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Dialectical Behavior Therapy (DBT) for Addiction Treatment 

Dialectical behavioral therapy (DBT) is an evidence-based type of psychotherapy used to treat clients with multiple mental health conditions. DBT was developed by Dr. Marsha Linehan, a psychologist, and her colleagues in the 1980s.  

DBT is based on cognitive-behavioral therapy (CBT) and treats high-risk behaviors, such as chronic suicidal ideation and severe mental health conditions.  

Difference Between CBT and DBT 

The main difference between CBT and DBT is that DBT focuses on accepting and validating uncomfortable feelings rather than working around or avoiding them.  

DBT is commonly used in individual and group treatment settings to treat several conditions, including: 

  • Attention-deficit/Hyperactivity Disorder (ADHD) 
  • Bipolar Disorder 
  • Borderline Personality Disorder (BPD) 
  • Depression 
  • Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder) 
  • Generalized Anxiety Disorder (GAD) 
  • Major Depressive Disorder (includes Chronic Depression and Treatment-Resistant Major Depression) 
  • Obsessive-Compulsive Disorder (OCD) 
  • Post-traumatic Stress Disorder (PTSD) 
  • Substance Use Disorder (SUD) 
  • Suicidal Behavior 

DBT is an effective form of therapy for clients who have been self-harming. Some clients may cut or burn themselves as a means of coping with their emotional pain. Focusing on the physical response means they push their trauma to the background.  

DBT Focuses on Life Skills Development 

Dialectical behavior therapy focuses on the client’s lack of crucial life skills to cope with ups and downs. For this reason, DBT sessions focus on teaching the participants those skills.  

DBT includes teaching clients the skills they need to cope with life. The therapy gives clients techniques they can use in their personal lives, and the therapist supports the client in improving these skills.  

Six Main Points of DBT 

Clients receiving dialectical behavior therapy for addiction treatment or another mental health issue work with their therapist to resolve the client’s contradiction between self-acceptance and making positive changes while in treatment.  

As part of the process, the therapist validates the client. This technique makes clients more likely to cooperate with doing homework and participating in group therapy. It also makes them less likely to experience distress when thinking about making changes in their lives.  

The therapist validates clients’ actions by pointing out that they make sense when viewed through the lens of their personal experiences. However, the therapist doesn’t necessarily believe that all the client’s actions are the best way to solve a problem.  

The six main points of DBT therapy are: 

1. Acceptance and Change 

Clients in DBT therapy learn strategies for accepting and tolerating their emotions, situations, and themselves. They develop skills that assist with making positive behavioral changes, including how they interact with others.  

2. Behavioral Patterns 

People in DBT therapy also gain the skills required to analyze problems and destructive behavior patterns. Based on this analysis, clients learn how to replace their destructive behaviors with healthier ones.  

3. Changing Cognitive Beliefs 

This aspect of DBT focuses on assisting clients with changing their unhelpful or ineffective thoughts and beliefs. 

4. Collaboration with Mental Health Professionals 

Clients learn to communicate effectively with their mental health care team (therapist, group therapist, and psychiatrist). Establishing trust with a therapist is crucial to helping clients feel comfortable sharing their thoughts and feelings.  

5. Skill Sets 

Clients acquire new skills that will enhance their capabilities. They learn how to accept their negative emotions and sit with them instead of instantly taking action.  

6. Support 

Clients undergoing DBT therapy are encouraged by their therapists to recognize their positive attributes and strengths. Once clients recognize these positive traits, they receive support and encouragement to develop and use them.  

Dialectical behavior therapy can be combined with other treatments, such as CBT (cognitive behavioral therapy), Motivational Interviewing, and mindfulness-based cognitive therapy (MBCT).  

Main Areas of Focus for Dialectical Behavior Therapy 

DBT is talk therapy that can help clients learn new skills to manage their complex emotions. It also helps clients cope with conflict in relationships. DBT sessions focus on four main areas: 

  • Emotional Regulation 
  • Distress Tolerance 
  • Interpersonal Effectiveness 
  • Mindfulness 

Distress Tolerance teaches participants to sit with discomfort. It also encourages them to accept their negative emotions. When someone is experiencing stress, they may experience physical reactions, including the following: 

  • The muscles may become tense. 
  • The person may feel hot. 
  • Their breathing may become shallow and labored.  

DBT techniques may be used to reverse the physical reactions to stress.  

Clients experiencing distress or a life crisis learn techniques to distract and soothe themselves. These skills give participants a toolkit to cope with intense emotions, giving them a positive, long-term perspective. 

Emotional Regulation is something people learn to do as they mature. Negative emotions (anger, frustration, and anxiety) can lead to someone acting in ways they don’t like or aren’t positive. The person then regrets what they do or do, increasing the intensity of their negative emotions and battling their self-image.  

