Initially developed in the 1980s by the psychologist Marsha Linehan, Dialectical Behavior Therapy, or DBT, is a form of Cognitive Behavioral Therapy (CBT) that is a therapeutic technique that helps people explore how and why they think the way they do, and to recognize patterns of thoughts that may be self-destructive. Thoughts are closely connected to actions, and CBT strives to change negative thoughts in order to illicit positive change with behaviors.
What Is DBT?
Dialectical Behavior Therapy is a form of CBT, but it differs in that it focuses on validation and acceptance of difficult feelings, thoughts, and behaviors as well as change. Dialectical is a term that quite literally means integrating opposites – finding a balance between what needs to change and what can be accepted as is. The journal Psychiatry reports that DBT has been shown to be most effective when helping individuals who suffer from bipolar disorder and those who have suicidal ideations. A study published in the journal Behavior Research and Therapy indicates that DBT helped to vastly reduce self-injurious behaviors in the participants in a relatively short period of time.
DBT has also been shown to be beneficial in helping those who struggle both with bipolar disorder and substance abuse, the journal Psychiatry further publishes. In studies of people diagnosed with bipolar disorder who also struggled with substance abuse, people abused drugs less often when being treated with DBT.
The National Survey on Drug Use and Health (NSDUH) publishes that more than 15 million Americans (aged 12 and older) struggled with alcohol addiction in 2016. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that nearly 8 million adults in the United States struggled with co-occurring disorders in 2014. DBT may be highly beneficial for people who suffer from both a mental disorder and alcoholism at the same time, as it helps to manage extreme emotions and potentially self-destructive behaviors, which can include substance abuse.
Using DBT for Alcoholism
DBT is a short-term and research-based therapeutic model that focuses on helping people to manage emotions that may be intense and painful. Often, alcohol may be used as a method of coping, or self-medicating, emotions that are difficult, such as anxiety or depression. Alcohol can temporarily soothe troubling thoughts and serve as a way to escape from reality. As a central nervous system depressant, alcohol lowers stress and anxiety, and can produce feelings of pleasure and relaxation.
With regular alcohol abuse, however, dependence can form. Side effects of dependence include withdrawal symptoms that are opposite to the effects of alcohol, including anxiety and depression. Repeated alcohol abuse can cause mood swings and difficult emotions to worsen. DBT can help a person learn how to cope with these emotions and provide tools for managing them. It can also help clients to work through potential triggers and curb self-destructive and maladaptive behaviors.
There is often a lot of guilt and shame that accompanies addiction, and DBT can help individuals to accept themselves for who they are and move forward in a positive manner. With acceptance can come heightened self-esteem and motivation for positive change. A bond is created between therapist and individual in DBT, which can provide a positive and healthy outlet for emotional and spiritual growth. DBT sessions provide life skills training that teaches coping mechanisms and tools for minimizing instances of relapse.
DBT may be combined with the use of medication, counseling, and support group meetings, and used as part of a comprehensive addiction treatment program. In some instances, a person may need to attend a detox program before entering an alcohol addiction treatment program to reach a stable physical level first.
DBT and Substance Abuse Treatment
DBT sessions include both individual and group sessions that are led by a trained therapist, and they may be performed as part of an outpatient or residential addiction, mental health, or co-occurring disorders treatment program. Group sessions are skills training “classes” that usually last about 2.5 hours once a week, Behavioral Tech publishes. These sessions follow a specific curriculum that works through the following four main modules:
- Mindfulness: learning how to be aware of oneself and one’s feelings, and being fully present in the current moment
- Interpersonal effectiveness: finding ways to maintain self-respect while saying “no” and/or asking for what is desired and improving relationship skills
- Emotional regulation: learning how to modify emotions that are difficult and not desirable
- Distress tolerance: accepting that pain is part of life and learning how to accept it without attempting to always change it
DBT can help individuals to recognize intense emotions, how to accept some of them as a part of life, and how to change ones that lead to negative actions. Through DBT, individuals learn how to accept themselves for who they are and develop tools for dealing with difficult emotions and managing stress. Painful emotions are part of life, and DBT can help people to see this and learn to cope with them in a healthier manner.
Homework is generally given after every DBT group skills training sessions, so individuals can practice some of the things they learned in their daily lives between sessions. Therapists are available for phone coaching with individuals in between sessions, often around the clock, to help people through specific situations in the moment. Individual DBT sessions also run concurrently with group sessions, and typically, a person will attend these once a week as well.
What Happens During DBT for Substance Abuse?
During an individual DBT session, the therapist will focus first on crisis management, and suicidal and self-harming behaviors will take first priority. Next, behaviors that may keep a person from attending therapy or participating fully in sessions are addressed. Issues involving quality of life are examined and then, the focus is on improving a person’s overall wellbeing. Emotional trauma is explored, and healthy coping mechanisms are built to counteract maladaptive behaviors that may be in place currently. Basic social skills, such as communication, among others, are enhanced during individual DBT sessions as well.
A person’s self-image is assessed and improved upon through a working therapeutic relationship between the therapist and individual. Clients are encouraged to understand that their thoughts and feelings are valid, to accept themselves as worthwhile, and to find the motivation to modify negative thoughts and behaviors. Emotional pain is part of life, and individuals are taught through DBT to accept this and learn how to work through it. Therapists are nonjudgmental and not confrontational in their approach.
The National Alliance on Mental Illness (NAMI) publishes that DBT can help a person to focus more on their own personal strengths, find proper balance between what needs to change and what should be accepted as is, discover motivation to change what needs to be improved upon through positive reinforcement, and decrease self-destructive, risky, and potentially dangerous behaviors, such as alcohol abuse and addiction.