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Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a combination of cognitive and behavioral therapies, used to treat a variety of mental and behavioral conditions.

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The goal is to take negative thinking patterns and associated destructive behaviors, and transform them into positive thoughts, behaviors, and outcomes.

This approach has been particularly useful in treating addiction. In a DBT session, the client will talk with a therapist to identify the root causes of their problems. They’ll then take specific steps to change behaviors.

How Dialectical Behavior Therapy (DBT) Works

The point of dialectical behavior therapy is to create a controlled, safe environment to practice emotional regulation, either individually with a therapist or in a group setting. When in combination with group therapy, DBT helps people build skills for self-management in daily life.

doctor diagnosing a patient
DBT was originally developed to treat those with borderline personality disorder or who have ongoing thoughts of suicide. Now, in addition to treating these issues, dialectical behavior therapy is applied to the following conditions:
  • Depression
  • Eating disorders
  • Self-harming struggles
  • Substance use disorders

Skills that DBT focuses on building include:

  • Mindfulness of what is happening in the present moment.
  • Distress tolerance to reduce destructive coping mechanisms.
  • Interpersonal effectiveness to understand how major mood shifts affect those around you.
  • Self-respect by creating and understanding boundaries, including your own.
  • Emotional regulation so painful or negative feelings do not feel engulfing.

Applying DBT to Other Conditions With Goal-Setting and Emotional Soothing

DBT has been found effective for several mental and behavioral conditions. For example, at the Linehan Institute at the University of Washington, cutting-edge research found that DBT was helpful for people with borderline personality disorder (BPD), especially people who had severe suicidal thoughts and difficulty managing their emotions. The therapy has now been applied to other conditions with positive results.

DBT is:
  • Focused on support. The therapist helps the client find their strengths and build on them. This results in improved self-esteem.
  • Based in cognitive reasoning. The client identifies thoughts, beliefs, and assumptions that make life harder, like perfectionism or fear of angry outbursts.
  • The client continually works in tandem with the therapist. It is an active therapy that requires persistent participation from both parties.

Dialectical behavior therapy has been successfully used to treat eating disorders by helping people learn to:

  • Regulate their emotions and stress levels.
  • Build self-management skills.
  • Reduce anxiety.
  • Control destructive eating habits.

These steps can also be applied to addiction treatment. People who struggle with substance abuse may experience high-stress situations as triggers to consume intoxicating substances. This can imbalance brain chemistry and make stress and anxiety, along with other mental health disorders, worse over time. By reducing anxiety, managing emotions, and reflecting on personal triggers for destructive behaviors, a therapist can guide their client toward controlling self-destructive behaviors like getting high or drinking too much.

DBT sessions can be used to create behavioral plans. These are particularly useful throughout treatment as well as during the first few years after completing the program.

More rehabilitation programs are focusing on aftercare plans with their clients. A daily, weekly, and monthly schedule centered on personal health and wellness has been linked to reduced problems with relapse. DBT’s behavioral plans address this.

In group DBT sessions, a therapist can cultivate group support and understanding for each individual journey. Group sessions can serve as a safe space to discuss problems and options for fixing them, helping participants to develop understanding of the shared human experience.

Sessions Teach Coping Skills

Each DBT session will involve homework assignments, roleplaying new ways of interacting with others, and practicing coping mechanisms and self-soothing skills to manage overwhelming emotions when upset.

Through sessions, participants will learn to:

  • Identify and name emotions.
  • Recognize obstacles to changing emotions.
  • Reduce vulnerability to emotional whims.
  • Increase positive emotional events.
  • Take opposite actions to change destructive behaviors.
  • Apply distress tolerance techniques.
family in treatment

DBT that is focused on changing substance abuse behaviors ideally starts with the client immediately quitting use of the drug. This should be done in conjunction with a medical detox program.

Just because you can safely quit using a drug does not mean you will not relapse. Relapses are not a moral failing. Nonjudgmental problem-solving sessions reinforce that behavioral change is good. DBT sessions can view relapse as a step on the overall journey to recovery rather than a failure.

  • Increases awareness of negative consequences from drug or alcohol abuse.
  • Teaches a component of the abstinence violation effect (AVE). This addresses the feelings of guilt that come with an initial lapse back to substance abuse. DBT sessions aim to help clients learn from the lapse rather than spiral back into an abusive cycle.

Some sessions are adjusted depending on the client’s physical needs during detox. For example, those struggling with opioid addiction may take maintenance medications rather than demanding complete abstinence from all substances.

Use With Other Therapies

DBT is a subset of cognitive behavioral therapy. There is a lot of overlap in the two approaches, as both involve talking through problems to find underlying patterns of behavior and developing better coping skills or ways to change these behaviors.

adventure therapy

Unlike CBT, dialectical behavior therapy focuses on changing interpersonal relationships and managing emotions. This is largely because this is a major component of borderline personality disorder, which is marked by large, dramatic mood swings that can lead to statements or attempts at suicide, stalking, or other disturbing and even illegal behaviors. These issues can obviously make it difficult to maintain relationships.

People who have BPD or eating disorders are at higher risk of developing substance abuse problems. Using DBT alongside other substance abuse treatments can help a wider range of people who struggle with drugs or alcohol. By addressing all co-occurring disorders simultaneously, people have a better chance at sustained recovery from substance abuse.

References

What Is DBT? (September 2016). Psychology Today.

Dialectical Behavioral Therapy (DBT). (January 2019). Healthline.

An Overview of Dialectical Behavioral Therapy. (June 2019). Psych Central.

Dialectical Behavior Therapy for Substance Abusers. (June 2008). Addiction Science & Clinical Practice.

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