What Is DBT? Dialectical Behavior Therapy

People suffering from substance use disorders are 6 times more likely to attempt suicide than those without. One powerful method is known as DBT, but just what is DBT, or dialectical behavior therapy?

Dialectical Behavior Therapy is an evidence-based method for helping addicts take control of their behaviors. With the skills it teaches, patients are better equipped to maintain sobriety.

Suicidality is one of many unwanted thoughts and behaviors that can accompany addiction. Learning how to cope with those thoughts and behaviors through therapy is a key component of addiction treatment.

If you or a loved one is suffering from addiction, DBT therapy techniques might be your road to recovery. Keep reading to learn more about this promising therapy and how it works.

What Is Dialectical Behavior Therapy?

Marsha M. Linehan developed Dialectical Behavior Therapy in the late 1980s. She developed this psychotherapy method to treat patients experiencing suicidal thoughts as a symptom of borderline personality disorder.

Today, it’s recognized as an effective treatment for a number of mental health conditions. These include:

• Posttraumatic stress disorder (PTSD)
• Bipolar disorder
• Depressive disorders
• Anxiety disorders
• Eating disorders
• Substance use disorders

In terms of treating addiction, DBT therapy focuses on helping patients accept and manage their emotions. Addiction is accompanied by guilt, shame, anger, and other negative emotions. But DBT therapy techniques help an addict understand these intense and painful emotions that lead to low-self esteem and self-destructive behaviors.

This is accomplished through the four skills that DBT teaches throughout treatment. Patients will learn about mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Having learned these skills and how to use them, addicts are better able to stop using drugs and alcohol.

CBT vs DBT

Cognitive Behavioral Therapy (CBT) is the most common type of therapy used to treat substance use disorders. It teaches how to recognize triggers that lead to drug and alcohol use. It focuses on changing your thoughts and behaviors for more healthy ones in order to stay sober.

DBT is based on CBT. It shares the belief that unwanted, negative thoughts and behaviors are learned and reinforced. Where DBT therapy techniques differ is in their approach to these thoughts and behaviors.

Whereas CBT places a lot of emphasis on changing thoughts and behaviors, DBT works through acceptance of them. The dialectics portion of this therapy is where it differs from CBT. Dialectics involves balancing validation and acceptance with a desire to change the behavior.

This is why DBT involves a lot of optimistic outlooks that are lacking in CBT. As such, DBT involves acceptance of the following facts on behalf of the patient:

• Everyone is doing their best with the current situation they face
• There is a desire to improve that current situation
• Everyone is capable of changing their situation through learning new behavior
• Although the problems people face are not always their fault, they have ad duty to address the problems and fix them

Validation and acceptance are practiced on behalf of the therapist and the patient. Importantly, acceptance doesn’t mean that the thoughts and behaviors are encouraged. It simply acts as a way to understand them and using that understanding as motivation for change.

The Four Components of DBT Therapy Techniques

There are four pieces to DBT therapy techniques. These include learning the sour skills central to DBT, individual therapy, phone coaching, and team consultation. We’ll explain each of these in more detail below.

Skills Training

During a Dialectical Behavior Therapy treatment program, patients are expected to attend a skills group. These group sessions will be attended by other people who exhibit self-destructive symptoms. It works like any other classroom, where a therapist leads the class through a topic or skill and then assigns homework to the participants.

Classes are typically held once per week for 24 weeks and last for about two hours each. This is where they’ll learn the four skills that DBT teaches. Namely, mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

Let’s look at these in more detail.

Mindfulness

This is the practice of being fully present in your body, mind, and environment. It allows you to be aware of where you are and what you are doing, without assigning judgment to sensations, emotions, or things happening around you.

People who struggle with addiction are often plagued by unwanted thoughts and distracted thinking about themselves, their past, and their future. But knowing how to mindful can help them focus on the present moment. In fact, mindfulness is scientifically proven to reduce anxiety, prevent depression, and increase self-esteem.

Distress Tolerance

People who abuse drugs and alcohol are more likely to deal with distressing situations by trying to escape them with using. This skill is exactly as it sounds – it teaches the patient how to accept and tolerate distressing experiences instead of turn to drugs and alcohol.

Interpersonal Effectiveness

DBT therapy techniques teach communication and conflict resolution skills. The belief is that, with these skills, the patient is better able to interact with other people. Having happier, more fulfilling relationships can greatly improve someone’s outlook on life.

Emotional Regulation

With this skill, patients learn to identify unwanted thoughts and emotions. They work the therapist to determine ways of changing them.

Individual Therapy

Individual therapy is one-on-one sessions between the patient and therapist. This is an opportunity to build on what’s learned in the classroom. The therapist will help the patient apply those skills and techniques to real-life situations from the past and present.

In the first few sessions, the focus is usually on crisis management. The therapist will work with the patient on understanding suicidal thoughts and self-destructive behavior.

Once those have been dealt with, the therapist will begin to explore behaviors that may be a deterrent to treatment. Finally, the therapist and patient will work to find ways to improve their quality of life and wellbeing. Part of this may involve exploring the role of emotional traumas in the development of addictive behaviors.

Phone Coaching

Applying the tools learned in skills training and individual therapy can be difficult in the real world. This is why DBT offers phone coaching between patient and therapist. When the patient faces a difficult situation, they have the option of calling their therapist to walk them through their decision-making process.

The goal here is not to have the therapist provide the answer or instruct the patient on the best way forward. Instead, they act as a guide and a coach. They help the patient recall the skills they’ve learned and how to apply them in that particular situation.

Team Consultation

Team consultation is directed at therapists. It’s a way to help therapists and other healthcare providers stay motivated when treating some of the most difficult patients.

The Goal of Treatment

Ultimately, the goal of DBT treatment for addicts is to help them remain clean and sober. But being sober is more than abstaining from drugs. It means leading a happy and fulfilling life.

In order to do this, the goal of DBT treatment is broken into four stages. Below, we’ll explain each stage in more detail.

Stage 1

The first goal of DBT is to address reckless, self-destructive behaviors with the goal of getting them under control. Only by getting control of these behaviors can the rest of the DBT program work.

The therapist works with the patient to improve their sense of stability and balance. They do this through building skills around increasing their attention, understanding their emotions and managing distress. These skills should also make the patient more open to what they’re learning in therapy.

Stage 2

By the second stage of DBT, patients should have control over their self-destructive behaviors and a better sense of how to deal with other people. In this stage, they’ll move onto addressing and controlling emotional health issues. With a better understanding of their emotions, patients are better able to deal with them without drugs and alcohol.

Stage 3

The third stage of DBT is all about real-life. In stage 3, the goal is to improve patients self-respect and self-esteem and set reasonable expectations for happiness.

They’ll focus more on common life problems and how to deal with them. These might include relationship conflicts, work issues, and life goals.

Stage 4

In the final stage of DBT, the goal is to see the patient feeling complete and connected. While the other stages focused more on reducing unwanted thoughts, beliefs, and patterns of behavior, this stage is about applying all of those learnings to living a happy and fulfilled life.

More Treatment Options

Dialectical Behavior Therapy is an evidence-based method for treating mental health disorders as well as addiction. In contrast to CBT, it places a high value on validating and accepting the unwanted thoughts and feelings that often accompany addiction. It teaches important skills that, first, help a patient to manage and control their thoughts and second, live a happy and fulfilling life.But DBT is only one type of treatment among many. If you or a loved one is struggling with addiction, you should know your options. Read more about addictions and treatment options on our blog.