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There are many different types of therapy for those suffering from substance use disorders. Sometimes it can be confusing choosing the right therapy for you.

Dialectical Behaviour Therapy (DBT) is one therapy you may not have heard of. This is an evidence-based treatment that’s considered highly effective for those suffering from addiction.

What is DBT?

DBT is a form of talking therapy. It uses a similar approach to Cognitive Behaviour Therapy (CBT). However, it differs from CBT in three important ways.

First, DBT involves more group therapy. Second, it focuses on acceptance as well as change. And third, it is aimed more at those with mental health problems, and those who are at risk of harming themselves.

DBT is ‘dialectical’, which means that it uses ideas which are in tension with each other. In this case, the ideas are ‘acceptance’ and ‘change’.

When Marsha M Linehan invented DBT, she noticed something in her patients. She found that they reacted badly to the idea of change. When told that they needed to change, her patients would ignore her advice, or stop treatment.

On the other hand, when told to accept difficult situations, her patients could not face their problems.

In other words, ‘acceptance’ and ‘change’ were not enough on their own. What was needed was a bit of both.

‘Acceptance’ and ‘change’ are hard ideas to fit together. If you accept yourself, then that implies you don’t need to change. If you decide that you need to change, that involves rejecting yourself, rather than accepting yourself.

However, DBT attempts to merge both ideas. It argues that this is the only way to deal with certain types of patient.

Who is DBT for?

DBT came about as a form of therapy for suicidal patients and those who could not control their emotions. It was then brought to bear on patients with Borderline Personality Disorder (BPD). It was found to be successful in those with BPD.

For instance, this study, by CR Koons et al, found that DBT was successful in treating women veterans with BPD. [1]

There have been fewer studies on the use of DBT for substance abuse disorders. However, initial results have been encouraging.

In order for a patient to try DBT, they normally need to meet a few criteria. First of all, if they have BPD, this might make DBT more effective.

Second, if they are having suicidal thoughts, that might be another reason to try DBT. Third, if they have tried lots of different forms of therapy, and had limited success, DBT might be worth a try.

DBT is typically used with patients that have some form of co-occurring mental health problem.

How is DBT delivered?

DBT is delivered through a blend of four main modes of therapy. They are:

  • Skills groups: These are group meetings where people learn important skills for dealing with strong emotions and cravings. We go into more detail about these skills in the next section.
  • One-to-one therapy: One-to-one therapy is important for giving people the close attention they need. One-to-one sessions normally happen once a week. This allows the patient to go through individual problems with the therapist. In one-to-one DBT sessions, the therapist will place an emphasis on acceptance and change. These are two of the most important concepts in DBT.
  • Phone Coaching: The therapist is available at all times for phone coaching. This is where the patients calls up their therapist for help with difficult situations. An example would be if a person in recovery was going through a craving. They can call their therapist to help them manage the craving using techniques and ideas from DBT. This includes the idea of ‘clear mind’, which we will talk about more later on in the article.
  • Team Consultation: This is about therapists, not patients. In order to deliver DBT well, therapists are put on teams. These teams can offer support and advice. This helps therapists to do their job as best they can.

Through a mix of these four modes, DBT aims to reap the benefits of various different kinds of therapy. It has been argued, for instance, that group therapy carries several benefits which one-on-one therapy does not.

Likewise, one-to-one therapy does many things which group therapy cannot. Through combining both, DBT aims to get the best of both worlds.

What skills does DBT teach?

DBT targets four main areas to improve. These are:

  • Mindfulness: Mindfulness is all about making people notice what is going on around them. This is a strategy for living more ‘in the moment’. It can be useful for dealing with stress and cravings. By teaching mindfulness
  • DBT aims to give people more control over their mental state. It also tries to give them the tools for avoiding and dealing with stress. Reducing stress has been proven to reduce the risk of relapse. [2]
  • Emotional regulation: Therapy can be a crucial tool in teaching people how to control their emotions. Many of those who receive DBT have difficulty controlling their emotions. DBT can help to fix this. The hope is that by regulating their emotions, people will be less likely to relapse. They will also be less prone to episodes of extreme emotion, which might lead to self-harm or suicide.
  • Interpersonal skills: One of the casualties of addiction is relationships with other people. Improving these relationships is key to beating a harmful substance abuse disorder.

