Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is adapted from cognitive behavior therapy (CBT). The main goals of DBT are:

• To teach people how to live in the moment
• To show them healthy ways to cope with stress
• To give them positive ways to regulate their emotions
• To improve their relationships

History of DBT

Marsha Linehan, Ph.D., developed DBT as a strategy to treat borderline personality disorder (a mental illness that severely impacts a person’s ability to manage their emotions) in the early 1990s. DBT works by helping clients develop healthy coping skills to replace unhealthy behaviors. During DBT therapy, clients learn skills related to the following:

• Mindfulness
• Emotional Regulation
• Increasing Tolerance to Distress

Benefits of DBT

The goal of DBT is for the client and the therapist to work to resolve the conflict between self-acceptance and change so the client can see positive changes in treatment. The therapist offers the client validation, which confirms that the client’s actions make sense within their personal experiences. This approach differs from the therapist agreeing that the actions are necessarily the best way to solve a problem.

The main points of DBT are:

1. Acceptance and Change

Clients learn to accept and tolerate their life circumstances and emotions. They also develop skills to make positive changes in their lives.

2. Behavioral

Clients develop skills to analyze their behavior and replace harmful patterns with healthier ones.

3. Cognitive

Participants focus on changing thoughts that are not helpful.

4. Collaboration

Participants gain the skills they need to communicate effectively.

5. Skill Sets

Clients learn new skills as they undergo therapy.

6. Support

Clients are encouraged to recognize their positive attributes and their strengths through the process and develop and use them.

How Dialectic Behavior Therapy Works

Dr. Linehan put forward a theory that the fundamental problem in clients with borderline personality disorder is that they have difficulty regulating their emotions. The lack of regulation comes from mixing biology (genetic and specific biological risk factors) and the environment (emotionally unstable childhood).

DBT helps clients learn skills that will help them to decrease their emotional dysregulation. Dialectical behavior therapy is also used to help clients find better ways to cope with strong emotions.

DBT for Addiction Treatment

Many people with a substance use disorder report they turned to drugs and alcohol to cope with strong emotions. They didn’t have the means to cope with these emotions on their own, and chemicals were used as a type of anesthesia to make them easier to deal with.

Since dialectical behavior therapy is geared toward helping people cope with strong emotions, it makes sense to use this therapy with clients struggling with substance use disorder.

How DBT Works

DBT usually includes three components: group therapy/skills training, individual psychotherapy sessions, and coaching. The participants are asked to monitor their symptoms and how they use their new skills daily, and their progress is tracked. They learn these skills in DBT therapy:

Mindfulness Meditation Therapy

Mindfulness is about being in the present. Clients learn to use all their senses to fully appreciate where they are and what they are doing “right now.” They become aware of how they are experiencing their thoughts, physical sensations, and emotions and observe things in their environment without passing judgment on these experiences as either positive (‘good’) or negative (‘bad’).

Someone with substance abuse disorder may become overwhelmed by their feelings. At that point, they turn to drugs or alcohol to help themselves cope without considering the consequences of getting high or drunk. Learning to be mindful gives them skills to step back, interpret how they are feeling, and respond appropriately to the situation causing strong emotions.

Interpersonal Effectiveness Skills

This part of DBT focuses on teaching clients how to express their needs assertively. It also works on conflict in personal relationships. When a person’s interpersonal effectiveness skills are improved, it can help lower anxiety levels and improve depression symptoms.

Distress Tolerance Skills

Distress tolerance skills as part of DBT involves learning how to accept and tolerate distress without doing anything that would make the situation worse, such as engaging in self-harm.

When experiencing strong emotions, a person with substance use disorder may use alcohol or drugs to escape what they feel is an intolerable feeling. If the person doesn’t get the numbing effect they seek from their “regular” dose, they may take more of their drug of choice. This decision puts them at risk of overdosing or alcohol poisoning.

Someone under the influence of drugs or alcohol may also engage in impulsive or risky behaviors to cope with strong emotions. They may drive too quickly, pick fights, or engage in unsafe sex. Unfortunately, these behaviors get worse over the long term without treatment. Distress tolerance skills teach people how to cope with emotions and respond appropriately.

Emotion Regulation Skills

In this part of treatment, clients learn how to manage their emotional reactions. Regulating the emotional response involves either enhancing or reducing emotions to respond appropriately in given situations. Part of DBT may involve assisting a client with learning how to accept their emotions and finding ways to deal with a particular emotion without lashing out at another person or changing their behavior to change the situation.

DBT requires a significant time commitment on the client’s part. In addition to regular therapy sessions, participants must complete homework to work on skills outside of their individual and group counseling sessions.

Practicing the skills may prove challenging for some people. At different treatment stages, clients explore their emotional pain and traumatic experiences. This part of therapy is likely to be upsetting. An experienced DBT therapist is required to help clients cope with these intense emotions.

The Aviary Recovery Center offers DBT along with other therapies to provide our clients with safe and effective treatment for substance abuse disorders (formerly called substance abuse). Our facility treats the entire person holistically. Dialectic behavioral therapy is provided as part of a personalized recovery plan that allows clients to focus on healing and move toward long-term recovery.