DBT Therapy, How it Works? What Does it Treat? DBT Treatment for Co-Occurring Mental Health & Substance Use Disorders
What is DBT?
DBT stands for dialectical behavioral therapy, and it is an intensive therapy for people who have high emotional responses that inhibit normal functions. DBT is a form of cognitive-behavioral therapy (CBT), or psychotherapy, that teaches the individual to appreciate their emotions and feelings with acceptance. Originally, it was used for borderline personality disorder (BPD) and developed by Dr. Marsha Linehan. It is now widely used by many therapists, counselors, and psychologists for different types of emotional and mental health disorders. It can be used for almost any condition, including alcoholism, drug addiction, and eating disorders.
Dialectical behavior therapy (DBT) is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. When DBT is successful, the patient learns to envision, articulate, pursue, and sustain goals that are independent of his or her history of out-of-control behavior, including substance abuse, and is better able to grapple with life’s ordinary problems. DBT’s emphasis on building a life worth living is a broader therapeutic goal than the reduction in problem behaviors, symptom management, or palliative care .
What Does DBT Therapy Treat?
Managing difficult emotions and regulating the conditions that cause them are essential to DBT. This form of therapy can help people who have mental health issues, emotional and behavioral illnesses, behavioral conditions, and anxiety disorders. Some of these conditions include:
DBT therapy can also be used for learning disabilities such as attention deficit hyperactivity disorder (ADHD), short-term and long-term memory issues, executive functioning problems, non-verbal learning disorder (NLD), language processing disorder, and dyslexia.
For substance-dependent individuals, substance abuse is the highest order DBT therapy target within the category of behaviors that interfere with the quality of life. DBT’s substance-abuse–specific behavioral targets include:
- Decreasing abuse of substances, including illicit drugs and legally prescribed drugs taken in a manner not prescribed
- Alleviating physical discomfort associated with abstinence and/or withdrawal
- Diminishing urges, cravings, and temptations to abuse
- Avoiding opportunities and cues to abuse, for example by burning bridges to persons, places, and things associated with drug abuse and by destroying the telephone numbers of drug contacts, getting a new telephone number, and throwing away drug paraphernalia
- Reducing behaviors conducive to drug abuse, such as momentarily giving up the goal to get off drugs and instead functioning as if the use of drugs cannot be avoided
- Increasing community reinforcement of healthy behaviors, such as fostering the development of new friends, rekindling old friendships, pursuing social/vocational activities, and seeking environments that support abstinence and punish behaviors related to drug abuse.
How Does DBT Work?
The word dialectic refers to the synthesis of two opposites. The fundamental principle of DBT therapy is to create a dynamic that promotes two opposed goals for patients: change and acceptance. This conceptual framing evolved in response to a dilemma that arose in the course of trying to develop an effective treatment for suicidal patients.
Dr. Linehan’s basic premise for DBT was that people who wanted to be dead did not have the requisite skills to solve the problems that were causing their profound suffering and build a life worth living. However, a sole emphasis on promoting behavioral change quickly proved unworkable.
Many patients were exquisitely sensitive to criticism; when prompted to change, they responded by shutting down emotionally or by exhibiting increased, sometimes overwhelming emotional arousal. For example, storming out of sessions or, occasionally, even attacking the therapist. At the same time, dropping the emphasis on change and instead encouraging patients to accept and tolerate situations and feelings that distressed them produced equally negative consequences. Patients then viewed their therapist as ignoring or minimizing their suffering and responded with extreme rage or fell into a sea of hopelessness.
In short, patients experienced both promptings for acceptance and promptings for change as invalidating their needs and their experience as a whole, with predictable consequences of emotional and cognitive dysregulation and failure to process new information.
To overcome this dilemma—to keep the suicidal patient in the room and working productively—DBT therapy incorporates a dialectic that unites change and acceptance. The treatment balances the patient’s desire to eliminate all painful experiences (including life itself ) with a corresponding effort to accept life’s inevitable pain. Without this synthesis, the patient’s problems tended to converge and overwhelm both patient and therapist; with it, the patient can work on changing one set of issues while tolerating (at least temporarily) the pain evoked by other problems.
The treatment of severe disorders requires the synthesis of many dialectical polarities, but acceptance and change are the most fundamental. The simultaneous embrace of acceptance and change in DBT therapy is consistent with the philosophical approach found in Twelve-Step programs, expressed in the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
The spirit of a dialectical point of view is never to accept a proposition as a final truth or indisputable fact. In therapeutic dialogue, dialectic refers to bringing about change by persuasion and making strategic use of oppositions that emerge within therapy and the therapeutic relationship. In the search for the validity or truth contained within each contradictory position, new meanings emerge, thus moving the patient and therapist closer to the subject’s essence under consideration. The patient and therapist regularly ask, “What haven’t we considered?” or “What is the synthesis between these two positions?”
DBT therapy has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions. Settings in which DBT therapy are often used include:
- Group therapy where patients are taught behavioral skills in a group setting.
- Individual therapy with a trained professional where a patient’s learned behavioral skills are adapted to their personal life challenges.
- Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.
Not everyone will utilize each modality. Instead, your therapist will choose the method with the highest success rate for treating your specific disorder.
Some of the strategies and techniques that are used in DBT therapy include the following.
- Interpersonal effectiveness, which is a technique that helps people communicate with others assertively and maintain self-respect. This will also build a stronger relationship with others.
- Emotional regulation is a strategy that helps individual control and changes their intense emotions, which creates fewer problems in their lives.
- Distress tolerance is a way to increase the acceptance and tolerance of negative emotions instead of trying to escape or ignore them.
