Dialectical behavior therapy (DBT) is an evidence-based technique that mental health professionals use to treat complex mental disorders. Although psychologist Marsha Linehan developed DBT in the late 1980s to treat patients with bipolar disorder (BPD), researchers have found DBT to be an effective treatment for addiction and other mental illnesses.
For those struggling with addiction, clinically known as substance use disorder, learning to recognize and manage triggers that lead to destructive behavior are critical to long-term recovery. Therapists use dialectical behavior therapy to teach people in recovery how to cope with stress, manage their thoughts and emotions, improve their interpersonal relationships, and live in the moment.
Before Dr. Lineman developed DBT, many mental health professionals used cognitive behavioral therapy (CBT) alone to treat addiction and mental disorders. Dr. Lineman believed the addition of DBT to the treatment protocol would improve patient outcomes. Decades later, psychotherapists commonly include CBT, DBT, and other behavioral approaches in the treatment plan.
What is the Difference Between DBT and CBT?
DBT and CBT are both types of talk therapy, meaning the patient speaks with a mental health counselor in a safe, confidential space. The therapist and patient work together to resolve issues underlying emotional difficulties. The interaction may take place one-on-one or in a group setting, in-person, by phone, or in a virtual setting. Although the therapeutic approaches are similar, there are some key differences.
Cognitive-behavioral therapy
Psychiatrist Aaron Beck developed CBT in the 1960s, and it soon became the gold standard of treatment for many mental disorders, including substance use and eating disorders. Beck believed people could change their mood and behavior by changing their thought patterns. CBT teaches patients to recognize and interrupt “hot thoughts” that trigger negative emotions and addictive behaviors and consciously choose a healthier response.
Dialectic behavior therapy
In psychology, dialectic thinking refers to conflicting viewpoints that may overlap, like acceptance and change. Marsha Linehan explains that “dialectical thinking is a middle ground between two opposite ways of thinking and acting.” When patients learn to accept past experiences, they can create a balance between their rational and emotional minds.
While the primary focus of CBT is on helping patients recognize and reframe negative thoughts, DBT helps patients learn to accept themselves, appreciate their innate strengths, manage their emotions, and improve their relationships.
How DBT Can Help You Recover from Addiction
Your doctor may diagnose substance use disorder if your “recurrent use of…drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school or home.” Simply put, if you continue to use an addictive substance even in the face of negative consequences, you may have a SUD.
Some of the most dangerous triggers to addiction and relapse are unmanaged stress and negative emotions. These can be triggered by unhealthy relationships, isolation, and places or events associated with addiction. Dialectical behavior therapy helps you learn healthy ways to cope with these personal triggers, using mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
Addiction professionals use several evidence-based treatment approaches in addiction recovery. Often a combination of one or more modalities is most effective. DBT may be used on its own or in combination with other therapies.
Here’s more information about the typical components of DBT therapy:
Mindfulness
When you practice mindfulness, you focus your mind on the present moment and connect with your environment through your five senses. Being mindful encourages you to accept your feelings, thoughts, or physical sensations without judgment.
With the regular practice of mindfulness, you can learn to:
- Manage your stress
- Calm your mind when you are feeling anxious or uncomfortable
- Avoid quick reactions, so can you respond with healthy coping strategies
- Observe how your emotions are associated with certain behaviors and thoughts
Distress tolerance
Distress tolerance skills help you recognize the threat of an emotional crisis and develop coping strategies to help you handle intense emotions and react in a healthy manner.
Distress tolerance practices help you tolerate and even find meaning in the face of emotional distress.
- Plan distractions and coping techniques to manage a potential emotional crisis
- Recognize an event as negative or sad, but refuse to let it overwhelm you
- Learn how to use your senses to soothe your emotions
- Learn to reconnect with the present moment and not dwell on the past or future
- Practice ways to strengthen the mind-body connection, like yoga, progressive muscle relaxation, and biofeedback
Interpersonal effectiveness
Healthy relationships are crucial to addiction recovery. Learning to listen and communicate with others, especially those who may challenge you, improves interpersonal relationships and strengthens your healing.
Interpersonal effectiveness skills help you:
- Respect yourself
- Recognize and value your own needs and ask for what you need
- Communicate without anger or judgment but be assertive when necessary
- Set boundaries and say “no” when appropriate
- Actively listen and acknowledge the other person’s feelings
- Know when to walk away from a destructive relationship
Emotion regulation
Emotion regulation means maintaining control over your emotional state, especially in challenging situations. When emotions overwhelm you, they can trigger impulsive or addictive behavior. DBT teaches you to deal with your feelings before they escalate into negative behaviors. Emotion regulation includes learning how to:
- Focus on positive emotions
- Identify and accept emotional experiences without unhealthy judgment
- Employ techniques to experience fewer unwanted emotions
- Control your reactions during extreme emotions so things don’t escalate
- Use healthy coping techniques to manage stressful or uncomfortable emotions
- Strengthen your ability to control impulsive behavior
Most experts agree that combining dialectical behavior therapy with other forms of behavioral therapy speeds the recovery process. Studies find DBT and CBT are effective for people of any age, gender, ethnicity, or socioeconomic group.
Studies Support the Efficacy of Behavioral Therapy
The National Institute on Drug Abuse supports the use of behavioral interventions for adolescents in recovery, saying such approaches encourage young people “to actively participate in their recovery from drug abuse and addiction and enhance their ability to resist drug use.”
Those struggling with any mental illness, including substance use disorder, are at an increased risk of suicidal thoughts or actions. A two-year randomized study conducted by Dr. Linehan found patients who underwent DBT had half the rate of suicide attempts than those who did not undergo behavioral therapy.
DBT and Relapse
Addiction is a chronic, relapsing disease, which means if you do not have a long-term recovery plan in place, your danger of relapse increases. Even if you experience a relapse, you are encouraged to view it as part of recovery. Relapse may signal a need for changes to your treatment plan and additional support services.
Therapists who use DBT do not view relapse as a failure. Instead, relapse signals the need to understand the cause of your return to substance use and how to decrease the risk of a future relapse.
If you take an active role in your recovery, you are more likely to achieve long-term success. Practitioners of DBT expect you to keep up with regular “homework” assignments throughout the treatment process. Many of these assignments allow you to practice and improve the coping skills you are learning in your sessions. The more you practice these coping skills, the more those skills strengthen until they become second nature.
Rising Phoenix Wellness Services
At Rising Phoenix, our skilled psychotherapy team uses DBT, CBT, and other evidence-based modalities and treatments to heal the whole person. We understand that for innate healing to occur, there must be a healthy balance in all aspects of the person – mind, body, and spirit.
Our innovative addiction recovery program includes:
- Weekly individual and group therapy sessions
- Case management and coaching services
- Psychiatric and medical services
Contact Rising Phoenix Wellness Services for more information or to schedule an appointment.