Dialectical behavior therapy

When you begin the process of undergoing addiction treatment, the numerous methods and practices that are used can be puzzling to figure out. What do all the abbreviations mean? What kind of therapy is best? What are the differences in these types of therapy? Today, let’s take a closer look at Dialectical Behavioral Therapy.

What Is DBT?

Dialectical behavior therapy (DBT) is a dynamic therapy for addiction treatment. Therapy sessions help a person overcome negative, substance-abusing behaviors and damaging emotions. In their place, treatment providers help participants create positive behaviors that build a strong foundation for recovery success. Learning healthy ways to cope with stress or other hardships is important in successful long-term recovery.

Addiction is frequently fueled by self-destructive behaviors and dysfunctional emotions. The physical, mental, and emotional instability caused by chronic drug or alcohol use can aggravate these patterns even more. This damage can deplete a person’s health, destroy relationships and undermine a person’s career.

Even when faced with this knowledge, it can be hard for a person to change. Further, many people struggle to accept the situations they face, which can also be a stumbling block to recovery.

Dialectical behavior therapy encourages a balance between change and acceptance so that a person is empowered to take steps towards a drug-free life. As therapy progresses, a person learns how to control urges or cravings, manage unhealthy emotions, develop relapse prevention skills, and set positive and affirming goals. Together, these changes nourish sobriety and create better mind-body-spirit balance.

The program places an emphasis on building a sustainable quality of life, while also working to decrease behaviors that cause harm. DBT is effective for treating anyone with difficulty regulating emotions.

DBT is different from other forms of therapy because the principles of DBT hold that therapy should be a real relationship between two people. Both the therapist and the patient work hard to reach their goals. A common metaphor for DBT is rowing in a rowboat; both persons are rowing hard to make sure the boat is moving towards its destination. DBT is about patients and therapists working together to prevent substance use and manage addiction.

What Does Dialectical Mean?

The word “dialectical” is a philosophical term referring to two things that appear to be opposites, but can actually both exist at the same time. In the context of addiction treatment, DBT views two things as contradictory, but essential for recovery: acceptance and change.

To improve their lives, people must accept they struggle to control cravings and are addicted to drugs and alcohol. At the same time, they must balance this realization, or acceptance, with a strong willingness to change and work hard to stop using drugs or alcohol. DBT harnesses the power of behavioral change to move a person closer to the ultimate goal of sobriety.

Dialectical Behavior Therapy In Addiction Treatment

Dialectical behavioral therapy was originally developed by Dr. Marsha M. Linehan to treat borderline personality disorder. It was first introduced to prevent people with borderline personality disorder (BPD) from harming themselves. Since then, DBT is now recognized as an effective therapy for treating various issues of mental health, including addiction.

It has since been adapted as a treatment for substance use disorders and other forms of mental illness. Within addiction treatment programs, DBT is beneficial because it promotes acceptance and change, is realistic about abstinence and motivates engagement in and completion of treatment. This dual application makes it an excellent choice for dual diagnosis treatment programs.

Therapy may be offered in an outpatient or inpatient setting, however, inpatient drug rehab typically offers more intensive therapies and opportunities for healing than does outpatient care.

In order for DBT to be successful, the therapist and client must form a collaborative partnership. While this may be hard at first, DBT treatment methods help clients form this important relationship.

As soon as treatment begins, DBT encourages complete abstinence. For a person newly in recovery, this can be a very intimidating prospect. Because of this, DBT breaks down long-term sobriety into smaller, more easily obtained goals.

The therapist may suggest that a person set a small goal, such as being sober for an hour, a day or a week. Once a person has successfully attained this goal, they renew it and begin again. As a person continues to succeed, they gain stability and move closer to long-term abstinence.

