Recovering from Addiction: Can Dialectical Behavioral Therapy Help?

Dialectical Behavioral Therapy for addiction treatment

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Dialectical behavior therapy (DBT) is based on principles rooted in cognitive behavioral therapy (CBT). Adapted from CBT techniques, it teaches skills to cope with cravings and manage strong emotions. For this reason, DBT is extremely effective in treating disorders such as addiction. DBT therapy techniques are practiced in a number of settings, including schools, hospitals, community treatment centers, and outpatient and inpatient mental health programs.

Dialectical therapy was initially developed to help people with borderline personality disorder and chronic suicidal ideation. However, the therapy was found to be effective in treating a number of other mental health problems. DBT for substance abuse is a well-established comprehensive treatment that is designed to encourage abstinence and reduce relapses. Several randomized clinical trials have shown that DBT therapy is effective in decreasing substance abuse.

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Table of Contents:

What is DBT Therapy?

How to define dialectical behavior therapy? It is a type of psychotherapy that was modified and adapted from cognitive-behavioral therapy (CBT). DBT was developed by well-known psychologist Marsha M. Linehan in the 1980s and 1990s to treat people with borderline personality disorder. Dr. Linehan expanded upon the principles of CBT and added dialectics and acceptance to the original framework.

DBT has proven to be effective in treating a number of mental health issues, including bipolar disorder, anxiety and depression, post-traumatic stress disorder (PTSD), eating disorders, and substance abuse. Addictions treated with DBT include alcohol, tobacco, opiates, prescription pain dbt proess with therapistmedicines, stimulants like methamphetamines, marijuana, antidepressants, and illegal drugs such as heroin, cocaine, and LSD.

The word dialectical is a philosophical term which means two opposite things can be true at the same time. Based on this principle, DBT encourages recovering addicts to balance two opposing goals – acceptance and change. Acceptance refers to doing one’s best and accepting life as it is. Change refers to working harder, being motivated, and altering behaviors to change one’s life.

During sessions, validation is used to help a recovering addict understand why they act in a particular way. The use of dialectics (back-and-forth debate) allows the therapist to work with the addict and investigate false beliefs and elicit the truth. The fundamental idea is to help an individual understand three key notions:

  • Emotions, thoughts, and behaviors are all connected
  • Change is constant
  • Acceptance and change are opposites and can be balanced

What is dialectical behavior therapy? DBT is not a suicide prevention program. It does not prevent behaviors that bother other people. The program teaches an addict to balance an acceptance of things that cannot be changed and the courage to change behaviors that can make life better. It helps individuals live a more meaningful life with the things that really matter to them.

Dialectical Behavior Therapy: How is it Different from CBT?

Dialectical treatment and cognitive therapy share many beliefs and views. In fact, DBT is an expansion of the basic principles of CBT. Both rely on the underlying belief that persistent mental health problems, such as addiction, are the result of two factors: emotional vulnerability and an invalidating environment. CBT places an emphasis on change, whereas DBT includes validation in the process. Validation offers a recovering addict an understanding of why they act in a particular way.

Does dialectical therapy work for addiction treatment? People with addictions are emotionally vulnerable due to past traumatic events or a natural predisposition. This emotional vulnerability makes them react quickly and strongly to situations. When the environment is non-validating, the resultant feelings are perceived as wrong. DBT introduces optimism, which is lacking in CBT. The ideas conveyed during dialectical behavioral therapy are:

  • As a recovering addict, patients are doing their best, given the current circumstances
  • There is a desire to improve
  • New behaviors can bring about change
  • The addiction is not the personal fault, but it is patients duty to try and overcome it

CBT has higher dropout rates (patients discontinue treatment before it is completed). This is because CBT offers limited flexibility in allowing a recovering addict to come to terms with harmful behaviors. In addition, CBT focuses on individual therapy, whereas dialectical therapy is more comprehensive and includes group sessions, phone therapy, and consultation teams.

