Dialectical Behavioral Therapy (DBT)

If you’re entering a program for substance use disorder treatment soon, you’ll probably hear the term dialectical behavior therapy frequently when you’re looking at programs.

Dialectical behavior therapy or DBT is an offshoot of cognitive-behavioral therapy and a staple in addiction treatment.

In CBT, you learn to identify thought patterns that are negative or destructive so that you can manage the behavior and emotions that come from those thoughts. It’s common in addiction treatment programs because relapse behaviors are directly related to negative thought patterns.

DBT uses the same concept to help patients learn to:

• Live in the moment
• Learn healthy coping skills
• Regulate their emotions
• Improve their relationships

While DBT was originally developed to treat borderline personality disorder (BPD), people living with substance use disorder (SUD) can benefit from the treatment as well. Addiction disorders can cause severe problems in relationships and coping the same way BPD does.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy is an evidence-based behavioral treatment that’s been around since the 1980s. Dr. Marsha Linehan, a psychologist specializing in BPD and substance abuse, developed DBT after finding that CBT didn’t work well on self-destructive patients.

DBT includes four modules:

• Mindfulness, or the ability to stay in the moment with your thoughts and feelings
• Distress tolerance, or the ability to tolerate being emotionally or physically uncomfortable
• ,Emotional regulation,, or the ability to recognize, cope with, and challenge your emotions
• ,Interpersonal effectiveness,, or the ability to communicate and connect with others

Even though DBT was first used to treat borderline personality disorder, it found other uses fast. Therapists and psychologists today use it to treat any disorder that leads to self-destructive behavior, including substance use disorder. 

DBT is especially used in patients who have co-occurring disorders with addiction, such as:

• Depression
• Post-traumatic stress disorder
• Complex PTSD
• Traumatic brain injuries
• Binge eating disorders
• Mood disorders, such as bipolar disorders

Dialectical Behavior Therapy in Addiction Treatment

It’s common to find dialectical behavior therapy in addiction treatment centers. DBT focuses on areas where people with substance use disorders often have deficits, including:

• Mindfulness: It’s common for people in active addiction or recovery to have trouble with mindfulness, or the skill of existing in the moment without giving your thoughts and worries excessive attention. In substance use disorders, learning mindfulness makes it easier to keep your mind off relapsing.
• Emotional regulation: People who have substance use disorders commonly have problems with recognizing and controlling their emotions. Learning emotional regulation helps you to experience your feelings without letting them take over your day.
• Distress tolerance: Many people with substance use disorders have low distress tolerance, meaning that it’s more challenging to get through emotionally or physically uncomfortable moments. This skill helps you to remember that even the hard moments will pass.
• Interpersonal effectiveness: It’s common to have problems with social functioning at work, with your family and loved ones, or elsewhere in life. Interpersonal effectiveness is a DBT skill that helps you communicate, empathize and connect with people more easily.

DBT won’t be the only part of your treatment, but it will be an important part. In most programs, treatment centers pair DBT with other treatments, such as:

• Individual counseling
• Other types of behavioral treatment, such as CBT or 12 Steps
• Group therapy
• Medication-assisted treatment where appropriate
• Educational programs to help you understand your disorder better

Also, dialectical behavior therapy can be part of inpatient or outpatient treatment. Behavioral treatment is just as important in an outpatient program!

Who is a Candidate for DBT?

You may be a candidate for DBT if you have any disorder that causes self-destructive behavior or tendencies. Substance use disorders qualify by themselves, but you might especially benefit from DBT if you have another psychological disorder.

Some common co-occurring disorders that also benefit from DBT include:

• Bipolar disorders type I and II
• Major depression
• Seasonal affective disorder
• Post-traumatic stress disorder
• Chronic PTSD
• Borderline personality disorder

What to Expect From DBT

You should expect to learn coping skills and start identifying and processing your emotions in DBT. That takes place in 4 different ways during treatment:

Individual Therapy in DBT

During individual therapy, you’ll talk to your therapist one-on-one about your emotional experience. That includes your substance use disorder history and any trauma or other related history.

These sessions take place once weekly in outpatient programs, but can be more frequent in treatment.

Group Therapy in DBT

Group therapy takes place in a small-group environment that’s safe and intimate. Group therapy can take place a few times per week or daily. During these sessions, the therapist will guide the conversation to talk about challenges, successes, and coping tools.