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As treatment progresses, DBT targets several behaviors that improve a person’s chance of recovery:

  • Reducing or alleviating withdrawal symptoms
  • Reducing cravings and temptations for relapse
  • Removing social and environmental triggers for drug use, such as people, places or events
  • Overcoming behaviors or thoughts that encourage drug use
  • Reinforcing healthy relationships, behaviors and environments that support sobriety

A main goal of DBT is to help a person develop what is referred to as a “clear mind.” In this state, a person remains focused on their recovery goals while also being aware of potential threats to their sobriety. Being mindful, with a clear mind, helps a person to avoid relapse triggers and cope with them should they arise.

Dialectical Behavior Therapy Builds Sober Living Skills

One of dialectical behavior therapy’s main functions is to teach a person life skills that support sober living. This function is referred to as enhancing capabilities.

Addiction can make it difficult for a person to take care of themselves. Making positive choices, following through on important responsibilities and maintaining healthy behaviors can be hard for a person who is addicted to drugs or alcohol.

In many cases, when a person arrives at substance use treatment they may not have certain life skills, or if they do, they may need improvement. A DBT therapist helps a client to recognize areas of their life that they need to work. Once the therapist and client have identified these areas, they work together to develop an arsenal of life skills that fight these negative influences.

Sometimes the way a person reacts to a situation can make it worse. This is especially true when a person’s judgment and thoughts are clouded by the influence of drugs or alcohol. To counter this, coping skills are personalized to fit the hurdles a person will likely face in their life.

Dialectical behavior therapy focuses on improving four major areas of a person’s life:

  • Emotion regulation skills: Negative and dysfunctional emotions can be triggers for substance use. If a person is unable to handle their emotions in a healthy way they may be tempted to self-medicate with drugs or alcohol and relapse. Therapy sessions teach a person to regulate and relate to their emotions in a more productive way.
  • Mindfulness skills: Mindfulness teaches a person to be more aware and present in the moment instead of getting overwhelmed by thoughts and feelings that are tied to the past and future. By paying better attention to these things, a person is better able to create a more calm and balanced state of mind. This can also help to reduce stress, a trigger for relapse.
  • Interpersonal effectiveness: Relationships can become strained under the weight of addiction. Families, friendships and work relationships often suffer as a person makes finding and using drugs a priority above most everything else. Interpersonal effectiveness teaches a person how to improve their communication and relationship skills.
  • Distress tolerance skills: These sessions work to remove or reduce any self-sabotaging behaviors in a person’s life. Under the therapist’s guidance, a person will work to develop tools that can help them overcome crisis situations. They will also learn how to handle distress better. One way of doing this is by practicing radical acceptance. Radical acceptance encourages a person to accept the present moment instead of resisting it or exhausting themselves by fighting to change it.

The Five Functions Of Dialectical Behavior Therapy Treatment

An individual therapist usually takes the lead when working with someone who can benefit from treatment. The therapist takes responsibility for developing and maintaining an individual treatment plan for the person suffering from addiction or co-occurring disorders.

Within this framework, DBT is grounded in five main functions. These functions help a person to uproot negative thoughts, emotions, and behaviors in their life that undermine sobriety.

These five functions include:

  • Enhancing capabilities: The aim of this function is to teach or improve existing life skills that nurture a stable recovery. Group therapy sessions and homework assignments help clients to achieve these goals.
  • Generalizing capabilities: Therapy sessions are individualized to help each person develop coping skills that meet the unique challenges of their life. Homework assignments help a person practice their skills between therapy sessions. Individual therapy provides more intensive opportunities for skill building. It also gives a person a chance to practice their skills under the guidance of their therapist.
  • Improving motivation and reducing dysfunctional behaviors: This function relies most heavily on individual therapy sessions. These sessions work on boosting a client’s desire to make positive changes in their life. Therapists also help a person cut out negative behaviors that threaten their well-being, health or sobriety.To do this, treatment participants fill out a diary card that outlines their treatment goals and issues that they’re struggling with from session to session. The diary cards help the therapist to determine what issues, or treatment targets, are most important to tackle first. Therapists address treatment targets in the following order.
  • First: Behaviors that endanger a person’s life, such as self-injury or suicidal thoughts.
  • Second: Behaviors that create problems in therapy, such as being late, missing sessions or not cooperating.
  • Third: Behaviors that cause issues in a person’s life, such as unemployment.
  • Structuring the environment: The focus of this function is two-fold. First, the therapist and client work to create a therapeutic environment that is conducive to healing and progress. Secondly, the therapist continues to help clients remove harmful influences in their life that could jeopardize sobriety or lead to relapse. For instance, at this stage, it’s important that a person recognize and remove social influences that trigger thoughts of drug use.
  • Enhancing and maintaining therapist capabilities and motivation: This function focuses on the therapist by providing an opportunity for skill building and professional development. From this, a therapist stays up to date on the best therapeutic methods, so that they’re equipped to provide the highest level of therapy. Recovery coaching can support a person as they work through the DBT functions. Recovery coaches understand the challenges of treatment, as they’re walking their own recovery journeys. These individuals provide additional support, guidance, inspiration, and coping skills throughout treatment.