DBT teaches people how to express themselves better, and how to value other people more. These are important skills for life, and for maintaining a good support network.

Dealing with distress. Difficult situations can lead those with BPD, or those who struggle to control their emotions, to do destructive things.

That can mean self-harming or relapsing. DBT teaches people how to manage their distress in order to avoid these negative outcomes. Concepts such as ‘failing well’ can be useful for this. We discuss this idea in more detail below.

Helping patients get clean through change

DBT emphasizes the need for change, as well as acceptance. In this section we look at two ideas which are key to DBT’s focus on change. Both are techniques for getting sober.

The first idea is this. Abstinence can seem like a hard mountain to climb. Someone with substance abuse problems may not be able to imagine scaling this mountain.

So how does the therapist help them to do so? By getting them to commit to small periods of sobriety. For example, the therapist may ask the patient at the start of DBT how long they think they could last without substances.

Whether the patient says five minutes, or an hour, or a day, the therapist should tell them to start with that. Slowly but surely, they can piece together lots of small periods of sobriety. This is one way to make the mountain of abstinence seem less scary. Similar to the 12-Step approach, this way of seeing abstinence can help those in recovery to face up to the challenge of sobriety.

The second idea is called the ‘cope ahead’ method. It is a strategy for staying sober by planning ahead for moments that could trigger a relapse. The ‘cope ahead’ method aims to avert these situations. For example, let’s say you are invited to a birthday party.

An event like this could pose a problem for someone who has issues with alcohol if the people there are drinking. It might be wise not to attend, or to check whether there will be alcohol at the party before you go. This is just one example of how the ‘cope ahead’ method can be used to aid sobriety.

Preventing destructive behaviour through acceptance

We’ve talked about how the idea of change is used to encourage abstinence in DBT. The other main idea in DBT is acceptance. What role does acceptance have to play?

Absolute abstinence is the end goal of DBT. But DBT is also realistic. It recognises that many will fail on the path to sobriety. It, therefore, uses the idea of ‘failing well’. This is to make sure that failures to not get in the way of the ultimate goal.

‘Failing well’ means being honest with your therapist when you relapse. It also means talking about how and why you relapsed, and how you can get back to sobriety as quickly as possible. Finally, it means avoiding future relapses.

DBT tries to make failure constructive. It understands that failure is a part of the recovery process, and uses it as a route to future success.

It’s worth saying that as soon as the patient is back on track, the focus switches back to total abstinence. DBT does not in any way encourage failure, it just tries to make use of it.

Benefits of DBT for addiction

DBT has been used to treat addiction for many years now, with some success. Although it might not have the same body of research behind it as CBT, it is still a very reputable form of therapy.

It carries several benefits. It has the ability to change people’s lives for the better. Not only that: it can change the lives of people for whom other forms of therapy have failed.

It may be the best form of therapy for people with affective disorders, suicidal tendencies and severe mental health problems.

DBT aims to:

  • Lessen reliance on substances
  • Reinforce good behaviours
  • Make cravings less common
  • Steer away from triggers
  • Reduce feelings of bodily discomfort that come with withdrawal

DBT gives those in recovery a way to deal with difficult emotions, such as stress. Through its focus on strategies like mindfulness, it tries to target the roots of substance abuse.

In emotionally unbalanced people, substance abuse is often a symptom of the failure to control these emotions. By helping people to control their emotions, DBT makes them less reliant on substances.

Finally, the ideas of ‘acceptance’ and ‘change’ that underpin DBT are part of its appeal. Unlike CBT, it is more realistic about the prospect of relapse. It includes an approach for dealing with relapse – the idea of ‘failing well’ – that uses failure constructively.

Final thoughts

Many people in recovery have found DBT to be a very effective form of therapy. We would recommend it for those who have tried other forms of therapy and not liked them. It is also beneficial for those with mental health problems such as BPD.

If you’d like to find out more about DBT, and where you can receive this treatment, please get in touch. We are in contact with many rehabs that offer this form of therapy.

References

[1] https://scholar.google.com/scholar_lookup?journal=Behavior+Therapy&title=Efficacy+of+dialectical+behavior+therapy+in+women+veterans+with+borderline+personality+disorder&author=CR+Koons&volume=32&issue=2&publication_year=2001&pages=371-390&

[2] https://pubmed.ncbi.nlm.nih.gov/10740986/