Treating Addiction With Dialectical Behavioral Therapy (DBT)
Dialectical behavior therapy (DBT) help clients embrace change and acceptance so that they’re better equipped to live a sober, healthier life.
Dialectical behavior therapy (DBT) is a dynamic therapy for addiction treatment. Therapy sessions help a person overcome negative, substance-abusing behaviors and damaging emotions. In their place, treatment providers help participants create positive behaviors that build a strong foundation for recovery success.
Addiction is frequently fueled by self-destructive behaviors and dysfunctional emotions. The physical, mental and emotional instability caused by chronic drug or alcohol use can aggravate these patterns even more. This damage can deplete a person’s health, destroy relationships and undermine a person’s career.
Even when faced with this knowledge, it can be hard for a person to change. Further, many people struggle to accept the situations they face, which can also be a stumbling block to recovery.
Dialectical behavior therapy encourages a balance between change and acceptance so that a person is empowered to take steps towards a drug-free life. As therapy progresses, a person learns how to control urges or cravings, manage unhealthy emotions, develop relapse prevention skills and set positive and affirming goals. Together, these changes nourish sobriety and create better mind-body-spirit balance.
Dialectical Behavior Therapy In Addiction Treatment
Dialectical behavioral therapy was originally developed by Dr. Marsha M. Linehan to treat borderline personality disorder, however, it has since been adapted as a treatment for substance use disorders and other forms of mental illness. This dual application makes it an excellent choice for dual diagnosis treatment programs.
Therapy may be offered in an outpatient or inpatient setting, however, inpatient drug rehab typically offers more intensive therapies and opportunities for healing than does outpatient care.
In order for DBT to be successful, the therapist and client must form a collaborative partnership. While this may be hard at first, DBT treatment methods help clients form this important relationship.
As soon as treatment begins, dialectical behavioral therapy encourages complete abstinence. For a person newly in recovery, this can be a very intimidating prospect. Because of this, DBT breaks down long-term sobriety into smaller, more easily obtained goals.
The therapist may suggest that a person set a small goal, such as being sober for an hour, a day or a week. Once a person has successfully attained this goal, they renew it and begin again. As a person continues to succeed they gain stability and move closer to long-term abstinence.
As treatment progresses, DBT targets several behaviors that improve a person’s chance of recovery:
- Reducing or alleviate withdrawal symptoms
- Reducing cravings and temptations for relapse
- Removing social and environmental triggers for drug abuse, such as people, places or events
- Overcoming behaviors or thoughts that encourage drug abuse
- Reinforcing healthy relationships, behaviors and environments that support sobriety
A main goal of DBT is to help a person develop what is referred to as a “clear mind.” In this state, a person remains focused on their recovery goals while also being aware of potential threats to their sobriety. Being mindful, with a clear mind helps a person to avoid relapse triggers and cope with them should they arise.
Dialectical Behavior Therapy Builds Sober Living Skills
One of dialectical behavior therapy’s main functions is to teach a person life skills that support sober living. This function is referred to as enhancing capabilities.
Addiction can make it difficult for a person to take care of themselves. Making positive choices, following through on important responsibilities and maintaining healthy behaviors can be hard for a person who is addicted to drugs or alcohol.
In many cases, when a person arrives at substance abuse treatment they may not have certain life skills, or, if they do, they may need improvement. A DBT therapist helps a client to recognize areas of their life that they need to work. Once the therapist and client have identified these areas, they work together to develop an arsenal of life skills that fight these negative influences.
Sometimes the way a person reacts to a situation can make it worse. This is especially true when a person’s judgment and thoughts are clouded by the influence of drugs or alcohol. To counter this, coping skills are personalized to fit the hurdles a person will likely face in their life.
Dialectical behavior therapy focuses on improving four major areas of a person’s life:
- Emotion regulation skills: Negative and dysfunctional emotions can be triggers for substance abuse. If a person is unable to handle their emotions in a healthy way they may be tempted to self-medicate with drugs or alcohol and relapse. Therapy sessions teach a person to regulate and relate to their emotions in a more productive way.
- Mindfulness skills: Mindfulness teaches a person to be more aware and present in the moment instead of getting overwhelmed by thoughts and feelings that are tied to the past and future. By paying better attention to these things, a person is better able to create a more calm and balanced state of mind. This can also help to reduce stress, a trigger for relapse.
