Addiction Treatment: Dialectical Behavioral Therapy
Written by: Peter Dimaira Created June 1, 2017
Written by: Peter Dimaira Created June 1, 2017
(DBT) Dialectical Behavioral Therapy is a form of (CBT) Cognitive Behavioral Therapy which was established to help mental health clients struggling with (BPD) Borderline Personality Disorder.
Due to it being so effective, it was later used in treating drug addiction and alcoholism as well as many other mental health disorders. 1 Dialectical Behavioral Therapy is based on four components: 1, 2
If you’re interested in Bright Futures Treatment Centers (DBT) treatment for you or your loved one, call 1-844-207-7772 for information on our treatment program.
Dr. Marsha Linehan has been most frequent to be credited with the promotion of dialectical behavioral therapy. During the 1970s she offered the standard version of cognitive behavioral therapy to her patients, who were woman experiencing suicidal tendencies. It was discovered by her later that many of her clients fit the criteria for (BPD) borderline personality disorder.3
Throughout the years, Dr. Linehan and many other collaborators expanded their understanding of cognitive behavioral therapy with the use of dialectics, where therapists can alternate the clients focus on change and acceptance. Dialectics are known to help the clients and the therapists avoid putting the focus on negative behaviors, thoughts or feelings that hinder the recovery process.1, 2
DBT is used through:
DBT therapy focuses on:
Skills training is similar to vocational training which includes group sessions which enhance patients ability to change negative behavior patterns. A therapist will lead the sessions and teach life skills. Homework assignments are also required with the therapy. Groups will meet weekly for 2.5 hours for as many weeks as necessary. Some sessions could be re-implemented throughout the course of the weeks of DBT therapy if a patients meets the criteria to be in therapy for up-to one year.
Individual therapy sessions typically emphasize motivation to continue the treatment process and teaching you to apply the skills learned to daily life and challenges one faces to avoid drug-seeking and usage. The individual sessions are typically once a week, but can be twice depending on the patient for the duration of the treatment program. Individual sessions usually run simultaneously with the group meetings.
Dialectical Behavioral therapists offer live coaching for patients and families facing difficult situations, such as relapse. You may rely on communication with your therapist outside of your normal sessions to receive coaching if you’re in a critical need of help.
Consultative approaches by therapists is actually offered as a platform for therapists providing dialectical behavioral therapy. The team of consultants help DBT therapists remain competent and motivated to work with clients who have difficult-to-treat disorders such as drug addiction and alcoholism. The support aids in ensuring that they will have the ability to provide the best treatment available.
According to Dr. Marsha Linehan, CBT didn’t offer flexibility to allow clients to come to terms with the reasoning behind why their addiction was so harmful before engaging them in activities that promote motivation to change the behaviors and thoughts attributed to their addictions. This typically leads to higher relapse or drop out rates prior to the treatments completion.
Cognitive Behavioral Therapy also focuses on individual therapy. This strategy often failed to address the different aspects of emotional and physical problems that BPD sufferers or substance abusers typically presented.
The four components of DBT allow several therapists to collaborate together. It also makes it easier to provide multiple modes of therapy, including group sessions, individual sessions and phone coaching.1, 2 These are critical aspects that help clients receive continuous support and instance coach availability, which leads a patients motivation to complete the program in its entirety.
Research Shows Dialectical Behavioral Therapy Success is Effective in:
The same studies suggest that dialectical behavioral therapy dramatically improves the outcome of individuals struggling with co-occurring disorders including borderline personality disorder, substance abuse, eating disorders and other combinations of either three. The development of healthier behavioral skills contributes to its effectiveness such as:
Mindfulness: Being self-aware of one’s actions
Interpersonal Effectiveness: Learning to say no and still have a sense of self-respect as well as relationships with other peers and family members
Tolerance of Distress: Coping with difficult situations
Regulation of Emotions: Gaining control over their emotions which led to the destructive behaviors in the past.
Completion of DBT Therapy shows promise in helping people overcome addiction.7, 8
Working with a licensed therapist is one of the most important factors that will improve the chances of success and completion of the program. Four things to look for in a therapist:
A Degree: You want to make sure that the professional has a master’s or doctoral degree in counseling, psychology or other certifications from an accredited college or university.
Training: You want to make sure they are extensively trained to work with groups and individuals who’ve been treated for co-occurring disorders such as behavioral, emotional and mental health disorders.
Licensure: The majority of therapists have to pass state exams and will display their degrees in their office.
DBT Experience: requesting the amount of years experience the therapist has with dialectical behavioral therapy will provide an indication of the length of experience a therapist has had with DBT therapy.
1. Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J. W., Craft, J. C., Comtois, K. A., & Recknor, K. L. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. American Journal on Addiction, 8, 279-292.
2. Verheul, R., Van Den Bosch, L. M. C., Koeter, M. W. J., De Ridder, M. A. J. , Stijnen, T., & Van Den Brink, W. (2003). Dialectical Behaviour Therapy for Women with Borderline Personality Disorder, 12-month, Randomised Clinical Trial in The Netherlands. British Journal of Psychiatry, 182, 135-140.
3. Allmon, D., Armstrong, H. E., Heard, H. L., Linehan, M. M., &.Suarez, A. (1991). Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients. Archives of General Psychiatry, 48, 1060-1064.
4. Linehan, M.M. (2015). DBT Skills Training Manual: Second Edition. New York: Guilford Press.
5. Miga E, Karlson A, DuBose T. Financial cost-effectiveness of dialectical behavior therapy (DBT). PsyD Behavioral Tech, LLC. 2013; 1-8. http://behavioraltech.org/downloads/Financial-Cost-Effectiveness-DBT.pdf
6. Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract. 2008; 4(2):39-47.
7. Rizvi SL, Dimeff LA, Skutch J, Carroll D, Linehan MM. A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behav Ther. 2011; 42(4):589-600.
8. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav Res Ther. 2010; 48(9):832-839.