Dialectical Behavioral Therapy (DBT): Skills and Goals

Behaviors can be reinforced and rewarded. Reinforcers are things that increase the likelihood of a behavior occurring again. For example, if a dog gets a treat for sitting down, the treat is the reinforcer. DBT harnesses the power of reinforcers and behavior change to move a recovering addict closer to their goals. Therapists work to establish target behaviors – actions that an addict wants to increase or decrease. For example, someone with a substance abuse problem may have an initial target of reducing thoughts about using drugs or alcohol.

The primary goal of DBT therapy is to make sure the addict stays safe and alive. A secondary goal is to ensure that the recovering substance abuser stays in therapy until they have achieved what they set out for. Goals of DBT therapy include:

  • Reducing dangerous and reckless behaviors, increasing positive emotions, and learning to manage stress
  • Fully experiencing feelings and avoiding escapism from strong emotions
  • Building healthy relationships and working on life goals
  • Moving towards a happy future by feeling complete and connected

DBT Techniques: An Overview

Dialectical behavior therapy techniques are research-backed and include four modes of treatment:

Structured individual therapy

The focus is on the individual’s past and present behavior and dialectics (balance of acceptance and change). Recovering addicts are asked to track their emotions and behaviors outside sessions. The focus is on dealing with everyday challenges such as avoiding drug-seeking behavior. Addicts are taught to stay motivated and apply the skills to practical daily life. Sessions are usually weekly and last for an hour. Family therapy may be included as part of the program.

Weekly group meetings

These meetings are about 2 to 2.5 hours in duration and are usually conducted for 24 weeks. The focus is on a different behavioral skill each week. Skills include changing negative behaviors, coping with stress, managing emotions, and developing healthy relationships. Teens and young adults attend sessions with family members so they can learn the same life skills.

Skills coaching

Recovering addicts have 24-hour live phone access to the therapist to help with coping skills and target behaviors. The DBT therapist acts like a personal coach to change the addict’s reaction at stressful times. If a recovering addict is in dire need of help, they can call the therapist outside of normal session hours. The therapist does not tell the addict what to do. Rather, they guide the addict on the options and aid in decision-making.

Consultation team

A number of DBT therapists work in collaboration to ensure the recovering addict receives the best treatment possible. Changing life-threatening behaviors is a stressful process. Teamwork ensures that therapists can discuss their client’s progress and remain competent to treat serious disorders such as substance abuse. This support ensures the patient receives high-quality care.

DBT for Substance Abuse: Is It Effective?

Dialectical behavior therapy has been studied for a number of different clinical problems. All the psychological problems treated with DBT have one thing in common – they are the result of an individual’s inability to regulate emotions. Who can benefit from DBT? This therapy works well for emotionally volatile people, for example, those who are easily disappointed, cry at movies, or frequently feel out of place. Is DBT for substance abuse effective? For substance abusers, life can feel like an emotional roller coaster. This is why dialectical therapy is so effective in addiction treatment.

This behavior counseling helps decrease use of illicit substances, support abstinence, reduce withdrawal symptoms, diminish temptations and cravings, avoid situations that trigger abuse, improve support within the community, and encourage positive and healthy vocational and recreational activities. This is achieved by acquiring behavioral skills such as mindfulness (awareness of one’s actions), effective interpersonal relationships, tolerance to distress, and regulation of emotions.

DBT Treatment: Finding Therapy That Works

DBT therapists have a lot of specialized training and follow a number of guidelines that are different from other psychotherapies. A good DBT therapist understands where the recovering addict is coming from while also pushing them to make the changes that will make their life better. The relationship between a DBT therapist and a recovering addict is one of equals. Both work in collaboration to achieve the client’s goals.

Woman talks to a medical specialstThe best dialectical therapists are able to push a client towards their long-term goals. For an individual addicted to illicit substances, the goals can often appear unattainable. DBT residential treatment centers have trained therapists who understand how difficult the change is and keep pushing the addict forward in their recovery. Comprehensive DBT for addiction should include other aspects such as medication management, treatment for substance abuse, and vocational rehabilitation.

How to choose a good DBT therapist? A recovering addict should ensure the therapist has a master’s or doctor degree from an accredited university and specialized training in dialectical behavior treatment. Most states require therapists to pass licensure examinations and the degree is typically displayed in the counselor’s office. Recovering addicts may also inquire about the number of years a therapist has practiced DBT as an indication of their experience.

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