Dialectical Behavior Therapy

What Is DBT And How Can It Help With Addiction?

Dialectical behavior therapy (DBT) is an evidence-based form of psychotherapy used to treat a wide array of severe mental health disorders and drug and alcohol addiction.

“Dialectal” in dialectical behavior therapy is a term that is focused on the belief that opposite thought and ideas can both be true to create a balance. For example, validation and change are important components in this type of psychotherapy. Individuals learn to validate their thoughts and emotions and also learn healthy coping skills to regulate emotions and develop appropriate behaviors.

DBT was initially used to treat high-risk mental health disorders such as suicidal thoughts, self-harm behaviors, and borderline personality disorder, but its use has expanded to treat many types of mental health and substance use disorders (SUDs).

Individuals who struggle with addiction to drugs and alcohol have a difficult time regulating their emotions, coping with everyday challenges, and problem-solving. Whether it is unresolved past trauma or never learning how to handle stressful situations, people who struggle with addiction often turn to drugs and alcohol to cope.

In response to this, dialectical behavior therapy is rooted in the belief that people with addiction do not have the skills to overcome stressful situations and, therefore, choose to engage in self-destructive behaviors such as drug and alcohol use.

DBT focuses on validation and acceptance of the negative thoughts and feelings underlying the addiction. DBT believes that accepting your thoughts and feelings, even when painful, can help you manage and work through difficult thoughts, emotions, and behaviors. This may mean accepting past trauma, abuse, low self-esteem, or adverse childhood events and learning to sit with how these experiences make you feel.

The other component of DBT involves changing these problematic behaviors and thoughts, which are usually related to the acts of using and drinking. To do this, DBT adopts a level of optimism that assumes people are doing the best they can when they enter into addiction treatment and want their situation to improve.

In addiction treatment, dialectical behavior therapy aims to create a prosperous future where a person learns new behaviors to replace substance use and change their future. To do this, the person must be willing and able to change and work closely with their therapist during the individual sessions, work closely with others in the group sessions, and commit to their homework.

What Does DBT Involve?

Dialectical behavior therapy involves many treatment components that are often divided into four treatment categories.

Individual Therapy

Individual therapy includes weekly one-on-one sessions with a therapist to talk about the patient’s past experiences and current emotions and how they relate to their addiction. The therapist has the patient self-monitor and track their emotions and negative behaviors.

Honesty, trust, and transparency are essential for the client and the therapist during this phase. This requires a person to acknowledge their substance misuse and be honest about their habits. They must work together to communicate and dive deep to uncover hidden emotions and past experiences that have shaped current thoughts and behaviors related to addiction.

In these individual sessions, the therapist also assigns homework, which is reviewed during the following session. This homework is a way to take skills and insights gained in sessions with the therapist and apply them to everyday life. It is the bridge between the theory you learn and the actual life practice, ensuring that the skills learned become essential to your coping skills.

Homework should not be seen as a burden or a “checklist” but instead as a supportive companion in the addiction treatment process. Homework is also a way to reflect on your learning and actively participate in consistent training.

Group Skills

Group skills are taught in an environment where a group of clients (often 2-12 people) meet with a therapist once a week for 2-3 hours each session.

Addiction treatment often utilizes group sessions to allow individuals to focus on boundaries and effective communication and to practice skills they have learned with others. The interpersonal component of DBT encourages clients to ask others what they need in terms of personal relationships while learning how to say “no” and maintaining healthy boundaries. This is a positive group environment where interpersonal skills that may be difficult or intimidating to practice in real life can be practiced in this safe group setting.

Phone Coaching

Phone coaching is a helpful “lifeline” that allows you to call your therapist between sessions when you are going through a difficult time or working through complicated emotions and thoughts.

Phone coaching allows you and your therapist to identify appropriate skills that can be used in the moment to help work through your current issues. This “in the moment” approach allows the therapist to work with you and provide guidance in real time. Phone coaching is not always a part of DBT; it is an as-needed benefit.

It’s important to talk with your therapist about their approach to phone coaching, as each therapist may have their own boundaries and rules for utilizing this practice.

Consultation Therapy Team

Although this work is rewarding, treating patients using DBT can be exhausting and even problematic for therapists, especially when treating patients with severe behaviors and disorders such as suicidality, self-harm, and severe addiction. A consultation therapy team provides therapists with resources to manage their own feelings and self-care while becoming better therapists. An effective strategy to help therapists manage their feelings while continuing to be the best for their patients is to provide them with continued support, training, skill-building, validation, and encouragement.

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DBT Treatment Components

Four key strategies are used in dialectical behavior therapy, including:

Mindfulness

Mindfulness focuses on “the now” to explore your feelings, thoughts, and environment. We are very ingrained in thinking about the past and worrying about the future, but DBT works to tune our focus into what is happening in the present, both inside of us and within our surroundings. This can help us focus on healthy coping skills and slow down when we are in a stressful situation or the midst of emotional pain. Staying mindful can also help us stay calm in a chaotic environment and prevent us from engaging in harmful or distressful behaviors, ultimately helping avoid relapse.

