Dialectical behavioral therapy, or DBT, is a form of psychotherapy often used in addiction treatment programs. It is based on the more widely used cognitive behavioral therapy, or CBT, but DBT is more structured and focused and is used for a limited number of tough mental health challenges. The following is a brief overview of DBT.

 

DBT Was Developed to Treat Borderline Personality Disorder

 

DBT was originally developed in the 1980s by psychologist Marsha Linehan to treat clients with borderline personality disorder, or BPD. BPD is characterized by a tendency towards volatile emotions and strong emotional reactions.

People with BPD often see the world in black and white; someone can be their best friend one day and their worst enemy the next. This, combined with their strong emotional reactions understandably puts a strain on their relationships.

For this reason, DBT is especially focused on helping clients do two things: cope with volatile emotions and improve their relationship skills.

 

Unfortunately, Linehan discovered that the tools of CBT were not always suited to helping clients with BPD. The main emphasis of CBT is changing or eliminating thoughts and behaviors that lead to emotional distress.

However, clients with BPD often resisted this approach, feeling that it invalidated their thoughts and feelings. Clients felt as though they were being criticized or misunderstood and dropped out of treatment. 

 

As a result, Linehan began incorporating therapeutic techniques that emphasized acceptance and validation. The “dialectical” in dialectical behavioral therapy is about striking the right balance between accepting and changing thoughts and behaviors. This dynamic is guided by the interaction of the client and therapist.

 

DBT Has Since Been Expanded to Treat Other Conditions

 

Although DBT was originally developed to treat clients with BPD and BPD with suicidal behavior, it has since been adapted to treat other challenging conditions including substance use disorders, major depression, eating disorders, and complex PTSD. Since DBT can be used to treat substance use disorders, it clearly has a place in addiction treatment programs and many of the other conditions listed above commonly co-occur with addiction. For example, an estimated 78 percent of adults with BPD will develop a substance use disorder at some point in their lives. 

 

DBT Is Highly Structured

 

While traditional CBT is a sort of toolbox that therapists can pull from as needed, DBT has a few particular areas of emphasis and relies on certain groups of skills. More on those below. DBT also involves much more contact with the therapist.

While someone undergoing a course of CBT will typically have individual or group sessions once a week, someone going through DBT will typically have one individual therapy session and one group therapy session each week and will have phone calls with their therapist between sessions. The group therapy sessions are specifically designed to give clients an opportunity to practice social skills and emotional regulation skills in a safe, supervised environment with other people who are dealing with the same challenges. 

 

The Four Key Skills of DBT

 

As noted above, DBT emphasizes a specific set of tools from CBT as well as incorporating tools not typically used as part of CBT. These tools are geared toward helping clients improve four specific skills.

 

Mindfulness

 

Mindfulness is a core skill of DBT because it’s what enables the client to use every other skill and strategy. Mindfulness is a concept borrowed from Eastern contemplative traditions such as Buddhism but there are no metaphysical or moral components incorporated into the form of mindfulness used in DBT. It is essentially a process of learning to observe emotions, thoughts, and sensations non-judgmentally.

So, for example, with a bit of practice, you can learn to notice the feelings of anger–perhaps tightness in the jaw or heat in your face–and observe them without letting those sensations dictate your behavior. In this way, volatile emotions–which DBT sees as largely biologically determined–don’t necessarily lead to counterproductive behavior.

 

Interpersonal Effectiveness

 

Since relationships are a particular challenge for people with BPD, it makes sense to make social skills a particular emphasis of DBT. And since the social connection is such a crucial aspect of recovery from many conditions, including major depression and substance use disorders, it makes a lot of sense to include it in treating those as well.

Most of us are never taught social skills; we learn them by watching other people, especially our parents, other relatives, and friends. If you grow up in an environment with social dysfunction, you may never have had a chance to learn effective social skills.

And if your social interactions have always been dictated by volatile emotions, you may not quite understand why you have so many relationship problems. DBT focuses on helping clients improve their social skills and practice them in a safe environment.

 

Distress Tolerance 

 

Unfortunately, life does not always respect your recovery timeline. Bad things happen whether your ready for them or not. That’s why distress tolerance is a key skill to learn as part of DBT.

Distress tolerance is a set of skills you can use to get through tough times. These rely heavily on mindfulness but include other strategies, such as exercise, deep breathing, relaxation, self-soothing, and so on.

 

Emotional Regulation

 

Emotional volatility is a particular problem for people with BPD but anyone with a mental health challenge can benefit from improved emotional regulation. This is especially true of people with substance use disorders since intense negative emotions are often a prelude to relapse.

Again, mindfulness is important here, particularly for identifying and labeling challenging emotions. Emotional regulation also entails other strategies like employing distress-tolerance techniques, taking action to change your circumstances, and learning to create positive emotions.

 

Dialectical behavioral therapy is a bit like industrial-strength CBT for especially tough conditions. Not everyone seeking help for a substance use issue will need DBT but it’s good to have the option, especially if you have a co-occurring condition such as major depression, an eating disorder, suicidal behavior, or complex PTSD.

At The Kimberly Center, DBT is one of many evidence-based methods we use to treat substance use disorders. To learn more about our treatment options, call us today at 855-452-3683.