These functions are incorporated into four modes of therapy, which involve different aspects of treatment to meet the specific needs of each function.

The four modes of treatment include:

  • Structured Individual Therapy: Focuses on behaviors and striking a balance between acceptance and change.
  • Skills Group: A group meeting wherein people learn a behavioral skill to manage emotions, tolerate stress, and have effective emotional relationships.
  • Skills Coaching: Individuals can call their therapist 24 hours a day to get help with coping skills or to avoid engaging in harmful behaviors. The coach can help a person learn to react in healthy ways.
  • Consultation Teams: DBT therapists work on a team that offers support and collaboration, which is essential to DBT.

Dialectical Behavior Therapy In Dual Diagnosis Treatment

Dialectical behavior therapy can help people with a mental illness to better cope with emotional instability, stress, and troubled relationships. It may also help a person to heal any wounds that relate to these issues.

A large number of people struggling with addiction face another form of mental illness. This is called a co-occurring disorder or dual diagnosis. Experiencing both of these conditions can cause a person’s emotions to spiral even further out of control. It can also make it difficult for them to manage distressing situations. When used as part of an integrated treatment plan, DBT helps to restore emotional and mental balance.

In addition to treating borderline personality disorder, dialectical behavioral therapy has shown promise in treating:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Bulimia
  • Binge-eating disorder
  • Depression
  • Post-traumatic stress disorder

While treating both conditions may require more intensive therapies and harder work on the client’s part, successful treatment is possible. The best co-occurring disorder treatments are individualized, and because of this, other forms of therapy may be integrated into a person’s care plan.

Benefits Of DBT In Addiction Treatment

DBT is beneficial in addiction treatment because it addresses harmful behaviors that act as barriers to improving people’s lives. Within addiction treatment programs, DBT focuses on substance use and how it affects quality of life, while also promoting target behaviors essential for overcoming addiction. 

These behavioral targets include:

  • Alleviating physical discomfort associated with withdrawal
  • Avoiding triggers and cues related to substance use
  • Community reinforcement of positive behaviors
  • Decreasing substance use
  • Reducing behaviors conducive to drug use, like momentarily giving up the goal to stop using drugs or alcohol, and instead functioning as if drug use can’t be avoided
  • Reducing cravings and urges to use substances

Problematic behaviors often occur as a way to cope with a bad situation or feeling, like using substances to deal with depression, anxiety, or other mental health issues. DBT can help those suffering from addiction develop effective ways to manage stress, regulate emotion, and be mindful about themselves and others. Within addiction treatment programs, DBT is beneficial because of its unique approach to mental health and wellness, like promoting acceptance and change.

Promoting Acceptance And Change

For addiction treatment, DBT pushes the person to stop using drugs or alcohol immediately. At the same time, DBT also acknowledges that relapse can happen, which doesn’t mean the person can’t eventually achieve a fulfilling and substance-free life. This is the dialectic facet of DBT, or the union of the opposing forces of acceptance and change.

DBT constantly insists the person stop using drugs and alcohol, emphasizing the importance of abstinence. However, this approach is combined with non-judgemental, problem-solving responses to relapse. These responses include various techniques that work to reduce the dangers of infection and overdose and promote change.