Emotion Regulation

Emotion regulation helps you navigate negative emotions, such as anger and self-doubt, so you do not act on them in harmful ways. By turning them into neutral emotions, you can learn to harbor your anger in healthy outlets instead of using substances. You can learn to suppress your feelings and instead accept your emotions and change your mindset. With emotional regulation, you carry out emotions in a healthy way, such as going for a run, listening to music, or some other distraction instead of reaching for a drink or engaging in self-harm or physical angry outbursts.

Emotional regulation also means learning to reduce one’s emotional vulnerability by avoiding situations or environments that can be emotionally draining.

Interpersonal Effectiveness

Many people who struggle with addiction lack healthy communication and conflict resolution mechanisms, instead turning to substances to help regulate their emotions. That is why conflict resolution and communication are a priority in DBT. This is commonly practiced in group therapy and revolves around learning to communicate with others and asking them what they need in a relationship or friendship. This can be a colleague, a boss, a friend, or a romantic partner. Interpersonal effectiveness also involves setting healthy boundaries and learning to say “no.”

Distress Tolerance

Often, when people express unwanted and negative emotions, their first reaction is to get rid of that emotion. As a result, they may use alcohol or drugs to cope. Distress tolerance allows us to cope during a crisis and accept the current situation for what it is instead of what it should be without needing to channel those emotions elsewhere.

Effectiveness Of Dialectical Behavior Therapy For Addiction Treatment

The effectiveness of any therapy, including DBT, depends on several factors, such as the client’s willingness to change, the client/therapist alliance, and the client’s ability to remain motivated and properly apply the skills they learn in therapy to their daily life.

DBT was initially developed to treat serious mental health disorders such as borderline personality disorder, self-harm behaviors, and suicidality. However, it is now being used to treat other disorders, including addiction. There is no conclusive evidence to prove how effective DBT is at treating substance use disorders; however, therapists and clients have had success when using DBT as part of their addiction treatment.

There is evidence that shows the effectiveness of using dialectical behavior therapy to treat SUDs with co-occurring mental health disorders, including borderline personality disorder and depression. Addiction treatment usually requires a multidisciplinary approach, meaning the client undergoes a few different treatment strategies, including medication management and therapy.

Benefits Of Dialectical Behavior Therapy And Addiction Treatment

The benefits of DBT improve many areas of a person’s life and include:

• Learning to accept and live with negative thoughts that cannot be changed without turning to destructive behaviors
• Changing other negative thoughts (that can be changed) into positive mindsets
• Changing unwanted and unhealthy behaviors associated with substance abuse into positive behaviors
• Reduction in urges and cravings
• Reduction or elimination of substance abuse
• Learning how to set boundaries
• Learning effective communication with others
• Avoiding triggers associated with substance use
• Improving self-esteem
• Learning that relapse should not hinder your treatment journey
• Adopting both acceptance and change

What Other Conditions Can DBT Help Treat?

DBT is used to treat many conditions, including the following:

• Borderline personality disorder
• Eating disorders (specifically binge eating and bulimia)
• Bipolar disorder
• Suicidal thoughts
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)

What’s The Difference Between DBT And Cognitive Behavioral Therapy?

DBT is largely based on cognitive behavioral therapy (CBT), but the primary difference is that DBT works to accept and validate uncomfortable feelings in addition to changing undesirable behaviors (whereas CBT is focused only on change). DBT also works on interpersonal skills and relationships, while CBT mainly teaches individual skills.

Does Insurance Cover The Cost Of Dialectical Behavior Therapy?

The 2008 Mental Health Parity and Addiction Act requires health insurance companies to cover mental health and addiction treatment and services similar to providing medical coverage. This means all insurance companies should cover a portion of your DBT therapy, assuming your therapist or treatment center accepts your insurance.

You may still be responsible for copays or a certain percentage out of pocket. You should check with your insurance provider and your DBT treatment provider to see how much of your treatment is covered before you commit; that way, you are financially aware of your service costs beforehand.

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Is DBT Covered By The VA Or Veterans Benefits?

DBT is offered at many VA treatment centers across the country and is covered (at least partially) by your VA benefits. You can also use your Medicare, Medicaid, or private insurance with your VA benefits. It is important to look into your VA coverage to see how much of your DBT is covered and how much out-of-pocket fees you must pay before committing to therapy.

How To Find Dialectical Behavior Therapy Treatment

Therapists who practice DBT are specifically trained in this discipline, meaning that not all therapists practice DBT. If you are looking for a therapist trained in DBT, you can start by asking your doctor for resources or using online resources with therapy directories.

Many mental health and addiction treatment centers offer DBT, and you should clarify this with your chosen center before applying. After the application process, treatment specialists will determine if DBT may be beneficial for you during treatment.

To learn more about the addiction treatment options available to you, contact a treatment provider today for free.