- Interpersonal effectiveness: Relationships can become strained under the weight of addiction. Families, friendships and work relationships often suffer as a person makes finding and using drugs a priority above most everything else. Interpersonal effectiveness teaches a person how to improve their communication and relationship skills.
- Distress tolerance skills: These sessions work to remove or reduce any self-sabotaging behaviors in a person’s life. Under the therapist’s guidance, a person will work to develop tools that can help them overcome crisis situations. They will also learn how to handle distress better. One way of doing this is by practicing radical acceptance. Radical acceptance encourages a person to accept the present moment instead of resisting it or exhausting themselves by fighting to change it.
The Five Functions Of Dialectical Behavior Therapy Treatment
Dialectical behavior therapy is grounded in five functions. These functions help a person to uproot negative thoughts, emotions and behaviors in their life that undermine sobriety.
These five functions include:
- Enhancing capabilities: The aim of this function is to teach or improve existing life skills that nurture a stable recovery. Group therapy sessions and homework assignments help clients to achieve these goals.
- Generalizing capabilities: Therapy sessions are individualized to help each person develop coping skills that meet the unique challenges of their life. Homework assignments help a person practice their skills between therapy sessions. Individual therapy provides more intensive opportunities for skill building. It also gives a person a chance to practice their skills under the guidance of their therapist.
- Improving motivation and reducing dysfunctional behaviors: This function relies most heavily on individual therapy sessions. These sessions work on boosting a client’s desire to make positive changes in their life. Therapists also help a person cut out negative behaviors that threaten their well-being, health or sobriety.To do this, treatment participants fill out a diary card that outlines their treatment goals and issues that they’re struggling with from session to session. The diary cards help the therapist to determine what issues, or treatment targets, are most important to tackle first. Therapists address treatment targets in the following order.
- First: Behaviors that endanger a person’s life, such as self-injury or suicidal thoughts.
- Second: Behaviors that create problems in therapy, such as being late, missing sessions or not cooperating.
- Third: Behaviors that cause issues in a person’s life, such as unemployment.
- Structuring the environment: The focus of this function is two-fold. First, the therapist and client work to create a therapeutic environment that is conducive to healing and progress. Secondly, the therapist continues to help clients remove harmful influences in their life that could jeopardize sobriety or lead to relapse. For instance, at this stage, it’s important that a person recognize and remove social influences that trigger thoughts of drug abuse.
- Enhancing and maintaining therapist capabilities and motivation: This function focuses on the therapist by providing an opportunity for skill building and professional development. From this, a therapist stays up to date on the best therapeutic methods, so that they’re equipped to provide the highest level of therapy. Recovery coaching can support a person as they work through the DBT functions. Recovery coaches understand the challenges of treatment, as they’re walking their own recovery journeys. These individuals provide additional support, guidance, inspiration and coping skills throughout treatment.
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Dialectical Behavior Therapy In Dual Diagnosis Treatment
Dialectical behavior therapy can help people with a mental illness to better cope with emotional instability, stress and troubled relationships. It may also help a person to heal any wounds that relate to these issues.
A large number of people struggling with addiction face another form of mental illness. This is called a co-occurring disorder or dual diagnosis. Experiencing both of these conditions can cause a person’s emotions to spiral even further out of control. It can also make it difficult for them to manage distressing situations. When used as part of an integrated treatment plan, DBT helps to restore emotional and mental balance.
In addition to treating borderline personality disorder, dialectical behavioral therapy has shown promise in treating:
- attention-deficit/hyperactivity disorder (ADHD)
- bipolar disorder
- binge-eating disorder
- post-traumatic stress disorder
A dual diagnosis can complicate a person’s treatment needs. While treating both conditions may require more intensive therapies and harder work on the client’s part, successful treatment is possible. The best treatments are individualized, and because of this, other forms of therapy may be integrated into a person’s care plan.
Contact AddictionCampuses.com for more information on dialectical behavioral therapy.
- University of Washington — Dialectical Behavior Therapy
- US National Library of Medicine — Dialectical Behavior Therapy: Current Indications and Unique Elements, Dialectical Behavior Therapy for Substance Abusers