Dialectical Behavioral Therapy (DBT) in Addiction Treatment

Dialectical behavioral therapy is a treatment method that focuses on changing negative beliefs. It was developed to help patients with borderline personality disorder but is now used to treat a wide range of mental health problems, including addiction. When used as part of a wider program of recovery, DBT is a powerful tool for challenging negative thoughts and behavior patterns.

DBT History

DBT History

DBT was developed in the late 1980s by psychologist Marsha Linehan, Professor of Psychology at the University of Washington. It was designed as a way to treat patients suffering from borderline personality disorder – in particular, those who struggled with self-harm or had attempted suicide. DBT was based on the principles of cognitive behavioral therapy but adapted to increase the focus on personal acceptance. The success of DBT has led to research into its effectiveness for treating a whole range of mental health problems, from eating disorders to addiction.

What is DBT?

What is DBT

DBT is a talking therapy that’s based on cognitive behavioral therapy. The aim of DBT is to help patients overcome negative thinking patterns and behaviors, replacing them with healthy habits and ways of seeing things.

There are two main components to DBT. First, you’ll practice recognizing and accepting your current emotions and behaviors. This could mean recognizing why you’ve used drugs or engaged in other self-destructive behaviors. Second, your therapist will help you to change your behaviors and learn healthier ways of coping with difficult emotions.

A key difference between CBT and DBT is the focus on acceptance of who you are. For patients with a long history of unhealthy behaviors, this can be really helpful. While CBT is all about changing negative patterns, DBT also focuses on why the negative patterns arose in the first place. DBT also places a greater emphasis on a strong relationship between you and your therapist, which can help you to feel understood and stay motivated.

DBT is generally made of up two main components. The first is a regular one-on-one meeting with a qualified practitioner, while the second is a group session led by a DBT therapist. The focus on support makes the group setting a valuable part of the process, especially when trying to overcome issues like addiction, which can make sufferers feel alienated.

The 4Core Modules of DBT

The 4 Core Modules of DBT

Group DBT sessions are focused on teaching skills from four core modules, core mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.

Interpersonal Effectiveness

Interpersonal effectiveness is focused on helping you to understand your own needs and respect the needs of others. This means learning to communicate effectively in relationships, deal with difficult people, and understand when to set boundaries. These skills can help in multiple ways when it comes to addiction. You’ll be more prepared on how to say no when others try to pressure you into using drugs, making relapse less likely. You’ll also learn the skills you need to repair relationships that might have been damaged by your addiction.

Emotion Regulation

Many addicts struggle to cope with intense emotions without using drugs. Emotional regulation teaches you to notice and accept your feelings, and then deal with them in a healthy way. This helps to ensure that you’ll be able to ride the ups and downs of life without giving in to cravings.

Core Mindfulness

Learning mindfulness helps you to stay present in the here and now, instead of worrying about the past or future. It’s an important skill that helps you to focus and ground yourself, even while experiencing negative emotions.

Mindfulness also teaches you to slow down and think carefully before making decisions. This encourages you to make choices that won’t hurt you and helps prevent impulsive behavior. For example, you might learn to journal about your emotions after an argument, instead of using drugs to feel better.

Distress Tolerance

Distress tolerance teaches you to cope with negative feelings in a healthy way, even when you can’t immediately solve what’s bothering you. For example, you might not be able to stop a family member from dying or a partner from breaking up with you, but you can learn coping mechanisms to help you deal with this kind of event in a healthy way. This also reduces the chances of relapsing when life gets hard.

 As well as attending one-on-one sessions and groups, patients taking part in DBT will be given homework to complete. This involves filling in daily diary cards to track how you’ve been feeling, whether you’ve had any self-destructive urges and whether you’ve used any coping skills. This diary is an important tool for self-reflection and helps you and your therapist to track your progress.

In some cases, DBT will also involve phone coaching between sessions. This is helpful if a crisis arises and you need immediate help and advice. This can be especially helpful to addicts in early recovering who are at a high risk of relapse.

Misconceptions

Many people think that DBT is only used to treat borderline personality disorder, but this isn’t true. DBT is actually used to treat a range of different mental health problems, particularly those which involve self-destructive behavior. Since drug addiction can damage your health, relationships, career, finances, and well-being, it can be classed as self-destructive. You don’t need to be diagnosed with borderline personality disorder to benefit from DBT, although it is often used to treat high-risk patients with multiple diagnoses.

There's also a common misconception that DBT is the same as CBT. While DBT is based on a cognitive behavioral model, it has some key differences that make it especially useful to addicts. The focus on accepting yourself and your feelings, building a connection with your therapist, and taking part in group work make DBT more suitable for dealing with complex and longstanding issues.

The final misconception is that DBT is all about sitting in a room talking to a therapist. While this is one part of the treatment, it’s equally important to complete homework, take part in group sessions, and use phone coaching when appropriate. It’s also essential to make use of tools like mindfulness in your day-to-day life.

Effectiveness

Effectiveness
Studies have shown that DBT is effective in reducing self-injurious behaviors and the number of inpatient hospital stays for patients with borderline personality disorder. A study focusing specifically on addiction showed that DBT was effective in reducing substance abuse. 
A key point highlighted in this study was the fact that although DBT encourages addicts to change their habits to stop using drugs, it also encourages acceptance of relapses. This means that addicts being treated with DBT will be less likely to give up after a short relapse, and more likely to re-engage with treatment. For those who have chronically struggled with treatment, this is really valuable.

Even when patients don’t immediately succeed in getting clean, DBT encourages harm reduction practices like using less or using in a less harmful way. This practical, non-judgmental approach can make DBT more appealing to long-term addicts.

Certification

Becoming a DBT-certified therapist involves training to deliver both group and one-on-one DBT sessions. Therapists must take an exam to demonstrate their knowledge of DBT, and show evidence of their clinical proficiency via video recordings. Many therapists who are qualified to use DBT will also have knowledge of similar treatment methods, like CBT. Some may specialize in treating a specific type of patient – for example, those with substance abuse issues.

Treatment Locations

Treatment Locations

You can receive DBT treatment while staying in an inpatient rehab with a qualified therapist, while receiving outpatient treatment, or independently by requesting a referral from your doctor. While DBT works best when you take part in both the groups and one-to-one sessions, it is possible to choose one or the other. If you’re not sure what’s right for you, it’s a good idea to chat with a qualified therapist and get their thoughts.

DBT after Discharge

DBT after Discharge
If you use DBT during treatment, whether inpatient or outpatient, it should become a key part of your life. You’ll be filling in your DBT diary daily, using mindfulness to stay in the present moment as much as possible, and practicing the new skills you learn during groups.

You can carry DBT into your life after treatment by continuing with your diary, using your interpersonal effectiveness skills when speaking to others, and dealing with difficult times using your distress tolerance and emotion regulation skills. You can also continue attending regular sessions with a therapist and group sessions with other addicts(4). This is especially valuable if you don’t want to attend a 12-step group, but do want some connection with others in your recovery. Making use of telephone support from your therapist is a valuable tool during difficult times, especially when you’re worried about relapse.

DBT is a powerful tool that was originally developed to treat borderline personality disorder but has since been shown to have multiple benefits for those with substance abuse issues. It’s ideal for anyone who wants to understand why they use drugs, learn to accept their negative emotions, and make positive changes to their behavior.