Dialectical Behavior Therapy Treatment
DBT (dialectical behavioral therapy) is a specific form of CBT (cognitive behavioral therapy).
This therapy was developed back in the late 1980s by Marsha Linehan, a University of Washington psychologist.
Originally, Linehan conceived DBT as a method of helping to more effectively manage patients with BPD (borderline personality disorder). From here, Linehan utilized DBT to treat patients with chronic suicidal thoughts. Many of these patients had previously attempted suicide on multiple occasions. The patients engaged in self-harming behaviors, too. We know that dealing with mental health treatment is not an easy road, clients often fight against their own minds while trying to engage in wellness practices. That’s why it’s important that clients find dialectal behavioral therapy inpatient facilities. The goal of treatment with DBT was to help these patients to become more accepting of those things they couldn’t change, but at the same time helping them find and create a life worth living.
Since its inception, DBT has been proven useful for treating a variety of conditions beyond BPD, including:
- OCD (obsessive compulsive disorder)
- Substance abuse
How Does DBT Differ from Other Behavioral Therapies?
There are three main ways in which DBT is different from other common types of behavioral therapy:
- Dialectical behavioral therapy is support-based
- Dialectical behavioral therapy is cognitive-based
- Dialectical behavioral therapy is collaborative
Dialectical behavioral therapy is support-based
Designed from the ground up to be a supportive therapy in all ways.
You’ll learn to identify your strengths, and then you’ll develop and use strategies based on these strengths to combat and avoid relapse.
Dialectical behavioral therapy is cognitive-based
Cognitive-based therapies help you to identify the negative thoughts, emotions, beliefs, and assumptions that typically hinder you when you’re trying to overcome problems. Through DBT sessions, you can learn to better understand who you are and how you think. Resultantly, you’ll strengthen your chances of avoiding relapse.
Dialectical behavioral therapy is collaborative
You’ll work closely with your therapist during this collaborative therapy. This is not the type of behavioral therapy where you’ll talk at length while your therapist writes notes copiously. Instead, you’ll work together interactively to address your problems head-on.
The 4 Modules of DBT
The modular approach of DBT makes it easier for clients to focus on one task at a time.
DBT’s 4 core modules are:
- Distress tolerance
- Emotion regulation
- Interpersonal Effectiveness
When Linehan developed DBT, mindfulness was one of the core elements.
Mindfulness is considered the first module of dialectical behavioral therapy as it is foundational for the other modules.
The concept of mindfulness is simple: clients learn to pay very close attention to the present. This is often expressed as living in the moment. At the same time, clients will learn to fully embrace their thoughts and emotions.
The mindfulness module of DBT involves two sets of skills:
- What skills: Observing the environment
- How skills: Maintaining focus even in the face of negative environments
2) Distress tolerance
The second module of DBT is distress tolerance. With this module, clients build on the what and how skills learned during the mindfulness module.
The purpose of this module is to show clients how to better cope with stressful situations without resorting to negative behaviors. The object here is to focus firmly on the positive.
3) Emotion regulation
In DBT’s third module (emotion regulation), clients discover how to keep emotions in check instead of being emotionally-driven in their actions. This is of prime importance for anyone recovering from a substance abuse disorder or alcohol use disorder.
4) Interpersonal effectiveness
Clients learn important interpersonal skills in the fourth and final module of DBT, interpersonal effectiveness.
The object of this module is to help clients identify their own needs more accurately and to ask for help if these needs are not being met.
Clients will also learn how to say no to people, behaviors, or situations that run counter to their recovery goals. Part of this module involves conflict management.
DBT for Severe Personality Disorders
Clients with severe personality disorders and/or suicidal thoughts often become reactive when someone attempts to get them to address their drinking habits. They often shut down emotionally during therapy and often become aggressive when asked to accept what they feel is unacceptable, even if it’s something over which the client has no control. Resultantly, the drop-out rate is high.
With DBT, the aim is to synthesize these opposite states – the word dialectic means a synthesis of opposing viewpoints – and to help clients not only by synthesizing conflicting issues but also by helping them to change certain behaviors while being more accepting of reality.
DBT harnesses a supportive approach. Clients will learn to identify their strengths while also learning how to change certain behaviors and attitudes and becoming more accepting of external aspects of the world.
As a form of cognitive-behavioral therapy, DBT focuses on the thinking processes – the cognitions – that underpin a client’s personal assumptions, assumptions about the world, and overarching belief systems. As the client learns to change faulty or irrational assumptions and beliefs, behavioral change can be encouraged and achieved.
DBT places a heavy emphasis on the therapeutic alliance. This is simply the working bond shared between therapist and client. Also, clients are encouraged to form an alliance between the therapist, the client, and other important people in the client’s life. This can be helpful both for making changes and also accept those things that cannot be changed.
With DBT, then, clients attempt to change elements of the self that are changeable. These aspects include behaviors, expectations, and attitudes. At the same time, acceptance is encouraged. DBT assumes that change is vital for growth, and clients learn how to approach and implement change effectively.
DBT for Dual Diagnosis Treatment
For anyone suffering from a co-occurring disorder – substance use disorder with an underlying mental health disorder – DBT can be beneficial. Clients will learn how to better cope with troubled relationships, stress, and emotional instability, even if they have a mental illness. DBT can also help with healing from traumas stemming from these issues.
