One of the challenges of addiction recovery is learning to cope with stress and triggers in healthy ways. In the past, drugs and alcohol were likely your go-to for numbing difficult feelings or experiences. Developing healthy coping skills to deal with these issues is critical for long-term recovery. A therapeutic approach that’s proven helpful in regulating emotions and managing stress in people with addictions and-co-occurring mental health disorders is dialectical behavior therapy (DBT). A type of cognitive behavioral therapy (CBT), DBT helps you identify and change destructive thoughts and behaviors with mindfulness skills, emotion and distress regulation techniques, and ways to improve interpersonal effectiveness.
Some clinicians have found DBT improves:
- Emotion regulation
- Distress tolerance
- Relationships
- Quality of life
- Personal discord
- Self-esteem
Research shows dialectical behavior therapy can also be particularly effective when treating people with suicidal thoughts or mental health conditions like borderline personality disorder, and recently it’s shown promise for people with bipolar disorder, complex post-traumatic stress disorder, and eating disorders.
One DBT technique that can help you with stress and anxiety before you get caught up in a cycle of negative emotions and triggered is the IMPROVE skill. The goal of this technique is to “improve the moment” by transforming the distressing situation and emotions into more positive ones. This can make difficult experiences and emotions less intense, so you’re better able to tolerate them and not feel the urge to numb through drugs and alcohol. Depressed and anxious thoughts are often underlying issues of substance abuse.
“Racing thoughts, obsessions, and worry are common symptoms of anxiety,” said Stephanie Pruefer, a licensed professional counselor and certified alcohol drug counselor who often uses DBT in her work. “If we are able to use skills to calm these symptoms, anxiety can actually help to motivate our behavior and facilitate change in our life.”
Below are seven examples of ways to use the DBT IMPROVE the moment technique to improve distress tolerance:
#1 Imagery
Imagery can help guide thoughts and emotions into a calm and relaxed state. There are many ways to do this. One way Pruefer suggests is to imagine yourself in a safe place where you feel comforted, supported, validated, and internally at peace.
- What would be around you?
- What does this place look like?
- Who would be in this safe place with you?
Another approach is to visualize working toward goals and aspirations. You can also imagine something humorous and light-hearted. For example:
- If you were a superhero, what superpowers would you have?
- What would your costume look like?
- Would you have a sidekick?
It may sound silly, but if you pay attention to positive imagery, it can distract you from worrisome thoughts.
#2 Meaning
Finding the positivity in distress doesn’t mean you are denying the challenges of it, the goal is to simply find a way to “improve the moment” by using ways to feel better and deal with the difficult situation and feelings. “Finding purpose and perspective in overwhelming times can help decrease hopelessness,” said Pruefer. Questions she sometimes asks her clients to consider:
- Have you handled something like this in the past?
- Have difficult times taught you anything?
- Has getting through stress improved your relationships?
Answers to these questions can help you refocus and think about the situation on a deeper level.
#3 Prayer
Whether you identify as religious, spiritual, or neither, prayer can be beneficial for dealing with stress and intense emotions and find meaning in them. Mentally releasing intense emotional experiences can help decrease negative feelings that can lead to relapse. “Praying to a higher power or any force outside of yourself can help decrease loneliness and hopelessness in situations,” said Pruefer. “If you struggle with higher power or religious practices, try speaking out loud to yourself. You could also journal these thoughts and emotions as another outlet.”
#4 Relax
Relaxation can help:
- Regulate body temperature.
- Decrease racing thoughts.
- Improve your ability to breathe and circulate oxygen.
“Planned activities could include a bubble bath, getting a massage, manicure or pedicure, or doing something you enjoy,” said Pruefer. “If you need to relax with short notice or on a budget, try using essential oils for calming lotion — spearmint, eucalyptus, or lavender, light a candle, take a short walk, stretch out your legs or arms, or try four square belly breathing.” To do this:
- Breathe in for four seconds.
- Hold for four seconds.
- Exhale for four seconds.
- Pause for 4 seconds.
#5 One Thing at a Time
Being in the “now” allows you to let go of anger, shame, and worry about the past and future, where ruminating increases suffering. Pruefer suggests grounding yourself by:
- Identifying animal letters: A-Z (alligator, bear, cat, dolphin, etc.).
- Count five things you can hear.
- Identify three places where your body makes contact with something else (feet on the floor, back on the chair, etc.).
- Count five breaths inhaling and exhaling.
#6 Vacation
This skill refers to mental vacations rather than geographical vacations. Try taking a mini break from the presenting stressor. Give yourself five to 10 minutes to take a mental vacation and focus on improving the moment. Some examples of what you could do include:
- Listening to music.
- Making a phone call to someone in your support system.
- Watching a YouTube video.
- Taking a brief walk.
- Having a small snack.
#7 Encouragement
Be nice to yourself. Instead of cycling through negative thinking patterns, try saying things like:
- This situation won’t last forever.
- I’ve been through painful experiences, and I’ve survived them.
- This too shall pass.
- My feelings make me uncomfortable right now, but I can accept them.
“Self-affirmations can help improve our sense of self-confidence, which could decrease overall anxiety and fear,” said Pruefer. “If you’re engaging in negative self-talk], ask yourself if you would talk to your best friend this way.”
How DBT Helps in Addiction Recovery
Stress, unhealthy thought patterns, and lack of coping skills are proven risk factors of addiction relapse. Dialectical behavior can serve you well in all of these areas. When faced with triggers, the techniques you learn in DBT can be an important part of your toolbox of recovery skills to draw upon. Addiction treatment centers like Footprints to Recovery offer DBT as just one of the evidence-based approaches used in substance abuse treatment and coping skills training. If mental health symptoms and unhealthy thinking patterns are getting in the way of your recovery, reach out for help.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145450/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889144/
- https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2768029
- https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00299-z
- https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1802-z
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
