therapist
Working with a qualified DBT therapist can make all the difference in your treatment plan. It’s important to connect with a therapist who’s been specially trained to guide clients through this specific process so they can develop and utilize the skills they need to recover. Your DBT therapist will work closely with you to create a customized treatment plan based on your needs.
Incorporating DBT in Your Recovery Plan
DBT isn’t a new therapy but we’re starting to see that it’s an effective therapy for people with addictions. It helps you improve your entire life by teaching you skills like distress tolerance and interpersonal effectiveness. DBT differs from other therapies in that it focuses on validating your feelings.
The classic DBT program structure has several components including individual and group sessions but different treatment settings may adapt it differently. If you’re weighing the costs and benefits of investing money and time into a course of DBT treatment then consider the costs of treatment against the costs of untreated substance use.
DBT is an effective and well-liked treatment for substance use disorder. Meanwhile, the costs of untreated substance use include lost employment and lost relationships and may even have consequences for other family members.
The core components of this treatment approach including mindfulness and emotional regulation can help you manage your thoughts, reduce your relapse risk, and create a foundation for long term recovery.
