Dialectical Behavior Therapy in Addiction Treatment

What is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy (CBT). The foundation of CBT is the identification of negative or untrue beliefs. Gradually reshaping an individual’s thought process to a positive and healthy mindset can change negative behavior. DBT aims to teach healthy coping mechanisms and effective conflict resolution skills in relationships.

DBT is an evidence-based therapy developed in the late 1980s by psychologist Marsha M. Linehan.  DBT was originally intended to treat individuals suffering from borderline personality disorder or chronic suicidal ideation .

However, research has since shown DBT to be a highly effective form of treatment across the spectrum of mental health. Conditions like disruptive mood dysregulation disorder, post-traumatic stress disorder (PTSD), major depressive disorder (MDD), substance use disorder (SUD), and many other mental health conditions can all be alleviated with DBT.

How Dialectical Behavior Therapy helps Addiction Recovery

Dialectical behavior therapy focuses on a cognitive-behavioral approach.  Cognitive behavior therapy is a form of psychotherapy that focuses on changing the mindset in order to change unwanted behavior, (aka talk therapy).   This means that the therapy process consists of altering an individual’s thought process and providing alternative views on various stimuli.  Over time, a state of mind can shift from negativity to a more realistic and objective view.

During the recovery process from addiction shifting your state of mind is crucial. Drugs change the brain chemistry; therefore, it is important to “re-train” the mind to view drugs as a destructive force in life.  The individual’s new thought process will learn to recognize the harmful and destructive actions associated with the overwhelming urge to use drugs.

DBT emphasizes psychosocial factors in this modality of treatment.    Individuals with addiction tend to respond negatively to what is commonly known as triggers.

For example, an individual with addiction may find that certain people, music, or environments can lead him or her to compulsively use drugs. DBT aims to find an individual’s emotional homeostasis so that he or she may control emotions while triggered.  Emotional instability can occur from drug abuse and the negativity it causes between family, friends, coworkers, and romantic relationships. It can also be caused by interactions with total strangers.

Addiction Triggers

Researchers have identified the arousal levels to certain stimuli are much higher and begin much in people who are dealing with drug addiction, BPD, or emotional dysregulation.  Individuals with addiction tend to experience unexpected mood swings, isolation, suicidal ideation, and many other mental health concerns.  DBT can hep a person manage those triggers and lessen their impact.

Dialectical Behavior Therapy in Therapeutic Settings

The three therapeutic settings DBT is practiced in:

Group settings:

Individuals interact with each other by performing life skill exercises, such as roleplaying and various assignments to build interaction skills.  DBT in group therapy can be useful because it allows individuals who are likely experiencing similar situations or problems to associate and relate to one another.  It will often highlight shared experiences, which may provide a sense of belonging and stability. Addiction is a lonely place and can feel like living on an island. When you are able to be meet and talk to other people who clearly identify with your story, it can drive that loneliness away.

Individual therapy:  

Therapists may also provide DBT to individuals on a one-on-one basis.  Often, many individuals feel shame for developing an addiction.  In private sessions, clients are provided the comfort and privacy necessary for them to share their more personal struggles. This can help them discover the obstacles and triggers unique to their own experience.

Phone coaching/teleconference:  

DBT can be provided via phone coaching or teleconferencing is also known as telehealth.  Telehealth is an accessible, convenient, and cost-effective way to receive healthcare services through telecommunication via electronic devices.  . Healthcare providers and patients share information virtually and remotely.  This form of treatment has become more popular since the global Covid pandemic that began in 2020.  It also allows people from rural areas to receive healthcare treatment, without having to commute to the nearest healthcare facility.  However, it is a new component of addiction treatment and is currently being evaluated for its effectiveness and efficiency compared to physical appointments.Dialectical Behavior Therapy Techniques for Addiction Treatment

The Main Components of Dialectical Behavior Therapy

Cognitive-based:

 Individuals will talk through problems or issues and will help identify the beliefs, thoughts, and perceptions that provoke his or her maladaptive behaviors.  The idea is to recognize triggers and find solutions that are healthy coping mechanisms. This reduces the urge to use drugs by replacing that with rational and positive thoughts.

Support-oriented:

 This portion of DBT is about identifying an individual’s strengths and focusing on them so that they can live a more productive life.  Developing stronger self-esteem aids greatly in maintaining the emotional homeostasis so essential to maintaining sobriety.

Collaborative:

 This component of DBT is much more dynamic than the previous two components.  It is a tactic that teaches how to work toward healthy and progressive mutually beneficial resolutions.  Individuals are asked to complete assignments relating to skills they have learned from DBT and outline how he or she will apply those skills in real-life situations and his or her relationships. Roleplay is also included as a means of learning to healthily interact with other individuals in deliberately placed situations and events given by the healthcare team.  This also includes using coping skills when the individual may become bothered or agitated.

These exercises from DBT are crucial to progress.  Therapy takes place typically every week, with new lectures, reviewing assignments from last sessions, and learning new coping mechanisms to replace the negative ones.

The Four Models of Dialectical Behavior Therapy for Addiction Treatment

Mindfulness:

 Mindfulness skills are a significant part of DBT. It helps the individual ask themselves what to do in certain situations.  This means the individual will think more deliberately before he or she decides to act.  The core of mindfulness is to observe, describe, and participate.  Individuals with addiction will apply the principles to resist the temptation of using drugs.

Interpersonal Effectiveness:

 This module of DBT improves interpersonal emotional reactions to triggers and interactions with other individuals and personal relationships.  It teaches assertiveness, without using aggression or negativity.  It is a new pattern of being able to relate appropriately with others, especially interpersonal conflict. Distress Tolerance:    Denying real pain will only lead to a worsening mental state.  Distress tolerance develops from mindfulness skills because they both accept without contempt or judgment of oneself or painful stimuli or situations.  It is important to note that acceptance is not approval.  It simply means to tolerate the reality of the distress in a way that healthily regulates an individual’s emotions.  This is a module designed for individuals to be able to tolerate and cope with crises.  Acceptance is a major theme in distress tolerance and is a learned skill.

Emotional Regulation:

 Individuals who undergo dialectical behavior therapy are typically emotionally fragile, especially those with addiction.  They may also have additional or other diagnoses, such as borderline personality disorder, major depressive disorder, or anxiety disorders.  They can even be suicidal.  Therefore, emotional regulation is an important part of the four modules in DBT.  Skills to help regulate emotion include:

• Identifying and categorizing emotions.
• Identifying obstacles to changing emotions.
• Reducing vulnerability to “emotion mind.”
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques