Dialectical Behavioural Therapy (DBT)
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This Page was last reviewed and changed on August 8th, 2023
Dialectical Behavioural Therapy, or DBT, is a therapeutic approach that has been shown to be successful in the treatment of addiction. Developed by Dr Marsha Linehan in the 1980s, DBT is a cognitive-behavioural therapy that aims to help people manage their emotions and change their behaviour. But how does DBT for addiction work in practice and how can it help you through recovery?
What is DBT for addiction?
At its core, DBT for addiction is about helping people to change their behaviours. This might involve learning new coping mechanisms for dealing with difficult emotions or situations or making changes to the way you think about yourself and your addiction.
Since its development, DBT has proven very helpful for other conditions and it is now being used effectively to treat substance abuse and addiction, borderline personality disorder (BPD), depression, anxiety, obsessive-compulsive disorder (OCD), and other mental disorders involving interpersonal struggles.
There are three features of DBT that make it an effective therapy for addiction treatment:
How does DBT for addiction treatment work in practice?
Dialectical behaviour therapy for addiction involves four main modules:
1: Mindfulness
Linehan created DBT with mindfulness being one of its core elements. The principle of mindfulness is one of using various meditative exercises to teach patients to be in the present and live in the moment. This will allow you to fully embrace your thoughts and emotions. There are two sets of skills learned in the mindfulness module: what (observing the current environment) and how (maintaining focus even when the current environment is not positive).
Meditative exercises may include:
- Progressive muscle relaxation
- Diaphragmatic breathing
- Guided imagery
- Mantra repetition
- Walking meditation
All of these exercises help you to focus on the present, which is an important skill in recovery. It can be easy to dwell on the past or worry about the future, but mindfulness helps you to stay in the here and now and accept your thoughts and emotions without judgement.
2: Distress tolerance
The second module is known as distress tolerance. It naturally flows from mindfulness in that it uses the what and how skills to teach you how to deal with stressful situations without falling back on previous negative behaviours. Distress tolerance teaches you how to work through stressful situations through a variety of strategies to keep your mind focused on the positive. These include:
- Learning to accept reality
- Distracting yourself from thoughts and feelings related to the stressful situation
- Self-soothing using positive activities or sensory experiences (e.g., listening to music, going for a walk)
- Improving the moment by doing something fun or positive
- Reframing your thinking about the stressful situation in a more positive light
3: Emotion regulation
The third module is known as emotion regulation. The skills learned during emotion regulation are designed to keep your emotions in check rather than allowing them to dictate your actions. This is of particular importance to people in addiction treatment who are prone to temptations by way of their emotions.
The skills you will learn may include:
- Identifying and labelling emotions
- Refraining from reacting to emotions in an unhealthy way
- Reducing the intensity of negative emotions
- Increasing positive emotions
- Taking the opposite action to your emotion
4: Interpersonal effectiveness
The fourth and final module is interpersonal effectiveness. In this module, you will learn skills that will govern your interpersonal relationships. You will learn to identify your own needs and ask for help in meeting them. You will learn to say no to people, circumstances, and behaviours that are negative and to positively and effectively handle interpersonal conflicts with others.
The skills you may learn include:
- Effectively communicating your needs
- Saying no in a positive way
- Asking for what you want
- Dealing with disagreements and difficult people constructively
How does DBT for addiction complement other addiction treatments?
DBT for addiction is most effective when used in conjunction with other addiction treatments, such as 12-step programmes, individual therapy, and group therapy. DBT complements these other treatments by teaching you the necessary skills to effectively cope with your emotions and manage stress without turning to drugs or alcohol.
This is very important because the recovery journey can be a stressful and emotional time, and it is during these times that you are most likely to relapse. DBT provides you with the tools you need to deal with these difficult emotions and situations in a healthy way.
How is DBT used after rehab?
DBT is often used after rehab in order to help you transition back into everyday life. The skills you learned during treatment will be put to the test when you are no longer in the protective environment of rehab.
This is why it is so important to continue practising your DBT skills after rehab, either in individual therapy or in a DBT skills group. This will help you to solidify the skills you learned in treatment and continue to use them in your everyday life.