Approach To Abstinence

Abstinence is encouraged from the first session onward but gives the person a reasonable time-frame for this commitment. For example, a lifetime of abstinence may be too difficult, so they may instead focus on whatever is attainable for that person. This could be a few hours, a full day, a month or whatever is reasonable. When this period is up, the patient renews this commitment over and over, with the hope of ultimately achieving long-term abstinence.

During this time, patients learn to “cope ahead.” This method helps them develop the behavioral skills needed to anticipate potential triggers and take preventative measures to be prepared for situations that risk substance use. While the therapist focuses on these issues, they are constantly reiterating the dangers of addiction and the need to stop use.

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Using Relapse To “Fail Well”

While DBT therapists can help the person make a quick recovery, relapse is treated more as a problem that can be solved than as a personal weakness or failure of treatment. If relapse does occur, the therapist will often help the patient “fail well,” or guide them to evaluate their behaviors and determine what led to substance use. Then, they can apply strategies to avoid relapse in the future.

This is a key benefit of DBT, since it doesn’t punish the patient for slipping up and using drugs or alcohol. Instead, DBT uses relapse as a teaching moment for improvement. Within addiction treatment programs, many people feel a slip-up means recovery is hopeless, feeling intense negative emotions that can lead to further use.

DBT works to repair the harm caused by relapse, which involves increasing awareness of the harmful consequences brought on by substance use. The therapist will then reiterate abstinence, which is often better understood after a relapse.

Developing The “Clear Mind”

In many cases, those suffering from substance use disorders often begin addiction treatment in a certain mental and behavioral state of mind. Drugs or alcohol have taken over their actions, thoughts, beliefs, and emotions. Once they have achieved abstinence promoted by DBT, their minds become more open to different possibilities, which can make them feel like they’re immune to future problems. This can trigger relapse because they may be ill-prepared for high-stress situations.

With the guidance of a DBT therapist, alternating between these two frames of mind can lead to the emergence of a new outlook that accepts their need to use substances, but also understands they have the power to change and take measures to cope with and avoid relapse. This balance is called the “clear mind,” which can help people achieve long-term abstinence.

Strategies In Completing Treatment

In the first session, the therapist directly addresses the likelihood of the patient falling out of treatment. To accept this possibility, the therapist and patient establish a “just in case” plan. This involves a list of places the patient may frequent during relapse as well as a list of supportive friends and family members who are willing to intervene if necessary.

Other strategies include continual contact with the patient during the early stages of therapy, shortening or lengthening therapy sessions (depending on their needs), and bringing therapy to the patient (going to their home or room in the rehab center).

Contact us today for more information on dialectical behavior therapy (DBT) and addiction treatment.

Frequently Asked Questions

What are the five main points of dialectical behavior therapy?

Most treatment programs identify five main points of DBT. These points include: enhancing capabilities, generalizing capabilities, improving motivation and reducing dysfunctional behaviors, structuring the environment, and enhancing and maintaining therapist capabilities and motivation.

What does dialectical behavioral therapy mean?

Dialectical behavior therapy (DBT) is a dynamic therapy for addiction treatment. Therapy sessions help a person overcome negative, substance-abusing behaviors and damaging emotions. In their place, treatment providers help participants create positive behaviors that build a strong foundation for recovery success.

Dialectical behavior therapy encourages a balance between change and acceptance so that a person is empowered to take steps towards a drug-free life. As therapy progresses, a person learns how to control urges or cravings, manage unhealthy emotions, develop relapse prevention skills and set positive and affirming goals.

What are the DBT skills?

There are a variety of skills that can fall under different names. In general, though, the categories remain very similar to one another. DBT skills can include: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.

What is the difference between cognitive behavioral therapy and dialectical behavioral therapy?

DBT shares aspects of CBT, including identifying and focusing on how thoughts, feelings, and behaviors affect each other and are intertwined. The difference lies in the emphasis and focal point of each therapy. DBT focuses more on regulating emotion, mindfulness, accepting pain and eventual change.