Clients learn how to identify, name, and change the adverse effects of an emotional response. They know to take charge of their emotions, resulting in improved mood, increased self-esteem, and more empathy toward others.  

Interpersonal Effectiveness works on giving clients the skills necessary to balance their priorities as opposed to daily life demands. In other words, it helps clients distinguish between their “needs” and “wants.” Many clients in DBT struggle with relationship challenges. The interpersonal effectiveness part of DBT gives participants tools to repair and maintain healthy relationships.  

DBT teaches participants how to have healthy relationships. This treatment phase also teaches clients how to end destructive personal relationships. Clients receive assertiveness training to help them create healthy boundaries with others. They learn how to communicate clearly and effectively.  

As a result, clients feel they can master their life. They develop greater self-respect and their sense of overall well-being increases. These interpersonal skills help improve their relationships with others.  

Mindfulness is a state of mind at the core of DBT treatment. It allows individuals to focus on the present moment while they calmly (and without judgment) acknowledge their thoughts, feelings, sensations, impulses, and body. This type of therapy trains clients to put their life experiences into perspective instead of automatically reacting emotionally to situations.  

Clients learn how to master what is happening inside them. They also learn how to tune into their senses and their physical environment. These skills allow clients to slow down and focus on healthy coping skills when experiencing emotional pain.  

How Does DBT Work? 

Dialectical behavior therapy is made up of four distinct parts: 

IndividualTherapy Sessions. This type of therapy involves weekly individual sessions with a therapist and having the client participate in group therapy. The therapist focused on working with the client on their coping skills. The individual sessions also include work on interpersonal and mindfulness strategies. Dialectical behavior therapy counselors may assign “homework” to their clients to encourage them to apply the new skills they are learning to real-life situations.  

Group Therapy Sessions. Clients may be encouraged to report their experiences during group therapy sessions. The therapist and fellow group members can then provide feedback and advice to their fellow participants. The group environment focuses on promoting and supporting the participants. Ideally, this process keeps the participants on course and motivated to continue with their therapy.  

Therapists’ Team Meetings. DBT therapists must feel supported and validated to be practical and helpful to their clients. Therapists using DBT therapy for their clients meet weekly to discuss the issues and challenges they are facing, such as how to deal with a suicidal client or one who misses their scheduled sessions.  

Coaching by Phone. Clients can contact their therapist by phone for immediate support when challenging situations arise between sessions.  

The length of time for DBT depends on each client’s progress in developing the skills presented in therapy and on the time required for the client to reach their therapy goals, as discussed with the counselor.  

Effectiveness of Dialectical Behavior Therapy 

Studies have shown that DBT is a practical approach for clients who are motivated to change their coping methods. Clients from multiple backgrounds (age, gender, ethnicity, or sexual orientation) can benefit from DBT. Research studies have validated DBT’s effectiveness, as follows: 

Borderline Personality Disorder 

DBT is effective for treating clients living with borderline personality disorder. It reduces the risk of suicide in clients with BPD. The results of one study found that after 12 months of DBT therapy, over 75 percent of clients with BPD no longer met the diagnostic criteria for the disorder. 

Suicidal Behavior 

A study found that therapeutic interventions that included skills training seemed to be more effective at reducing suicidal thoughts than DBT presented without skills training. 

Other Mental Health Conditions 

Most research studies on DBT have focused their attention on effectiveness rates for people with borderline personality disorder who have suicidal thoughts or think about harming themselves. Dialectical behavior therapy has been shown to be effective for treating other mental health concerns.  

What to Consider: Before Starting Dialectic Behavior Therapy (DBT) for Addiction Treatment 

Dialectic behavior therapy is not the right approach for everyone living with an addiction. Before starting this type of therapy, a client would need to meet with a counselor trained in using this technique. The therapist will evaluate the client’s symptoms, consider their past treatment history, and discuss their therapy goals to determine whether DBT may be effective.  

DBT requires a significant time commitment. In addition to weekly therapy sessions, participants must also commit to completing their homework outside of the individual, group, and phone counseling sessions.  

Some clients may find practicing the skills they learn in DBT difficult. As clients work through the different treatment stages, they explore their emotional pain and traumatic experiences, which may cause distress. The homework portion may be challenging for people struggling to keep up with the work regularly.  

About Bel Aire

Located in the natural landscape of the beautiful Kansas prairie, Bel Aire Recovery Center serves adult men and women suffering from addiction to opiates, heroin, alcohol, benzodiazepines, prescription drugs, and other substances. We offer medically-monitored detoxification, residential treatment, a family program, and aftercare support.