When DBT is used as part of a comprehensive treatment program, it can help to restore balance, both emotionally and mentally.
As well as being used to treat borderline personality disorder, DBT also shows promise for treating the following:
- Binge-eating disorder
Benefits Of DBT for Addiction Treatment
DBT is especially useful for addiction treatment. This is because it directly addresses harmful behaviors that block clients from improving their lives.
Within the framework of an addiction treatment program, DBT focuses on substance use and the way in which it impacts the quality of life. At the same time, ideal target behaviors are encouraged to help clients overcome addiction. These targets include:
- Mitigating the physical discomfort of withdrawal
- Positive behaviors reinforced
- Avoiding cues and triggers linked to substance use
- Minimizing substance use
- Reducing behaviors that encourage drug use
- Working to reduce cravings for substances
Often, problematic behaviors manifest as a means of coping with a bad feeling or a bad situation. An example of this is using substances to deal with depression or anxiety. By engaging with DBT, clients can develop more effective ways of managing stress, regulating emotion, and being mindful, both about themselves and others.
The way in which DBT promotes change and acceptance makes it unique among behavioral therapies, and especially well-suited as part of a comprehensive addiction treatment program. What makes change and acceptance so relevant to addiction treatment, though?
The Advantages of DBT Promoting Acceptance And Change
When DBT is used for the purposes of addiction treatment, the client is pushed to stop using drink or drugs immediately.
DBT also acknowledges that relapse is a reality for many people in recovery. It’s hard to get accurate data, but most estimates suggest anywhere from 40% to 60% of those in recovery relapse at least once. By accepting that relapse can happen without giving up on the idea of living a substance-free life, we see the dialectic facet of DBT at work in this union of acceptance and change, two opposing forces.
DBT’s Approach To Abstinence
While abstinence is encouraged from the very first session, clients are given a reasonable timeframe for this as the idea of a lifetime of abstinence makes many people with severe addictions recoil. The time period could be as little as a few hours or a day, or it could be a month or more. The personalized nature of this therapy means elements like this will differ from client to client. Once this agreed period elapses, the client renews their commitment. In this way, long-term abstinence can be achieved without seeming like an insurmountable obstacle.
Clients are urged to “cope ahead.” Developing the required behavioral skills to deal with potential triggers minimizes the chance of relapse happening. Sometimes, though, relapse is unavoidable.
Relapse and DBT
Instead of being viewed as a failure or a personal weakness, DBT treats relapse like a problem that can be solved.
In the event of relapse, therapists encourage clients to “fail well.” The client will get the opportunity to evaluate the behaviors that led to substance abuse and relapse. This can help strengthen the chances of avoiding relapse if it next becomes a threat. In this way, DBT uses relapse as a teaching moment. The therapist will look to repair the damage done and to reiterate the benefits of ongoing abstinence. This message often sinks in more fully in the aftermath of relapse.
The Clear Mind and Strategizing for Completing Treatment
One of the most common issues for those seeking treatment for substance use disorders is starting treatment in a state of mental and behavioral disarray. Drugs or alcohol can pervade a client’s thoughts, beliefs, emotions, and actions.
Even when the abstinence promoted by DBT is achieved, though, the client should never let their guard down. Unfortunately, as the client’s mind starts opening up again once free of substances, a feeling of immunity can descend. To help ease the conflict between these two frames of mind, a DBT therapist can guide clients to accept their need to use substances without indulging. Clients learn to understand that they have the ability to change and that they can take sensible measures to avoid relapse. This balancing is referred to as “the clear mind”, and it can be highly effective for shepherding clients into sustained recovery from substance abuse.
Also, from the first session, a DBT therapist will directly address the likelihood that a client will fail to complete treatment. While accepting this possible outcome, the therapist and client work together to draw up a contingency plan. This included a list of places the client is likely to frequent during relapse, along with a list of friends and family who are supportive and prepared to step in if required.
During the early stages of DBT, the therapist remains in continual contact with the client.
DBT vs CBT
DBT and CBT are similarly named and closely related. Indeed, DBT is a specialized form of CBT, but the two therapies have some notable differences as well as similarities.
- CBT: This is a psychotherapeutic treatment. The primary goal is to help clients to better understand how their thoughts and emotions are tied together. Using specific goals as markers, the therapist leads the client and helps them to identify the thoughts that can lead to relapse. CBT is a time-limited therapy.
- DBT: Built on the foundational principles of CBT, clients learn how to start restructuring the thoughts they have identified, and they learn how to produce positive emotions and behaviors instead of relying on a chemical crutch.
Who Can Legally Perform DBT?
As a form of psychotherapy, DBT must be delivered by a licensed and qualified mental health professional. For anyone looking to practice DBT, this means an advanced degree in a related field followed by obtaining licensing to practice therapy in their chosen state. From this point, further training specific to the DBT process and DBT techniques is required.
How The District Recovery Community Utilizes DBT
In some cases, especially with dual diagnosis, DBT can be used as part of your overall treatment program at The District Recovery Community. Our team of researchers and clinicians can help set you up for success at our center for dialectal behavioral therapy.
If you or a loved one is struggling with addiction, the first step is seeking the right treatment. Reach out to TDRC today at 844.257.8506 and we’ll help you get back on track.