- Mindfulness is a common treatment that is focused on being present in the moment and being able to accept emotions without judgment.
6 Main Points of Dialectical Behavior Therapy
Dialectical behavioral therapy has roughly six main points that need to work in conjunction with each other. Patients are instructed to not think too far into the future, which can be a trigger for an individual and lead them to experience the following episodes:
- Depressive state
- Destructive behaviors
- Encourage eating disorders
- Suicidal behaviors
Individuals will be taught positive, healthy ways to deal with stress and general emotions that will occur from daily situations, improve their overall relationships with loved ones and regulate their emotions. The end result of dialectical behavioral therapy is to identify, change and help an individual cope with negative and unhealthy behavior patterns and emotions, mainly during social situations. Dialectical behavior therapy (DBT) is usually referred to individuals who suffer from destructive behaviors, mental health complications, and chronic suicidal attempts.
DBT therapy was established on a six-point structure. Trained therapists use these points to help patients develop new thinking & behavioral skills
- Acceptance & change – accept circumstances to make positive changes.
- Behavioral – analyze problems and replace them with healthy patterns.
- Cognitive – focus on changing thoughts or actions that aren’t helpful.
- Skill sets – learn new skills and hobbies.
- Collaboration – work collaboratively & as a team with others
- Support – recognize your strengths and positive features to help others
Benefits of DBT
One benefit of dialectical behavioral therapy is learning skills for both acceptance and change. This may sound confusing, acceptance and change. If you accept something, why would you need to change it? It’s about learning to balance opposites.
A good example is something that takes place in therapy: learning to accept your life and self while also making improvements where needed and when the opportunity arises.
Other Benefits Include the Following:
- Replacing unhealthy behavior patterns with healthy ones
- Recognizing your strengths and applying them to all areas of your life
- Improving communication skills.
- Helping you feel more in control of your emotions, relationships, and life overall.
- Teaching you how to change negative thought processes so you can avoid impulsive reactions.
- Teaching you how to set priorities, say no, and ask for what you need.
- Implementing mindfulness techniques for better self-care and emotional regulation. You will learn how to be more aware of what is going on inside you and surrounding you. This will help you make informed decisions out of reason rather than impulse.
- Learning distress tolerance which can help you sort through the things you can and cannot change. You make decisions based on what is factual and logical rather than on your thoughts or feelings about a situation.
What Happens During DBT for Substance Abuse?
During an individual session of DBT therapy for addiction to alcohol, drugs, or both, the therapist will focus first on crisis management, and suicidal and self-harming behaviors will take first priority. Next, behaviors that may keep a person from attending therapy or participating fully in sessions are addressed.
Issues involving quality of life are examined and then, the focus is on improving a person’s overall wellbeing. Emotional trauma is explored, and healthy coping mechanisms are built to counteract maladaptive behaviors that may be in place currently. Basic social skills, such as communication, among others, are enhanced during individual sessions of DBT therapy for substance use as well .
A person’s self-image is assessed and improved upon through a working therapeutic relationship between the therapist and the individual. Clients are encouraged to understand that their thoughts and feelings are valid, to accept themselves as worthwhile, and to find the motivation to modify negative thoughts and behaviors. Emotional pain is part of life, and individuals are taught through DBT therapy to accept this and learn how to work through it. Therapists are nonjudgmental and not confrontational in their approach.
In the quest for abstinence, the DBT dialectic takes the form of pushing for immediate and permanent cessation of drug abuse (i.e., change), while also inculcating the fact that a relapse, should it occur, does not mean that the patient or the therapy cannot achieve the desired result (i.e., acceptance). Therefore, the dialectical approach joins unrelenting insistence on total abstinence with nonjudgmental, problem-solving responses to relapse that include techniques to reduce the dangers of overdose, infection, and other adverse consequences.
DBT for Co-Occurring Mental Health & Substance Use Disorders
Often, with any mental health disorder, the afflicted person tends to have a co-occurring or co-morbid disorder. When individuals are afflicted with co-occurring disorders, they often present with a much more complex set of barriers to overcome than when they present with only one primary disorder.
Substance abuse can be considered impulsive behavior that includes self-harm. Therefore, a substance abuse disorder is regularly checked when evaluating diagnostic criteria for borderline personality disorder (BPD), and clinicians routinely identify high rates of co-morbidity.
Borderline personality disorder ( BPD ), also known as an emotionally unstable personality disorder ( EUPD ), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, a distorted sense of self, and strong emotional reactions.
Research steadily has affirmed that borderline personality disorder and substance use disorder (SUD) rates are frequently between 67% and 76% of the BPD populations. Criteria are met when BPD patients abuse at least one substance to the degree they meet the criteria for the diagnosis of a SUD.
According to the National Center for Biotechnology Information (NCBI) , DBT therapy and its adaptation may also be effective for SUD patients with multiple, complex problems rooted in emotional dyscontrol who have not responded to other evidence-based approaches.
How Can I Find a DBT Therapy Near Me?
It is best to find someone who specializes in this field. Dialectical behavioral therapy is offered in a variety of healthcare settings that offer addiction treatment and treatment for mental health disorders.
Where DBT therapy is offered:
The best way to find out if DBT therapy is right for you is to talk with a professional who is trained in the method. They will evaluate your symptoms, treatment history, and therapy goals to see if DBT therapy might be a good fit.
If you or a loved one are struggling with long-term substance abuse and co-occurring mental health condition, contact one of our helpful treatment specialists today. We Level Up NJ can provide information on dual diagnosis programs, and detox programs that may fit your specific needs.