Team Consultations in DBT

Every week, your care team meets behind the scenes to discuss your progress and upcoming care. They’ll make any adjustments based on your condition so you get the right level of care.

Phone Coaching in DBT

Daily phone sessions are a part of outpatient DBT and some inpatient DBT programs. In inpatient programs, these sessions can be in-person. A phone session is a short call to review recent DBT skills, share challenges, and reinforce the plan for coping that day.

How DBT Works

DBT is designed to help people who are:

• Reactive to stress
• Sensitive to their environments
• Slow to recover from stress

It helps people overcome these challenges by learning to apply new skills to solve the problems in their lives. You’ll learn how to:

• Observe your feelings and thoughts 
• Tolerate moments of crisis
• Avoid behaviors that are destructive
• Identify, process, and let go of emotions
• Deal with conflict effectively
• Increase your self-esteem and self-respect 

Choosing a DBT Program

When you’re choosing a program, it’s natural to want the best care you can get. You can choose a top-notch DBT program by asking questions like:

• Are your therapists properly trained in DBT?
• Do your therapists continue their DBT education?
• Is your program evidence-based with proven DBT principles? 

Dialectical Behavior Therapy Techniques & Skills

The biggest focus of DBT is skill-building. Coping skills can follow you through your entire life and keep you stable and healthy.

Skills For Mindfulness

Mindfulness skills help you consciously focus your attention on the moment. The most common types in DBT include:

• Opening the mind, or observing what comes into your mind without holding onto it
• Focusing the mind, or putting your attention on something specific, like a memory, a candle flame, or deep breathing

Skills for Distress Tolerance

Distress tolerance skills help you learn to handle emotional and physical pain without impulsive coping (like substance use). The idea is that pain with acceptance is pain, but pain without acceptance is suffering.

ACCEPTS is the most famous distress tolerance skill. To practice ACCEPTS when you’re distressed, follow this list:

• Activities: Focus your attention on a task, any task, whether it’s cleaning the house, running an errand, or going on a walk.
• Contributing: Think of a thoughtful act that you could do for someone else, even if it’s just calling a friend or sending a text.
• Comparisons: Take your current emotions and compare them to other times in your life. Is this moment really as bad as it feels?
• Emotions: Feel your emotions by partaking in art (reading, listening to music, painting), or doing whatever moves you.
• Pushing Away: This sounds negative, but it’s not. It simply means stepping away from the stressful situation mentally until you feel able to face it.
• Thoughts: Keep your thoughts occupied by singing in your head, counting to 100, looking for patterns in a painting, or anything else that focuses your attention.
• Sensations: Sensory stimulation can draw your attention to your body and senses rather than your stressed-out mind. Try squeezing a stress ball, listening to music, or playing with ice cubes.

Skills for Emotional Regulation

Emotional regulation skills help you slow down the flow of your feelings so that you can process them. STOP is a common coping skill for emotional regulation:

• Stop: When your emotions are out of control, freeze for a moment before you act. The act of freezing in place gives you control and a moment to name the emotion.
• Take a step back: Getting emotional in a crisis makes it hard to deal properly. Step away from the situation and take deep breaths until your emotions are no longer controlling your thoughts.
• Observe: Instead of acting right away, gather all the facts so you can make a decision that’s helpful instead of destructive.
• Proceed mindfully: Do you know what you want the outcome of the situation to be? Emotions can muddle our mind and make it hard to know what we want. Stop to think about the outcome and how you might get there.

Skills for Interpersonal Effectiveness

Low interpersonal effectiveness makes it hard to have healthy relationships at home, work, and elsewhere. Boundary-building is an important skill in maintaining relationships in addiction. You’ll practice identifying boundary crossings that are a go or a no go, and how to respond to them.

Dialectical Behavior Therapy Programs at Bedrock Recovery Center

Bedrock Recovery Center can start your dialectical behavior therapy journey with our top class addiction programs in Canton, MA.

In addition to DBT, our treatment programs include:

• Behavioral treatments including CBT, 12 Steps, and more
• Medication-assisted treatment for patients who are candidates
• Addiction education to help empower patients to take control of their condition
• Group therapy to help build peer bonds and practice skills in a group environment